skeletal health in early egypt mphil thesis sarah musselwhite

8/20/2019 Skeletal Health in Early Egypt MPhil Thesis Sarah Musselwhite

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SKELETAL HEALTH IN EARLY EGYPT

The Effects of Cultural Change and Social Status

Sarah Musselwhite

Christ’s College

This dissertation is submitted for the Degree of Master of

Philosophy

August 2011

University of Cambridge


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PREFACE

This dissertation is the result of my own work and includes nothing which is theoutcome of work done in collaboration, except where specifically indicated in the

text.

The dissertation does not exceed the 15,000 word limit stipulated by the Degree

Committee for the Faculty of Archaeology and Anthropology.

Word count: 14,965


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ABSTRACT

This study investigates variation in skeletal health among Predynastic and Early

Dynastic Egyptian populations in relation to state formation and social status. Health

has been shown to correlate with political, economic and social change in past

societies, but many studies utilising skeletal data fail to examine its archaeological

context in detail. Here, variation in the frequency and severity of three skeletal stress

markers that reflect population health—cribra orbitalia, porotic hyperostosis and

linear enamel hypoplasia—was measured. 179 individuals were sampled across 6

distinct Predynastic and Early Dynastic populations. The social context of each

population was investigated through examination of original excavation reports. The

results suggest that overall health improved after the initial transition to agriculture

due to dietary diversification, but then declined with increasing urbanisation

because of the negative effects of increasing population density. Investigation of

elites buried in Cemetery T at Nagada and individuals buried around the First

Dynasty royal funerary enclosures at Abydos revealed that high social status did not

always confer good health in early Egypt. The adoption of methods from both

Egyptology and Biological Anthropology has shown great promise in reconstructing

the health of the early Egyptians and relating it to their social context.


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TABLE OF CONTENTS

1. INTRODUCTION 1

1.1. Research context and questions 11.2. What determines health? 2

1.3. Health and cultural change 3

1.4. Health and social status 3

1.5. How do you measure skeletal health? 4

1.5.1. Skeletal stress markers 5

1.5.2. Linear enamel hypoplasias 6

1.5.3. Porotic hyperostosis and cribra orbitalia 7

1.5.4. Childhood health 9

1.5.5 The osteological paradox 10

1.6. Previous studies of skeletal health in Egypt 11

1.7. Research aims and contribution 13

2. DATA AND METHODS 15

2.1. The skeletal material used 15

2.1.1. El-Badari 18

2.1.2. Hierakonpolis 19

2.1.3. Nagada B 21

2.1.4. Nagada T 22

2.1.5. Tarkhan 23

2.1.6. Abydos 24

2.2. Sampling procedure 25

2.3. Assigning age and sex 25

2.3.1. Age 25

3.1.2. Sex 28

2.4. Measuring the skeletal stress markers 29


2.4.2. Porotic hyperostosis and cribra orbitalia 30

2.5. Data analysis 32

3. RESULTS 33

3.1. Inter-population differences in stress markers 33

3.1.1. Cribra orbitalia 33

3.1.2. Porotic hyperostosis 39


3.2. Intra-population variation in stress markers 58

3.2.1 Sex 58

3.2.2. Age 59

3.3. Association between different stress markers 60

4. DISCUSSION 61

4.1. Health and cultural change—temporal trends in the stress markers 614.1.1. The Badarian period 61


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4.1.2. The Nagada I period onwards 62

4.1.3. The Protodynastic (Nagada III) and Early Dynastic periods 65

4.2. Health and social status—is there a link? 68

4.2.1. Servants to the First Dynasty kings—subsidiary burials around the

royal funerary enclosures 68

4.2.2. High status elites and leaders of Nagada—Cemetery T 73

4.2.3. Health and gender 75

5. SUMMARY AND CONCLUSION 76

BIBLIOGRAPHY 78

APPENDICES (CD) 83


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ACKNOWLEDGEMENTS

I would like to thank my supervisors Dr Kate Spence and Dr Jay Stock for their advice

throughout the year and for reading drafts of this dissertation. Thanks also goes tothe Directors of the Duckworth Laboratory and Ms. Maggie Bellatti for allowing me

access to the skeletal material.

I would also like to acknowledge Daniel Strange and Lucy Musselwhite for

proofreading and technical assistance.


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LIST OF TABLES

Table 1 - Origins of the skeletal material used in this study ....................................... 16

Table 2 - The skeletal sample taken in this study ........................................................ 25

Table 3 - The age distribution of the individuals sampled .......................................... 27

Table 4 - The scoring system used for measuring cribra orbitalia and porotic

hyperostosis ................................................................................................................ 31

Table 5 - Percentages of the highest frequency molar, premolar, canine and incisor

with LEH, by population ............................................................................................... 55

Table 6 - Percentages of the two highest frequency molars with LEH, bypopulation .................................................................................................................... 56

Table 7 - Average age (years) of LEH formation per individual (averaged across all

LEH bands), by population ........................................................................................... 56

Table 8 - Average age (years) of LEH formation in left maxillary second molar, by

population .................................................................................................................... 57

Table 9 - Average age (years) of LEH formation in right maxillary second premolar,

by population ............................................................................................................... 57

Table 10 - Average age (years) of LEH formation in right maxillary canine, by

population .................................................................................................................... 58

Table 11 - Average age (years) of LEH formation in right maxillary second incisor,

by population ............................................................................................................... 58


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LIST OF FIGURES

Figure 1 - Linear enamel hypoplasia bands .................................................................. 7

Figure 2 - Porotic hyperostosis ..................................................................................... 9

Figure 3 - Cribra orbitalia ............................................................................................... 9

Figure 4 - Map showing the locations of the populations sampled ........................... 17

Figure 5 - Timeline of the periods studied .................................................................. 17

Figure 6 - Sexually dimorphic cranial features ........................................................... 29

Figure 7 - Location of the cemento-enamel junction ................................................. 30

Figure 8 - Percentage of individuals with cribra orbitalia severity score 1 or above,

by population ............................................................................................................... 34

Figure 9 - Percentage of individuals with cribra orbitali a severity score 2 or above, by

population .................................................................................................................... 35

Figure 10 - Percentage of individuals with each severity score of cribra orbitalia, by

population .................................................................................................................... 36

Figure 11 - Average severity of cribra orbitalia in each population ............................ 37

Figure 12 - Percentage of individuals with severe cribra orbitalia (scores 3 & 4), by

population .................................................................................................................... 37


by time period .............................................................................................................. 38

Figure 14 - Percentage of individuals with porotic hyperostosis severity score 1 or

above, by population ................................................................................................... 40


above, by population ................................................................................................... 40

Figure 16 - Percentage of individuals with each severity score of porotic

hyperostosis, by population......................................................................................... 41

Figure 17 - Average severity of porotic hyperostosis in each population ................... 42

Figure 18 - Percentage of individuals with severe porotic hyperostosis

(scores 3 & 4) by population ........................................................................................ 42


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above, by time period .................................................................................................. 43

Figure 20 - Percentage of individuals with LEH in each population ............................ 45

Figure 21 - Average percentage of scorable teeth with LEH per individual, bypopulation .................................................................................................................... 45

Figure 22 - Percentage of individuals with LEH, by time period.................................. 46

Figure 23 - Average number of scorable teeth per individual in each population ..... 47

Figure 24 - Average number of scorable teeth in individuals with LEH and without

LEH, by population ....................................................................................................... 48

Figure 25 - Association between number of scorable teeth per individual and

number of teeth with LEH, whole sample ................................................................... 49

Figure 26 - Diagram of tooth types ............................................................................. 50

Figure 27 - Average number of posterior and anterior teeth per individual in each

population .................................................................................................................... 51

Figure 28 - Percentage of each tooth type with LEH, whole sample .......................... 51

Figure 29 - Percentage of individuals with LEH in posterior dentition in each

population .................................................................................................................... 53

Figure 30 - Percentage of individuals with LEH in posterior dentition, by time

period ........................................................................................................................... 53


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CHAPTER 1 – INTRODUCTION

1.1. Research context and questions

This study uses skeletal data to investigate how health varied among Predynastic

and Early Dynastic Egyptian populations, as the Egyptian state formed and new social

classes emerged. These periods were characterised by profound economic, political

and social changes: agriculture was introduced into the Nile Valley from the Fertile

Crescent and allowed the production of surplus food to support craft specialisation;

foreign trade flourished and allowed exotic raw materials to be imported into Egypt

for the manufacture of elite prestige items; urban centres developed and acted as

important arenas of elite activity and social stratification became more pronounced.

These changes cumulated in the rise of several different ‘proto-states’, of which the

most significant were centred on the Upper Egyptian sites of Nagada, Hierakonpolis

and This (Kemp 2006), and ultimately provided the ideological foundations for later

Egyptian kingship. Cultural unification of Egypt was complete by the Nagada II

period, followed soon after by political unification in the Nagada III period (Wilkinson

2000) and the establishment of a new political capital at Memphis. However, little is

known about how all of these processes affected the physical wellbeing of people

and how their relationship with the physical environment changed over time.

Skeletal remains are a particularly important source of information in these early

periods because archaeological evidence is generally poor compared to later

periods. Much of our evidence so far has come from studies of material culture

associated with burials or changing cemetery patterns, but these are limited in what

they can tell us about societal change and are biased towards representation of the


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deceased in the afterlife. Skeletal health can tell us about the key political, economic

and social factors that shaped people’s lives whilst they were living. Furthermore,

skeletal health can provide insight into whether the changes brought to society by

state formation had the same effects on everyone, regardless of the social group to

which they belonged.

This study will address two key questions. Firstly, did health change over time

from the beginning of the Predynastic Period to the Early Dynastic Period, and if so,

why? What factors were underlying such changes? Secondly, were social status and

health correlated in these early periods? Ultimately, this study will examine the link

between political, economic and social change, and the health of populations.

1.2. What determines health?

Health can reveal many things about a group’s physical and social environment:

the diet and level of nutrition obtained from it, disease prevalence, population size

and density, quality of living conditions, sanitation level, access to healthcare

facilities, occupational status and the level of technological development. These

factors rarely influence health singularly, but rather are all interlinked: for example,

infectious diseases will spread more easily and quickly in a high-density settlement

with cramped living conditions and poor sanitation. All of these factors affecting

health can be influenced by changes within the biological environment, such as the

introduction of a new disease or a change in climate. But, changing social, political

and economic factors have the potential to have a bigger impact on health,

especially if the biological environment remains fairly constant (Goodman et al.

1984).


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1.3. Health and cultural change

The cultural changes brought about by the emergence of the Egyptian state

would have provided great potential for health change over time, bringing new

health risks and benefits. The introduction of agriculture brought with it a change in

diet and its nutritional value. It also increased the potential for disease spread

through greater animal-human contact and exposure to Nile floods. A new type of

economy emerged, based on agricultural surplus and foreign trade. The latter might

have allowed the exchange of ideas that may have benefited health, but would also

have increased the likelihood of new diseases being introduced into Egypt to which

no immunity existed. As communities became increasingly sedentary and focused on

key political centres, increases in population density would have increased the

potential for disease spread and unsanitary living conditions. The rise of social

inequality and the uneven distribution of power may have resulted in some groups

of people being deprived of essential resources needed to maintain good health.

One would expect to see temporal change in the general level and type of health

problems people were experiencing.

1.4. Health and social status

The emergence of the state in Egypt was characterised by increasing social

stratification and the growing power of a social elite. In a society which has

substantial status differences between different groups of people, it is proposed that

high status individuals should theoretically have a better level of health than lower

status individuals. This theory is based on the concept of differential access to

resources, in which your social status determines your level of access to food,


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particularly that with high nutritional content, and other resources which can affect

health such as general environmental quality and healthcare (Keita & Boyce 2006).

The promotion of easy access to such resources among higher status individuals

results in a better biological response to the environment (Cucina & Işcan 1997) and

the stresses it causes.

Some studies have revealed a link between high status and good health (Cook

1981). However, there are also studies which have shown no such health distinctions

between high and lower status individuals groups from the same society. Robb et al.

(2001) found no significant association between various skeletal indicators of health

and social status as defined by grave goods from the Italian Iron Age site of

Pontecagnano; Cucina and Iscan (1997) found that disruption in childhood growth

was common among a high status group from the Fort Center site in Florida, US,

dated to A.D.200-800. This variation indicates that the relationship between social

status and health depends very much on the particular social context from which the

studied groups originate and the mechanisms in place within that particular society

to control resource distribution. The present study ensures that the social context of

each skeletal population sampled is investigated in detail so that the relationship

between social status and health can be examined further.

1.5. How do you measure skeletal health?

The health of past populations can be assessed in a variety of different ways. In

Egypt, information about common health problems and medicine can be gained

from medical papyri, items found in burials and artistic representations in tomb

scenes. However, these do not allow us to make detailed comparisons between


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different groups and are also biased towards the elite view of the world. The analysis

of stable isotope ratios from bone and teeth is very informative of past diet, which

has a strong influence on health, but is not a direct measure of an individual’s health.

The analysis of skeletal health provides the most direct way of quantifying health

differences between populations and hence will be used in this study.

1.5.1. Skeletal stress markers

A skeletal stress marker is simply a skeletal response, often visible by eye, to a

physiological stressor, whether that stressor is a strain, trauma, disease or nutritional

disorder. In this study, three skeletal stress markers will be used to quantify the

health of each individual, and subsequently populations: linear enamel hypoplasias

of the teeth, porotic hyperostosis of the cranial vault and cribra orbitalia of the roofs

of the orbits. Specific stress markers were chosen, rather than simply recording all

signs of poor health, so that health was directly comparable between populations.

Although only a handful of diseases or conditions manifest themselves on the

skeleton, the stress markers chosen are three of the most frequently documented

among ancient societies, and are thus the most commonly used markers in the

investigation of skeletal health. These markers were also chosen because they

manifest themselves on the skull; this was very important because only cranial

skeletal material was present for the populations being investigated. Furthermore,

by measuring three skeletal stress markers, and looking for any association between

them, a more complete picture of an individual’s health will be gained than if just

one was used in isolation.


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1.5.2. Linear enamel hypoplasias

Linear enamel hypoplasias (LEH) are a type of defect in the thickness of the tooth

enamel, which appear as horizontal grooves on the enamel surface and are usually

visible with the naked eye (Goodman & Rose 1990) (Figure 1). They form in

childhood as the result of severe physiological disturbance to growth, which in turn

can be the consequence of malnutrition or disease, or most probably an interaction

between the two (Lovell & Whyte 1999; Keita & Boyce 2001); if a child is

malnourished, they are more susceptible to disease, and vice versa. As tooth enamel

does not remodel after its initial formation, any defects due to growth disruptions

will be preserved in adults, and thus linear enamel hypoplasias provide a reliable

index of childhood health (Goodman & Rose 1990). Studies of modern populations

have frequently linked high enamel hypoplasia prevalences to poor living conditions

and low socio-economic status because they promote poor diet and/or high disease

prevalence (Larsen 1997); higher prevalences have in general been found among

individuals from developing countries than those from developed countries

(Goodman & Rose 1991). As linear enamel hypoplasias are not caused by a specific

condition, they are therefore viewed as general indicators of childhood health

(Larsen 1997).


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Figure 1 - Linear enamel hypoplasia bands (Adapted from: (Larsen 1998))

1.5.3. Porotic hyperostosis and cribra orbitalia

Porotic hyperostosis is characterised by the porous appearance of regions of the

surface of the cranial vault (i.e. the bones surrounding the brain), often with notable

bilateral symmetry in its distribution (White & Folkens 2005) (Figure 2). Cribra

orbitalia is the appearance of similar lesions, but confined to the roofs of the orbits

and is also often bilaterally distributed (Stuart-Macadam 1989) (Figure 3). The most

commonly cited view is that both porotic hyperostosis and cribra orbitalia are

caused by iron-deficiency anaemia, a condition which can be caused by dietary

deficiency in iron and/or diseases which lead to the loss of iron, such as some

intestinal parasites (Larsen 1997; Keita & Boyce 2006). Under this theory, the porous

lesions result from the expansion of the tissue between the inner and outer bone

layers of the skull, caused by the bone marrow’s attempt to increase production of

red blood cells (White & Folkens 2005). Like LEH, they are also thought to develop in

childhood, with the cases present on adult skeletal remains being those which have


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not remodelled. Thus they are indicative of childhood health (Stuart-Macadam

1985).

However, it is important to note that some recent studies have challenged these

assumptions. Some have suggested that porotic hyperostosis and cribra orbitalia

may not always have the same underlying cause (Stuart-Macadam 1989). It has also

been suggested that a wider range of metabolic disorders may also be responsible

for the conditions. A recent study by Walker et al . (2009) has suggested that porotic

hyperostosis may be caused by inherited haemolytic anaemia or acquired

megaloblastic anaemia resulting from vitamin B12 and/or folate deficiency, and that

cribra orbitalia may be caused by infectious disease, scurvy or vitamin B12 deficiency

megaloblastic anaemia. A subsequent paper though argued that iron-deficiency

anaemia should not be ruled out as a potential cause of either porotic hyperostosis

or cribra orbitalia (Oxenham & Cavill 2010). Furthermore, like LEH, the synergetic

link between malnutrition and disease in causing the conditions is emphasised

(Facchini et al. 2004). In view of this debate, these two markers, as with LEH, will be

treated as general indicators of childhood health in the present study. The iron-

deficiency anaemia hypothesis will be considered within the specific environmental

context of early Egypt in the discussion.


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Figure 2 - Porotic hyperostosis (Source: (Gregg & Gregg 1997))

Figure 3 - Cribra orbitalia (Adapted from: (Aberdeen Art Gallery and Museums

Collections n.d.))

1.5.4. Childhood health

It should be emphasised that these stress markers together provide a measure of

childhood health, but from this we can gain an idea of the general level of disease


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and/or malnutrition present within the general population (Keita & Boyce 2001). The

relationship between environmental stress and poor health is complex, especially

among children. Children, particularly those under five years of age, are highly

susceptible to bacterial, viral and parasitic infections. After weaning, these can often

occur from contact with contaminated food and water, the risk of which is increased

when general sanitation is poor (Kent 1986). Many infections can lead to chronic

diarrhoea which can cause severe dehydration and malnutrition by inhibiting the

absorption of nutrients from ingested food (Carlson et al. 1974; Facchini et al. 2004).

If the diet is already nutritionally inadequate, then the effects of this will be

enhanced.

1.5.5. The osteological paradox

There has been debate, termed the ‘osteological paradox’ (Wood et al. 1992), as

to whether poor skeletal health is always representative of poor health during an

individual’s life, with the argument that it may sometimes indicate that an individual

survived for long enough with a disease for it to manifest itself on the skeleton, and

thus could be considered as a sign of good health. Moreover, a high frequency of

childhood stress markers observed in adults may also suggest that that individual

was actually strong enough to overcome those stresses and survive into adulthood.

However, this argument can be criticised as many diseases only become manifest on

the skeleton when they have reached a severe enough state and a high frequency of

stress markers still indicates that individuals were not sufficiently protected from

disease or malnutrition in the first place. Skeletal health can still be used to reliably

compare the level of disease and/or nutritional stress present within the


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environment in which a group lived and the likelihood of a member of that group

suffering from poor health.

1.6. Previous studies of skeletal health in Egypt

Existing studies of skeletal health in ancient Egypt are limited in that often data is

used to make very broad temporal comparisons between populations. For example,

Zakrzewski (2003) investigated changes in stature (a general indicator of health)

from the Badarian period to the Middle Kingdom. Another study by Duhig (2000)

measured changes in several skeletal stress indicators from the Predynastic Period to

the Middle Kingdom, although did choose to focus on the First Intermediate Period.

Although such broad comparisons are useful for pinpointing time periods for more

detailed study, failure to fully take into account the variation in the physical and

social environment of the populations sampled severely reduces the accuracy with

which changes in health can be interpreted. This limits what can be said about the

relationship between health and cultural change.

In the context of early Egypt, few studies have been carried out with the level of

detail needed to make reliable interpretations of health change over time. Keita and

Boyce (2001) investigated changes in the prevalence of porotic hyperostosis and LEH

over the Nagada I, II and III periods, with their results indicating an improvement in

health over time, despite increasing population density and increasing social

inequality. A further study by Keita (2003), which looked at just porotic hyperostosis

prevalence, complements this with an observed decline in health from the Badarian

to Nagada I periods, followed by an improvement to the First Dynasty. Another by

Starling and Stock (2007), investigating LEH prevalence, also points towards an


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improvement in health after the Badarian period, although this study was not

focused solely on Egypt. Studies using just one or two populations have also been

carried out, with the advantage that they often employ a multitude of different

skeletal stress markers to quantify health. One such study by Greene (2006)

compared both diet and dental health between two populations from Hierakonpolis

and Nagada, mostly dating to the Nagada II period, and found that children from

Hierakonpolis were healthier than those from Nagada. Another study by Kumar

(2009) used multiple stress markers to compare the health of individuals from a

Nagada II cemetery at Hierakonpolis with data from other populations dating from

the Upper Palaeolithic to the Old Kingdom, and concluded that there was an overall

decline in health with the introduction of agriculture and increasing socio-economic

disparities.

These existing studies of health in early Egypt are limited in their scope and the

approaches they employ. Firstly, the relationship between health and cultural

change only becomes apparent when populations from different contexts are

compared with one another, so studies involving just one or two populations are

limited in what they can reveal. Secondly, the most useful studies which have

compared several populations over the Predynastic and Early Dynastic periods have

not always used multiple stress markers to quantify health change; the study by

Keita (2003) above only looked at the change in porotic hyperostosis prevalence. The

use of multiple indicators is essential if reliable conclusions of overall health change

are to be made as each skeletal stress marker only tells us about one aspect of an

individual’s or population’s health. Furthermore, the use of more than one stress


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marker reduces the number of potential interpretations that can be made from the

data.

Thirdly, many studies have failed to trace the skeletal material used back to their

original archaeological contexts; often original excavation reports are not even

referenced in studies, implying that they were not consulted. This has resulted in

interpretations of health changes and differences being made without fully

considering how a group’s social context could have affected their observed health.

Finally, the relationship between social status and health has only been touched

upon, not just in the context of early Egypt, but for most periods of Egyptian history.

This is surprising considering that social status is such an important issue within

Egyptology.

1.7. Research aims and contribution

The present study will carry out an in depth investigation of the temporal and

social variations in health. It will compare the health of six early Egyptian populations

using three different skeletal stress markers to quantify change. Importantly, the

social context of each population will be investigated in detail so that the observed

changes can be more reliably interpreted.

This study adopts a multi-disciplinary approach using the methods of both

Egyptology and Biological Anthropology to quantify health differences between

different early Egyptian populations. This allows a much fuller picture to be gained of

health and the fundamental social differences between the studied groups than

would otherwise be gained if each discipline was used in isolation. The results

contribute to our knowledge of social change and social status in early Egypt, a


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period of Egyptian history for which we know comparatively less than later periods.

Beyond Egyptology, it has wider implications for investigating the effects that major

cultural changes such as agriculture, urbanisation and social stratification have on

the ability of a human group to adapt to its environment, as well as providing more

accurate models for state formation in other areas of the world.


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CHAPTER 2 – DATA AND METHODS

2.1. The skeletal material used

Six populations were sampled, from a range of archaeological sites of significant

socio-political importance in the emergence of the Egyptian state and dating to

various cultural phases spanning the early Predynastic to Early Dynastic periods. A

summary of the populations is presented below (Table 1), along with a map of their

locations (Figure 4) and a timeline (Figure 5). All of the skeletal material used in this

study is from the Duckworth Collection, held in the Leverhulme Centre for Human

Evolutionary Studies, at the University of Cambridge.


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Table 1 - Origins of the skeletal material used in this study

Origin of

skeletal material

Approximate date of

skeletal material

Excavator(s) of skeletal material &

publication date of excavation

report

El-Badari -

Badarian graves

Badarian period Brunton & Caton-Thompson (1928)

Hierakonpolis -

Prehistoric &

possibly the

‘Fort’ cemeteries

Mainly Nagada II period,

with possibly some

Nagada I & III

Quibell & Green (1902)

Nagada -cemetery B

Mainly Nagada II period Petrie & Quibell (1896)

Nagada -

cemetery T

Nagada II & III period Petrie & Quibell (1896)

Tarkhan Mainly Nagada III period,

with some First Dynasty

Petrie (1914)

Abydos - ‘Tombsof the Courtiers’ First Dynasty Petrie (1924)


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Figure 4 - Map showing the locations of the populations sampled (Adapted from:

(Grajetzki & Quirke 2001))

Figure 5 - Timeline of the periods studied (Created by the author – dates taken

from (Shaw 2002))

N.B. ‘Nagada III’ and ‘Protodynastic’ are just different names for the same time period.


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To reconstruct the original archaeological context of the skeletal material the

Duckworth Collection’s records were initially consulted. However, these did not

contain sufficient information. Therefore, the original excavation reports and

previous studies in which the material had been used were investigated instead.

Particular attention was paid to grave numbers written either on the material itself

or on the boxes, so that individuals could be traced back to the excavation reports

more easily. Importantly, and in contrast to previous approaches to investigating

Egyptian skeletal remains, the social context from which the population originated

was investigated in detail before samples were taken, with specific cemeteries within

the overall population region being sampled if at all possible. To assist with this,

tables linking grave details (if recorded) with the skeletal material were compiled

(see Appendix A).

2.1.1. El-Badari (Appendix A1)

The material from El-Badari is from several Badarian period (c. 4400-4000 BC)

cemeteries excavated by Brunton and Caton-Thompson (1928); by noting the four

digit grave numbers written on boxes, the skeletal material could be traced

specifically to cemeteries 5100, 5300, 5400, 5600, 5700 and 5800. Badarian period

graves generally consisted of a single individual buried in an oval or rectangular pit

(Trigger 1983). The body was wrapped in matting, cloth and animal skin and was

placed in a contracted position on its left side, with the head oriented to the south,

but facing west. Some graves contained the remains of reeds, which probably

formed some kind of roofing over the body. Graves were generally rich in burial

goods: a variety of pottery types including ‘red-polished, black-topped’ vessels, bone


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tools, various ivory items such as bracelets and rings, bone and ivory combs,

siltstone palettes, ostrich egg shell vessels, shell and stone beads, and copper items

such as pins (Midant-Reynes 2000; Brunton & Caton-Thompson 1928). There has

been debate as to the level of social stratification that Badarian period graves

represent. Trigger (1983) suggests that although graves were differentiated in size,

there were no strong wealth distinctions in terms of burial goods because rich

burials of children were not found; certainly, the concept of inherited status had not

developed at this point. Anderson (1992) argues against this and suggests that there

were burial good differences and that this argues against the traditional view of

Badarian society being largely egalitarian in its structure. Regardless of this though,

social status differences in tombs become much more evident in the latter half of

the Predynastic Period, as the ideological foundations of Egyptian kingship were

developing amongst a powerful elite class.

2.1.2. Hierakonpolis

The Predynastic material from Hierakonpolis is the most difficult to assign a

detailed provenance to, as the Duckworth records are the sparsest for this collection

and little has been done to investigate the provenance in previous studies where the

material has been used. Most of the individuals sampled have different one, two or

three digit grave numbers written on the skulls. A few have ‘232 E’ written on them

instead and some have the same number, ‘318’. An entry by an unknown author in

the records lists three archaeological excavations where the material could have

come from: ‘Egypt Research 1898’, ‘Petrie 1898’ and ‘Green & Quibell 1899’. The

Egyptian Research Account, formed by Petrie, dispatched Green and Quibell to


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salvage the Predynastic site at Hierakonpolis in 1897 (The Friends of Nekhen n.d.),

from which two excavation reports, Hierakonpolis I (Quibell 1900) and Hierakonpolis

II (Quibell & Green 1902) were published. The next expedition to Hierakonpolis was

in the 1905-06 season by Garstang and Jones (The Friends of Nekhen n.d.).

Therefore, it seems likely that the material originated from Quibell and Green ’s

excavations. They investigated two main Predynastic burial areas: one within the

Fort region and one at the south of the desert site. The latter was a Nagada II

cemetery in which the ‘Painted Tomb’ (tomb 100) was found (Wilkinson 2000),

which possibly belonged to an early king (Case & Crowfoot Payne 1962). This

represented the main Predynastic cemetery area, and so is the most likely place

from which the material sampled in this study originated. However, in their report,

Quibell and Green make little mention of graves other than the large, brick-lined

ones to which tomb 100 belonged. They are quoted as saying:

‘The rest of the graves were mere rough rectangular excavations in the hard desert

sand varying in depth from 2.0 m. to 0.5 m. The roofs had in many instances been

made out of wood as the remains of the ends of the beams were found in some

cases… Nearly all had been robbed, and most of those that had escaped contained

little except pottery ’ (Quibell & Green 1902, p.22).

It is not clear how many graves they were referring to, though Crowfoot Payne

(1973) mentions a series of 150 Predynastic graves in a manuscript register compiled

by Green and suggests that they are from the tomb 100 cemetery. The contents of

most of these graves seem to have been published in (Adams 1974). However,


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hardly any of the grave numbers associated with the skeletal material sampled in

this study are mentioned.

As a result of the material not being recorded in any detail, it is not possible to

make any significant statements about the social status of the individuals

represented in the skeletal material sampled at Hierakonpolis. All that can be said is

that most were probably of lower status than tomb 100 and other similar graves

(although one skull labelled with the number ‘100’ could possibly have belonged to

the person buried in this tomb). As it is not possible to be completely sure that all of

the skeletal material originates from this one cemetery, but it is fairly certain that it

all came from the excavations of Quibell and Green, the Hierakonpolis group has

been labelled as a general Mid Predynastic-Protodynastic group, which could include

Nagada I and III period material (the ‘Fort’ cemetery was used over these periods

(Wilkinson 2000)) in addition to that from the Nagada II period.

2.1.3. Nagada B (Appendix A2)

One set of material from Nagada is from Cemetery B, a predominantly Nagada II

period (Bard 1994) (c. 3500-3200 BC) cemetery of 144 graves excavated by Petrie

(Petrie & Quibell 1896). It was distinguished from the other Nagada material by the

two or three digit numbers preceded by ‘B’ written on boxes. Most Cemetery B

graves were rectangular pits, with some oval or round ones. In general, bodies were

contracted and were positioned on their left side, with their head to the south and

facing west (Petrie & Quibell 1896). Grave goods included pottery, particularly of the

red and black type, beads, shell, stone vases and slate palettes (Petrie & Quibell

1896; Baumgartel 1970). A detailed comparison of mortuary practices in the three


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different cemeteries at Nagada by Bard (1994) points towards Cemetery B being for

lower status individuals than Cemetery T and N West on account of the smaller

average grave size, greater density of graves and lower number of ‘rich’ graves. Bard

suggests that the cemetery was for middle-class individuals living in a nearby farming

village.

2.1.4. Nagada T (Appendix A3)

The second set of material from Nagada is from Cemetery T, which was mainly in

use during the Nagada II and III periods (Bard 1994) (c. 3500-3000 BC), and was also

excavated by Petrie (Petrie & Quibell 1896). The material was identified as belonging

to this cemetery by the one or two digit numbers preceded by ‘T’ written on the

boxes. Cemetery T was the smallest cemetery at Nagada, with just 69 graves (Bard

1994). It seems to be well accepted among the literature that Cemetery T was a

high-status, elite burial ground, where perhaps the early leaders of Nagada were

buried (Case & Crowfoot Payne 1962; Kemp 1973). As well as its separate location,

Cemetery T had the lowest density of graves out of all of the Nagada cemeteries, the

largest average grave size and, in the Nagada II period, the highest average number

of pots per grave (Bard 1994). Many of the tombs contained large quantities of

pottery and luxury high-status goods, including slate palettes, beads made of

precious stones and shell, and hard stone vessels (Baumgartel 1970; Petrie & Quibell

1896), all representing a significant investment of resources. There were also several

larger, brick-lined tombs containing multiple burials, including those of children,

which ties in with what was observed during data collection for the present study:

adult skeletal material was often associated with that of infants from the same


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tomb. The similar treatment of subadults as adults in burial suggests a degree of

inherited rather than acquired status (Wilkinson 2000), something which was not

evident in the Badarian period graves discussed earlier.

2.1.5. Tarkhan (Appendix A4)

The material from Tarkhan was excavated by Petrie (1914), from a large

cemetery of over 2000 graves dating to the Nagada III period and First Dynasty. The

material sampled from the Duckworth is mainly from the Nagada III period, with a

small number of individuals from the First Dynasty. Most individuals could be traced

back to grave entries in Petrie’s excavation report on the basis of the two, three or

four digit grave numbers written on boxes (preceded by ‘F’ due to a previous

classification system). Petrie organised all the graves excavated at Tarkhan by

sequence date based on pottery, assigning S.D. 77 and 78 to the Nagada III period (or

Dynasty 0 as he called it), and 79-62 to the First Dynasty. Five of the individuals

sampled did not have entries in the report, but it was assumed that they were from

either the Nagada III period or the First Dynasty. Most of the graves sampled were

square or oval pits and commonly contained pottery and beads. Other items

included were slate palettes, stone vessels, and sometimes copper and ivory objects.

Grajetzki (2004) notes that the cemetery at Tarkhan is notable for the range of

different social classes that its graves represent; the poorest graves being just 1.5 –

1.8 m deep and containing pottery and sometimes jewellery, and the richest graves

having coffins and/or large mud-brick superstructures. There was also a spatial

distinction in that the most important tombs were carved into rocks overlooking the

valley, whereas the densely distributed graves occupying the middle valley were of


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poorer people. Given that the graves associated with the material sampled in this

study are from a variety of different locations within the cemetery, and contain a

variety of different types and numbers of grave goods, the sample is likely to contain

individuals of a range of different social classes.

2.1.6. Abydos (Appendix A5)

The skeletal material from Abydos was excavated by Petrie (1924) and is from the

subsidiary burials situated around the funerary enclosures of three First Dynasty

kings of Egypt, Djer, Djet and Merneith (the majority from the former two). The

graves are brick-lined and it has been suggested that they were once surmounted by

a brick superstructure (Kemp 1966). Similar subsidiary burials were also found

around several royal tombs of the First Dynasty kings. Kemp (1967) suggested that

the purpose of all of the subsidiary burials was so that the individuals could serve the

kings in the afterlife, and although it is debated, it is possible that at least some of

the individuals were killed for this purpose (O’Connor 2009). Some individuals

appear to have been minor officials, on the basis of titles such as ‘seal-bearer’ and

the presence of high status burial goods such as ivory combs and cosmetic

implements (Petrie 1924). More recently it has been proposed that many of the

individuals were court artisans (Bestock 2007; O’Connor 2009), suggested by the

inclusion of copper tools in many burials. Bestock has also suggested that there is

some degree of spatial grouping of burials containing specific types of objects (e.g.

arrowheads, model granaries, ivory game pieces) possibly relating to different

functions that the kings wanted these individuals to perform in the afterlife. The

apparent close relationship with the early kings of Egypt and the high level of


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resource investment represented by the burials suggests that these individuals were

accorded a special high status.

2.2. Sampling procedure

A total of 179 individuals were sampled. The fragmentary nature of the skeletal

material was an important factor in choosing which individuals were sampled:

individuals were excluded from sampling if preservation was very poor or if the

material was very fragmentary. The final sample size is shown below (Table 2).

Table 2 - The skeletal sample taken in this study

Population Total number

of individuals

sampled

Number of

individuals

observable for

porotic

hyperostosis

Number of

individuals

observable for

cribra

orbitalia

Number of

individuals

observable for

LEH (at least 1

scorable

tooth)

El-Badari 30 30 30 30

Hierakonpolis 39 39 39 29

Nagada B 24 24 20 24

Nagada T 24 24 23 15

Tarkhan 30 30 29 28

Abydos 32 32 30 31

TOTAL 179 179 171 157

2.3. Assigning age and sex

2.3.1. Age

Where possible, only adults were sampled, with subadults or individuals with

undefined age only being included if insufficient adult skeletal material was present

for a population; only 14 out of the 179 individuals sampled were classed as


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subadults or undefined. For the purposes of this study, distinction between different

age categories within ‘adults’ was not made, as aging an individual from only cranial

material is considered to be an inaccurate method (Dr J.T. Stock, personal

communication) and because of the time constraints of the study. Adult status was

assigned primarily on the basis of dental status. Dental status was assigned for each

tooth using and adapting the scoring system developed by Dr J.T. Stock (personal

communication):

O - In occlusion/fully erupted tooth present (adapted in this study to include caseswhere only part of a tooth was present because of post-mortem damage)

E - Emerging

U - Unerupted

CO - Crypt open (i.e. tooth about to emerge)

P - Postmortem loss

A - Antemortem loss

M - Missing for unknown reason

An individual was considered an adult if at least one fully erupted third molar was

present, or in the case of postmortem tooth loss, where there was evidence of one

having been present; the third molar (wisdom tooth) emerges from the age of 18

years (White & Folkens 2005). However, this method is limited in that third molar

emergence can be delayed by several years into adulthood, with the timing varying

between individuals within a population. Evidence of extensive cranial suture fusion

was also occasionally used to assign adult status if either no evidence of fully

erupted third molars was present or if there was insufficient dental material.

Subadult status was assigned if it could be confirmed that no fully erupted third


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molars were present. If for any reason age status could not be confirmed, the

individual was recorded as ‘undefined’.

Table 3 - The age distribution of the individuals sampled

Population Number of adults Number of

subadults

Number of

individuals of

undefined age

El-Badari 30 0 0

Hierakonpolis 39 0 0

Nagada B 24 0 0

Nagada T 11 3 10

Tarkhan 30 0 0

Abydos 31 0 1

TOTAL 165 3 11

As can be seen from Table 3, the age distribution of individuals sampled varied

between populations. This is a common challenge faced by palaeopathologists and is

important to be aware of because it can affect the prevalence of stress markers

observed in each group. In the case of cribra orbitalia and porotic hyperostosis, a

sample with an overall older age distribution could theoretically exhibit a lower

prevalence than a sample with a younger age distribution. This is because both are

thought to form in childhood, but can then remodel and heal later in life (Stuart-

Macadam 1985). LEH does not suffer from the same bias, as tooth enamel does not

remodel after its initial formation (Goodman & Rose 1990), but it should be

remembered that a skeletal sample will only consist of the individuals who survived

periods of childhood stress. For the samples used in the present study it was not

possible to see whether the prevalence of any of the stress markers changed


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significantly with age. However, the inclusion of mostly adults minimises any bias

that could have arisen from higher prevalences among subadults.

3.1.2. Sex

Each individual was assigned a sex to enable any differences in health between

males and females to be identified in data analysis. Sex was determined from each

cranium using the standard method of Buikstra and Ubelaker (1994), in which five

sexually dimorphic cranial features (Figure 6) are given a score of 1-5 based on their

robusticity, where 1 is hyperfeminine and 5 is hypermasculine:

Rugosity of the nuchal crest

Size of the mastoid process

Thickness of the supraorbital margin

Prominence of the supraorbital ridge

Size of the mental eminence

The scores are then averaged to give an overall sex. An individual with an average

score of 1-2.5 was recorded as female and 3.5-5 as male. Those individuals with

scores of 2.6-3.4 were recorded as ‘undefined’ (Starling 2005). Where preservation

of material was poor, an individual was required to have a minimum of three out of

the five (i.e. more than half) cranial markers present for sex to be assigned with

confidence. If not, they were recorded as ‘undefined’. Any pre-assigned sex written

by previous researchers on either the skulls or boxes was also noted, as well as those

recorded in the original excavation reports.


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Figure 6 - Sexually dimorphic cranial features (Source: (Buikstra & Ubelaker 1994))

2.4. Measuring the skeletal stress markers

2.4.1. Linear enamel hypoplasia

For the purposes of this study, linear enamel hypoplasia was defined as a

horizontal (or near horizontal) groove occurring on the enamel surface (Goodman &

Rose 1990). In addition, a linear sequence of pits occurring on the enamel surface

(these were rare) was also counted as linear enamel hypoplasia because in practice it

is difficult to distinguish these two defects from one another.

For each individual, all scorable teeth were scored for the presence of LEH bands

on the enamel surface which faces outwards (as is shown in Figure 1). For a tooth to


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be considered scorable, it needed to have at least half of its enamel surface present

and visible (Starling 2005). The poor preservation of tooth enamel was a significant

problem in this study. A 10x magnifying glass was used to examine teeth for LEH, but

a tooth was only recorded as having LEH if the band was visible with the naked eye

too. The distance of the LEH band, or the most severe one in the case of multiple

bands, from the cemento-enamel junction (Figure 7) was measured using a pair of

digital callipers. This was so that the approximate age at which the growth disruption

had occurred could be calculated; tooth enamel formation begins from the top of

the tooth. This was done using the formulae presented by Goodman and Rose

(1990).

Figure 7 - Location of the cemento-enamel junction (Source: (Spiller 2000))

2.4.2. Porotic hyperostosis and cribra orbitalia

If an individual had a complete or at least 50 % complete cranial vault with at

least one side of each cranial bone present they were scored for the presence and

severity of porotic hyperostosis, using the standard scoring system laid out by

Ubelaker & Buikstra (1994), which has been frequently cited in previous studies


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(Table 4). In cases where porotic hyperostosis of multiple severity levels was present

in the same individual, only the most severe was scored.

Any individual with at least one orbit present was scored for the presence and

severity of cribra orbitalia, using the same scoring system as for porotic hyperostosis

(Table 4). Again, only the most severe manifestation of the condition was scored if

multiple severity levels were present. Only one orbit was required to be able to

measure cribra orbitalia because of its noted bilateral distribution (Stuart-Macadam

1989). An incomplete orbit could still be scored for cribra orbitalia as long as the

orbital roof was present, where cribra orbitalia usually appears (White & Folkens

2005). If both orbits were present and of sufficient preservation, only the most

severe occurrence of cribra orbitalia was recorded, but it was also noted whether

cribra orbitalia appeared in one or both orbits.

Table 4 - The scoring system used for measuring cribra orbitalia and porotic

hyperostosis (Buikstra & Ubelaker 1994)

Score Criteria

0 No porosity present

1 Indistinct porosity/barely visible

2 True porosity

3 True porosity with coalesced foramina(i.e. pores which have joined up)

4True porosity with coalesced foramina

and thickening of the bone surface


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2.5. Data analysis

Data was analysed using Microsoft Excel and the statistics software SPSS 19.0.

The relative frequency of each skeletal health marker within the six populations

sampled was calculated and any statistically significant trends were identified.

Differences between males and females were also assessed, as well as the degree of

association between each stress marker. Before analysis, tests were run on the data

to assess whether it showed a normal distribution, as many statistical tests require

that data is normalised in order to make accurate conclusions about statistical

significance. If the data was not normally distributed, non-parametric tests were

carried out instead of parametric ones.


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CHAPTER 3 – RESULTS

N.B. The raw data collected in this study can be found in Appendix B.

3.1. Inter-population differences in stress markers

3.1.1. Cribra orbitalia

3.1.1.1. Prevalence

Significant differences were observed in the prevalence of cribra orbitalia

between populations. When the percentage of individuals with cribra orbitalia,

severity scores 1 or above was compared (Figure 8), Tarkhan had the highest

percentage of affected individuals (72.41 %), though this was only marginally higher

than that found at Hierakonpolis (71.79 %). Conversely, Abydos had the lowest

percentage (40.00 %), but again this was only slightly lower than that of Nagada T

(43.48 %). Overall, the differences between the populations were found to be

statistically significant (Kruskal-Wallis test: X2=11.766, df=5, p


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El-Badari had the highest percentage (30.00 %), though this was only slightly higher

than Hierakonpolis (28.21 %) and Tarkhan (27.59 %). There was also very little

difference between the two Nagada groups (20.00 % vs 21.74 %).


by population


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Figure 9 - Percentage of individuals with cribra orbitali a severity score 2 or above,

by population

3.1.1.2. Severity

There were also differences in the severity of cribra orbitalia between

populations; the overall severity distribution is presented in Figure 10. Both Tarkhan

and Hierakonpolis had the highest average severity (1.10) and Abydos had the

lowest (0.57) (Figure 11). Nagada T also had a lower average severity (0.78) than

Nagada B (0.95). It should be noted though that these differences in average severity

were quite small and not significant (Kruskal-Wallis test: X2=9.045, df=5, p=ns).

Interestingly, Abydos was the only population in which the most severe occurrence

of cribra orbitalia, severity scores 3 and 4, was not observed, whereas Nagada B had

the highest percentage of individuals with these scores (15.00 %) (Figure 12).

Furthermore, Nagada T (8.70 %) had a lower percentage of individuals with severe


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cribra orbitalia than Nagada B. Again though, these differences were not significant

(Kruskal-Wallis test: X2=4.310, df=5, p=ns).

Figure 10 - Percentage of individuals with each severity score of cribra orbitalia, bypopulation


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Figure 11 - Average severity of cribra orbitalia in each population

Figure 12 - Percentage of individuals with severe cribra orbitalia (scores 3 & 4), by

population


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3.1.1.3. Temporal trends

In order to identify whether the prevalence of cribra orbitalia changed over time,

the six populations were arranged into three time period categories (Figure 13):

Early Predynastic (El-Badari), Mid Predynastic-Protodynastic (Hierakonpolis, Nagada

B & Nagada T) and Proto-Early Dynastic (Tarkhan & Abydos). The sample size of each

group was different and this may have influenced the perceived prevalence. The

prevalence of cribra orbitalia (severity score 2 or above) decreased all the way from

the Early Predynastic to the Proto-Early Dynastic. The differences in prevalence over

time were not significant though (Kruskal-Wallis test: X2=0.680, df=2, p=ns), for all

population comparisons.


by time period


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3.1.2. Porotic hyperostosis

3.1.2.1. Prevalence

As with cribra orbitalia there were substantial differences in the prevalence of

porotic hyperostosis between populations. A comparison of the percentage of

individuals with porotic hyperostosis, severity scores 1 or above (Figure 14) revealed

that the highest percentage of affected individuals occurred at Hierakonpolis (92.31

%), whereas the lowest percentage occurred at Abydos (65.63 %). Overall these

differences were not significant (Kruskal Wallis test: X2=9.319, df=5, p=ns).

When the more accurate measure of porotic hyperostosis prevalence was used,

i.e. the percentage of individuals with severity scores 2 or above (Figure 15), the

highest percentage of affected individuals occurred at El-Badari (50.00 %), which was

much higher than the second highest percentage found at Hierakonpolis (28.21 %).

Nagada B and Nagada T both had the lowest percentage (8.33 %) and Abydos the

second lowest (18.75 %). Overall the differences between populations were highly

significant (Kruskal; Wallis test: X2=18.861, df-=5, p=0.001).


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above, by population


above, by population


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3.1.2.2. Severity

Similar to cribra orbitalia, the severity of porotic hyperostosis showed

differentiation between populations; the overall severity distribution is presented in

Figure 16. El-Badari had the highest average severity (1.50), and Nagada B (0.83),

Nagada T (0.83) and Abydos (0.84) had the lowest (Figure 17). Again, these

differences were fairly small, although highly significant (Kruskal Wallis test:

X2=17.779, df=5, p


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Figure 17 - Average severity of porotic hyperostosis in each population

Figure 18 - Percentage of individuals with severe porotic hyperostosis (scores 3 &

4) by population


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Porotic hyperostosis prevalence (severity score 2 or above) decreased

substantially from the Early Predynastic to the Mid Predynastic-Protodynastic, the

same trend observed with cribra orbitalia (Figure 19). Prevalence then increased

slightly in the Proto-Early Dynastic, in contrast to the slight decrease found for cribra

orbitalia. However, it was only the Early Predynastic group which was significantly

different to both later groups (Mann-Whitney tests: U=877.500, Z=-3.528, p


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3.1.3. Linear enamel hypoplasia

3.1.3.1. Prevalence

The percentage of scorable individuals with at least one tooth with LEH was

compared between populations (Figure 20) and the differences observed were

found to be highly significant (Kruskal-Wallis test: X2=26.279, df=5, p


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Figure 20 - Percentage of individuals with LEH in each population

Figure 21 - Average percentage of scorable teeth with LEH per individual, bypopulation


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When analysed by time period, the percentage of individuals with LEH decreased

from the Early Predynastic to Mid Predynastic-Protodynastic, then increased again to

the Proto-Early Dynastic, but to a lower level than the earliest time period (Figure

22). Overall, the differences were highly significant (Kruskal-Wallis test: X2=22.959,

df=2, p


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a similar overall pattern to the initial graph for LEH prevalence (Figure 20),

suggesting that the likelihood of recording LEH in an individual was affected by the

number of scorable teeth that that individual had; the populations with the three

highest average numbers of scorable teeth per individual, El-Badari, Abydos and

Tarkhan, also had the highest percentage of individuals with LEH. This was confirmed

by the finding that individuals with LEH had a higher average number of scorable

teeth than individuals without LEH in all populations (Figure 24). Finally, there was a

highly significant association between the number of scorable teeth per individual

and the number of those teeth with LEH in the overall sample (excluding individuals

with no scorable teeth, who would always have no teeth with LEH) (Kendall’s tau

correlation test: τ=0.516, p


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Figure 24 - Average number of scorable teeth in individuals with LEH and without

LEH, by population


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Figure 25 - Association between number of scorable teeth per individual and

number of teeth with LEH, whole sample


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A more specific source of preservation bias was that the overall number of

posterior teeth, i.e. molars and premolars (see Figure 26 for tooth types) was much

higher than the number of anterior teeth, i.e. canines and incisors (Figure 27). It has

been shown that anterior teeth have a greater susceptibility to developing LEH than

posterior teeth (Goodman & Armelagos 1985), and indeed in this study anterior

teeth were preferentially affected by LEH over posterior teeth (Figure 28). This could

have resulted in the prevalence of LEH being overestimated in the populations

where more anterior teeth were preserved. Indeed, the three populations which

show the highest LEH prevalence, El-Badari, Abydos and Tarkhan (Figure 20), do

have the highest numbers of preserved anterior teeth.

Figure 26 - Diagram of tooth types (Adapted from: (White & Folkens 2005))


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Figure 27 - Average number of posterior and anterior teeth per individual in each

population

Figure 28 - Percentage of each tooth type with LEH, whole sample


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3.1.3.4. Minimising preservation bias

To minimise the bias of differential tooth preservation, both in the number and

type of teeth preserved, LEH prevalence was then analysed using just the posterior

teeth (Figure 29); these were preserved in far greater numbers across the whole

sample than anterior teeth. The results revealed a similar pattern to that observed

when the whole dentition was considered (Figure 20) and overall this was highly

significant (Kruskal-Wallis test: X2=27.541, df=5, p


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Figure 29 - Percentage of individuals with LEH in posterior dentition in each

population

Figure 30 - Percentage of individuals with LEH in posterior dentition, by time period


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LEH prevalence by individual tooth type was explored to try to minimise

preservation bias further. Choosing individual teeth still allows a comparison of the

percentage of individuals with LEH in each population, but all bias of differential

tooth susceptibility is removed. The highest frequency tooth from each of the four

main tooth types (molars, premolars, canines and incisors) was chosen and the

percentage of each with LEH was calculated (Table 5). It was not possible to get the

same number of individuals represented from each population due to differential

preservation, but this method ensured greater consistency in tooth preservation

than the above method. Unfortunately, the analysis was not particularly revealing as

there was no population which had the highest or lowest LEH prevalence across all

tooth types. Although Hierakonpolis had the lowest (or among the lowest) LEH

prevalence for three out of the four teeth tested, this comparison is made redundant

by two of them only having one tooth present in the whole population. It is

potentially interesting though that Abydos had the highest LEH prevalence in two

teeth, in addition to having the highest percentages in the previous analyses (Figures

20 & 29).

Finally, LEH prevalence was compared across the two most frequently preserved

molars, the right maxillary second molar and left maxillary second molar (Table 6);

molars have often been used in previous studies to compare LEH prevalence (Keita &

Boyce 2001; Keita & Boyce 2006). Tarkhan had the lowest LEH prevalence for both

teeth, as was found in the earlier comparison of posterior teeth (Figure 29), but this

was the only apparent consistency between the two teeth. As these comparisons of

individual tooth types didn’t show any overarching trends, the earlier comparison of


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posterior teeth should be viewed as most accurate and feasible way of comparing

LEH prevalence between populations (Figures 29 & 30).

Table 5 - Percentages of the highest frequency molar, premolar, canine and incisorwith LEH, by population

N.B. If a box has been left blank, no scorable teeth were present.

Population Left maxillary

second molar

Right

maxillary

second

premolar

Right

maxillary

canine

Right

maxillary

second

incisor

El-Badari 8.70 % (2 of

23)

9.52 % (2 of

21)

31.58 % (6 of

19)

16.67 % (1

of 6)

Hierakonpolis 6.67 % (1 of

15)

0.00 % (0 of

10)

0.00 % (0 of

1)

0.00 % (0 of

1)

Nagada B 7.14 % (1 of

14)

0.00 % (0 of 5) - -

Nagada T 9.09 % (1 of

11)

25.00% (1 of

4)

0.00 % (0 of

1)

100.00 % (1

of 1)

Tarkhan 4.55 % (1 of

22)

12.50 % (2 of

16)

53.33% (8 of

15)

53.85 % (7

of 13)

Abydos 16.00 % (4 of

25)

0.00 % (0 of

21)

87.50 % (7 of

8)

50.00 % (3

of 6)

TOTAL 9.09 % (10 of

110)

6.49 % (5 of

77)

47.73 % (21

of 44)

44.44 % (12

of 27)


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Table 6 - Percentages of the two highest frequency molars with LEH, by population

Population Left maxillary second

molar

Right maxillary second

molar

El-Badari 8.70 % (2 of 23) 16.67 % (4 of 24)

Hierakonpolis 6.67 % (1 of 15) 10.53 % (2 of 19)

Nagada B 7.14 % (1 of 14) 8.33 % (1 of 12)

Nagada T 9.09 % (1 of 11) 28.57 % (2 of 7)

Tarkhan 4.55 % (1 of 22) 5.00 % (1 of 20)

Abydos 16.00 % (4 of 25) 7.41 % (2 of 27)

TOTAL 9.09 % (10 of 110) 11.01 % (12 of 109)

3.1.3.5. Age of linear enamel hypoplasia formation

The average age of LEH formation per individual (Table 7) and for the four teeth

chosen earlier (Tables 8, 9, 10 & 11) was compared across populations. No overall

trends between populations were apparent.

Table 7 - Average age (years) of LEH formation per individual (averaged across all

LEH bands), by population

Population Average age (years)

El-Badari 4.48

Hierakonpolis 4.98

Nagada B 5.00

Nagada T 4.83

Tarkhan 4.03

Abydos 4.45

TOTAL 4.50


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Table 8 - Average age (years) of LEH formation in left maxillary second molar, by

population


El-Badari 6.93

Hierakonpolis 7.03

Nagada B 6.71

Nagada T 6.04

Tarkhan 6.84

Abydos 5.87

TOTAL 6.40

Table 9 - Average age (years) of LEH formation in right maxillary second premolar,

by population


El-Badari 4.59

Hierakonpolis -

Nagada B -

Nagada T 4.35

Tarkhan 4.76

Abydos -

TOTAL 4.61


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Table 10 - Average age (years) of LEH formation in right maxillary canine, by

population


El-Badari 4.20

Hierakonpolis -

Nagada B -

Nagada T -

Tarkhan 4.10

Abydos 3.49

TOTAL 3.93

Table 11 - Average age (years) of LEH formation in right maxillary second incisor, by

population


El-Badari 3.35

Hierakonpolis -

Nagada B -

Nagada T 3.76

Tarkhan 3.36

Abydos 2.92

TOTAL 3.28

3.2. Intra-population variation in stress markers

3.2.1. Sex

The prevalence of each stress marker in males and females was analysed. In the

overall sample, there were 33 males, 95 females and 51 individuals of undefined sex.


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Overall, there was no significant difference between males and females in the

prevalence of cribra orbitalia (severity score 2 or above) (Fischer’s Exact test: p=ns),

the prevalence of porotic hyperostosis (severity score 2 or above) (Fischer’s Exact

test: p=ns), or the prevalence of LEH (posterior teeth) (Fischer’s Exact test, p=n). This

was consistent across populations as well as in the overall sample. Although this lack

of difference may be suggestive, these results must be treated with caution as the

sample size of individuals with assigned sex was very small for many of the

populations and it is difficult to assign sex accurately using just cranial remains. Thus,

the same statistical tests were also run using the pre-assigned sex values recorded in

the original excavation reports. Again there were no significant differences between

males and females in the prevalence of any of the stress markers.

3.2.2. Age

Although the variation in the stress markers by age was not assessed in this

study, the potential bias of including a small number of subadults in the sample was

measured. Apart from one individual in the Abydos group, it was only the Nagada T

group which contained any individuals that classified as either subadults or

undefined age. However, no significant differences were found between adults and

undefined individuals when the frequencies of the different stress markers were

compared within the Nagada T group (Mann-Whitney tests: U=50.000, Z=0.000,

p=ns; U=15.000, Z=-0.522, p=ns; U=11.000, Z=-0.264, p=ns) (it was not possible to

carry out adult to subadult comparisons because of the small subadult sample size).

This suggests that the effects of having a potentially younger age distribution (at

least in terms of subadults vs adults) than the other populations was probably small.


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3.3. Association between different stress markers

The level of association between the different stress markers was measured. In

the overall sample, cribra orbitalia presence (severity score 2 or above) was found to

be highly significantly associated with porotic hyperostosis presence (severity score 2

or above) (Pearson Chi-Square test: X2=5.504, df=1, p


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CHAPTER 4 – DISCUSSION

4.1. Health and cultural change—temporal trends in the stress markers

4.1.1. The Badarian period

When viewed temporally, the results of this study show that health changed

substantially over the period of state formation in Egypt. The population from El-

Badari, which represent the first predominantly agricultural society to inhabit Upper

Egypt, has the highest prevalence (severity score two or above) and among the

highest average severities of both cribra orbitalia and porotic hyperostosis, as well

one of the highest prevalences of LEH (just using posterior teeth) of all the

populations sampled. The high prevalence of all three skeletal stress markers in the

population strongly suggests that their overall health was poor. Although it is not

possible to say on the basis of this data how health changed from the period

preceding the Predynastic, the poor health among the Badarian population supports

the current thinking that the transition to agriculture in many regions of the world

resulted in an initial decline in overall health. Documented health problems that

arose with agriculture include increased prevalence of dental caries (cavities) due to

the increase of starch-based foods in the diet, the increased prevalence of infectious

disease as a result of increased population density and sedentism, and an increase in

nutritional disorders because of reduced diversity and nutritional content of some

agricultural products (Larsen 1995).

The high prevalence of all three stress markers suggests overall poor health

among the Badarian population, but in particular the high cribra orbitalia and porotic

hyperostosis prevalences could plausibly be linked to an increased prevalence of


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iron-deficiency anaemia with agriculture. The predominant crops to be introduced

with agriculture were emmer wheat and 6-row barley (Wengrow 2006), which are

naturally low in iron. If not combined with enough meat and vegetables, an iron-

deficient diet could ensue. Thus, if children are weaned onto a diet which is low in

iron, they are susceptible to iron-deficiency anaemia and this susceptibility could be

further increased if infectious disease is prevalent within the environment (as has

been documented for the agricultural transition), through the increased likelihood of

infant diarrhoeal infections (Facchini et al. 2004). An iron-deficiency anaemia

hypothesis is also likely given that the parasitic disease schistosomiasis, which causes

substantial iron-loss, is thought to have been prevalent in ancient Egypt (Keita 2003),

and has been identified in mummy remains from the Predynastic Period (Deelder et

al. 1990). The disease is prevalent in Egypt today and infection is strongly associated

with exposure to infected water. It has therefore been postulated to have become

more prevalent with agriculture in Egypt because of prolonged exposure to Nile

floods and the development of basin irrigation.

4.1.2. The Nagada I period onwards

The prevalence of each stress marker then decreases in the subsequent Mid

Predynastic-Protodynastic (with the decrease in porotic hyperostosis and LEH being

statistically significant), suggesting that there was a general improvement in health

around the middle of the Predynastic Period. A similar improvement in health was

found by Starling and Stock (2007), with LEH prevalence initially decreasing after the

Badarian

skeletal health in early egypt mphil thesis sarah musselwhite

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