Childhood Health in The Roman World

Childhood in the Past 3, 2010, 1542
Childhood Health in the Roman World:

Perspectives from the Centre and Margin
of the Empire
Rebecca Gowland and Rebecca Redfern
Abstract
Very few studies to date have presented contextualised interpretations of bioarchaeo
logical evidence from Roman urban environments. This paper compares and
contrasts the osteological data for childhood health from two urban centres, one at
the centre and the other at the margins of the Roman Empire Rome and London.
We synthesise recently published and newly recorded data on childhood indicators
of physiological stress (e.g. cribra orbitalia and enamel hypoplasias) from both sites.
Contrary to expectations, we find that the prevalence of these stress indicators is
comparable between sites. In order to contextualise these findings we compare the
results to published data from other sites of the same period (from both rural and
urban locales) within the respective countries. We find that the data from London
is anomalous for Roman Britain, while that from Rome is similar to findings from
contemporaneous Italian sites. We interpret these findings in terms of child-rearing
practices, the local living environment and high levels of migration into Roman London
from Mediterranean regions.
Keywords: cribra orbitalia, enamel hypoplasias, immigration, diet, weaning
Introduction
This is the first study to compare and contrast bioarchaeological data relating to
childhood health from sites within Rome and London dating from the first to the fourth
centuries AD. The analysis of these two important Roman centres one at the core
and the other at the periphery of the Roman Empire aims to assess, compare and
interpret the nature of each of these urban environments as reflected in the skeletal
evidence for childhood health. In the Roman period, Rome, under the watchful eye of
Authors addresses: Rebecca Gowland, Department of Archaeology, Durham University, South
Road, Durham DH1 3LE, UK, Email: rebecca.gowland@dur.ac.uk; Rebecca Redfern, Centre for
Human Bioarchaeology, Museum of London, 150 London Wall, London EC2Y 5HN, UK, Email:
rredfern@museumoflondon.org.uk
16
the goddess Roma, was the first and most important city; it was the economic, political
and social heart, the centre from which the Empire was managed (Adkins and Adkins
1998). Britain, in stark contrast, was considered to be on the rim of Oceanus, at the very
edge of the known world and therefore, a place of mystery and barbarism (Faulkner
2000, 15; Millett 1998a, 11). However, once Britain (Britannia) was incorporated into
the Roman Empire following the Claudian conquest in AD 43, Londinium became the
largest settlement in the province.
This study presents a departure from many bioarchaeological studies of health
which often focus on regional rural/urban divides. The identification of rural and
urban cemeteries is problematic, because away from the Roman cities there is not a
straight-forward or direct association between the geographical location of a cemetery
and the community who used it. For instance in Britain, this can be exemplified by the
Romano-British communities in Dorset, where cemeteries located outside the walls of
the regions main town, Durnovaria, were not solely urban in character. Instead, many
are associated with farming settlements on the outskirts of the town and display more
rural characteristics in terms of funerary practices (Hamlin 2007; Redfern 2006; Redfern
et al. 2010). In contrast, because we are employing data from cemeteries located directly
outside the city walls of Rome and London, it is thought less likely that these would
have been chosen burial locations for those living in rural settlements or small towns,
because of economic cost and family traditions (Hope 2009; Pearce 2001; 2008).
Additionally, the amount of subadult bioarchaeological data from cemeteries
excavated in rural areas during Roman times, i.e. those not associated with towns
(civitas)/large settlements or displaying urban characteristics (Esmonde Cleary 2001;
Pearce 2001; 2008), is sparse in both Italy and Britain and, for the most part, disseminated
in a manner which prevents incorporation into other studies (see Roberts and Cox
2003, 2630). Unfortunately, at the present time, because of these factors we are unable
to examine core-periphery disparities in health (Panter-Brick 1998; Rousham and
Humphrey 2002; Vuorinen et al. 1988) but acknowledge that, as today, they would
have influenced health in the Roman Empire.
In recent years, regional studies have examined health in Roman Britain but for
the most part these have concentrated on Romanisation and compared pre- and postconquest populations in Dorset and Yorkshire (Peck 2009; Redfern 2006; 2007; 2008;
Redfern and DeWitte accepted; Redfern et al. 2010). The work of the second author
has attempted to place their findings in the broader perspective of the Empire but, as
outlined above, such attempts are limited by the current available dataset (Redfern
2008). Although, data on Roman populations from Italy are available (e.g. Belcastro
et al. 2007; Facchini et al. 2004; Fitzgerald et al. 2006; Killgrove 2005; 2010; Manzi et al.
1999), no regional or even intra-city studies have been published.
This preliminary research represents the first study to synthesise and interpret the
skeletal evidence for childhood health and well-being in cities at the centre and margins
of the Roman world. It focuses on skeletal markers relating directly to the childhood
period, namely cribra orbitalia and enamel hypoplastic defects, conditions which have
been recognised for their ability to provide information on health stressors during
growth and development (Goodman and Martin 2002). In order to help contextualise the
data from London and Rome more broadly, we will briefly discuss skeletal indicators
Childhood Health in the Roman World
17
of health status from contemporaneous sites within Britain and Italy. This will allow
us to assess whether the observed patterns are representative of other Roman period
sites or whether they present anomalies that relate to the specific nature of these
urban environments. Our analysis includes the remains of both subadult and adult
individuals; however in either group the skeletal markers examined could only have
formed during skeletal and dental development (Goodman and Martin 2002). Before
discussing the skeletal material examined in this study it is worth first outlining the
role of bioarchaeology in the study of childhood in the past.
Childhood and Bioarchaeology

Children have recently become the focus of a considerable amount of historical,
archaeological and anthropological research (e.g. Crawford 1991; Crawford and
Shepherd 2007; Gowland 2001; Lewis 2007; Montgomery 2008; Sofaer 2006). This journal
is itself a testament to the burgeoning interest in the subject. Within archaeology, much
of the initial work on childhood was inspired either by the feminist critique which
argued against the construction of an androcentric past (e.g. Baker 1997; Lillehammer
1989), or by the work of historians such as Aris (1962) who suggested that attitudes
towards childhood differed markedly in past societies from those today. That childhood
is subject to cultural construction and differs across time and space has been explored
by a number of sociologists and anthropologists (e.g. Ginn and Arber 1995; James and
Prout 1990; Schildkrout 1978) whose work has also been influential in archaeological
studies of childhood.
From a bioarchaeological perspective the skeletal remains of children have also
been comparatively neglected until recently (amongst others, Baxter 2005; Perry
2005). This was in part due to the under-representation of subadult skeletal remains
at many archaeological cemetery sites, but was also rooted in the same cultural biases
that permeated the rest of archaeology: children were perceived to be of lesser social
significance than adults. Furthermore, the biological immaturity of the childs body was
also viewed as subject to universal interpretation. However, because individuals grow
up and grow old within social contexts (Campbell and Alwin 1996, 34), age cannot be
reduced to physicality or the simple passage of time (Fry 1996, 117). Within our society,
the physical immaturity of the body indicates a child and all of the social qualities that
our culture bestows on them (e.g. innocence), but such associations are not recognised
in all societies. There is often a close synchronicity between biological and social age
transitions (as with the onset of menstruation) (Myerhoff 1984, 307); however, the social
identity of a particular age group within a society is not the naturalised manifestation
of their physical development. When one examines the ethnographic evidence, bodily
maturity is not necessarily a prerequisite for adult status. Indeed, biology and culture
in this respect may often appear entirely disparate. For example, amongst the Boran
in Ethiopia and Kenya, while a boys physiological age may be recognised, some are
initiated into elder age sets, with subsequent implications for their social identity and
relations (Legasse 1973).
The intertwining of biology and culture during the growth period has been
acknowledged in the biocultural approach to human skeletal remains for many years.
18
This approach has only been more explicitly developed in relation to children more
recently (e.g. Gowland 2001; 2006; Halcrow and Tayles 2008; Lewis 2007; Redfern 2007;
Sofaer 2006; Sofaer Derevenski 1997). Cultural practices can have a profound effect
upon the age of attainment of so-called biological milestones (Bock and Sellen 2002).
For example, walking and talking is viewed as the beginning of personhood for many
cultures, both past and present, and yet cultural practices may either significantly
delay or advance such abilities (Levine 1998). Like-wise, with respect to osteological
techniques of analysis, social and environmental factors can acutely impact upon skeletal
development and subsequent interpretations of age-at-death (Gowland 2006).
Over the last two decades there has been an increasing awareness of the significance
of childrens remains for understanding past health (e.g. Lewis 2007; Saunders 2000).
Bones and teeth during the growth period are particularly susceptible to environmental
onslaughts such as poor nutrition and exposure to pathogens. As Lewis (2007) has
discussed in the Bioarchaeology of Children, their skeletal remains provide a particularly
sensitive barometer of overall population health. Importantly, a number of these skeletal
indicators of childhood health stress are retained in the adult skeleton (Humphrey
and King 2000). Therefore, we are not restricted to the often under-represented and
fragmentary remains of children in order to uncover evidence of stressors during growth.
Skeletal remains provide the most direct evidence for the health of past populations
(Roberts and Manchester 2005). The skeleton as part of a once-living individual becomes,
to an extent, imprinted by the lived social and physical environment in terms of both
the chemical composition of the bones and their macroscopic appearance (Sofaer
2006). Skeletal remains can thus provide fundamental information about the lives of
individuals and populations. The analysis and interpretation of skeletal evidence is
not without its problems (see below), nevertheless, such studies can provide important
direct evidence of the lives of people across the Roman Empire. Some of the insights
provided by human remains (e.g. mobility, diet and health) simply cannot be accessed
directly by any other archaeological means (Buikstra 2006, 351).
The study of children and childhood has a very strong tradition in Roman studies,
with research focusing on their role within households, activities and how they were
represented in Roman culture (amongst others, e.g. George 2005; Rawson 1986; 2003).
These studies have provided a strong foundation for more recent research which
has sought to incorporate a life course approach (e.g. Harlow and Laurence 2002).
This approach has expanded our knowledge of how Roman lives were structured by
recognising that a persons age is not simply the sum total of years lived, but a social
and cultural age linked to their social status and gender which may be different to their
physical maturity (Bock and Sellen 2002; Hutchinson 2008). Harlow and Laurences
(2002) examination of the Roman life course has shown that a persons life was divided
into a series of stages, each occurring at different times according to gender and
influenced by status. Childhood lasted from birth to puberty, which was legally defined
as twelve years for a girl and fourteen years for a boy; this stage included the important
time of infantia (birth to seven years old), a period when the individual was formally
accepted into the family by its father and their body underwent physical changes,
such as the eruption and exfoliation of deciduous teeth (Harlow and Laurence 2002,
347). After puberty, girls entered adolescence where they prepared for marriage in
19
their late teens and early twenties (for a full discussion of this period, see Harlow and
Laurence 2002, 567). For boys, this stage was regarded as juventus (youth) and could
last into their twenties, depending on their social and economic status. It was a liminal
period of their lives, often regarded as a form of illness that ended with marriage and
citizenship (Harlow and Laurence 2002, 6571). As a societys life course is culturally
grounded, it is subject to temporal and spatial differences, which are attested in the
Roman Empire (Gowland 2001; Revell 2005). However, because life course studies
employing funerary data have yet to be carried out on the samples employed in this
preliminary research, the authors will focus on the biological aspects of the life course
the fundament of the approach.
Roman London
Before the Roman invasion, London did not exist, although Iron Age material culture
and a few roundhouses and burials have been encountered in what is now considered
to be the Greater London area (Kendall 2000). During the Roman conquest of lowland
Britain, the army crossed the river Thames in AD 43 and built the first bridge at the
main crossing point (Perring 1991, 3). The settlements location was pivotal to its
success, because it was not located in an area of conflict, and was founded by the
military, state and traders, enabling it to become the focal point of contact between the
province and the Empire (Mattingly 2006, 273; Millett 1998b; Perring 1991, 321). By
AD 60, Tacitus noted that despite not having colonia status, Londinium was a famous
centre of commerce (Merrifield 1983, 412).
London was a natural hub for key road and shipping networks and in the first century
became the primary administrative centre for the province (Wilkes 1996). With the
migration of merchants, skilled manufacturers of pottery and metalwork, and traders
from elsewhere in Britain and the neighbouring provinces, the town quickly grew into
a bustling settlement which was destroyed by Boudicas army in AD 60. A period of
rapid construction and development soon followed and by AD 100 the forum, basilica,
public baths and forts were being built to reflect Londons status and the presence of
a major port. Over the centuries of Roman rule the fortunes of London are believed to
have waxed and waned, with a contraction in population in the early second century
followed by further construction (including Londons wall) in the late second to early
third centuries (Perring 1991; Perring and Brigham 2000). London grew to be the largest
town in Roman Britain in terms of area and maintained its Continental connections
throughout the Roman occupation. By the early fifth century, the forum had been
demolished, the Southwark settlement south of the Thames had been abandoned and
the settlement on the north bank decreased in size (Perring 1991).
Estimates of population density for Roman London range from over 20,000 to 30,000
people (Barber and Bowsher 2000, 311; Swain and Williams 2008, 39). Not a great
deal is known about the population composition of Londinium, though a substantial
proportion of the inhabitants were believed to have been incomers (Mattingly 2006;
Millett 1996). The limited inscription evidence reveals that amongst the inhabitants
were auxiliary veterans, soldiers, Roman citizens, slaves and libteri (freed slaves) from
Italy, Asia Minor and Continental Europe (Barber and Bowsher 2000, 316; Perring 1991,
20
402). In recent years, epigraphic data has been supplemented by a small number of
stable isotope studies, which have identified individuals from the Mediterranean or
other areas of Britain (Cotton 2008, 152; Watson 2003). The population structure of the
town is thought to have altered over the course of the Roman occupation, though the
manner of change appears to be a matter for speculation rather than based on material
evidence (Birley 1980).
Environmental evidence provides an independent dataset with which to understand
the conditions in which people lived, particularly those from a domestic context
(Kenward and Hall 1997). The site of 1 Poultry provides an unrivalled insight into living
conditions during the early part of Londons history. Located on the western bank of
the Walbrook stream in the heart of the City, the site consists of timber homes, shops
and out-buildings, all of which were preserved in a water-logged condition following
their destruction during the Boudican rebellion (Rowsome 2000). Houses constructed
from timber were the most common in Romano-British towns at least up until the
second century (Mattingly 2006, 284). Environmental data from 1 Poultry shows that
the houses sheltered house mice and black rats; the yards were used to keep pigs and
chickens and were also places where household rubbish and waste were dumped. Wells
for water were also dug into the yards; latrines were located in or close to kitchen areas;
and open drains running between house plots carried the waste from the homes and
nearby industrial areas into the Walbrook and River Thames (Rowsome 2000).
Evidence for living conditions from the coloniae of Roman Britain is very limited
and biased towards military contexts. These data show that there were clean and dry
areas but does not imply cleanliness and also more squalid areas, containing rotting
material, food remains, faecal material and insects such as fleas and lice (Dobney et al.
1999).
Roman London has been extensively excavated, particularly over the last two decades,
and much of this work has uncovered substantial cemetery sites within and around the
City. While much of this evidence (archaeological and skeletal) has been presented in
summary form, however, it has yet to be the subject of interpretive analysis until now
(Reece 1996; Redfern and Roberts 2005). In terms of current published bioarchaeological
analyses, only two studies have included data derived from Londinium (Redfern and
Roberts 2003; Roberts and Cox 2003).
Ancient Rome
The city of Rome at its peak, in the late Republican and early Imperial period (first
century BCsecond century AD), had a population estimated to be in the region of
around one million (though estimates vary) (Lo Cascio 2006). The population of the
City had grown rapidly during the late Republic period; an expansion fuelled by
immigration. It was by far the largest of the cities in the Roman Empire. Over recent
years interest has grown among historians in the health, nutritional status, morbidity,
mortality and demography in general of the inhabitants of Rome (Gowland and
Garnsey in press). The prevailing viewpoint has been that Rome was not a healthy
place to live. It has been suggested that the diet of ordinary Romans is likely to have
been limited and inadequate in respect of both quantity and range of foodstuffs, with
21
detrimental consequences for health (Garnsey 1998). In addition, Scobies (1986) detailed
assessment of sanitation in the City, based primarily on historical sources with limited
archaeological evidence, points to dire levels of hygiene, with open cesspits in kitchens
and a lack of fresh water and adequate waste disposal.
The population density of Rome has also been estimated to have been extremely
high, even taking into consideration more conservative estimates. Overcrowding in
conjunction with poor sanitation is likely to have exposed the inhabitants of the City to
high levels of infectious disease and parasites. It is worth noting that not all historians
and archaeologists are willing to paint quite so bleak a picture of conditions within
the City and Scobies (1986) analysis is not without its detractors (e.g. Laurence 1997;
Lo Cascio 2006). Lo Cascio (2006, 61) argues that urban planning after the great fire
of AD 64 created wider streets and squares which would have mitigated some of the
effects of overcrowding. In addition, aqueducts supplied quantities of fresh water,
while the sewers helped prevent the stagnation of water. Lo Cascio (2006) concludes
that sanitary conditions within Rome, while not optimum, were likely to have been no
worse than those experienced by other pre-industrial cities. Morley (2005) also states
that, while the living environment for the majority of Romes population may have
been far from sanitary, it is likely to have been better than those later encountered in
most Medieval cities.
Based on a variety of sources (e.g. census data and epigraphic evidence), historians
have argued that life expectancy in Rome (and the wider Empire) is likely to have
been very low (between twenty-five and thirty years) and that the population levels
and growth of the City could only have been sustained through substantial levels
of immigration (e.g. Frier 1982; Morley 1997; Paine and Storey 2006; Scheidel 2001).
Mobility on such a scale brings its own health problems. Immigrants may well have
lacked immunity to Romes pathogens and in turn would have helped transmit diseases
from elsewhere, thus contributing to the spread of epidemics such as smallpox in the
City (Morley 2005). In addition to these hazards, malaria was endemic to the City
something that is well attested by contemporary medical writers (Sallares 2002). The
impact of malaria on the health of the population is thought to have been profound and
a malaria-related seasonal increase in mortality has been observed in the epigraphic
data (Scheidel 1994). Gowland and Garnsey (in press) have recently assessed the skeletal
evidence for the impact of malaria on the health of those living in Rome as well as less
urbanised environments within the Roman Empire, hypothesising that it significantly
affected morbidity as well as mortality.
Living conditions, population structure and diet in the ancient City of Rome has
received a great deal of attention from historians (e.g. Garnsey 1998; Lo Cascio 2006;
Morley 1996; 2005; Scheidel 2001; 2003; Scobie 1986). However, it is only over the
last decade that significant excavations of cemeteries have taken place within the
City. Subsequently, bioarchaeological evidence has played a limited role in attempts
to understand life in Rome. Recently, brief interim reports on skeletal remains from
the ancient City have been published (e.g. Buccellato and Catalano 2003; Buccellato
et al. 2008; Catalano 2008; Heinzelmann 2001), although these are largely descriptive
and none have presented a detailed discussion of the relationship between health
and environment. An in-depth analysis of the skeletal material from the necropolis
22
of Isola Sacra has been published (Prowse et al. 2004; 2005; 2007; 2008), however, this
site is located some 30 km from the City and the skeletal findings cannot be taken as
a reflection of life within Rome.
Skeletal and Dental Stress Indicators

This study examines two key skeletal indicators of physiological ill-health cribra
orbitalia and enamel hypoplasias. Due to taphonomic damage it was not possible to
provide a statistically valid sample to investigate growth, and the inability to undertake
large-scale radiographic and microscopic analyses at both locations prevented the
authors from including additional indicators of stress, such as Harris lines in long
bones and Wilson bands in the dentition. Numerous bioarchaeological studies have
investigated cribra orbitalia and enamel hypoplasias as indicators of poor health in past
populations (amongst others, Lewis and Roberts 1997). The prevalence of these two
conditions have been shown to provide a reliable perspective on health in cross-cultural
and temporal studies (Steckel and Rose 2002), therefore we consider that within our
skeletal samples, these indicators will yield crucial bioarchaeological information on
the health of those living and dying in Rome and London during the Roman period.
Cribra Orbitalia
Cribra orbitalia is a term used to describe small holes in the orbits formed in response
to hyperplasia of the inner layer of the skull and thinning of the outer cortex. The
cause of cribra orbitalia is still the focus of much debate within bioarchaeology. Most
interpretations of the presence of cribra orbitalia in skeletal populations have been
based on the premise that it is the result of iron deficiency anaemia caused through
blood loss, poor diet, parasitism and/or exposure to environments with a high pathogen
load. A degree of iron deficiency has been shown to confer some resistance against
acute infection in children (Wander et al. 2009). However, in a significant recent study,
Walker and colleagues (2009) argued that dietary deficiency of vitamin B9 (folic acid) and
vitamin B12 is the most likely cause of the condition when observed in archaeological
populations.
Due to the changing physiology of the bone marrow and the shift in loci of
production of red blood cells with age, these lesions when observed in adults are
thought to represent childhood episodes of the condition (Stuart-Macadam 1992). It is,
of course, possible that the condition remains ongoing into adulthood from childhood.
Other conditions that result in a similar appearance to the bone are vitamin D and C
deficiencies and infectious processes, and care must be taken to differentiate between
these conditions, particularly in the absence of marrow hyperplasia (Brickley and
Ives 2008; Ortner 2003). Diagnosis is complicated by the inter-related nature of many
deficiency diseases; for example, folic acid deficiency will affect iron and vitamin C
status (Brickley and Ives 2008). While the multiple aetiologies of anaemia and gaps
in our knowledge concerning the osteological processes involved in the formation of
cribrotic lesions may cause interpretational difficulties, it is generally accepted that
this condition is a robust (though non-specific) index of poor health (Goodman and
Martin 2002, 2730).
23
Linear Enamel Hypoplasias

Linear enamel hypoplasias are bands of decreased enamel thickness on the external
surface of the tooth crown, most commonly observed on the anterior dentition
(Goodman and Rose 1990; Skinner and Goodman 1992). These bands result from a
temporary disruption in ameloblast deposition during enamel formation. No specific
aetiology has been implicated in the formation of hypoplastic defects, but when
multiple defects are found on several teeth within an individual, severe childhood
illnesses and/or malnutrition are thought to be the most likely causes (Guatelli-Steinberg
and Lukacs 1999). The examination of enamel hypoplasias has the advantage over
other stress indicators in that the teeth are not remodelled during adulthood, and so
a chronological record of the episode(s) of ill health is retained. However, because
the marker is located in the crown of the tooth, it can be removed by dental wear. In
theory, by measuring the location of the defect on the crown surface in relation to the
cemento-enamel junction and taking into account mean crown height for the tooth
type within the population, the age at which the defect formed can be ascertained
(Goodman and Song 1999, 21218; Swrdstedt 1966). However, it has recently been
demonstrated that the relationship between defect location and chronological age is
not as straightforward as was previously assumed because teeth do not grow in a
simple linear manner (Goodman and Song 1999; Hillson and Bond 1997; Hodges and
Wilkinson 1990; Reid and Dean 2000). Therefore, observations of enamel defects in this
study are restricted to presence/absence only.
Cribra orbitalia and enamel hypoplasias are non-specific indicators of physiological
stress that present complementary and overlapping evidence (Goodman and Martin
2002, 2230; Goodman et al. 1988). Subadults from archaeological contexts are the nonsurvivors of their age cohort and their health-statuses must be understood within the
osteological paradox model (Wood et al. 1992). This model recognises that risk of disease
and death are not equal in a population, instead the health patterns we identify were
subject to individual variation in frailty, and these non-survivors have the potential
to have a higher rate of active responses to disease compared to the living population
(Wood et al. 1992, 3435, 349, 3524). Recent work by DeWitte (2009) and DeWitte and
Bekvalac (2010) examining the relationship between skeletal indicators of stress and
frailty in adults have shown that individuals, particularly males, with these markers
have an increased risk of frailty and die at younger ages the cumulative nature of
these episodes has a detrimental effect on age-at-death (Wood et al. 1992). Therefore, in
this study, as with all studies employing osteological data, the results will be affected
by hidden heterogeneities which are influenced by underlying sex differences in
morbidity and mortality over the life-span (DeWitte 2009; DeWitte and Bekvalac 2010;
Wood et al. 1992). However, as we are focusing on childhood i.e. health before the
age of eighteen years, these differences cannot be examined in more detail because it
is not possible to reliably sex subadults individuals (Mays and Cox 2000, 1213).
24
Materials
Londinium and Roman Britain

Our understanding of the cemeteries of Roman London is changing due to ongoing
construction work in the City. Funerary practices consisted of both cremation and
inhumation, but parts of human bodies were also disposed of in pits and rivers (Barber
and Bowsher 2000, 31011). Both intra-mural burials and extra-mural cemeteries have
been encountered during excavations within the City of London. The extra-mural
cemeteries were close to the main gates and roads out of the City (Perring 1991, 70),
and their excavation has shown that a range of status groups used the cemeteries, with
individuals buried with a range of grave-goods, such as pottery, metalwork, utility
items and jewellery (Hall 1996).
Our study includes data extracted from one intra-mural cemetery and the remainder
from the extra-mural burial locations (Table 1), which were concentrated close to the
Citys defensive walls and main roads linking Londinium to the rest of Britannia. The
extra-mural cemeteries are generally thought to be the burial location of the inhabitants
of the City (Perring 1991).
The cemeteries of Roman London have been organised according to geographical
location. The northern cemetery was built either side of Ermine Street the major road
leading to the north; the eastern cemetery served the City and its Southwark suburb; the
southern cemetery south of the Thames appears to be located south of the junction
of Stane and Watling Streets; and the western cemetery follows the roads leading out
of the City to the west (Barber and Bowsher 2000).
The London data presented here derives from three sources re-analysis of
previously published (i.e. the Eastern cemetery) and un-recorded sites by the Centre for
Human Bioarchaeology since 2003, and the recording of recently excavated material by
Museum of London Archaeology. The osteological data was entered onto the Museum
of Londons database by six bioarchaeologists, and collated by the second author for this
project (see below); because of the nature of archaeology in London, precise locations
are provided by the London Archaeological Archive and Research Centre (Table 1).
To provide a broader context we have also included some data from contemporary
sites in England. These data represent a mix of skeletal information collected by the
authors or from published sources.
Rome
Until recently the skeletal evidence from Rome has been sparse, but current extensive
excavations are occurring in Romes eastern suburbs and amongst the discoveries is
a previously unknown cemetery along the via Collatina consisting of approximately
2041 skeletons (Catalano 2008). Anthropologists at the Soprintendenza in Rome have
recorded a wide range of skeletal information from a sample of these skeletons (e.g.
Buccellato and Catalano 2003; Buccellato et al. 2008; Catalano 2008; Heinzelmann
2001). In 2005, the first author was granted access to some of the databases produced
from this material and to a sample of the skeletal material. The latter was important
for ascertaining whether the recorded skeletal information was broadly compatible

Location
Intramural burial
Northern Cemetery
Eastern Cemetery
Southern Cemetery
Western Cemetery
Cemetery name and site code

(WORD data)
Baltic Exchange (BAX95)
Bishopsgate (BOS87)
Eldon Street (ELD88)
Spitalfields Market (SRP98)
Haydon Street (HAY86)
Hooper Street (HOO88)
Mansell Street (MSL87 & MST87)
West Tenter Street (WTE90)
Calverts Buildings (15SKS80)
Courages Brewery (COSE84)
Great Dover Street (GDV96)
Red Cross Way (REW92 & RWG94)
Atlantic House (ATC97)
St Bartholomews (BAR79)
South West House (SWH86)
1-4 Giltspur Street (WES89)
TOTAL MNI
Number of
subadults
1
1
1
37
2
25
60
2
1
3
10
4
3
6
1
28
185
25
Number of
adults
0
5
18
93
11
77
180
1
5
3
13
3
16
11
1
17
454
Table 1: Data derived from the Roman London cemeteries (http://www.museumoflondon.org.

uk/laarc/catalogue/index.asp; detailed location data is available at London Archaeological Archive
and Resource Centre (LAARC) online site).
in terms of methods and observations with those data derived from skeletal remains
within Roman Britain (see below). Data presented in this study has been taken from
the published interim reports on via Collatina. Work on this unprecedented skeletal
collection is ongoing and the current study is the first time that this evidence has been
published in English. In order to provide some context against which to interpret the
results from via Collatina, we have made comparisons with other published osteological
data from contemporaneous cemeteries within Romes suburbs (Osteria del Curato,
Casal Bertone) (Table 2).
Bioarchaeological Methods
Osteological methods of analysis are developing apace. One unfortunate consequence
of this however, has been the lack of standardisation with which skeletal remains are
recorded and data presented particularly between countries. Bioarchaeology in the
UK and USA has striven to address this issue by introducing standardised recording
methodologies, such as those published by Buikstra and Ubelaker in 1994 and Brickley
and McKinley in 2004. As with all scientific disciplines, data recording is also affected
by inter- and intra-observer error. The degree of error can be investigated statistically,
which allows us to not only interrogate our dataset but also put in place procedures to
minimise errors, such as field limitations in databases. In this study, such procedures
26
Location
Eastern suburb
Southeast suburb

Cemetery Name
Via Collatina1
No. individuals
2041
Via Basiliano2
142
Casal Bertone
Osteria del Curato I
Osteria del Curato II
166
61
71
Data source
Buccalleto and Catalano
2003; Buccalleto et al. 2008;
Catalano 2008; Catalano et
al. 2001
2003; Catalano et al. 2001
Musco et al. 2008
2003; Egidi et al. 2003
Table 2: Published information on skeletons from Rome (1while data on stress indicators have
been published from Via Collatina, the proportion of these individuals for whom the published
sex and age data refers is not clear in publications. 2Via Basiliano represents a sub-sample of the
Via Collatina site for which age and sex data has been published in more detail).
have been put in place for the London data, making our findings robust and reliable.
However, as the data from Rome presented here was derived from published findings,
this source of error cannot be investigated for these sites.
For the London samples, the human remains were recorded using the method
statement published by Powers (2008) on the Wellcome Osteological Research Database
(WORD). This is based on standard methodologies compatible with Buikstra and
Ubelaker (1994) and Brickley and McKinley (2004). With regard to the data from Rome,
the anthropologists are not always explicit in their publications regarding the methods
used (e.g. Catalano 2008). However, where they are, it is apparent that the criteria
used for sex and age estimation follows standard methods as outlined by Buikstra and
Ubelaker (1994). These data will therefore be broadly compatible with that obtained from
Londinium. Intra- and inter-observer error with respect to ageing and sexing of skeletal
remains will always create compatibility issues when comparing data between sites
and recorded by anthropologists working from differing bioarchaeological traditions.
Such issues will plague all studies of this sort. As a consequence, inferences regarding
demography in particular can be highly problematic. Therefore the age distributions
presented below will serve only to provide an indication of sample composition.
In addition to compatibility problems inherent in basic osteological techniques such
as ageing and sexing, the methodologies utilised for recording pathological changes may
be variable within bioarchaeology (Miller et al. 1996). Therefore in this study we included
data on a presence/absence basis only. Although this prevented us from making more
nuanced interpretations of cribra orbitalia based on the presence/absence of active and
healed lesions, it provides a robust and reliable assessment of skeletal change between
populations (Buikstra and Ubelaker 1994; Goodman and Martin 2002).
When examining stress indicators it is appropriate to take into account both True
Prevalence Rate (TPR) and Crude Prevalence Rate (CPR). TPR refers to the number of
observable skeletal elements exhibiting the condition (i.e. number of hypoplastic teeth
out of the total number of teeth), whereas CPR refers to the percentage of individuals
27
with the condition. TPR is the most suitable index for comparison between sites as CPR
does not make an allowance for differential preservation both within and between sites
and this could potentially skew the data (Roberts and Manchester 2005, 9; Waldron
1994). Unfortunately, osteological data are not always published in a format that allows
an estimation of TPR. Consequently, for those sites with insufficient published data,
CPR rates are discussed. It should be noted that due to disparities in published data
(i.e. only quotation of percentages rather than actual numbers) the authors were unable
to undertake statistical analysis of the dataset.
Results
Age Distribution
Figure 1 shows the composition of the sample in terms of the age distribution of the
skeletal remains. The age categories imposed on this sample are entirely artificial and
are in no way intended to reflect Roman perceptions of the life course. All non-adult
age groups are represented in both London and Rome, including infants (Chamberlain
2006). This is of some significance because infants (below the age of one year) were
often buried within settlements rather than in formal cemetery sites (Gowland 2001;
Scott 1992; 1999). It has been suggested that children of less than six months had a more
ambiguous identity in Roman society in terms of personhood (Harlow and Laurence
2002). However, their presence in formal cemeteries demonstrates that infants were
clearly not excluded in any rigorous manner. While one cannot interpret these data as
though they represent a true picture of infant and child mortality, such analyses are of
use for comparison of burial practices between populations (Chamberlain 2006).
The cemeteries from Rome are notable in terms of their lack of older individuals
(40 years +) when compared to Roman London. This is a factor also commented on
by Cucina and colleagues (2006) for the site of Vallerano, a more rural locale situated
at the outer limits of Romes suburbs. Age distributions such as these obtained from
skeletal series are poor approximations of mortality in living populations. Skeletal
ageing techniques are notorious for under-ageing older adults (Kemkes-Grottenthaler
2002; Wittwer-Backofen et al. 1998). As mentioned previously, life expectancy at
birth for Rome has been estimated to be only 2530 years for males (Scheidel 2001).
However, statistics such as mean age-at-death and life expectancy at birth calculated
from cemetery populations have been shown to be more a reflection of fertility than
mortality (Sattenspiel and Harpending 1983).
Amongst the adults, both sexes were equally represented at the cemeteries within
Rome, including the large Via Collatina cemetery. The only exception was Casal
Bertone where the ratio of males to females was 3:2 (Buccellato et al. 2008, Catalano
2008). For the cemeteries in Roman London, males outnumbered females overall in a
ratio of 3:2. This may relate to a significant proportion of the population of Londinium
being male migrants from overseas. As mentioned previously, interpretation of such
evidence in terms of the overall population structure for either city is problematic
due to methodological problems. In addition, at both cities, there has been extensive
fragmentation of skeletal material due to disturbance in antiquity as well as more
recent construction (Buccellato et al. 2008; Thomas 2004). For example, examination of
28
30
Rome
London
25
% Individuals
20
15
10
0
0-1
2-6
7-12
13-19
20-29
30-39
40-49
50+
Age (years)
Figure 1: Age distribution of the cemetery populations from the Via Collatina, Rome, and the
London cemeteries. (Italian data Buccalleto and Catalano 2003; Buccalleto et al. 2008; Catalano
2008; Catalano et al. 2001; Egidi et al. 2003; Musco et al. 2008. London data WORD
database).
the skeletal completeness in the western and southern cemeteries of Roman London
has shown that the majority of subadult and adult individuals were less than 35%
complete (WORD database 2010).
Physiological Indicators of Poor Health

The prevalence of enamel hypoplasias and cribra orbitalia recorded for skeletons from
both Rome and London are comparable (Fig. 2). Rome was a considerably larger city in
terms of population density and one might have expected the stress indicators to have
reflected this (i.e. significantly higher prevalences). In order to be able to interpret these
data in any meaningful way it is necessary to contextualise the evidence by comparing
these figures with those obtained for other sites within Italy and Britain.
The true prevalence rate of linear enamel hypoplasias at the sites within Rome is
high and this would fit with the evidence suggested by many historians for poor diet
and insanitary living conditions in the city (Fig. 3). Elsewhere in Italy, however, linear
enamel hypoplasias are also frequently recorded; for example, Vallerano the rural site
on the outskirts of Rome. Lower prevalences were observed at Isola Sacra although a
substantial 37% were recorded (Fig. 3). One could interpret the lower figure for Isola
Sacra to be a reflection of the moderately well off status of the inhabitants. One would
29
70
60
Rome
London
TPR (%)
50
40
30
20
10
Enamel Hypoplasia
Cribra Orbitalia
Figure 2: True prevalence rate (TPR%) of linear enamel hypoplasias and cribra orbitalia in
Italian and London populations. (Italian data Buccalleto and Catalano 2003; Buccalleto et al.
2008; Catalano 2008; Catalano et al. 2001; Egidi et al. 2003; Musco et al. 2008. London data
WORD database).
expect that the port location of Portus (which the cemetery served) would have provided
access to more and varied food resources (see Prowse et al. 2004; 2005). Further afield
in Italy, the prevalence of linear enamel hypoplasias is as high as 58.9% at the extramural site of Quadrella located in the Marche region (Belcastro et al. 2007; Bonfiglioli
et al. 2003) and a CPR of 84% has been reported for the site of Ravenna (Facchini et
al. 2004) (not shown in Figure 3). The key point of interest here is that linear enamel
hypoplasias within Rome, while high, are not anomalously so when compared with
other sites in Italy.
While the prevalences of enamel hypolasias from Londinium are approaching those
from Rome, they are in fact more comparable with the site of Isola Sacra and it may
not be coincidental that both are ports. However, what is most significant about the
London data is that the figures recorded are anomalously high when compared to those
observed for any other site within Roman Britain. Roberts and Cox (2003, 140) report
an overall TPR for enamel hypoplasias of 9.1% for Roman Britain. Often only CPRs
are stated in published skeletal reports and those provided for other large settlements
in Roman Britain, that may be seen as broadly comparable to Roman London (e.g.
Cirencester, Winchester and Colchester), report values ranging from 10.8% to 17.7%
(Roberts and Cox 2003).
The same prevalence pattern is also apparent in relation to cribra orbitalia (Fig. 4).
30
70
TPR (%) Enamel Hypoplasia
60
50
40
30
20
10
Kempston
Baldock 3
London
Isola Sacra
Vallerano
Rome
Figure 3: True prevalence rate (TPR%) of linear enamel hypoplasias in Italian and RomanoBritish populations (Italian sites in black, Romano-British sites in grey). (Italian data Buccalleto
and Catalano 2003; Buccalleto et al. 2008; Catalano 2008; Catalano et al. 2001; Egidi et al.
2003; Musco et al. 2008. British data Baldock 3, Hertfordshire (Roberts 1984); Kempston,
Bedfordshire (Boylston and Roberts 2000)).
The prevalence of cribra orbitalia in Rome is, again, very high. It has frequently been
observed that the prevalence of cribra orbitalia tends to be high in Mediterranean
populations (Angel 1966), and similar prevalences have been recorded at many other
Italian sites (e.g. Cucina et al. 2006; Facchini et al. 2004). Gowland and Garnsey (in press)
have recently hypothesised that there is a correlation between those sites with relatively
high prevalences of cribra orbitalia and the distribution of malaria. Sallares (2002) has
shown that malaria is well documented to have been present in the Mediterranean and
North Africa at this time.
What is of most significance in this study is that the prevalence of cribra orbitalia in
London is also very high substantially higher, in fact, than has been observed at any
other site in Roman Britain. For example, at the sites of Baldock and Kempston (small
town and rural respectively) comparatively low prevalences were observed (Fig. 4).
Roberts and Cox (2003, 141) report that the TPR of cribra orbitalia overall for Roman
Britain is 16.9%. CPR data reported from a number of large Romano-British settlements
and urban centres (e.g. Cirencester, Winchester and Colchester) report values ranging
from 0.3% to 12.5% (see Roberts and Cox 2003). A recent study by Lewis (2010) has
provided a high figure of 38.5% for subadult individuals (a figure which still does not
approach that of Roman London) for the site of Poundbury Camp, Dorset (a cemetery
31
80
70
TPR (%) Cribra Orbitalia
60
50
40
30
20
10
Kempston
Baldock 3
London
Vallerano
Ravenna
Rome
Figure 4: True prevalence rate (TPR%) of cribra orbitalia in Italian (and Romano-British
populations (Italian sites in black, Romano-British sites in grey). (Italian data Buccalleto
and Catalano 2003; Buccalleto et al. 2008; Catalano 2008; Catalano et al. 2001; Egidi et al.
2003; Musco et al. 2008. British data Baldock 3, Hertfordshire (Roberts 1984); Kempston,
Bedfordshire (Boylston and Roberts 2000)).
site serving a small town and the surrounding rural population). Poundbury Camp
is an unusual site in Roman Britain in that the infants and children show exceptional
levels of a variety of metabolic diseases and trauma when compared to other sites in
Roman Dorset and Britain (Redfern 2007). Ongoing work using stable isotope analysis
also suggests that many of the sick infants were malnourished, and therefore, the results
should be understood in their wider context (Redfern et al. in prep.).
To provide more detail for the London sites Figure 5 shows an age-related breakdown
of the prevalence of cribra orbitalia. Unfortunately, comparative data was not available
for Rome. Note that Figure 5 does not provide information concerning whether these
lesions were active or healing at the time of death (see above), therefore we do not
know the age of on-set of this condition, particularly for those older children. What this
does show is that some infants from Roman London are displaying lesions prior to six
months of age and this may be potentially significant in terms of child-care practices
(see below).
32
60
CPR (%) Cribra Orbitalia
50
40
30
20
10
<18 years
12-17 years
6-11 years
1-5 years
7-11 months
1-6 months
Perinatal
Figure 5. Crude prevalence rate (CPR%) of cribra orbitalia by age-group in Roman London
(WORD database).
Discussion
Effectively London is an anomaly in Britain, while Rome is not necessarily so for Italy.
This suggests that although living in a city environment did result in a compromised
health status, other factors must be at play. We cannot simply interpret these differences
in terms of urban/rural or small/large town and city divides (e.g. Fang et al. 2009),
because the pattern does not follow the situation is clearly more complex than this,
as contemporary studies of health show (e.g. Farmer 2003).
It has been observed that cribrotic lesions and enamel hypoplastic defects begin
to manifest around the time of weaning due to the synergistic relationship between
pathogen exposure and poor weaning diet (Katzenberg et al. 1996). Medical advice
from ancient Rome recommended that infants were to be exclusively breast fed until
approximately the second half of the first year when transitional feeding would begin
with the introduction of cereals (Prowse et al. 2008; Rawson 2003, 730, 126). Stable
isotope investigations of bones and teeth provide another method of determining when
breast-feeding ceased (Fuller et al. 2006a, Herring et al. 1998; Katzenberg et al. 1996).
Available weaning data in Roman cemeteries from Britain, Italy and Egypt suggest that
the majority of infants were weaned around three years of age (Dupras and Tocheri
2007; Fuller et al. 2006b; Prowse et al. 2008). Breast milk is low in iron and the infant is
reliant on foetal iron stores up until approximately six months of age, by which time
they become depleted. Iron from a cereal-based diet is difficult for infants to absorb.
33
In addition phytates from the cereal inhibit the absorption of iron from other sources
(Katzenberg et al. 1996; Stuart-Macadam and Dettwyler 1995; Stuart-Macadam and Kent
1992). It has been suggested by other authors that such a weaning diet is likely to be
responsible for the levels of cribra orbitalia observed in the Italian sites (e.g. Facchini et
al. 2004). However, the presence of these lesions prior to six months (see Fig. 5), before
transitional feeding is likely to have commenced, indicates that foetal stores of nutrients
may have been insufficient a result also supported by the presence of other deficiency
diseases, such as rickets (vitamin D) and scurvy (vitamin C) in the London subadult
population generally (WORD database 2010). This would occur if maternal health and
nutritional status was poor, but would also arise if infant care was not optimum in
terms of breastfeeding practices or hygiene (Brickley and Ives 2008; Katzenberg et al.
1996; Stuart-Macadam and Dettwyler 1995; Stuart-Macadam and Kent 1992).
It seems improbable that maternal health and childrearing practices were so markedly
different in Londinium compared to other urban and rural centres within Roman Britain
to result in such stark health disparities between them. It seems that other explanatory
factors should also be considered. A key issue that must be addressed in the context of
Roman Britain is immigration. London is unusual amongst Romano-British towns in
that it grew from nothing at the start of the Roman period it was entirely a creation
of the Roman Empire (Perring and Brigham 2000, 157). Furthermore, Londinium was
an important frontier metropolis at the periphery of the Roman World (Perring and
Brigham 2000, 157) and it is thought likely that a substantial portion of the population
were migrants from overseas. Foreign craft specialists and traders flooded into the
town in the early centuries (Mattingly 2006, 294), and evidence from inscriptions
suggests that, in comparison with other towns in Roman Britain, London was much
more cosmopolitan and dominated by Roman citizens and officials (Millett 1996; Wilkes
1996). The River Thames provided a direct route and link with the Continent and Millett
(1996) has suggested that many inhabitants would have come from other Romanised
provinces. Limited research has been conducted to corroborate the historical evidence
concerning immigration, although some preliminary (unpublished) skeletal and isotopic
analysis have provided evidence for the multicultural nature of Roman London, with
individuals identified as having come from the Mediterranean. Elsewhere in Britain,
subadult and adult migrants from Europe, North Africa and other areas of the Empire
have been identified, reflecting the role of the military in colonisation (Chenery et al.
2010; Evans et al. 2006; Leach et al. 2009; Richards et al. 1998).
As discussed earlier, lesions such as cribra orbitalia and linear enamel hypoplasias
relate to childhood physiological stresses (Humphrey and King 2000; see also Wood et
al. 1992). As mentioned, these lesions tend to be high in Mediterranean populations
as a possible consequence of endemic malaria, but are less common in sites in
Britain. The extremely elevated levels of both of these lesions in adult skeletons from
Londinium when compared to the rest of Roman Britain may have no bearing on
living conditions and diet in London at all (Redfern and Roberts 2005). Instead, they
may provide further substantiation that a significant proportion of the population
of London were not indigenous to the City, but instead grew up and migrated from
those areas of the Mediterranean where these lesions are more commonly observed
(e.g. Angel 1966). A further aspect of the data that may support this is that, while the
34
overall cribra prevalence is 55%, the prevalence rates amongst the subadults alone is
substantially lower at 25.5%. Usually this trend is reversed, reflecting the healing of
these lesions into adulthood (Walker et al. 2009). However, this could be explained
if the lesions in the children reflect the fact that they were born and lived their short
lives in London, whereas their (in some instances) migrant parents were exposed to
the kind of environments during childhood where cribra orbitalia is more commonly
recorded (such as the Mediterranean).
Conclusion
When we compare the skeletal evidence from two cities, at the centre and margin of
the Roman world, we are struck by similarities in terms of the levels of health stress
observed. This demonstrates that these very large settlements negatively impacted on
health, and supports the observations for poor urban health in the Roman medical texts
(Jackson 2000, 38). It would be tempting to conclude that these prevalence rates relate
solely to the toxic nature of pre-industrial urban environments (Storey 1992), with the
slightly lower figures from London reflecting the less densely populated nature of
this environment compared to Rome. However, it is only when we contextualise these
data by comparison with other published samples from Italy and Britain that we see
that the pattern is more complex than this. With respect to Italy, comparable levels
of health stress are frequently observed at other sites of the same date. These sites
incorporate a range of settlement types including those in more rural areas. Indeed it
is surprising that Rome, the largest and most densely populated urban centre at this
time, is not particularly anomalous in terms of the prevalence of these particular health
stress indicators.
By contrast, a particularly striking feature of this analysis is that, while overall the
prevalence of health stress indicators observed in London are lower than in Rome,
they are substantially higher than any other Romano-British site in terms of both of
cribra orbitalia and enamel hypoplasias. The exceptionally high levels of health stress
at Londinium are not remotely matched by other urban centres or rural areas within
the province. We argue that one likely explanation for the anomalous nature of the
skeletal evidence from Londinium is the substantial migrant population (as indicated
by other archaeological and historical evidence). We suggest that the health stress
indicators recorded are not reflecting life within Londinium, but a childhood which
for a significant proportion of the adult population resided outside of Britain most
probably in the Mediterranean. We argue that further evidence to support this lies in
the lower prevalence of cribra orbitalia in subadults, who are more likely to have lived
their lives within Londinium, compared to adults.
Migration and core-periphery disparities in health have been identified as key impacts
on health in the clinical literature for many years, although cross-cultural differences
and economic factors have been identified as mitigating forces (e.g. Stillman et al. 2010;
Vuorinen et al. 1988). Therefore, based on the findings of our preliminary study, we
conclude that migration played a key role in the health of Roman communities in the
Empire, particularly those in large settlements, which we know were a focus for forced
and free migrants (Adkins and Adkins 1998). However, addressing this question relies
35
on additional research in many areas of Roman archaeology, concerning settlement

patterns, trade routes and military activity. With respect to bioarchaeology, much more
research needs to be undertaken on the ethnic composition of the population in Roman
cemeteries if we are to be on a firmer footing when interpreting these indicators of health
stress, and indeed the skeletal evidence generally. Future isotopic, skeletal and funerary
analyses should contribute to a greater understanding of this important issue.
Acknowledgements
We wish to thank the reviewers and editor for their constructive comments which
aided in the revision of this text. RR would like to acknowledge the help of Jenny
Hall and Roy Stephenson (MoL) and her colleagues past and present at the Centre
for Human Bioarchaeology and Museum of London Archaeology for their work on
the WORD database. RG would like to thank Professor Peter Garnsey (University of
Cambridge), the British Academy and, finally, Dr Tim Thompson (Teesside University)
for commenting on an earlier draft of this paper. Any errors remain our own.
Received February 2010, revised manuscript accepted May 2010.
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Childhood in the Past 3, 2010, 1542

Childhood Health in the Roman World:

Rebecca Gowland and Rebecca Redfern

Childhood and Bioarchaeology

Rebecca Gowland and Rebecca Redfern

Childhood Health in the Roman World

Rebecca Gowland and Rebecca Redfern

Childhood Health in the Roman World

Rebecca Gowland and Rebecca Redfern

Skeletal and Dental Stress Indicators

Childhood Health in the Roman World

Linear Enamel Hypoplasias

Rebecca Gowland and Rebecca Redfern

Londinium and Roman Britain

Childhood Health in the Roman World

Cemetery name and site code

Table 1: Data derived from the Roman London cemeteries (http://www.museumoflondon.org.

Rebecca Gowland and Rebecca Redfern

Childhood Health in the Roman World

Rebecca Gowland and Rebecca Redfern

Physiological Indicators of Poor Health

Childhood Health in the Roman World

Rebecca Gowland and Rebecca Redfern

TPR (%) Enamel Hypoplasia

Childhood Health in the Roman World

TPR (%) Cribra Orbitalia

Rebecca Gowland and Rebecca Redfern

CPR (%) Cribra Orbitalia

Childhood Health in the Roman World

Rebecca Gowland and Rebecca Redfern

Childhood Health in the Roman World

on additional research in many areas of Roman archaeology, concerning settlement

Rebecca Gowland and Rebecca Redfern

Childhood Health in the Roman World

Rebecca Gowland and Rebecca Redfern

Childhood Health in the Roman World

Legasse, A. 1973. Gada. New York: Free Press.

Rebecca Gowland and Rebecca Redfern

Panter-Brick, C. (ed.) 1998. Biosocial Perspectives on Children. Cambridge: Cambridge University

Childhood Health in the Roman World

Rebecca Gowland and Rebecca Redfern

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