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An ill child among mid-Holocene foragers of Southern Africa.

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An Ill Child Among Mid-Holocene Foragers of
Southern Africa
Susan Pfeiffer1,2* and Christian Crowder1
Department of Anthropology, University of Toronto, Toronto, Ontario M5S 3G3, Canada
Department of Archaeology, University of Cape Town, 7700 Rondebosch, South Africa
rickets; South Africa; Khoisan; infant mortality; infanticide
The skeletal remains of an infant from a
southwest South African rock shelter at Byneskranskop
show pervasive abnormalities that are consistent with the
effects of hypertrophic (hyperplastic) rickets. Diagnostic
features include beading of the costochondral junctions of
the ribs, flaring and tilting of the metaphyses, and cupping of the distal ulna, as well as general skeletal hypertrophy. With an uncalibrated accelerator mass spectrometry (AMS) radiocarbon date of 4820 ⫾ 90 BP (TO-9531),
this is a very early instance of the condition, among foragers whose environment and diet make dietary shortages
of active vitamin D or dietary calcium improbable. Carbon
The characteristics of those children who fail to
survive should tell us something about the stressors
faced by their society. In many parts of the world,
the burials of past foraging peoples are rare and
geographically dispersed. As a result, we know little
about their health, as reflected through palaeopathology. Relative to more sedentary groups, huntergatherers may have had less exposure to infectious
and nutritional diseases, and more experience with
accidental skeletal trauma (Cohen, 1989; Larsen,
1997; Bogin, 2001). The rarity of birth defects and
serious chronic diseases among the skeletons of foragers is consistent with scenarios suggesting that
the frail may not have been maintained within the
group, and that the option of perinatal infanticide
was part of the culture. Information about how past
foraging groups managed ill health is important to
our understanding of human biosocial adaptation.
The Later Stone Age of sub-Saharan Africa is an
especially rich source of information about foraging
adaptations. Until approximately 2,000 years ago,
human groups who appear to be ancestral to modern
Khoisan-speaking peoples moved through various
habitats, subsisting on hunted, fished, and collected
food resources (Deacon and Deacon, 1999). Populations appear to have favored the Cape region, in
which the climate is Mediterranean, with mild, wet
winters and hot, dry summers, and both terrestrial
and aquatic resources are available for exploitation
(Deacon and Lancaster, 1988). Well-preserved human skeletal remains have been excavated, especially from rock shelters in the Cape Fold Mountains, which were used for burial rituals during the
and nitrogen stable isotope ratios indicate a mixed diet,
including marine as well as terrestrial protein. Solicitous
care maintained the sick infant to an estimated age of
3.5–5 months; it was buried in a manner like that of other
deceased group members. This case suggests that if infanticide was practiced, it was an option only during the
immediate perinatal period, when this infant would have
appeared normal. This is consistent with documentation
of infanticide practices among historic foragers from
southern Africa. Am J Phys Anthropol 123:23–29, 2004.
2004 Wiley-Liss, Inc.
Holocene. While mature skeletons from the Later
Stone Age have been studied for indications of palaeodiet and habitual behaviors (cf. Churchill and Morris, 1998; Sealy and Pfeiffer, 1999; Stock and
Pfeiffer, 2001), juvenile remains have received less
attention. It was in the context of a broader documentation that the infant skeleton described here
was noted.
The study of Later Stone Age skeletal remains
may be informed by data from historically documented foragers of southern Africa, now limited to
the interior regions of Botswana, Namibia, and
northern South Africa. Studies from the era of the
Harvard Kalahari Research Group (ca. 1963–1970;
Lee, 1976) are particularly useful, because the application of a biosocial model caused researchers to
ask specific questions about health and mortality.
Studies of adult care of infants and children among
Kalahari foragers indicate solicitous care, with relatively late weaning as the norm (Konner, 1976;
Grant sponsor: Social Sciences and Humanities Research Council of
*Correspondence to: Susan Pfeiffer, Department of Anthropology,
University of Toronto, 100 St. George St., Toronto, Ontario M5S 3G3,
Canada. E-mail:
Received 6 September 2002; accepted 7 February 2003.
DOI 10.1002/ajpa.10297
Draper, 1976). Chronic maladies, like malnutrition
and gastroenteritis, were rare among children, and
child mortality was chiefly associated with epidemics (Truswell and Hansen, 1976). During the postnatal care of infants in the Kalahari environment, it
is reported that mothers would use their leather
capes to protect their infants from intense sunlight,
to the extent that infants occasionally showed
craniotabes. This term refers to the softening of the
parietal bone and the widening of fontanels that
occur chiefly in rickets. Once the babies were exposed to the sun, the rickets would disappear (Truswell and Hansen, 1976).
While it is difficult from any ethnographic study to
calculate the incidence of infanticide, its occasional
practice at the discretion of the mother is unquestioned in the Kalahari setting (Howell, 1976, 1979).
An expectant mother normally gave birth in solitude, and if an infant was deformed or was one of
twins, or if the mother seriously doubted that the
child’s life could be sustained, it was her prerogative
or duty to smother it (Shostak, 1981). Schapera
(1930) reported that among some historic Khoisan,
unwanted babies, such as those born while mothers
were still breastfeeding a child too young to wean,
were disposed of immediately after birth in a burrow
or hole in the ground. Several ethnographic accounts
(Schapera, 1930; Silberbauer, 1981; Shostak, 1981;
Barnard, 1992) describe how babies were named a
few days or weeks after their birth, after which time
they were seen as part of the family group and other
extended relationships.
Two cave sites in the Byneskranskop limestone
hill, Bredasdorp District, South Africa, were excavated in 1980 and reported by deVilliers and Wilson
(1982). The sites are roughly 160 km east-southeast
of Cape Town, straddling the southern and southwestern Cape regions. The lowest occupation layers
date to about 12,500 years ago, while sheep bones in
the upper layers indicate dates of less than 2000 BP.
Most of the deposit is artifactually characteristic of
the Wilton complex or tradition, known for its high
incidence of backed bladelets and of segments or
“crescents” (Deacon and Deacon, 1999). With the sea
coast 5– 6 km away, mollusc shells and the bones of
seal, fish, and sea birds occur, as well as terrestrial
large and small prey species (Klein, 1981). Eight
human skeletons, four of them immature, were excavated from shelters BNK 1 and BNK 3. Three
skeletons were radiocarbon dated to dates between
1480 –3190 BP (deVilliers and Wilson, 1982).
The infant described here, Burial 6, was loosely
flexed on its right side in BNK3. It shows red ochre
staining on its skull. Some apparently unrelated
postcranial elements were initially comingled, presumably from a prior burial that was disturbed by
this interment. While a field photograph and an
inventory of the skeleton were published, the abnormal nature of the bones was not noted. The focus of
that initial study was the determination that the
people associated with the Wilton complex were of
Khoisan rather than black African background. The
remains of Burial 6 are designated in the collections
at Iziko Museums, Cape Town, as SAM-AP 6060.
Another BNK3 infant of very similar age, Burial 7
(SAM-AP 6059), is used for comparison.
The remains were studied during research visits
in 2000, 2001, and 2002. Seven right ribs were used
for chronometric dating and light stable isotope
analysis. Casts of the destroyed material were provided to the Museum.
Isotopic analysis
The stable carbon and nitrogen isotope ratios were
measured from collagen (C/N ⫽ 3.0, yield 15.1%),
following standard procedures of light-stable isotope
analysis (Sealy, 1997; Sealy and Pfeiffer, 2000). The
value for ␦13C ⫽ ⫺16.6‰, and the value for ␦15N ⫽
The uncalibrated accelerator mass spectrometry
date (TO-9531) is 4820 ⫾ 90 BP. The proper calibration of this date should address both its southernhemisphere location and the effect of the dietary
incorporation of carbon from the “older” marine system. The Southern Hemisphere ’98 Curve, developed by the Quaternary Dating Research Unit (Pretoria, South Africa), is based on INTCAL with a
southern hemisphere correction. When applied, it
yields dates of 3631 BC, 3564 BC, and 3541 BC, with
one-sigma ranges of 3652–3507 BC and 4327–3386
BC. Recognizing the effect of marine carbon on radiocarbon dating, the Pretoria Laboratory developed
the West Coast ’93 (WC93) calibration curve, based
on the marine data set of Stuiver and Brazunias
(1993), with a local correction. The ␦13C value for
SAM-AP 6060, ⫺16.6‰, suggests that carbon was
being incorporated from both terrestrial and marine
systems, a “mixed” diet. Assuming that approximately half of the carbon in the infant’s bones was
marine-derived, recalibrating using the WC93
curve, averaging the intercepts with the results of
the calibration based on SH98, yields dates of 3267
BC, 3234 BC, and 3222 BC. Error terms are not
available for this adjustment.
Skeletal inventory
The dentition is represented by 11 unerupted deciduous tooth crowns: 3 maxillary incisors (Ri2, Ri1,
and Li1), and 8 mandibular crowns (first deciduous
molars, canines, and all incisors). The cranial vault
bones are somewhat fragmented and remain slightly
distorted, but all major vault bones are nearly complete, i.e., paired frontal bones and parietals, occipital squamae, and basilar and lateral parts. The
temporal bones are represented by the petrous portions, which appear “weathered” in a manner that
may instead reflect premortem bone remodeling of
an abnormal type. There are small fragments of the
sphenoid. Both maxillae are extant, although broken distally and missing frontal processes. The man-
dible consists of the anterior body (fused mesially)
and a portion of the right ascending ramus.
The postcranium includes 19 vertebral bodies
(most being lumbar, sacral, and cervical), two halves
of the atlas, 9 other unfused cervical arch halves, 22
unfused thoracic arch halves, 5 fused or partially
fused lumbar arches, 10 left ribs, and 8 right ribs.
Long bones include 10 hand/foot long bone shafts,
plus one first metatarsal; paired scapulae, ilia, ischia, and pubes; paired femora, tibiae, and humeri;
and one unsided fibula, right ulna, right radius, and
right clavicle. There are no epiphyses that clearly
match these bones. One epiphysis from a scapular
fossa may be from SAM-AP6060, but the match is
Estimated age
The formation of each tooth crown was assessed
using the standards of Moorrees et al. (1963). There
is consistency throughout the dentition; maturation
is consistent with an age of 0.3– 0.4 years, i.e., approximately 3.5–5 months of age. Skeletal maturation is consistent with this estimated age, except for
the posterior fusion of the lumbar arches, which
would be expected at a slightly later age.
While there are few Later Stone Age infants of
similar age available for comparison, the infant’s
longitudinal growth appears to have been retarded.
Long bone lengths are shorter than those of two
infants with comparable dental ages. Lengths are
very similar to those of a slightly younger, normally
developed infant from Byneskranskop. The younger
infant, SAM-AP 6059, has a dental age of 2–3
months, and has arm bones slightly longer and leg
bones slightly shorter than in SAM-AP 6060. The
diaphyseal diameters and distal diaphyseal widths
of SAM-AP 6060 are always greater than those of
SAM-AP 6059, by a ratio of about one third. There is
no radiographic evidence of episodic disruptions
(growth arrest lines), so the slow growth was probably persistent.
Fig. 1. Two frontal bones of SAM-AP 6060, demonstrating
rough and irregular new bone deposited supraorbitally, and diffuse porosity of orbits. Region of red ochre staining is immediately
superior to region of abnormal bone.
Fig. 2. Cross section of left frontal bone, illustrating additional new bone, deposited ectocranially. Diploic bone shows normal thickness, but diploe appear sclerosed.
Abnormal skeletal morphology
Probably the most obvious abnormal feature of
SAM-AP6060 is the thickening of the supraorbital
portions of the frontal bones. The bone is 12 mm
thick at the fronto-malar junction, and of similar
thickness along the metopic suture superior to the
glabella (Fig. 1). The interorbital distance is wide
(18 –19 mm). In the thickened regions, the ectocranial bone is rough and irregular, and on cross section
it appears to be superimposed on the diploic bone
(Fig. 2). Exposed diploic trabeculae appear sclerosed. The superior orbits are porous, but not in the
focal manner seen in the cribra orbitalia. Other cranial and jaw bones appear normal. The palate and
nasal floor appear normal. No deformation of the
very short right ascending ramus is apparent on the
fragmentary mandible, but the bone is damaged on
all edges. There is a horizontal notch near the tip of
one deciduous canine crown, suggesting the possi-
Fig. 3. Radiograph of SAM-AP 6060, including (clockwise
from upper left) clavicle, two representative ribs showing expansion at sternal ends, first rib, and ilia showing dense cancellous
pattern that accompanies abnormal bone thickness.
bility of some disruption in enamel formation in
utero, but this possible abnormality is very slight.
The ribs of SAM-AP6060 are flared at their sternal extremities, expanded, and filled with cancellous
bone. The irregular bones (especially the ilia and
Fig. 5. Tibiae of SAM-AP 6060 are central, in anterior-posterior view, compared with tibiae of SAM-AP 6059, an infant with
normal skeletal morphology who died at a slightly younger age.
Note angle of distal metaphyseal surfaces on affected tibiae,
which could have contributed to bowing of lower limbs, in life.
Fig. 4. Radiograph of selected long bones from SAM-AP 6060
in anterior-posterior view, including humeri, ulna, and radius
(upper row); grouped tibiae and femora (lower row). All long
bones show expanded diaphyses, narrowed medullary spaces, and
cortical bone that is less dense than normal.
scapulae) are thickened with cancellous bone, and
show indistinct surface morphology (Fig. 3).
All of the long bones, including the clavicle, are
expanded along their extent (Fig. 4). The shafts
show cortical thickening, with some surface irregularity caused by patches of irregularly structured
bone. The hand and foot bones are widened, with a
sausage-like appearance. The left tibia is slightly
bowed, medially. The metaphyses are flared, especially in the lower extremities, and the cortex is
thick but not dense. Metaphyseal surfaces appear
rougher than normal (as per Ortner and Mays,
1998). Radiographs reveal narrow medullary cavities. Some muscle attachment areas, especially the
linea aspera and those of the elbow region, are particularly rough, and show longitudinal cortical excavations. The popliteal line and the deltoideus region
look smooth and unexcavated. The distal right ulna
appears distinctly cupped. The metaphyseal ends of
the distal femora and tibiae appear laterally tilted
as compared to normal infant bones (Fig. 5), so there
may have been more bowing of the legs than is
apparent in the extant diaphyses.
The stable isotope values from the bone collagen of
SAM-AP 6060 can provide information on both diet
and health. However, neither interpretation is
straightforward in an infant of this young age from
this ecosystem. The site is situated between the
southern Cape, where terrestrial vegetation includes both C3 and C4 species, and the southwestern
Cape, a region with predominantly C3 terrestrial
flora. Hence, the degree of marine resource exploitation is most reliably assessed using different approaches in the two regions. Marine exploitation
should indicate dietary access to vitamin D-rich
fatty fish. Because breastfeeding is associated with
trophic-level enrichment in both nitrogen and carbon (Katzenberg, 2000), comparisons should focus
on other infants and young children. Isotopic values
for juveniles are not directly comparable with those
of adults, because of the trophic-level effect produced by breastfeeding. A further complication to
interpretation is the possibility that metabolic imbalances that stimulate rapid bone remodeling may
enrich the 15N/14N ratio (Katzenberg and Lovell,
Published juvenile ␦13C values from the coastal
southern Cape site of Oakhurst range from ⫺10.4‰
to ⫺16.4‰ for infants (N ⫽ 6, mean ⫽ ⫺14.3‰;
Sealy et al., 1992), thus tending to be less negative
than those from the southwestern Cape, and less
negative than the value for SAM-AP 6060. The isotope values of SAM-AP 6060 are intermediate between those of Later Stone Age infants and juveniles
from inland and coastal sites of the southwestern
Cape (Table 1). Applying the interpretive framework
that was developed for the southwestern Cape ecosystem (cf. Sealy et al., 2000), it appears that the ill
child was breastfeeding from a mother whose diet
included both terrestrial and marine protein
sources. It does not appear as a dietary outlyer.
TABLE 1. Stable carbon and nitrogen isotope values comparing SAM-AP 6060 with Later Stone Age, pre-2000 BPt,
infants and young children, South Africa1
Estimated age
SAM-AP 6060 (Byneskranskop)
WVR 16 (Watervalsrivier)
Eland Cave 1
Eland Cave 2
UCT 388 (Faraoskop)
SAM-AP 6314 (Steenbokfontein Cave)
SAM-AP 6054A (Malmesbury)
SAM-AP 6054B (Malmesbury)
SAM-AP 6054C (Malmesbury)
This study
Among southwestern Cape samples, first four comparators are from inland sites. Latter four are from sites near coast. References:
1, Sealy et al., 2000; 2, Sealy et al., 1992; 3, Jerardino et al., 2000; 4. Sealy and van der Merwe, 1988.
There is no indication that rapid, pathological bone
remodeling heightened the ␦15N value, but the comparator group is small.
TABLE 2. Infant skeleton compared against criteria that
indicate rickets in juvenile skeletal remains
(as per Ortner and Mays, 1998)
Diagnostic characteristics
Differential diagnosis
While most causes of juvenile morbidity and mortality do not affect the skeleton, rickets is an exception. Rickets is a metabolic disturbance of the ability
to deposit calcium and phosphorous within bone tissue, resulting in the failure of osteoid to properly
calcify. It commonly occurs in children aged 6
months to 2 years, although it may appear in children as old as 15 years (Passmore and Eastwood,
1986; Steinbock, 1976; Stuart-Macadam, 1989;
Aufderheide and Rodriguez-Martin, 1998). Most
commonly, the condition occurs when the body obtains insufficient effective vitamin D from the environment, either through lack of vitamin D in the diet
or lack of exposure to sunlight. Symptoms of the
condition are rarely seen in infants that are less
than 4 months old, because the newborn’s liver
stores placentally derived vitamin D (Ortner and
Putschar, 1981). The presence of rickets and of its
adult counterpart, osteomalacia, often highlight
maladaptive aspects of culture change. The potentially deleterious effects of rickets are a key feature
of one of the most popular scenarios for depigmentization of European populations (cf. Molnar, 1998),
although cases in the paleopathological literature
tend to come from skeletons of the past two millennia, often from relatively complex societies (Littleton, 1998; Ortner and Mays, 1998).
Many of the abnormal features of this infant are
consistent with the skeletal criteria of juvenile rickets (Ortner and Mays, 1998) (Table 2). The deformation of the sternal rib ends, in the manner of the
well-known “rachitic rosary,” the cupping of the distal ulna, and the slight bowing of several long bones
are consistent with rickets (Jaffe, 1972). However,
there are also skeletal features that are not consistent with rickets as it is commonly described. While
the ribs show the characteristic shape, the expanded
ends are filled with cancellous bone. Indeed, there is
no evidence of low bone mass in the skeleton. Further, there is no involvement of the parietal bones
and no craniotabes.
Cranial vault porosity, craniotabes
Orbital roof porosity
Deformation of mandibular ramus
Deformation of arm bones
Portion of frontal only
No, but cupped distal
Deformation of leg bones
Yes, slight bowing of tibia
Flared costo-chondral ends of ribs
Irregular and porous cortex of ribs
Thickening of long bones, especially Yes
Roughened metaphyseal surfaces
Teeth poorly mineralized1
Criterion from Mankin (1974).
A less common cause of rickets arises not from
environmental perturbations but from a defect in
metabolism, such that the effective vitamin D cannot be used for bone formation. The most common
source of renal tubular disfunction leading to vitamin D-resistant rickets is the X-linked dominant
condition of hypophosphatemia (Albright et al.,
1937; Blondiaux et al., 2002), but there are many
skeletal growth disorders that can disrupt the normal bone formation pathway (Ortner and Putschar,
1981; Aufderheide and Rodriguez-Martin, 1998).
Understandably, this type of rickets has received
less anthropological attention. However, the most
ancient examples and examples from very early infancy may represent this type of rickets. Formicola
(1995) argued that an adult male skeleton from an
Italian cave, radiometrically dated to over 10,000
BP, shows symptoms of a life lived with X-linked
vitamin D-resistant rickets. The man’s long life illustrates the variable clinical expression of this condition.
Nonrachitic conditions that might explain at least
some of the abnormalities were explored, including
infantile syphilis (Caffey, 1939), hypervitaminosis
A, infantile scurvy, and infantile cortical hyperostosis (Caffey’s disease). While infantile syphilis can
lead to increased bone density in both diaphyses and
metaphyses as seen here, it characteristically appears in focal zones, accompanied by necrosis, with
osteochondritis and considerable periosteal bone formation. The pervasive, diffuse nature of the bone
changes in SAM-AP6060 are inconsistent with infantile syphilis.
Hypervitaminosis A is another condition that
causes periosteal new bone formation (Jaffe, 1972;
Ruby et al., 1974; Walker et al., 1982). The metaphyses of long bones can appear irregular and cuplike
in shape, and there is widening of the epiphyses,
often associated with transient demineralization of
cortical bone. In cases that we reviewed, there was
no specific discussion of cranial changes. While it
may be possible that some unusual source of vitamin
A was ingested by the nursing mother and passed on
to the infant, this pathological condition does not
match the case under study. The bone shows no
areas of demineralization, and the metaphyses are
widened, but not irregular.
While infantile scurvy (Jaffe, 1972; Stuart-Macadam, 1989) causes periosteal bone formation in
response to hemorrhagic activity, the pattern of
bone changes differs from that seen in this case. The
new periosteal bone tends to be very tenuously attached to the cortex, and the radiopacity of rib ends
and metaphyses is due to calcified cartilage matrix,
rather than cancellous bone within the diaphyses.
The cranial pattern of bone change seen in infantile
scurvy, along chewing muscle attachment sites (Ortner et al., 2001), is not seen here.
Infantile cortical hyperostosis (Caffey, 1945) is an
idiopathic condition characterized by multiple cortical
hyperostoses scattered throughout the extremities,
ribs, clavicle, face, mandible, and scapular regions.
The mandible is always affected; other sites are variable. Cortical thickening of extremities does not extend to the terminal segments. In that the mandible of
SAM-AP 6060 is unremarkable and the terminal diaphyses are affected, this etiology is also unlikely.
The most probable etiology for the skeletal
changes described here is the hypertrophic or hyperplastic form of rickets, as distinct from the atrophic
or porotic form (Caffey, 1939; Jaffe, 1972; Ortner
and Putschar, 1981; Steinbock, 1976; Stuart-Macadam, 1989). The bone cortices, although porous,
become thickened from the deposition of osteoid by
the periosteum. The medullary cavity may be reduced in diameter. Thickening of the frontal and
parietals occurs, with most deposition on the outer
surface. In hypertrophic rickets, the bones become
enlarged, especially around the metaphysis. The
epiphyses may become displaced or tilted due to
weak connective tissue at the growth plate, causing
angulation at weight-bearing sites. The bowing of
long bones, the fracturing, and all the other sequellae of osteoporosis that are seen in the atrophic form
are not seen in the hypertrophic form of rickets.
The hypertrophic form of rickets occurs in wellnourished children, while the atrophic form is generally observed in malnourished children (Jaffe,
1972). Both forms may be the result of a shortage of
calcium or active vitamin D in the child’s environment, or a metabolic inability to incorporate vitamin
D during the mineralization process, usually
through inadequate renal function. The hypertrophic form of rickets is characterized by the exuberant deposition of poorly mineralized osteoid at periosteal and endosteal locations. Response to bonestimulating factors like mechanical loading can lead
to the deposition of more than the normal amount of
bone, but it is bone of reduced density.
It is unlikely that SAM-AP 6060 developed these
abnormal features through the X-linked dominant
condition of hypophosphatemia. Skeletal changes
caused by this condition are rarely manifest until later
in infancy, and its familial nature leads to relatives
showing indicators of the condition, such as abnormal
skull shape and premature synostosis. Such indicators
have not been noted in the Later Stone Age skeletons
from this region. It is unusual to see such a breadth of
rachitic skeletal abnormalities in such a young infant.
In both the hypotrophic and hypertrophic forms, the
fetal liver is expected to store vitamin D sufficient to
maintain normal skeletal growth through the first
four postnatal months. In the case of SAM-AP 6060,
renal malfunction may have been particularly severe,
with very early onset of symptoms.
Clinical symptoms of a rachitic infant are not restricted to the skeleton. They vary, depending on the
cause and severity of the disease. A rachitic infant may
be restless and irritable. The infant is prone to respiratory infections, and commonly has gastrointestinal
upsets and diarrhea or constipation (Mankin, 1974).
Other symptoms may include excessive sweating and
convulsions. The muscles may become weak, causing
the infant to have difficulty maintaining a sitting posture (Jaffe, 1972; Mankin, 1974; Stuart-Macadam,
1989). The varying pattern of cortical roughening at
muscle attachment sites may indicate that this infant
was swaddled in a manner that limited movement,
especially at the knees and shoulders. Care of such a
child would require extra energy and patience.
The health and survival of foragers are of central
importance to our understanding of human evolution. Assertions are made regarding what constituted successful adaptive strategies during the millennia in which our ancestors were dependent on
hunting and gathering for their subsistence, but
solid information is rare. Individual cases, when
contexts are firmly established, can contribute to our
understanding of flexibility and decision-making in
the foraging context. To our knowledge, this case
joins one other illustration of putative rickets from
prehistoric hunting and gathering peoples (Formicola, 1995). Evidence from archaeological food
waste, bone morphology, and stable isotope values
suggests that an etiology of malnutrition (either
general or specific to the nutrients needed for normal bone formation) is improbable in this case. The
abnormal bone formation may therefore have been
the result of an inborn error of bone metabolism. In
burial, the infant was treated in a fashion consistent
with that of other deceased group members.
Stable isotope assessment and radiocarbon date calibration were done by Prof. J.C. Sealy, Archaeometry
Unit, University of Cape Town. We thank G. Avery,
Iziko Museums of Cape Town, South African Museum,
for access to the material. The South African Heritage
Resources Agency granted permission for AMS dating
and light stable isotope analysis. We thank the manuscript reviewers for their helpful comments.
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