Variation in Porotic Hyperostosis in the Royal Cemetery Complex at Abydos, Upper Egypt: A Social Interpretation
Keita, S. O. Y., Boyce, A. J., Antiquity
This paper presents the results of a palaeopathological study of skeletal remains from the high status cemetery of Abydos in Upper Egypt associated with the rulers of the First Dynasty (Petrie 1900). The crania from two groups of spatially-distinct subsidiary burials were examined, associated with the First Dynasty kings Djer and Diet (Uadji), the second and third, or third and fourth kings of the dynasty, depending on who is regarded as the first ruler: Narmer or Aha (Wilkinson 1999). These burials are thought to have taken place near the time of the kings' interments. The investigation focused on porous defects, broadly called porotic hyperostosis, which were observed in the crania of the buried individuals, and the variations in this lesion were used to explore possible social differences. There is a relationship between social status and health that is readily appreciated, since the former determines access to nutrients, the overall environmental quality, and the ability to provide and receive medical care (Crooks 1995).
The sample population
All the rulers of Dynasty I (Kemp 1966, 1967) as well as predynastic kings and elites were interred at Abydos, a holy place perhaps regarded as an ancestral home, as opposed to the capital at Memphis, in northern Egypt (Spencer 1993; Wilkinson 1999). The main part of the cemetery, called the Umm El Qaab, contains the actual tombs of the rulers, although none of their physical remains have survived. In the same place, however, are subsidiary burials, frequently marked by stelae, which are regarded as those of court functionaries and members of the rulers' personal entourage (Petrie 1900; Emery 1961; Kemp 1966; Trigger 1983; Spencer 1993). The idea that they were simply servants or slaves has been contested (Thomson & Randall-MacIver 1905, Petrie 1925, Bestock 2002). Approximately one mile away in north Abydos are another set of subsidiary burials arranged roughly in squares (Petrie 1925) which outline the remains of structures variously called 'funerary palaces' or funerary enclosures (Kemp 1967; O'Connor 1989). These graves can be identified with the reigns of particular rulers by associated artefacts (Petrie 1925). The associated grave occupants were apparently a mixture of artisans and lower court officials such as a 'seal bearer'. Examples taken from skeletal material of both these groups of burials formed the subject of this investigation.
'Porotic hyperostosis' is generally used to describe defects in the outer table of the cranial vault of the skull, associated with a widened diploic space, and has varying degrees of severity (Angel 1964; Ortner & Putschar 1981; Goodman et al. 1984; Larsen 1997). The standard depictions of porotic hyperostosis show gross large bilateral vault porous defects sometimes associated with new bone formation in notably thickened parietal bones, and usually in children, but this is only the most severe manifestation. Lesions in the orbital roof(s) are usually called cribra orbitalia. The classic defects, whether in vaults or orbits, are hypothesised to be caused by a compensatory expansion of the bone marrow with resultant pressure induced alterations in the outer skull bones (Larsen 1997). Other bones can be affected. The expansion of bone marrow reflects the increased production of red blood cells in response to physiological states that have caused either decreased longevity of red blood cells and/or altered iron metabolism and deficiency. Clear examples of such states are thalassemia major and sickle cell anaemia where clinical data support the correlation of bony pathology with anaemia. The marrow response helps to counter the effects of anaemia. Sickle cell anaemia has been firmly diagnosed by bio-molecular means in predynastic sub-adult Egyptians whose remains exhibited skeletal changes known to be associated with haemolytic anaemias (Marin et al. 1999; Cerutti pers. …