Rare disease possibly identified in skeletal remains of 12th-century child

In the magazine Childhood in the pastPh.D. Candidate Duru Yağmur Başaran published the results of an analysis of the skeleton of a child more than 900 years old. The study found that a child aged 2.5 to 3.5 years suffered from a rare disease rarely seen in archaeology.

Excavated at the archaeological site of Aphrodisias, located in southwest Turkey, the remains were recovered in 1985 from the Tetrapylon cemetery site, dated to around the 10th to 12th centuries, 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 deformities, including thickening and swelling of various bony elements, including portions of the jaw, shoulder blade, and shaft of the child’s left arm bones. The left ulna (forearm bone), in particular, had swollen to almost double its usual size.

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

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

However, many of these diseases did not quite match the deformities seen in the child’s bones.

Among the list of diseases, Child Aphrodisias bore the greatest resemblance to ICH, also known as Caffey’s disease. This rare disease usually develops in early childhood and affects various elements of the skeleton and surrounding connective tissues. It usually develops around 5 months of age, although it can appear from birth and even in utero. Interestingly, the condition usually resolves on its own by around age three, although it can recur in rare cases.

Interestingly, Aphrodisias’ child showed the first signs of recovery just before her death.

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

It is possible that this disease contributed to the discrepancy between bone and tooth age estimates because bones are more sensitive to environmental stressors such as malnutrition. Such factors are likely to occur, especially in the case of ICH, as it affects the jaw, making it difficult for children suffering from the condition to feed.

The child Aphrodisias is one of the few known archaeological ICH cases. In fact, the disease, including its cause and reasons for its resolution, remains difficult to diagnose, even in modern clinical settings. However, some known symptoms include fever, irritability, bone thickening, and swelling of overlying soft tissues.

The disease appears to develop sporadically and disappear spontaneously, although a few familial cases have been reported, indicating that there may be a hereditary factor.

According to Ph.D. According to candidate Başaran, it is unclear whether 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 died from ICH, from complications resulting from ICH, or from a completely unrelated matter.”

This case contributes to our understanding of non-adult health in Middle Byzantine Aphrodisias. Additionally, the addition of this case to the registry of known ICH cases in archeology contributes to the development of a more refined and reliable method of diagnosing the disease in historical and prehistoric contexts.

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