cribra orbitalia

Healed cribra orbitalia (19th century young adult male).

“Porosities in the outer table of the cranial vault (porotic hyperostosis) and orbital roof (cribra orbitalia) are among the most frequent pathological lesions seen in ancient human skeletal collections. Since the 1950s, chronic iron-deficiency anemia has been widely accepted as the probable cause of both conditions. Based on this proposed etiology, bioarchaeologists use the prevalence of these conditions to infer living conditions conducive to dietary iron deficiency, iron malabsorption, and iron loss from both diarrheal disease and intestinal parasites in earlier human populations. This iron-deficiency-anemia hypothesis is inconsistent with recent hematological research that shows iron deficiency per se cannot sustain the massive red blood cell production that causes the marrow expansion responsible for these lesions…We argue that porotic hyperostosis and many cribra orbitalia lesions are a result of the megaloblastic anemia acquired by nursing infants through the synergistic effects of depleted maternal vitamin B12 reserves and unsanitary living conditions that are conducive to additional nutrient losses from gastrointestinal infections around the time of weaning (see Fig. 4). The lesions paleopathologists identify as cribra orbitalia can be attributed to a greater range of causes than porotic hyperostosis, and we argue here that subperiosteal bleeding associated with a codeficiency of vitamin C and B12 combine to explain the presence of the condition in Ancestral Puebloan populations" 

Walker, P. L. et al. (2009) The Causes of Porotic Hyperostosis and Cribra Orbitalia: A Reappraisal of the Iron-Deficiency-Anemia Hypothesis, American Journal of Physical Anthropology 139: 109-125