The Backbone of Europe: Health, Diet, Work and Violence over Two Millennia (Cambridge Studies in Biological and Evolutionary Anthropology, Series Number 80) 1108421954, 9781108421959, 9781108379830

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The Backbone of Europe Health, Diet, Work, and Violence over Two Millennia Using human skeletal remains, this volume traces health, workload, and violence in the European population over the past 2000 years. Health was surprisingly good for people who lived during the Early Medieval Period. The Plague of Justinian of the sixth century was ultimately beneficial for health because the smaller population had relatively more resources that contributed to better living conditions. Increasing population density and inequality in the following centuries imposed an unhealthy diet – poor in protein – on the European population. With the onset of the Little Ice Age in the Late Middle Ages, a further health decline ensued, which was not reversed until the nineteenth century. While some aspects of health declined, other attributes improved. During the Early Modern period, interpersonal violence (outside of warfare) declined, possibly because stronger states and institutions were able to enforce compromise and cooperation. European health over the past two millennia was hence multifaceted in nature. Richard H. Steckel is Distinguished University Professor Emeritus at the Ohio State University. He is a pioneer in blending human biology, anthropometrics, and measures from skeletal remains for insights into health and well-being. He has published over 120 articles, including two books with Cambridge University Press. Clark Spencer Larsen is Distinguished University Professor in the Department of Anthropology at the Ohio State University, and member of the National Academy of Sciences. His research focuses on the last 10 000 years of human evolution, with particular emphasis on the history of health and lifestyle. He is the author of Bioarchaeology: Interpreting Behavior from the Human Skeleton, second edition (Cambridge University Press, 2015). Charlotte A. Roberts is Professor of Archaeology at Durham University, UK. She has studied and interpreted human remains from archaeological sites for the past 30 years. She is specifically interested in exploring the interaction of people with their environments in the past through patterns of health and disease, taking a multidisciplinary and multi-method approach. She is the author of Human Remains in Archaeology: A Handbook (2018). Joerg Baten is Professor of Economic History at Eberhard Karls University in Tübingen, Germany, and Editor-in-Chief of Economics and Human Biology. His research focuses on the effects of nutrition, disease, and violence on human development. He has authored or co-edited seven books, including A History of the Global Economy, an easily comprehensible overview on economic history of all world regions in the last 500 years.

Published online by Cambridge University Press

Published online by Cambridge University Press

Cambridge Studies in Biological and Evolutionary Anthropology Consulting editors C. G. Nicholas Mascie-Taylor, University of Cambridge Robert A. Foley, University of Cambridge Series editors Agustín Fuentes, University of Notre Dame Nina G. Jablonski, Pennsylvania State University Clark Spencer Larsen, The Ohio State University Michael P. Muehlenbein, The University of Texas at San Antonio Dennis H. O’Rourke, The University of Utah Karen B. Strier, University of Wisconsin David P. Watts, Yale University Also available in the series 53. Technique and Application in Dental Anthropology Joel D. Irish and Greg C. Nelson (eds.) 978 0 521 87061 0 54. Western Diseases: An Evolutionary Perspective Tessa M. Pollard 978 0 521 61737 6 55. Spider Monkeys: The Biology, Behavior and Ecology of the Genus Ateles Christina J. Campbell 978 0 521 86750 4 56. Between Biology and Culture Holger Schutkowski (ed.) 978 0 521 85936 3 57. Primate Parasite Ecology: The Dynamics and Study of Host–Parasite Relationships Michael A. Huffman and Colin A. Chapman (eds.) 978 0 521 87246 1 58. The Evolutionary Biology of Human Body Fatness: Thrift and Control Jonathan C. K. Wells 978 0 521 88420 4 59. Reproduction and Adaptation: Topics in Human Reproductive Ecology C. G. Nicholas MascieTaylor and Lyliane Rosetta (eds.) 978 0 521 50963 3 60. Monkeys on the Edge: Ecology and Management of Long-Tailed Macaques and their Interface with Humans Michael D. Gumert, Agustín Fuentes and Lisa Jones-Engel (eds.) 978 0 521 76433 9 61. The Monkeys of Stormy Mountain: 60 Years of Primatological Research on the Japanese Macaques of Arashiyama Jean-Baptiste Leca, Michael A. Huffman and Paul L. Vasey (eds.) 978 0 521 76185 7 62. African Genesis: Perspectives on Hominin Evolution Sally C. Reynolds and Andrew Gallagher (eds.) 978 1 107 01995 9 63. Consanguinity in Context Alan H. Bittles 978 0 521 78186 2 64. Evolving Human Nutrition: Implications for Public Health Stanley Ulijaszek, Neil Mann and Sarah Elton (eds.) 978 0 521 86916 4 65. Evolutionary Biology and Conservation of Titis, Sakis and Uacaris Liza M. Veiga, Adrian A. Barnett, Stephen F. Ferrari and Marilyn A. Norconk (eds.) 978 0 521 88158 6 66. Anthropological Perspectives on Tooth Morphology: Genetics, Evolution, Variation G. Richard Scott and Joel D. Irish (eds.) 978 1 107 01145 8 67. Bioarchaeological and Forensic Perspectives on Violence: How Violent Death is Interpreted from Skeletal Remains Debra L. Martin and Cheryl P. Anderson (eds.) 978 1 107 04544 6

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68. The Foragers of Point Hope: The Biology and Archaeology of Humans on the Edge of the Alaskan Arctic Charles E. Hilton, Benjamin M. Auerbach and Libby W. Cowgill (eds.) 978 1 107 02250 8 69. Bioarchaeology: Interpreting Behavior from the Human Skeleton, 2nd Ed. Clark Spencer Larsen 978 0 521 83869 6 & 978 0 521 54748 2 70. Fossil Primates Susan Cachel 978 1 107 00530 3 71. Skeletal Biology of the Ancient Rapanui (Easter Islanders) Vincent H. Stefan and George W. Gill (eds.) 978 1 107 02366 6 72. Demography and Evolutionary Ecology of Hadza Hunter-Gatherers Nicholas Blurton Jones 978 1 107 06982 4 73. The Dwarf and Mouse Lemurs of Madagascar: Biology, Behavior and Conservation Biogeography of the Cheirogaleidae Shawn M. Lehman, Ute Radespiel and Elke Zimmermann (eds.) 978 1 107 07559 7 74. The Missing Lemur Link: An Ancestral Step in Human Evolution Ivan Norscia and Elisabetta Palagi 978 1 107 01608 8 75. Studies in Forensic Biohistory: Anthropological Perspectives Christopher M. Stojanowski and William N. Duncan 978 1 107 07354 8 76. Ethnoprimatology: A Practical Guide to Research at the Human–Nonhuman Primate Interface Kerry M. Dore, Erin P. Riley and Agustín Fuentes 978 1 107 10996 4 77. Building Bones: Bone Formation and Development in Anthropology Christopher J. Percival and Joan T. Richtsmeier 978 1 107 12278 9 78. Models of Obesity: From Ecology to Complexity in Science and Policy Stanley J. Ulijaszek 978 1 107 11751 8 79. The Anthropology of Modern Human Teeth: Dental Morphology and Its Variation in Recent and Fossil Homo Sapiens, 2nd Ed. G. Richard Scott, Christy G. Turner II, Grant C. Townsend and María Martinón-Torres 978 1 107 17441 2

Published online by Cambridge University Press

The Backbone of Europe Health, Diet, Work, and Violence over Two Millennia Edited by

RICHARD H. STECKEL Ohio State University

CLARK SPENCER LARSEN Ohio State University

CHARLOTTE A. ROBERTS University of Durham

JOERG BATEN Eberhard-Karls-Universität Tübingen, Germany

Published online by Cambridge University Press

University Printing House, Cambridge CB2 8BS, United Kingdom One Liberty Plaza, 20th Floor, New York, NY 10006, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia 314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre, New Delhi – 110025, India 79 Anson Road, #06–04/06, Singapore 079906 Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning, and research at the highest international levels of excellence. www.cambridge.org Information on this title: www.cambridge.org/9781108421959 DOI: 10.1017/9781108379830 © Cambridge University Press 2019 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2019 Printed in the United Kingdom by TJ International Ltd. Padstow Cornwall A catalogue record for this publication is available from the British Library. ISBN 978-1-108-42195-9 Hardback Additional tables and other resources for this publication at www.cambridge.org/9781108421959. Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Published online by Cambridge University Press

The Backbone of Europe Health, Diet, Work, and Violence over Two Millennia Using human skeletal remains, this volume traces health, workload, and violence in the European population over the past 2000 years. Health was surprisingly good for people who lived during the Early Medieval Period. The Plague of Justinian of the sixth century was ultimately beneficial for health because the smaller population had relatively more resources that contributed to better living conditions. Increasing population density and inequality in the following centuries imposed an unhealthy diet – poor in protein – on the European population. With the onset of the Little Ice Age in the Late Middle Ages, a further health decline ensued, which was not reversed until the nineteenth century. While some aspects of health declined, other attributes improved. During the Early Modern period, interpersonal violence (outside of warfare) declined, possibly because stronger states and institutions were able to enforce compromise and cooperation. European health over the past two millennia was hence multifaceted in nature. Richard H. Steckel is Distinguished University Professor Emeritus at the Ohio State University. He is a pioneer in blending human biology, anthropometrics, and measures from skeletal remains for insights into health and well-being. He has published over 120 articles, including two books with Cambridge University Press. Clark Spencer Larsen is Distinguished University Professor in the Department of Anthropology at the Ohio State University, and member of the National Academy of Sciences. His research focuses on the last 10 000 years of human evolution, with particular emphasis on the history of health and lifestyle. He is the author of Bioarchaeology: Interpreting Behavior from the Human Skeleton, second edition (Cambridge University Press, 2015). Charlotte A. Roberts is Professor of Archaeology at Durham University, UK. She has studied and interpreted human remains from archaeological sites for the past 30 years. She is specifically interested in exploring the interaction of people with their environments in the past through patterns of health and disease, taking a multidisciplinary and multi-method approach. She is the author of Human Remains in Archaeology: A Handbook (2018). Joerg Baten is Professor of Economic History at Eberhard Karls University in Tübingen, Germany, and Editor-in-Chief of Economics and Human Biology. His research focuses on the effects of nutrition, disease, and violence on human development. He has authored or co-edited seven books, including A History of the Global Economy, an easily comprehensible overview on economic history of all world regions in the last 500 years.

Published online by Cambridge University Press

Published online by Cambridge University Press

Cambridge Studies in Biological and Evolutionary Anthropology Consulting editors C. G. Nicholas Mascie-Taylor, University of Cambridge Robert A. Foley, University of Cambridge Series editors Agustín Fuentes, University of Notre Dame Nina G. Jablonski, Pennsylvania State University Clark Spencer Larsen, The Ohio State University Michael P. Muehlenbein, The University of Texas at San Antonio Dennis H. O’Rourke, The University of Utah Karen B. Strier, University of Wisconsin David P. Watts, Yale University Also available in the series 53. Technique and Application in Dental Anthropology Joel D. Irish and Greg C. Nelson (eds.) 978 0 521 87061 0 54. Western Diseases: An Evolutionary Perspective Tessa M. Pollard 978 0 521 61737 6 55. Spider Monkeys: The Biology, Behavior and Ecology of the Genus Ateles Christina J. Campbell 978 0 521 86750 4 56. Between Biology and Culture Holger Schutkowski (ed.) 978 0 521 85936 3 57. Primate Parasite Ecology: The Dynamics and Study of Host–Parasite Relationships Michael A. Huffman and Colin A. Chapman (eds.) 978 0 521 87246 1 58. The Evolutionary Biology of Human Body Fatness: Thrift and Control Jonathan C. K. Wells 978 0 521 88420 4 59. Reproduction and Adaptation: Topics in Human Reproductive Ecology C. G. Nicholas MascieTaylor and Lyliane Rosetta (eds.) 978 0 521 50963 3 60. Monkeys on the Edge: Ecology and Management of Long-Tailed Macaques and their Interface with Humans Michael D. Gumert, Agustín Fuentes and Lisa Jones-Engel (eds.) 978 0 521 76433 9 61. The Monkeys of Stormy Mountain: 60 Years of Primatological Research on the Japanese Macaques of Arashiyama Jean-Baptiste Leca, Michael A. Huffman and Paul L. Vasey (eds.) 978 0 521 76185 7 62. African Genesis: Perspectives on Hominin Evolution Sally C. Reynolds and Andrew Gallagher (eds.) 978 1 107 01995 9 63. Consanguinity in Context Alan H. Bittles 978 0 521 78186 2 64. Evolving Human Nutrition: Implications for Public Health Stanley Ulijaszek, Neil Mann and Sarah Elton (eds.) 978 0 521 86916 4 65. Evolutionary Biology and Conservation of Titis, Sakis and Uacaris Liza M. Veiga, Adrian A. Barnett, Stephen F. Ferrari and Marilyn A. Norconk (eds.) 978 0 521 88158 6 66. Anthropological Perspectives on Tooth Morphology: Genetics, Evolution, Variation G. Richard Scott and Joel D. Irish (eds.) 978 1 107 01145 8 67. Bioarchaeological and Forensic Perspectives on Violence: How Violent Death is Interpreted from Skeletal Remains Debra L. Martin and Cheryl P. Anderson (eds.) 978 1 107 04544 6

Published online by Cambridge University Press

68. The Foragers of Point Hope: The Biology and Archaeology of Humans on the Edge of the Alaskan Arctic Charles E. Hilton, Benjamin M. Auerbach and Libby W. Cowgill (eds.) 978 1 107 02250 8 69. Bioarchaeology: Interpreting Behavior from the Human Skeleton, 2nd Ed. Clark Spencer Larsen 978 0 521 83869 6 & 978 0 521 54748 2 70. Fossil Primates Susan Cachel 978 1 107 00530 3 71. Skeletal Biology of the Ancient Rapanui (Easter Islanders) Vincent H. Stefan and George W. Gill (eds.) 978 1 107 02366 6 72. Demography and Evolutionary Ecology of Hadza Hunter-Gatherers Nicholas Blurton Jones 978 1 107 06982 4 73. The Dwarf and Mouse Lemurs of Madagascar: Biology, Behavior and Conservation Biogeography of the Cheirogaleidae Shawn M. Lehman, Ute Radespiel and Elke Zimmermann (eds.) 978 1 107 07559 7 74. The Missing Lemur Link: An Ancestral Step in Human Evolution Ivan Norscia and Elisabetta Palagi 978 1 107 01608 8 75. Studies in Forensic Biohistory: Anthropological Perspectives Christopher M. Stojanowski and William N. Duncan 978 1 107 07354 8 76. Ethnoprimatology: A Practical Guide to Research at the Human–Nonhuman Primate Interface Kerry M. Dore, Erin P. Riley and Agustín Fuentes 978 1 107 10996 4 77. Building Bones: Bone Formation and Development in Anthropology Christopher J. Percival and Joan T. Richtsmeier 978 1 107 12278 9 78. Models of Obesity: From Ecology to Complexity in Science and Policy Stanley J. Ulijaszek 978 1 107 11751 8 79. The Anthropology of Modern Human Teeth: Dental Morphology and Its Variation in Recent and Fossil Homo Sapiens, 2nd Ed. G. Richard Scott, Christy G. Turner II, Grant C. Townsend and María Martinón-Torres 978 1 107 17441 2

Published online by Cambridge University Press

The Backbone of Europe Health, Diet, Work, and Violence over Two Millennia Edited by

RICHARD H. STECKEL Ohio State University

CLARK SPENCER LARSEN Ohio State University

CHARLOTTE A. ROBERTS University of Durham

JOERG BATEN Eberhard-Karls-Universität Tübingen, Germany

Published online by Cambridge University Press

University Printing House, Cambridge CB2 8BS, United Kingdom One Liberty Plaza, 20th Floor, New York, NY 10006, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia 314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre, New Delhi – 110025, India 79 Anson Road, #06–04/06, Singapore 079906 Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning, and research at the highest international levels of excellence. www.cambridge.org Information on this title: www.cambridge.org/9781108421959 DOI: 10.1017/9781108379830 © Cambridge University Press 2019 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2019 Printed in the United Kingdom by TJ International Ltd. Padstow Cornwall A catalogue record for this publication is available from the British Library. ISBN 978-1-108-42195-9 Hardback Additional tables and other resources for this publication at www.cambridge.org/9781108421959. Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Published online by Cambridge University Press

Dedicated to Phillip L. Walker, whose memory still inspires us

Published online by Cambridge University Press

Published online by Cambridge University Press

Contents

List of Contributors Foreword Jerome C. Rose Preface

1.

The European History of Health Project: Introduction to Goals, Materials, and Methods

page xi xiii xv

1

Richard H. Steckel, Clark Spencer Larsen, Charlotte A. Roberts, and Joerg Baten

2.

Contextual Dimensions of Health and Lifestyle: Isotopes, Diet, Migration, and the Archaeological and Historical Records

11

Rimantas Jankauskas and Gisela Grupe

3.

Measuring Community Health Using Skeletal Remains: A Health Index for Europe

52

Richard H. Steckel and Anna Kjellström

4.

The History of European Oral Health: Evidence from Dental Caries and Antemortem Tooth Loss

84

Ursula Wittwer-Backofen and Felix Engel

5.

Proliferative Periosteal Reactions: Assessment of Trends in Europe Over the Past Two Millennia

137

Carina Marques, Vitor Matos, and Nicholas J. Meinzer

6.

Growth Disruption in Children: Linear Enamel Hypoplasias

175

Zsolt Bereczki, Maria Teschler-Nicola, Antonia Marcsik, Nicholas J. Meinzer, and Joerg Baten

7.

History of Anemia and Related Nutritional Deficiencies: Evidence from Cranial Porosities

198

Anastasia Papathanasiou, Nicholas J. Meinzer, Kimberly D. Williams, and Clark Spencer Larsen

8.

Agricultural Specialization, Urbanization, Workload, and Stature Nicholas J. Meinzer, Richard H. Steckel, and Joerg Baten

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231

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Contents

9.

History of Degenerative Joint Disease in People Across Europe: Bioarchaeological Inferences about Lifestyle and Activity from Osteoarthritis and Vertebral Osteophytosis

253

Kimberly D. Williams, Nicholas J. Meinzer, and Clark Spencer Larsen

10.

The History of Violence in Europe: Evidence from Cranial and Postcranial Bone Trauma

300

Joerg Baten and Richard H. Steckel

11.

The Developmental Origins of Health and Disease: Early Life Health Conditions and Adult Age at Death in Europe

325

Charlotte A. Roberts and Richard H. Steckel

12.

Climate and Health: Europe from the Pre-Middle Ages to the Nineteenth Century

352

Richard H. Steckel and Felix Engel

13.

Multidimensional Patterns of European Health, Work, and Violence over the Past Two Millennia

381

Joerg Baten, Richard H. Steckel, Clark Spencer Larsen, and Charlotte A. Roberts

14.

Data Collection Codebook

397

Richard H. Steckel, Clark Spencer Larsen, Paul W. Sciulli, and Phillip L. Walker

15.

Database Creation, Management, and Analysis

428

Charlotte A. Roberts, Richard H. Steckel, and Clark Spencer Larsen Index

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449

Contributors

Joerg Baten Department of Economics, University of Tübingen, Tübingen, Germany Zsolt Bereczki Department of Biological Anthropology, Institute of Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary Felix Engel Biological Anthropology, Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg (Breisgau), Germany Gisela Grupe Anthropologie und Umweltgeschichte, Biozentrum der Ludwig-MaximiliansUniversität, Grosshadener, Martinsried, Munich, Germany Rimantas Jankauskas Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, Čiurlionio, Vilnius, Lithuania Anna Kjellström Institutionen för arkeologi och antikens kultur, Stockholm University, Stockholm, Sweden Clark Spencer Larsen Department of Anthropology, The Ohio State University, Columbus, OH, USA Antonia Marcsik Department of Biological Anthropology, Institute of Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary Carina Marques Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Portugal; Anthropology Department, William Paterson University, Wayne, NJ, USA Vitor Matos Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Coimbra, Portugal Nicholas J. Meinzer Department of Economics, University of Tübingen, Tübingen, Germany Anastasia Papathanasiou Ephorate of Paleoanthropology and Speleology, Greek Ministry of Culture, Athens, Greece

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List of Contributors

Charlotte A. Roberts Department of Archaeology, Durham University, Durham, UK Paul W. Sciulli Department of Anthropology, The Ohio State University, Columbus, OH, USA Richard H. Steckel Department of Economics, The Ohio State University and NBER, The Ohio State University, Columbus, OH, USA Maria Teschler-Nicola Naturhistorisches Museum, Wien, Austria Phillip L. Walker Formerly of Department of Anthropology, University of California at Santa Barbara, Santa Barbara, CA, USA Kimberly D. Williams Department of Anthropology, Temple University, Philadelphia, PA, USA Ursula Wittwer-Backofen Department of Biological Anthropology, Albert-Ludwigs-Universität Freiburg, Freiburg (Breisgau), Germany

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Foreword

I am honored and pleased to write this foreword and contribute in this very small way to the production of this remarkable book. The Backbone of Europe will be acclaimed for use of archaeologically excavated skeletons (bioarchaeology) to interpret the health consequences of historic economic and social change. Within these pages the reader will find that 17 principal investigators and 75 bioarchaeologists used skeletal data from 15119 individuals from 103 localities in 16 modern European countries to evaluate the relationships of health, nutrition, physical activity, and violence to the social and economic changes in the ways people lived between the third and nineteenth centuries. This is the largest set of human remains ever employed in a single research project. I like to think that this major accomplishment began as a conversation between Rick Steckel and myself over a cup of coffee at the 1988 annual meeting of the Economic History Association (Detroit, Michigan). As with human history itself, The Backbone of Europe is the outcome of many random intersecting lines of individuals and their research over many years. My journey in what I like to call macrobioarchaeology (interpreting large numbers of skeletons spread over large areas of time and space) began with an invitation to a conference on Paleopathology and the Origins of Agriculture, organized by Mark Cohen and George Armelagos in 1982 and published in 1984. Here I met many new bioarchaeology colleagues, including Clark Larsen, and learned how to collaborate on a large project involving many participants focused upon a single problem – the health consequences of adopting agriculture as a way of life. My involvement in this project and its influence on my research resulted in my invitation to participate in a conference far outside my normal field of interest and to meet Rick, accepting his invitation to have coffee. Our discussion was wide-ranging, from the reasons that the economic historians had savaged my presentation to Rick’s idea of a “health index” derived from concepts similar to GNP. We concluded the discussion with the idea that we could improve upon the research design of Paleopathology at the Origins of Agriculture. The excitement generated by this conversation led to my taking a sabbatical from the Anthropology Department of the University of Arkansas to spend a semester in the Economics Department of The Ohio State University working with Rick on these ideas. During our time together we concocted the rough outline of our project that led to the publication of The Backbone of History: Health and Nutrition in the Western Hemisphere (Steckel and Rose, 2002). Another accidental intersection was my introduction of Paul Sciulli from the Anthropology Department at Ohio State to Rick because they were both interested in human stature. Paul became a major factor in the development of the “health index.” After numerous planning and organizational meetings we were able to put together a team of 52 researchers who examined and interpreted the changes in

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Foreword

health and nutrition over more than 4000 years in the Western Hemisphere. We attempted to solve the methodological weaknesses of the “Origins of Agriculture” project by having all participants recode their existing data into a common format that permitted comparison of the diverse cultures, times, and localities using the “health index.” Despite wide acclaim for this book and the contributions that it made to our understanding of culture change and health, it still had weaknesses. In particular, there were significant amounts of missing data from many skeletal series because much of the previously collected information could not be transformed into the common coding format. This resulted in gaps and difficulties calculating the “health index.” Rick was not to be deterred; he was adamant that the “health index” would work and he and his colleagues put together an expanded team of researchers to realize this goal. The Backbone of Europe project and its principal investigators went on to solve these weaknesses. The data were collected directly from the skeletons using a standardized code book and entered directly into dedicated laptops which uploaded the data daily to The Ohio State University computers. The analytical results and interpretations presented in the 15 chapters of this book are truly revolutionary. Never before has such a large collection of skeletons been analyzed in a common format and compared to standardized ecological and cultural variables. This project represents a major leap forward in using skeletons to better understand our past. In my mind it is the creative conclusion to the research agenda begun by Cohen and Armelagos (1984). I am sure that readers will find this book as absorbing as I have. The detailed interpretation of health, nutrition, physical activity, and violence within their contexts of changing cultures, settlement patterns, economics, and climate are fascinating. Many of the conclusions will replace the traditional historical interpretations of health and nutrition during these two millennia. The conclusions reached by the authors of the various chapters will surprise and delight everyone interested in the history of Europe. This book is a truly spectacular outcome of a cup-of-coffee conversation between two people who had never met before. It is also a major accomplishment for bioarchaeology achieved by the incidental intersection of many individuals and their research agendas. My congratulations to the editors and their extraordinary team of researchers and authors. Jerome C. Rose University Professor, University of Arkansas

References Cohen, M. N.; Armelagos, G. J. (eds.) (1984). Paleopathology at the Origins of Agriculture. Orlando: Academic Press. Steckel, R. H.; Rose, J. C. (eds.) (2002). The Backbone of History: Health and Nutrition in the Western Hemisphere. Cambridge: Cambridge University Press.

https://doi.org/10.1017/9781108379830.001 Published online by Cambridge University Press

Preface This volume represents the results of the second study of health within the “Global History of Health Project,” after the 2002 volume, The Backbone of History: Health and Nutrition in the Western Hemisphere, edited by R. H. Steckel and J. C. Rose. With funding from the National Science Foundation (BCS-0117958) and The Ohio State University, initial efforts began with a conference organized by Richard Steckel, Clark Larsen, and Phillip Walker at The Ohio State University in June 2001. Apart from this volume’s editors, 34 senior researchers attended the conference, including 22 bioarchaeologists (19 from Europe and three from the USA), and 12 from the USA in other fields, including economics, history, and climate history. The project coalesced at six formal project meetings in Europe, at informal gatherings at most of the subsequent American Association of Physical Anthropology meetings, and at several of the European Paleopathology Association meetings. Through grants in 2002 and again in 2005 the National Science Foundation funded our ambitious project applications to carry out the work (NSF SES-0138129 and NSF BCS-0527658; Richard Steckel principal investigator, and Clark Larsen and Phillip Walker co-investigators). A grant from the German Science Foundation to Joerg Baten funded the concluding conference at the University of Tübingen in October 2016, at which time preliminary versions of the final chapters in this volume were presented for discussion, and where we organized final editing of the project database (SFB 1070, BA 1503–1611). Each chapter in this volume was reviewed by all the editors. Upon publication of the book by Cambridge University Press, the database will be released to the public through the Inter-University Consortium for Political and Social Research (ICPSR) at the University of Michigan. Apart from the editors, and the late Phillip Walker until his death in 2009, senior researchers who made important contributions to the design and conduct of the project include Benoit Bertrand (University Lille 2), Zsolt Bereczki (University of Szeged), Joël Blondiaux (Centre d’Etudes Paléopathologiques du Nord), the now late Ebba During (Stockholm University), Rimantas Jankauskas (Vilnius University), George Maat (Leiden University), Ana Carina Marques (Universidade de Coimbra), Antonia Marcsik (University of Szeged), Anastasia Papathanasiou (Greek Ministry of Culture, Athens), Inna Potekhina (National Academy of Sciences of Ukraine), Maria Teschler-Nicola (Natural History Museum, Vienna), and Ursula Wittwer-Backofen (Albert-Ludwig University of Freiburg). For important advice on the classification of trauma we thank Megan Brickley (McMaster University). Kimberly Williams (Temple University) and Nicholas Meinzer (University of Tübingen) undertook the arduous task of cleaning the database and, in collaboration with the lead authors, tailoring the data analyses to the needs of each chapter. Leslie Williams, Tracy Betsinger, Joshua Sadvari, Julia Musial, Stefan Preuss, Susanne Voegele, and, in particular, Katrin Rohland (University of Tübingen) provided exceptional research assistance

https://doi.org/10.1017/9781108379830.002 Published online by Cambridge University Press

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Preface

during many different phases of this project, and Jill Bryant was an able project administrator. Several dozen individuals, mainly graduate students, were essential to the project as data coders. They and the institutions and museum curators who facilitated data collection are also acknowledged in Chapter 15. We offer our thanks to faculty at The Ohio State University for their advice, support, and involvement in the growing understanding of environmental conditions that influenced the health of the populations we studied. Special acknowledgment goes to John Brooke, who advised us throughout the analytical portion of the project. Professor Carolyn Merry was very helpful with GIS issues, and Ellen MosleyThompson and Lonnie Thompson were important advisers on climate. Several conference presentations helped sharpen ideas and refine the analysis, including meetings at the National Bureau of Economic Research, the Economic History Association, the Social Science History Association, and the American Association of Physical Anthropologists. Seminars at numerous universities were also helpful in developing thoughts presented in the book, including those at Harvard University, University of Michigan, University of Kansas, University of Arkansas, University of Illinois, Indiana University, the Stanford-Berkeley Economic History workshop, The Ohio State University, University of Colorado, University of Toledo, and the University of Tübingen.

Additional tables and other resources for this publication are available at http://www.cambridge.org/ 9781108421959.

https://doi.org/10.1017/9781108379830.002 Published online by Cambridge University Press

1

The European History of Health Project Introduction to Goals, Materials, and Methods Richard H. Steckel, Clark Spencer Larsen, Charlotte A. Roberts, and Joerg Baten

1.1

Introduction This introductory chapter describes a large collaborative effort by European and American researchers who used the same protocol to record health indicators from the skeletal remains of 15119 individuals that were buried at 103 localities across the continent of Europe (representing 16 modern European countries) dated from the third to the end of the nineteenth century. The effort extends an earlier but smaller project for the Western Hemisphere (Steckel and Rose, 2002) by collecting data on more skeletal indicators of health, by adding a substantial number of contextual variables to aid interpretation, by recording the percentage of bone present on many skeletal elements, and by incorporating bio- and geochemical analyses. Project leaders developed computer-based software that used images to illustrate coding protocols, and created a series of tests to measure inter-observer error. Project members systematically analyzed the data to provide customized results to individual researchers for interpretation. Regular meetings in Europe and the USA helped to manage the logistics and organization needed to refine the skeletal data collection codebook, train data coders in the software, and select skeletal collections housed in European institutions for study.

1.2

Background The study of past human health and living conditions has long been a central area of interest for physical anthropologists and other natural and social scientists (Aufderheide et al., 1998; Cohen and Crane-Kramer, 2007; Grauer, 2012; Larsen, 2015; Ortner, 2003; Pinhasi and Mays, 2008; Roberts and Manchester, 2005). This project is the first large-scale attempt to track and interpret the history of human health in Europe. Our work stems from a smaller, more focused effort on the Western Hemisphere that originated in 1988, when Richard Steckel and Jerome Rose began to coordinate physical anthropologists, economists, and historians in a retrospective study of health centering on the quincentennial of 1492 CE. Building upon ideas in Paleopathology at the Origins of Agriculture (Cohen and Armelagos, 1984), they organized planning conferences held at The Ohio State University, which designed ways to pool skeletal data on the following health indicators: stature (from long bone lengths); oral health; osteoarthritis; cribra orbitalia and porotic hyperostosis; linear enamel hypoplasias; trauma; and skeletal infections (periosteal reactions).

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They envisioned using these data to document major health and lifestyle changes. Eventually, they and numerous collaborators assembled a combined database of 12 520 individuals who had been buried at 65 localities in the Western Hemisphere dating from approximately 5000 BCE to the early twentieth century. The research effort was published as The Backbone of History: Health and Nutrition in the Western Hemisphere (Steckel and Rose, 2002).

1.3

Aims and Objectives The frequency and severity of skeletal lesions in the Western Hemisphere database were correlated with a variety of environmental variables such as settlement size, elevation, topography, and subsistence patterns, reflecting a strong relationship between ecology and the human population studied, as seen in living populations (McElroy and Townsend, 2009). The responsiveness or sensitivity of health to the environment in these data suggested there would be great potential for understanding the long-term evolution of human health by gathering and analyzing skeletal and environmental data from other areas of the world – in this case, Europe. The European project substantially exceeds the Western Hemisphere project in size, scope, and complexity, and thus represents the largest research-based dataset ever amassed and analyzed in bioarchaeology. By creating several large databases, investigators and collaborators have been able to consider the history of human health from the late Roman period (the third century CE) to the late nineteenth century by pooling skeletal data from numerous skeletons. The aims of the project are to assess the extent to which human health and welfare were transformed by the diminished political and economic organization following the fall of Rome; climate change (especially the Medieval Warm Period and the ensuing Little Ice Age); population growth; the rise of Medieval cities that were later replaced by more complex forms of socioeconomic and political organization; and European colonization and industrialization. With a trans-Atlantic network of collaborators, the project undertakes a large-scale comparative study of the causes and health consequences of these and other dramatic changes impacting the lives of European ancestors. As noted above, this project extends work performed earlier on the Western Hemisphere. It collects data on the same seven variables given above and, in addition, the osteological record of specific infectious and metabolic diseases (tuberculosis, leprosy, treponemal disease, rickets, and scurvy). However, because of lack of data, ultimately infectious and metabolic disease data are not analyzed in this volume. It also expounds upon the original seven variables by scoring more joints for evidence of osteoarthritis, defining additional degrees of severity for most variables, explicitly defining and coding for the standard suite of sex and age estimation techniques, expanding the types and locations of various traumatic lesions, and, importantly, developing a codebook with visual references to accomplish standardized coding (Steckel et al., 2006). Many researchers have advocated standard data recording of skeletal remains, thus allowing datasets to be compared

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Figure 1.1 Location map of sites in the database.

(Brickley and McKinley, 2004; Buikstra and Ubelaker, 1994; Roberts and Cox, 2003). This project followed these overall recommendations. The geographic distribution of skeletal remains analyzed in the project is given in Figure 1.1, which shows the localities of sites represented in the skeletal sample from each country. One can see that Germany, Lithuania, and the UK lead the way in data collection, with strong representation from Austria, France, Hungary, the Netherlands, Poland, and Switzerland. Other significant contributors include Greece, Latvia, Portugal, Romania, Sweden, and Ukraine. Senior investigators and their students in these countries were particularly active in the project.

1.4

Project Organization Even before The Backbone of History was published, Richard Steckel, Clark Larsen, and Phillip Walker were gathering ideas for a new initiative. With funding from The Ohio State University and the National Science Foundation (BCS-0117958) to undertake a feasibility study, they organized a planning meeting at The Ohio State University in June 2001 to consider potential skeletal remains available for coding, discuss coding procedures, and to deliberate over administrative matters. A large number of senior researchers from European institutions attended this planning meeting. The European physical anthropologists reported personal access to over 130 000 skeletons at museums where they worked or conducted research.

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Participants discussed and debated many issues, but in general they agreed to: (1) complete a database of skeletal collections to which they had access for study; (2) prepare a codebook that would be used to gather data from skeletal remains for the project; (3) collect contextual information about the sites where skeletal remains would be analyzed; (4) share data, although there were some qualifications or concerns expressed by a few people; and (5) prepare a grant application to the National Science Foundation to fund the larger project. In 2002 and again in 2005 the National Science Foundation funded our ambitious project applications to carry out the work (NSF SES-0138129 and NSF BCS-0527658; Richard Steckel principal investigator, and Clark Larsen and Phillip Walker coinvestigators), which involved several steps, beginning with the writing of the codebook for data collection. General agreement on the variables to collect data on solidified within a year or so, but additional details over precise definitions, and the development and collection of diagrams and photographs to illustrate disease and other data categories, took longer and extended into organizational meetings in Buffalo, New York, USA (2002); Coimbra, Portugal (2002); Leiden, the Netherlands (2003); Albuquerque, New Mexico, USA (2003); and Durham, UK (2004).

1.5

The Codebook and Software Next came efforts to develop laptop-based software that would facilitate the data collection. The Center for Human Resource Research at The Ohio State University was an essential resource in this endeavor. The Center for Human Resource Research is widely respected for designing software to interview people for the National Longitudinal Survey in the USA, a large project in the social sciences that records a wide variety of information on repeated samples of households (www.bls.gov/nls). With some modifications we were able to “piggy-back” on their survey instruments and software, which allowed coders to “interview” the skeletal remains by completing a series of queries, beginning with the sex and age-at-death category of each individual, and an inventory of bones that potentially had diagnostic information. Thereafter, the software routed the investigator through a series of questions based on the skeletal elements available for study. At various suitable points the software screened answers for plausibility, for example by disallowing age-at-death entries for subadults that were outside the plausible age range. At any point in the process, the investigator could add comments to explain unusual situations or to describe complexities unanticipated by the codebook. The principal and co-investigators prepared a set of instructions to guide users through the software and the use of the laptop. These included directions in using the online system to upload the completed “cases,” or individual data files, to the central server at Ohio State University, where they were cleaned and stored. Although the codebook was heavily illustrated and the data collection interface displayed all the drawings and photographs needed to make categorical decisions on coding, we carefully considered the possibility of inter-observer error. Data coders were trained in various laboratories across Europe where scoring systems for some of

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the variables being coded varied. To address the problem, the team designed an interobserver error quiz that was made available online. Subsequently, Donald Ortner gave us permission to access his extensive collection of over 4000 photographs of a wide range of pathological conditions (Smithsonian Institution, Washington, DC), thus providing key examples from which to assess individual skeletons. We selected approximately 75 images to illustrate various conditions relevant to the project. Next, a committee of senior researchers, including Donald Ortner, collaborated to build consensus on how to grade each condition according to the standards of the codebook and with respect to established paleopathological protocols (Ortner, 2003). Finally, “quiz takers” were asked to score pathological conditions categorized on an ordinal scale represented in the photographs. Tracy Betsinger and Richard Steckel presented results of the quiz at the European Paleopathology Association meetings in Santorini, Greece (Steckel and Betsinger, 2006). Our studies of inter-observer error by project collaborators were highly promising using photographs of lesions for various variables. On average, the scoring was identical 72 percent of the time, and virtually all departures fell into an adjacent category for categorical variables. One could not reject the hypothesis that the distribution of differences (for interior cases, such that higher or lower scores were possible) was symmetrical around the average, and we concluded that there was no systematic bias in scoring. We organized annual project meetings in Europe to test the software; train data coders; discuss skeletal collections for coding; consider ecological or contextual variables; prepare site reports; discuss the purpose and organization of subcommittees; determine the logistics of chemical analyses; discuss progress in coding skeletal collections; make authorship arrangements; establish payment and accounting procedures; discuss the structure of data analyses and publication plans; and present preliminary results. The first of these meetings took place in Rome, Italy (January 2006), hosted by Alfredo Coppa, followed by Athens, Greece (2007; Anastasia Papathanasiou and Sotiris Manolis, hosts), Munich, Germany (2008; Gisela Grupe and George McGlynn, hosts), and Douai, France (2009; Benoit Bertrand and Pierre Demolon, hosts). Less formal but very productive gatherings also took place at the European Paleopathology Association meetings in Durham, UK (2004), Santorini, Greece (2006), Copenhagen, Denmark (2008), and Vienna, Austria (2010), as well as at the annual American Association of Physical Anthropologists meetings in Buffalo, New York (2002), Tempe, Arizona (2003), Tampa, Florida (2004), Milwaukee, Wisconsin (2005), Philadelphia, Pennsylvania (2007), Columbus, Ohio (2008), Chicago, Illinois (2009), Albuquerque, New Mexico (2010), and Minneapolis, Minnesota (2011). Finally, in 2016, a penultimate meeting was held in Tübingen, Germany (Joerg Baten, host), organized to review the resulting chapters (for which we acknowledge support by the German Science Foundation, DFG, grant SFB 1070 and BA-1503–1611).

1.6

Study Sample The first two project meetings in Rome and Athens devoted considerable time to the selection of skeletal collections for study, a process that is described in Chapter 15.

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Our goal was to create a database that contained skeletal and related contextual data that reflected the geographic, ecological, and temporal diversity of the European continent over a significant period of time, tracing the intensification of agriculture, and culminating with the later stages of industrialization. We were also cognizant of building a representative sample with regard to population demography, and obtaining sample sizes that would provide the statistical power to understand how population health changed over time in relation to selected contextual variables. The initial strength of our collaborators’ resources was clearly the access to large numbers of skeletal remains from a number of different sites representing the Middle Ages (roughly 500 CE to 1450 CE). We began coding these collections and then proceeded to identify and code earlier and later skeletal series, limited only by time and available budget. The database contains evidence from archaeological skeletal collections ranging from the Pre-Medieval period (300–500 CE) through the end of the Industrial/Modern period (c.1900 CE). The date ranges for which cemeteries were used for burials varied enormously across sites. A few, such as skeletal series derived from battlefield sites, were marked precisely in time, whereas other skeletal series represent accumulations of skeletal remains spanning several centuries or more. The latter sites are difficult to link with ecological variables that changed with time, such as temperature or climate, but in many cases they are seen to correlate with subsistence strategy, elevation, topography (if used by a population who lived in the same location over time), and other aspects of socioeconomic status.

1.6.1

Characteristics of the Database Although the total database contains 15 119 individuals, numerous skeletons have incomplete information across the variables observed. Therefore, sample sizes vary across presented tables and across chapters in this volume according to the information available. Similarly, limited ecological information at some sites restricted the types of analyses that could be conducted. Demographic features of the sample are described by the percentage of individuals distributed by sex and age at death (Table 1.1) and by time period and sex (Table 1.2). Elsewhere, these variables are further explored for only male and female adults (defined as 18+ years, or with complete epiphyseal fusion of all but the sternal end of the clavicle and iliac crest). One can see that the age distribution of deaths mainly followed a U-shape, with most deaths occurring under age ten. As is characteristic of many archaeological skeletal assemblages, the lowest share of deaths occurred in the age category of 10–19 years and rose steadily thereafter until age 50. Beyond that the frequencies decline, but this picture is clouded by ambiguities in estimating age at death, an issue well known to physical anthropologists (e.g., Chamberlain, 2006; Molleson and Cox, 1993). Of course, one cannot infer life tables from age distributions of death, which can be affected by migration and fertility and the selective nature of the archaeological record itself, but this age distribution is at least broadly consistent with what one would expect from plausible model life tables (Coale et al., 1983) thought to apply to pre-modern populations. Adult men and women have a

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Table 1.1 Distribution of the database by sex and age at death Age

Male

Female

Unknown

Total

Percent

0