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In the journal Childhood in the Past, Ph.D. candidate Duru YaÄŸmur BaÅŸaran the results of an analysis of an over 900-year-old skeleton of a child. The study revealed that a 2.5 to 3.5-year-old child had suffered from a rare disease seldom seen in archaeology.

Excavated from the archaeological site of Aphrodisias, located in southwestern Türkiye, the remains were recovered in 1985 from the site of Tetrapylon Cemetery, dated to around the 10th–12th century, placing it firmly in the Middle Byzantine period.

The grave, labeled "Tomb 73A" (S-TET-II-85 Tomb 73A), contained the remains of two non-adults, including children 73A and B. Skeleton 73A exhibited unusual skeletal deformations, including thickening and swelling of various bone elements, including parts of the child's jaw, shoulder blade, and shafts of the left arm bones. The left ulna (lower arm bone) in particular had swollen to nearly double its usual size.

Analysis of the remains revealed the child to be around 3 years old, although there was a discrepancy between the estimated age based on the long bones (1.5–2 years) and the teeth (2.5–3.5 years).

In order to determine what disease could have caused these deformities, several diseases and their characteristics were compared to the skeletal remains of the Aphrodisias child. These illnesses included hemolytic anemias, scurvy, rickets, tuberculosis, child abuse, and infantile cortical hyperostosis (ICH).

However, many of these diseases did not quite match the deformities observed on the bones of the child.

Of the list of diseases, the Aphrodisias child showed the greatest resemblance to ICH, also known as Caffey disease. This rare disease usually develops in early infancy and affects various skeletal elements and surrounding connective tissues. It typically develops around 5 months of age, though it can present itself as early as birth and even in utero. Interestingly, the disease normally also resolves itself around age three, though it may recur in rare cases.

Interestingly, the Aphrodisias child showed early signs of recovery just before its death.

The disease is characterized by asymmetrical thickening of bone caused by the inflammation of the periosteum (the membrane covering bones), which leads to new bone layers being deposited. The disease most commonly affects the jaw, forearm (ulna), shin bone, collar bone, shoulder blade, and ribs.

It is possible that this disease may have contributed to the discrepancy between the age estimate in the bones and teeth, as bones are more susceptible to environmental stressors such as malnutrition. Such factors are likely to occur, especially in ICH, as it affects the jaw, making it difficult to feed children suffering from the disease.

The Aphrodisias child is one of only a handful of known archaeological ICH cases. In fact, the disease, including its cause and the reasons for resolving itself, remains difficult to diagnose even in modern clinical settings. However, some known symptoms include fever, irritability, thickening of the bones, and swelling of the overlying soft tissue.

The disease seems to develop sporadically and disappear spontaneously, although some familial cases have been reported, indicating there may be some hereditary factor.

According to Ph.D. candidate BaÅŸaran, it is unclear if the child died from ICH, "Unfortunately, the cause of death cannot be determined in most cases where we only have skeletonized remains. It is possible that the individual passed away from ICH, complications that arose from ICH, or a completely unrelated matter."

The case contributes to our understanding of non-adult health in Middle Byzantine Aphrodisias. Additionally, the addition of this case to the record of known ICH cases in archaeology contributes to developing a more refined and reliable method of diagnosing the disease in historic and prehistoric contexts.

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