Life and Death in a Medieval Nubian Farming Community: the Experience at Mis Island

Home , Christianity in Sudan, Kulubnarti, Lower Nubia, Meinarti

LIFE AND DEATH IN A MEDIEVAL NUBIAN FARMING COMMUNITY: THE EXPERIENCE AT MIS ISLAND

Angela Soler

A DISSERTATION

Submitted to Michigan State University in partial fulfillment of the requirements for the degree of

DOCTOR OF PHILOSOPHY

Anthropology

2012

ABSTRACT

LIFE AND DEATH IN A MEDIEVAL NUBIAN FARMING COMMUNITY: THE EXPERIENCE AT MIS ISLAND

Angela Soler

Ancient Nubia, located in Sudan from the First to Sixth Cataracts of the Nile River, was at the heart of contact between indigenous African societies and the Egyptian Empire (Edwards

2007). This dissertation focuses on a small farming community on the fringes of the medieval

Nubian Christian Kingdom of Makuria, dating from the mid-fifth to the early fifteenth centuries

AD. The medieval Nubian era is characterized by an early period of political unification, economic prosperity, and strong political relations with Muslim Egypt that lasted for hundreds of years. However, as the medieval Nubian era continued, the political and economic situation gradually dissolved and political ties with Muslim Egypt became strained. Warfare increased, communities dissolved into feudal strongholds, and the Nubian Kingdoms struggled with political instability and crumbling power, until the Kingdom of Makuria eventually fell to

Muslim control in the early fifteenth century AD.

In 2006 and 2007 the Sudan Archaeological Research Society and The British Museum excavated three medieval Nubian Christian cemeteries located on Mis Island in the Fourth

Cataract of the Nile. This research focuses on a sample of 406 individuals excavated from two of these cemeteries. Cemetery 3-J-11 was used throughout the entire medieval period and dates from approximately AD 300 to AD 1400. Cemetery 3-J-10 represents only late medieval burials and dates to approximately AD 1100 to AD 1500. The main focus of this research is on the

skeletal health of a sample of 219 adults from cemeteries 3-J-10 and 3-J-11 at Mis Island.

Paleopathological indicators of stress, such as linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis, periostitis, and specific infectious diseases are analyzed according to adult age and sex cohorts. These findings are then compared to a medieval site in northern Nubia for an understanding of regional variability in the health of medieval Nubians. In addition, the use of mortuary space in the Mis Island cemeteries are analyzed to determine if there are any statistical patterns according to cemetery chronology or age and sex and whether mortuary practices reflect more communal, familial, or individualized social structures.

Results demonstrate that there are high prevalences for many skeletal indicators of stress, including porotic hyperostosis, cribra orbitalia, linear enamel hypoplasias, periostitis, and maxillary sinusitis. Despite high frequencies however, many of the adults exhibit well-healed lesions with minimal expressions, indicating that there is a demonstrated ability to adapt and survive both childhood and adult stressors. Furthermore, mortuary archaeology results demonstrate that there are different organizing principles governing the burial of individuals at cemeteries 3-J-10 and 3-J-11, indicating two different groups. While the meaning behind these distinctions in mortuary treatment remains unclear, the differences did not affect the skeletal health of individuals. Adults from both cemeteries 3-J-10 and 3-J-11 demonstrate the same overall prevalence rates of skeletal stress and there is no significant difference in health between the two sites. Therefore, the environmental and cultural stressors affected the overall population at Mis Island equally, regardless of their membership in specific sex or burial groups. A comparison of these results from sites in northern Nubia demonstrate that health in the remote farming community at Mis Island was particularly harsh and remained relatively stable despite the larger political and social changes happening throughout the greater Nubian Kingdoms.

ACKNOWLEDGEMENTS

Obtainment, curation, and ongoing research of the Mis Island Skeletal Research

Collection, now housed at Michigan State University (MSU), is entirely reliant upon the hard work of a number of dedicated individuals. Each of these individuals must be independently recognized, as this dissertation would not have been possible without their efforts. First, a large thanks to The British Museum and Sudan Archaeological Research Society for their commitment to preserving the artifacts and remains of the Nubian peoples located near the Fourth Cataract of the Nile River. Furthermore, a special thanks to archaeology teams from the Sudan

Archaeological Research Society, The British Museum, and Michigan State University, and lead archaeologist Andrew Ginns responsible for the detailed excavation of the cemetery sites and human skeletal remains presented in this research. Derek Welsby, director of the Sudan

Archaeological Research Society, deserves particular acknowledgement for his trust in MSU bioarchaeology researchers and transfer of the collection to the MSU laboratory. In addition, the support team from The British Museum, such as Rebecca Redfern, Daniel Antoine, and Rebecca

Green also deserve appreciation for their advice during the transfer of the collection, initial research on the remains, and creation of the database. In addition, the financial and academic support of the MSU School of Criminal Justice, and director Dr. David Foran, were integral in the obtainment of this skeletal collection. Last but certainly not least, an enthusiastic thanks to

Dr. Bob Hitchcock, Chair of the MSU Department of Anthropology, for his support for the Mis

Island Nubian Research Collection. The current dissertation and future research produced from this collection is directly due to your determination and efforts. Thank you.

At MSU, the team of students responsible for the cleaning, curation, and research of the

Mis Island Skeletal Research Collection must be recognized for their hard work and enthusiasm.

Graduate students Julie Fleischman, Ashley Kendell, Emily Niespodziewankski, Jen Vollner,

Carolyn Hurst, and Kacie Miner were an incredible help and relieved me of the daily stress of managing a large bioarchaeology laboratory. In addition, undergraduate student volunteers were an invaluable resource and this project would not have been possible without their assistance and dedication to the project. Justin Maiers, Janet Finlayson, Neysa Grider-Potter, Amy Junewick,

Jeff Lambert, Lori Mallon, Jessica Osborne, Katie Phalen, Erica Christensen, Lauren Charlton,

Abigail Grande, Mari Isa, Brooke Heikkila, Valerie Leah, Shannon Leary, Paige Wojcik, Dan

Wright and Margaret Zywicki: thank you so much for your efforts in the lab. It was a joy to work with each and every one of you.

I would like to acknowledge my committee members for their invaluable advice and direction throughout my graduate career and for assistance with the completion of this dissertation: Dr. Todd Fenton, Dr. Norm Sauer, Dr. Jon Frey, Dr. Bob Hitchcock, and Dr. Lynne

Goldstein. The immense support and contributions of my entire committee made this dissertation study possible. Appreciation is owed to Dr‟s Goldstein, Sauer, and Hitchcock for their encouragement through the years. A special thanks to Dr. Jon Frey for keeping me level-headed and sane throughout the whole process. Your insight and support helped me keep me on track when I began to waver. In addition, I would like to thank Dr. Julie Anderson of The British

Museum, for agreeing to be an adjunct committee member and for sharing your immeasurable knowledge of medieval Nubian archaeology and history. I appreciate all of your feedback over the years and thank you for being a guiding light in the initial stages of my research.

In particular, I would like to thank my chair, Dr. Todd Fenton, for his energy, dedication, and friendship over the years. Thank you for all of the wonderful opportunities that wouldn‟t have been possible without your support. My tenure at MSU was a joy and I will truly miss working with you. Finally, I would like to say a collective thanks to all of the graduate students at MSU for their support and friendship when I needed it most, especially Carolyn Hurst, Jared

Beatrice, Cate Bird, and Colleen Milligan. Everyone needs good friends to get them through graduate school and writing a dissertation, and I was lucky enough to have four incredible people by my side.

A number of people provided me with immeasurable assistance throughout the dissertation and merit additional thanks. Cindy Craig, in particular, deserves recognition for all of her hard work and efforts creating the ArcGIS maps presented in this dissertation. Cindy‟s expertise in ArcGIS contributed significantly to creating a more holistic research product.

Thanks so much for everything Cindy, as I couldn‟t have done it without you! Also, an additional thanks to Andrew Gins for sharing his detailed site maps for the ArcGIS component of this study. In addition, I would like to express my gratitude to Brian Spatola, from the National

Museum of Health and Medicine, for providing his advice and expertise on the paleopathological conditions of the remains presented in this research. Finally, Paul Curran from the MSU Center for Statistical Training and Consulting deserves warm thanks for providing me with statistical training and counsel related to this dissertation.

Last but not least, I would like to thank my family and friends for their patience over the years. Thanks for being my biggest supporters and helping me through this process. Your strength and love got me through some of the toughest years of graduate school and I wouldn‟t have made it this far without each of you!

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TABLE OF CONTENTS

LIST OF TABLES……………………………………………………………………………...... xi

LIST OF FIGURES……………………………………………………………………………..xvi

CHAPTER ONE INTRODUCTION………………………………………………………………………………...1 Introduction to the Research Goals………………………………………………………..5 An Outline of the Present Study…………………………………………………………..6

CHAPTER TWO THE FOUNDATIONS OF BIOARCHAEOLOGY AND MORTUARY ARCHAEOLOGY………………………………………………………………………………...8 The Multidisciplinary Analysis of Burials and Human Remains…………………………8 Bioarchaeological Approaches to Health and Disease…………………………………..10 Skeletal Indicators of Stress and Disease………………………………………...12 Limitations in Paleopathology Research………………………………………...22 Mortuary Archaeology Theory…………………………………………………………..26 Mortuary Archaeology: A Historical Review……………….…………….….….27

CHAPTER THREE MEDIEVAL NUBIA…………………………………………………………………………….35 The Medieval Nubian Phases………………………………………………………….…37 Transitional Phase (AD 550-600)………………………………………………..37 Early Phase (AD 600-850)……………………………………………………....39 Classic Medieval Phase (AD 850-1100)…………………………………………41 Late Medieval Phase (AD 1100-1400)…………………………………………..43 Terminal Medieval Phase (AD 1400-1500)……………………………………...45 Mortuary Archaeology of Medieval Nubia………………………………………………46 Medieval Nubian Mortuary Patterns……………………………………………..47 Paleopathology Studies of Medieval Nubia……………………………………………...53 The Natural Environment as it Relates to Health in Medieval Nubia…………...59

CHAPTER FOUR RESEARCH SAMPLE, QUESTIONS AND HYPOTHESES………………………………….73 The Mis Island Research Sample………………………………………………………...74 The Kulubnarti Comparative Research Sample………………………………………….80 Research Questions and Hypotheses…………………………………………………….82

CHAPTER FIVE METHODS………………………………………………………………………………………90 Osteological Data Collection…………………………………………………………….90 The Biological Profile…………………………………………………………....90 Paleopathology and Indicators of Stress and Disease…………………………....95

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Paleopathology Prevalence Rates and Statistical Analyses………….…………101 Mortuary Data Collection………………………………………………………………101 The Mortuary Variables………………………………………………………...102

CHAPTER SIX MORTUARY RESULTS…………………………………………………...………………….111 Cemetery 3-J-10………………………………………………………………….……..112 Cemetery Demography……………………………………………………...... 113 Spatial and Statistical Analyses: Age and Sex………………………………….114 Spatial Analysis: Skeletal Indicators of Stress………………………………….133 Cemetery 3-J-11……………………………………………………………………..….135 Cemetery Demography……………………………………………………...... 138 Spatial and Statistical Analyses: Diachronic Change…………………………..139 Spatial and Statistical Analyses: Age and Sex……………………………...... 151 Spatial and Statistical Analyses: Burial Clusters……………………………….159 Spatial Analysis: Skeletal Indicators of Stress………………………………………….171 A Comparison between Cemeteries 3-J-10 and 3-J-11…………………………………174

CHAPTER SEVEN OSTEOLOGY RESULTS……………………………………………………………………...179 Cemetery 3-J-10………………………………………….…………………………181 Demography………………………….…………………..……………………..181 Skeletal Indicators of Stress and Disease…………………………………...... 184 Cemetery 3-J-11…………….…………………………………………………………..194 Transitional Christian Burials: Demography…………………………………...195 Transitional Christian Burials: Skeletal Indicators of Stress and Disease……...196 Non-Transitional Christian Burials: Demography……………………………...200 Non-Transitional Christian Burials: Skeletal Indicators of Stress and Disease………………………………………………………………….202 A Comparison of Transitional and Christian Burials…………………………..215 A Comparison of Burial Clusters at Cemetery 3-J-11………………………….218 A Comparison of Cemeteries 3-J-10 and 3-J-11…………………………………....222 Demography…………………………………………………………………….222 Skeletal Indicators of Stress and Disease……………………………………….224 Placing Mis Island within a Regional Context: A Comparison to Kulubnarti……...... 236

CHAPTER EIGHT DISCUSSION ………………………………………………………………………………….243 A Discussion of the Mortuary Results………………………………………………….243 The Concept of Community Identity and Age at Cemetery 3-J-10…………...... 244 The Concept of Family or Clan Identity at Cemetery 3-J-11………………...... 251 A Transition from Family to Community Identity at Medieval Mis Island………..256 A Discussion of the Osteology Results………………………………………………....261 Summary………………………………………………………………………………..275

CHAPTER NINE CONCLUSIONS……………………………………………………………………………….277 Future Research………………………………………………………………………...285

APPENDICES………………………………………………………………………………….287 Appendix A- Mortuary Photographs…………………………………………………...287 Appendix B- Paleopathology Photographs……………………………………………..293

REFERENCES………..………………………………………………………………………..307

Table 1: Sudanese Chronological Phases………………………………………………………..38

Table 2: Lower vs. Middle Nubian Mortuary Complex…………………………………………53

Table 3: Mis Island Mortuary and Skeletal Samples…………………………………………….73

Table 4: Kulubnarti Adult Skeletal Sample……………………………………………………...73

Table 5: Age Groups, Associated Summary Age Ranges, and Kulubnarti Comparative Age Ranges……………………………………………………………………………………...95

Table 6: Cemetery 3-J-10 Age Demographics………………………………………………….114

Table 7: Cemetery 3-J-10 Sex Demographics………………………………………………….114

Table 8: Age Distribution of Monuments at Cemetery 3-J-10…………………………………118

Table 9: Age Distribution of Head Coverings at Cemetery 3-J-10…………………………….120

Table 10: Age Distribution of Body Position at Cemetery 3-J-10……………………………...124

Table 11: Age Distribution of Head Orientation at Cemetery 3-J-10…………………………..125

Table 12: Age Distribution of Leg Position in Cemetery 3-J-10……………………………….125

Table 13: Statistical Relationship Between Adult Age Cohorts and Burial Style……………...130

Table 14: Statistical Relationship Between Adult Sex Cohorts and Burial Style………………132

Table 15: Cemetery 3-J-11 Age Demographics………………………………………………...139

Table 16: Cemetery 3-J-11 Sex Demographics………………………………………………...139

Table 17: Chi-Square Tests Between Age Groups and Burial Style.….……………………….155

Table 18: Chi-Square tests between Males and Females and Burial Style..……………………156

Table 19: Age Distribution of Monument Types in Christian Graves at Cemetery 3-J-11…….158

Table 20: Age Distribution of Head Coverings at Cemetery 3-J-11…………………………...159

Table 21: Demographic Profiles of Cemetery 3-J-11 Burial Clusters………………………….165

Table 22: Demographic Profiles of Cemetery 3-J-11 Burial Clusters…………………….……165

Table 23: Frequency of Monuments in Burial Clusters at Cemetery 3-J-11……………...……167

Table 24: Frequency of Blocking Stones in Burial Clusters at Cemetery 3-J-11………………169

Table 25: Frequency of Head Coverings in Burial Clusters at Cemetery 3-J-11………………170

Table 26: Distribution of Body Position in Burial Clusters at Cemetery 3-J-11………….……175

Table 27: Number and Frequency of Blocking Stones at Mis Island……………………..……176

Table 28: Number and Frequency of Monuments at Mis Island………………………….……176

Table 29: Number and Frequency of Head Coverings at Mis Island……………………..……176

Table 30: Number and Frequency of Head Stone Types at Mis Island…………………...……176

Table 31: Number and Frequency of Body Orientation at Mis Island…………………………176

Table 32: Number and Frequency of Head Orientation at Mis Island…………………….……177

Table 33: Number and Frequency of Personal Adornment at Mis Island………………...……177

Table 34: Cemetery 3-J-10 Age Demographics…………………………………………...……182

Table 35: Cemetery 3-J-10 Adult Age and Sex Demographics…………………………...……182

Table 36: Frequency of Cribra Orbitalia in Males and Females at Cemetery 3-J-10………..…185

Table 37: Frequency of Cribra Orbitalia in Adults at Cemetery 3-J-10……………………..…185

Table 38: Frequency of Porotic Hyperostosis in Males and Females at Cemetery 3-J-10……..186

Table 39: Frequency of Porotic Hyperostosis in Adults at Cemetery 3-J-10………………..…186

Table 40: Frequency of LEH in Adults at Cemetery 3-J-10……………………………………187

Table 41: Frequency of LEH in Males at Cemetery 3-J-10………………………………….…188

Table 42: Frequency of LEH in Females at Cemetery 3-J-10……………………………….…188

Table 43: Frequency of LEH among Adult Age Cohorts at Cemetery 3-J-10…………………189

Table 44: Frequency of Periostitis in Males and Females at Cemetery 3-J-10…………...……190

Table 45: Frequency of Periostitis in Adults at Cemetery 3-J-10………………………………190

Table 46: Frequency of Maxillary Sinusitis in Males and Females at Cemetery 3-J-10……….191

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Table 47: Frequency of Maxillary Sinusitis in Adults at Cemetery 3-J-10………………….…191

Table 48: Frequency of Possible Tuberculosis in Males and Females at Cemetery 3-J-10...... 192

Table 49: Cemetery 3-J-11 Age Demographics: Transitional Burials……………………….…196

Table 50: Cemetery 3-J-11 Adult Age and Sex Demographics: Transitional Burials………….196

Table 51: Frequency of Cribra Orbitalia in Adults: 3-J-11 Transitional Burials……………….197

Table 52: Frequency of Porotic Hyperostosis in Adults: 3-J-11 Transitional Burial…...... ……197

Table 53: Frequency of LEH in Adults: 3-J-11 Transitional Burials…………………..………198

Table 54: Frequency of Periostitis in Males and Females: 3-J-11 Transitional Burials………..199

Table 55: Frequency of Maxillary Sinusitis: 3-J-11Transitional Burials………………………200

Table 56: Cemetery 3-J-11 Age Demographics: Christian Burials…………………………….201

Table 57: Cemetery 3-J-11 Adult Age and Sex Demographics: Christian Burials…………….201

Table 58: Frequency of Cribra Orbitalia in Males and Females: 3-J-11 Christian Burials…….203

Table 59: Frequency of Cribra Orbitalia in Adults: 3-J-11 Christian Burials………………….203

Table 60: Frequency of Porotic Hyperostosis in Males and Females: 3-J-11 Christian Burials…………………………………………………………………………………………..204

Table 61: Frequency of Porotic Hyperostosis in Adults: 3-J-11 Christian Burials……….……204

Table 62: Frequency of LEH in Adults: 3-J-11 Christian Burials………………………...……205

Table 63: Frequency of LEH in Males: 3-J-11 Christian Burials………………………………206

Table 64: Frequency of LEH in Females: 3-J-11 Christian Burials……………………………206

Table 65: Frequency of LEH among Adult Age Cohorts: 3-J-11 Christian Burials………...…207

Table 66: Frequency of Periostitis in Males and Females: 3-J-11 Christian Burials……...……208

Table 67: Frequency of Periostitis in Adults: 3-J-11 Christian Burials……………………...…209

Table 68: Frequency of Maxillary Sinusitis in Males and Females: 3-J-11 Christian Burials…………………………………………………………………………………………..210

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Table 69: Frequency of Maxillary Sinusitis in Adults: 3-J-11 Christian Burials………………210

Table 70: Frequency of Probable Tuberculosis in Males and Females: 3-J-11 Christian Burials…………………………………………………………………………………………..211

Table 71: Frequency of Probable Tuberculosis in Adults: 3-J-11 Christian Burials…………...211

Table 72: Frequency of Cribra Orbitalia at Cemetery 3-J-11…………………………………..216

Table 73: Frequency of Porotic Hyperostosis at Cemetery 3-J-11……………………………..216

Table 74: Frequency of LEH on Maxillary Canines at Cemetery 3-J-11………………………216

Table 75: Frequency of LEH on Mandibular Canines at Cemetery 3-J-11…………………….216

Table 76: Frequency of Periostitis at Cemetery 3-J-11………………………………………...217

Table 77: Frequency of Maxillary Sinusitis at Cemetery 3-J-11……………………………….217

Table 78: Frequency of Probable Tuberculosis at Cemetery 3-J-11……………………………217

Table 79: Demographic Profiles of Cemetery 3-J-11 Burial Clusters………………………….220

Table 80: Demographic Profiles of Cemetery 3-J-11 Burial Clusters………………………….220

Table 81: Skeletal Indicators of Stress in Cemetery 3-J-11 Burial Clusters……………………221

Table 82: A Comparison of Age and Sex Cohorts at Mis Island……………………………….223

Table 83: Frequency and Prevalence Rates at Mis Island……………………………………...225

Table 84: Frequency and Prevalence Rates for Males at Mis Island…………………………...227

Table 85: Frequency and Prevalence Rates for Females at Mis Island………………………...229

Table 86: Frequency and Prevalence Rates for Young Adults at Mis Island…………………..231

Table 87: Frequency and Prevalence Rates for Middle Adults at Mis Island………………….233

Table 88: Frequency and Prevalence Rates for Old Adults at Mis Island……………………...235

Table 89: Number and Frequency of Individuals in Adult Sex Cohorts……………………….237

Table 90: Number and Frequency of Individuals in Adult Age Cohorts……………………….237

Table 91: Frequency of Cribra Orbitalia in Adults at Mis Island and Kulubnarti………….…..239

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Table 92: Statistical Relationship for Prevalence Rates of Cribra Orbitalia at Mis Island and Kulubnarti………………………………………………………………………………………240

Table 93: Frequency and Prevalence of Maxillary Sinusitis at Mis Island and Kulubnarti……242

Table 94: Overall Frequency and Prevalence of Indicators of Health at Mis Island…………...265

Table 95: Severity of Cranial Lesions in the Mis Island Combined Sample………………...…272

Table 96: Severity of Periosteal Lesions in the Mis Island Combined Sample……………...…273

Table 97: Stages of Lesion Activity in Non-Specific Indicators of Stress at Mis Island………274

LIST OF FIGURES

Figure 1: Medieval Nubia…………………………………………………..……………………74

Figure 2: Map of the Fourth Cataract Archaeological Concessions…..…………………………76

Figure 3: Cemetery 3-J-10 site map……………………………………………………………...77

Figure 4: Cemetery 3-J-11 site map……………………………………………………………...79

Figure 5: MDSP Grave Monuments……………………………………………………………104

Figure 6: Grave Monument Type X10………………………………………………………….104

Figure 7: Overview of Excavated Burials at Cemetery 3-J-10…………………………………113

Figure 8: Spatial Distribution of Subadult and Adult Burials at Cemetery 3-J-10……………..116

Figure 9: Spatial Distribution of Monument Types at Cemetery 3-J-10……………………….117

Figure 10: Spatial Distribution of Head Coverings at Cemetery 3-J-10………………………..119

Figure 11: Spatial Distribution of Body Position at Cemetery 3-J-10………………………….121

Figure 12: Spatial Distribution of Head Orientation at Cemetery 3-J-10………………………122

Figure 13: Spatial Distribution of Leg Position at Cemetery 3-J-10…………………………...123

Figure 14: Spatial Distribution of Personal Adornment at Cemetery 3-J-10…………………...126

Figure 15: Spatial Distribution of Grave Goods at Cemetery 3-J-10…………………………..128

Figure 16: Spatial Distribution of Adult Age Cohorts at Cemetery 3-J-10…………………….129

Figure 17: Spatial Distribution of Males and Females at Cemetery 3-J-10…………………….131

Figure 18: Spatial Distribution of Maxillary Sinusitis at Cemetery 3-J-10…………………….134

Figure 19: Spatial Distribution of Periostitis at Cemetery 3-J-10………………………………135

Figure 20: Overview of Excavated Graves at Cemetery 3-J-11………………………………..137

Figure 21: Spatial Distribution of Blocking Stones at Cemetery 3-J-11……………………….141

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Figure 22: Spatial Distribution of Blocking Stones with Monuments at Cemetery 3-J-11….…142

Figure 23: Spatial Distribution of Blocking Stones with Grave Goods at Cemetery 3-J-11…...143

Figure 24: Spatial Distribution of Grave Monuments at Cemetery 3-J-11……………………..146

Figure 25: Spatial Distribution of Head Coverings at Cemetery 3-J-11………………………..147

Figure 26: Spatial Distribution of Personal Adornment at Cemetery 3-J-11…………………...148

Figure 27: Spatial Distribution of Body Position at Cemetery 3-J-11………………………….149

Figure 28: Spatial Distribution of Leg Position at Cemetery 3-J-11…………………………...150

Figure 29: Spatial Distribution of Head Orientation at Cemetery 3-J-11………………………151

Figure 30: Distribution of Subadult and Adult Burials at Cemetery 3-J-11……………………152

Figure 31: Distribution of Adult Age Cohorts at Cemetery 3-J-11…………………………….153

Figure 32: Distribution of Adult Sex Cohorts at Cemetery 3-J-11……………………………..154

Figure 33: Burial Clusters at Cemetery 3-J-11…………………………………………………161

Figure 34: Distribution of Monuments in Burial Clusters at Cemetery 3-J-11………………...164

Figure 35: Distribution of Blocking Stones within Burial Clusters at Cemetery 3-J-11……….167

Figure 36: Distribution of Head Coverings in Burial Clusters at Cemetery 3-J-11…………….168

Figure 37: Distribution of Body Orientation in Burial Clusters at Cemetery 3-J-11…………...170

Figure 38: Distribution of Maxillary Sinusitis at Cemetery 3-J-11…………………………….172

Figure 39: Distribution of Periostitis at Cemetery 3-J-11………………………………………173

Figure 40: Distribution of Tuberculosis at Cemetery 3-J-11…………………………………...174

Figure 41: Adult Age Estimations for Males and Females at 3-J-10…………………………...183

Figure 42: Age Estimations by Sex in Non-Transitional Christian burials at 3-J-11…………..202

Figure 43: Frequency of Health Indicators at Cemetery 3-J-11………………………………..217

Figure 44: A Comparison of Demographic Profiles at Mis Island…………………………..…224

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Figure 45: Frequency of Each Indicator of Health in Adults at Mis Island…………………….226

Figure 46: Frequency of Each Indicator of Health in Males at Mis Island……………………..228

Figure 47: Frequency of Each Indicator of Health in Females at Mis Island…………………..230

Figure 48: Frequency of Each Indicator of Health in Young Adults at Mis Island…………….232

Figure 49: Frequency of Each Indicator of Health in Middle Adults at Mis Island……………234

Figure 50: Frequency of Each Indicator of Health in Old Adults at Mis Island………………..236

Figure 51: Frequency of Cribra Orbitalia in Adult Age Cohorts……………………………….239

Figure 52: Overview of Cemetery 3-J-10………………………………………………………287

Figure 53: Overview of Cemetery 3-J-11………………………………………………………288

Figure 54: Examples of Christian Stone and Mud Brick Box Monuments at Mis Island, Cemegtery 3-J-18B……………………………………………………………………………..288

Figure 55: Cemetery 3-J-11 Grave 3266 Skeleton 3265, Blocking Stones…………………….289

Figure 56: Cemetery 3-J-11, Example of Burial with Head Covering and Grave Goods……...289

Figure 57: Cemetery 3-J-10 Grave 5236 Skeleton 5235, Head Covering……………………...290

Figure 58: Cemetery 3-J-11 Grave 1420 Skeleton 1422, Child Laid on Right Side with No Structural Elaboration…………………………………………………………………………..291

Figure 59: Cemetery 3-J-10 Grace 5074 Skeleton 5070, Adult Laid Supine with no Structural Elaboration……………………………………………………………………………………...292

Figure 60: Cemetery 3-J-11 Skeleton 1158, LEH, Left Mandibular Canine, Labial View…….294

Figure 61: Cemetery 3-J-11 Skeleton 1158, LEH, Left Manidbular Canine, Distal View……..294

Figure 62: Cemetery 3-J-11 Skeleton 1077, Healed Porotic Hyperostosis, Posterior View of Cranium Surrounding Lambda…………………………………………………………………295

Figure 63: Cemetery 3-J-11 Skeleton 1041, Healed Cribra Orbitalia………………………….295

Figure 64: Cemetery 3-J-11 Skeleton 1086, Active Maxillary Sinusitis with Spicule formation, Left Maxillary Sinus……………………………………………………………………………296

Figure 65: Cemetery 3-J-11 Skeleton 1086, Active Maxillary Sinusitis with Spicule

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Formation, Right Maxillary Sinus…..………………………………………………………….296

Figure 66: Cemetery 3-J-11 Skeleton 1146, Osteomyelitis, Left Tibia Overview……………..297

Figure 67: Cemetery 3-J-11 Skeleton 1146, Osteomyelitis, Left Tibia, Anterior View of Cloaca…………………………………………………………………………………………..298

Figure 68: Cemetery 3-J-11 Skeleton 1146, Osteomyelitis, Left Tibia, Lateral View of Cloaca with Bone Formation…………………………………………………………………...299

Figure 69: Cemetery 3-J-11 Skeleton 1074, Lytic Lesion, Tuberculosis, Anterior Bodies T11-L3………………………………………………………………………………...... ….300

Figure 70: Cemetery 3-J-11 Skeleton 1074, Lytic Lesions, Tuberculosis, Lateral Bodies T11-L3………………………………………………………………………………………….300

Figure 71: Cemetery 3-J-11 Skeleton 1074, Periostitis, Tuberculosis, Left Ribs 10-12 and Right Ribs 11-12…..……………………………………………………………………………301

Figure 72: Cemetery 3-J-11 Skeleton 1077, Lytic Lesions, Tuberculosis, Anterior Bodies T12-L4………………………………………………………………………………………….301

Figure 73: Cemetery 3-J-11 Skeleton 1131, Pott‟s Disease with Vertebral Destruction and Collapse, Tuberculosis, Lateral Bodies T6-L1…………………………………………………302

Figure 74: Cemetery 3-J-11 Skeleton 1288, Lytic Lesion, Tuberculosis, Anterior Body L2…..303

Figure 75: Cemetery 3-J-11 Skeleton 1288, Lytic Lesions, Tuberculosis, Posterior Body L2...303

Figure 76: Cemetery 3-J-11 Skeleton 1466, Periostitis and Lytic Lesions, Possible Tuberculosis, Visceral Surface Right Rib Fragments…………………………………………..304

Figure 77: Cemetery 3-J-11 Skeleton 3265, Lytic Destruction of Tarsals and Foot Phalanges, Possible Leprosy. Photograph Provided by Rebecca Redfern…………………..……………...304

Figure 78: Cemetery 3-J-11 Skeleton 3265, Lytic Destruction of Foot Phalanges, Possible Leprosy. Photograph Provided by Rebecca Redfern………………..………………………….305

Figure 79: Cemetery 3-J-11 Skeleton 3265, Lytic Destruction of Metacarpal and Hand Phalanges, Possible Leprosy. Photograph Provided by Rebecca Redfern……………………...305

xix CHAPTER ONE: INTRODUCTION

Arabs and Muslims in the postmedieval world (Edwards 2007). The culture-history of Nubia began with human occupation in the Paleolithic and moved through many cultural phases, including, but not limited to, the Kerma Empire, the Kingdom of Kush, the X-Group, the

Medieval Nubian Kingdoms, and the Arab Muslims.

This research focuses on the medieval Nubian kingdoms, spanning roughly 1,000 years from the mid-sixth century to the early sixteenth century AD. There are three distinct Nubian kingdoms situated from north to south: Nobadia (First to Third Cataract), Makuria (Third to Fifth

Cataract), and Alwa (Below Fifth Cataract). Very little is known about early Makuria and Alwa with the majority of our knowledge from the kingdom of Nobadia in the north. All three Nubian kingdoms emerged in the mid-sixth century and show a high degree of cultural and biological continuity to the previous Kushite state (Trigger 1965; Welsby 2002; Greene 1982; Van Gerven et al. 1976). By the mid-sixth century the three kingdoms independently converted to

Christianity, maintaining close political and economic ties with Egypt (Adams 1977). However, in the seventh century, the Roman Byzantine Empire collapsed and Arab Muslims conquered most of Northeast Africa, leaving Nubia as one of the last political strongholds of Christianity.

Arab invasions into Nubia in the mid-seventh century were rebuffed by the Nubian military, but increased political tensions led to unification of the kingdoms of Nobadia and

Makuria under the Makurian King, and creation of the Nubian-Arab Baqt Treaty in AD 651.

Many archaeologists believe that the Baqt Treaty represented the Muslim‟s acceptance of the

Christian Nubian kingdoms as independent polities (Spaulding 1995). For the next few centuries,

Egyptian and Nubian relations were peaceful and the societies prospered. By the ninth century, economic and political ties resulted in a free-trade zone between northern Makuria and Egypt.

However, in the late eleventh and early twelfth centuries, the political situation in Nubia deteriorated. Archaeological and historical documents (Monneret de Villard 1938) demonstrate that in the Late Medieval period the entire Kingdom of Makuria was plagued by a number of internal power struggles. At the same time increasingly violent invasions from Egypt sapped the strength of Nubia (Hasan 1967). By the end of the twelfth century the medieval kingdoms were politically unstable and the continuous trading contacts with Egyptian Muslims resulted in an influx of Islamic and Arab religion and culture (Hasan 1967). Furthermore, Egyptians under the

Mameluks were becoming more aggressive in pursuing their economic interests along the Nile, in Nubian gold mines, and on Nubian grazing lands. Domestic infighting and international aggression from the twelfth to fourteenth centuries dissolved the entire region into anarchy. A combination of Arab infiltration, isolation from Christian contacts in the north, and

Muslim/Christian intermarriage likely caused the final demise of the Medieval Nubian kingdoms

(Vantini 1970). By the mid-fourteenth century Muslims ruled Makuria, and Alwa was conquered by the Funj Sultanate in the early sixteenth century.

A number of archaeological studies have focused on a variety of these aspects of medieval Nubian cultural history (Adams 1977), including the Christianization of the region

(Vantini 1981; Wheeler 1991; Edwards 2001), medieval Nubian material culture and identity

(Shinnie 1965; Adams 1977; Welsby 2002; Welsby and Anderson 2004; Edwards 2004, 2007),

and the collapse of the Medieval Nubian Kingdoms (Hasan 1967; Vantini 1970; Welsby 2002).

These archaeological studies have characterized the religious, economic, and political structures of the medieval Nubian kingdoms and their overall impact on the communities located in the northern regions of Nubia (Green et al. 1974; Adams 1977, 1994; Welsby 2002, 2006; Edwards

2004a). However, knowledge of these interactions in regions further south have not been a focus of investigation until more recently, as a result of the Merowe Dam project.

This study aims to use skeletal biology and mortuary archaeology as a means of understanding these processes in a community located far from the centers of political control and Egyptian influences. Bioarchaeology and the anthropological study of human skeletal remains couples an understanding of human biology, archaeology, and history to answer questions about past human behavior and adaptation. Bioarchaeology in medieval Nubia can document past life history and adaptation as shown in the human skeleton and the mortuary record. Despite the vast potential of bioarchaeological research, there are a small number of well- preserved skeletal collections and therefore, few sites have been studied to document the health of medieval Nubians. To date the most extensive investigation of life and death in a medieval

Nubian population has focused on the site of Kulubnarti, located between the Second and Third

Cataracts of the Nile River. A high prevalence of numerous childhood skeletal health indicators of stress in the Kulubnarti population have portrayed the medieval period in this region as a time of environmental hardship, with elevated levels of social, political, and environmental stressors directly affecting quality of life for the local inhabitants (Hummert and van Gerven 1983; Moore et al. 1986; van Gerven et al. 1990; Mittler and van Gerven 1994; van Gerven et al. 1995;

Adams et al. 1999; Turner 2007; Hibbs 2011). However, few other archaeological sites and skeletal collections have been investigated to the same extent as Kulubnarti, and thus a large-

scale understanding of life throughout Nubia during the medieval period is still scarcely understood.

However, in the late 1990‟s the National Corporation for Antiquities and Museums of

Sudan made an international appeal for assistance in a large-scale archaeological rescue operation in the Fourth Cataract region of the Nile River. The Merowe Dam, the largest dam project to date in Africa, was scheduled to flood about 170 kilometers along the Nile Valley from

Hamdab to Abu Hamed, resulting in the resettlement of thousands of people and the permanent loss of Sudanese cultural heritage. In 1999 the British Museum and Sudan Archaeological

Research Society joined an international campaign to survey and recover hundreds of sites in the

Fourth Cataract of the Nile Valley. In 2006 and 2007 a team of researchers from the British

Museum and Michigan Sate University worked to salvage the archaeological remains of Mis

Island, before the scheduled completion of the dam in 2009.

Mis Island, a small farming community in the Fourth Cataract of the Nile, was continuously occupied for thousands of years from the Meroitic, X-Group, and medieval periods through modern times, up until the flooding and creation of Lake Nubia in 2008. Two archaeological field seasons at Mis Island resulted in the survey and rescue of a number of medieval Christian habitations, a church, and the skeletal remains of over 500 Nubian individuals from three medieval Christian cemeteries. The present study focuses on the mortuary patterns and human remains from two of the three medieval cemeteries, 3-J-10 and 3-J-11, located on Mis Island. The resulting skeletal collection of over 400 individuals is one of the largest such collections in the world and is presently curated at the Michigan State University

Department of Anthropology, in East Lansing, Michigan.

This archaeological and skeletal data available from the rescue excavations at Mis Island provide a unique opportunity for an extensive investigation of life experience for Christian communities living on the fringes of the economic, social, and political centers of the medieval

Nubian kingdoms. The Fourth Cataract was in a rather isolated and protected region of the Nile, often noted for its role as a refuge during the political upheavals of the Late and Terminal medieval periods (Osman 1973; Welsby 2002, 2006). In addition, an integrated analysis of Mis

Island and Kulubnarti can provide a more comprehensive reconstruction of medieval Nubia, as well as a better understanding of how much local populations might have been affected by regional differences in the political, economic and social structure, and the surrounding natural environment.

INTRODUCTION TO THE RESEARCH GOALS

This study aims to use multiple lines of evidence, including osteological analyses, mortuary archaeology theory, and historical and regional context to contribute to a deeper understanding of life and death in a medieval population at Mis Island. While mortuary archaeology may provide contextual basis in the form of social organization and burial relationships between sex, age, and status groups, osteology may provide a biological perspective in the form of group differences in patterns of occupation, diet, and disease. An integrated analysis that interprets the skeleton as an individual, and then places the individual within the grave and the grave within a spatial perspective can assist in interpreting the larger social questions, as well as help define the meaning and substance of mortuary artifacts and burial practices (Whitely 2009). Therefore, an osteological investigation of health coupled with an examination of mortuary patterns can hopefully begin to reconstruct how the community at

Mis Island adapted to the environmental, political, and social pressures of the medieval period in

Nubia. The specific goals of the present research are as follows:

To interpret burial patterns at Mis Island in an effort to provide a contextual framework

for osteological analyses of the skeletal sample;

To interpret burial patterns in two cemeteries at Mis Island to better understand whether

the mortuary ritual reflected the underlying religious, social, political, and economic

organization of the medieval population;

To gain a bioarchaeological perspective of health through an analysis of skeletal

indicators of stress in a medieval Nubian farming community on the periphery of political

and economic power;

To conduct an analysis of life experience for males and females at Mis Island, as

reflected through any differences in the prevalence of skeletal indicators of health and

mortuary treatment;

To provide a regional perspective of health at Mis Island and in comparison to other

contemporaneous sites along the Nile River in medieval Christian Nubia.

AN OUTLINE OF THE PRESENT STUDY

The primary goal of this study is to provide some perspective on the environmental, social, economic, and political hardships affecting the medieval community at Mis Island.

Chapter Two presents a background on the theoretical concepts used in this study to investigate the larger effects of the natural and social environment upon the livelihood and health of the local community. An introduction to the concepts of the subfields of bioarchaeology and mortuary archaeology and a discussion of their integrative potential is provided. Chapter Three

presents a detailed background on the political, economic, and social history of the region, with an in-depth review of the major events characterizing the Early, Classic, and Late medieval

Nubian periods. An analysis of the Nubian Christian burial patterns and their relation to the underlying religious and social organizing principles of the medieval period is discussed. A synthesis of the bioarchaeological studies of health in the region and their portrait of life on the

Nile River in this period of history is also provided. Chapter Four is a brief overview of the research samples, research questions, and the guiding hypotheses of the present research. Next,

Chapter Five presents the methods and variables of study for both the bioarchaeological and mortuary archaeological analyses of the Mis Island community. Osteological variables, such as age, sex, and the various skeletal indicators of stress, as well as the mortuary variables, such as burial features and grave inclusions, are discussed in detail. The last four chapters include the results and final interpretations of life and death within the Mis Island community. Chapter Six is a presentation of the spatial and statistical results of burial patterns in the two cemeteries at Mis

Island, while Chapter Seven provides the results of the demographic profiles and frequency and prevalence rates for skeletal indicators of stress and disease in all of the burial samples. Chapter

Eight discusses the implications of both the mortuary and bioarchaeology results and provides some possible explanations for the occurrence of specific burial patterns and potential causes and etiologies for many of the skeletal indicators of stress and disease found in the study sample.

This discussion will then lead into Chapter Nine, which will review the hypotheses and results, and provide the final conclusions and suggestions for future avenues of research on the Mis

Island archaeological and skeletal data in order to further reconstruct the details of life and death in this remote desert community.

CHAPTER TWO: THE FOUNDATIONS OF BIOARCHAEOLOGY AND MORTUARY

ARCHAEOLOGY

THE MULTIDISCPLINARY ANALYSIS OF BURIALS AND HUMAN REMAINS

At a most basic level, bioarchaeology is the scientific study of human skeletal remains from archaeological contexts (Buikstra 1977; Blakely 1977; Larsen 1997). Although based on changes in human skeletal biology, bioarchaeology is deeply rooted within the realm of anthropology and draws on the theoretical fields of cultural anthropology, archaeology, and physical anthropology (Armelagos 2003; Buikstra and Beck 2006). On the other hand, bioarchaeology relies just as much on the natural sciences, such as biology and chemistry

(Larsen 2006a). The resulting multidisciplinary approach has been used to address a number of topics, including

1) burial programs and social organization; 2) daily activities and division of labor; 3) paleodemography, including estimates of population size and density; 4) population movement and genetic relationships; and 5) diet and disease” (Buikstra 1977: 67).

However, for all they have in common, the studies of bioarchaeology and mortuary archaeology have mostly been pursued as separate fields. Mortuary archaeology has typically focused on the archaeological details and artifacts of burials with little to no attention paid to the actual remains of those buried, while bioarchaeology focuses almost exclusively on the skeletal remains with little integration of the burial context and mortuary practices (Buikstra 1981;

Goldstein 2006). This division is to the detriment of both studies, for without the contextual analysis of mortuary remains and the integrated osteological analysis of human remains much data is lost and the ability to understand deeper cultural or social meaning is limited. Yet until recently, the call to both osteologists and mortuary archaeologists to integrate and combine

efforts has resulted in little collaboration between the two fields (Buikstra 1977; Blakely 1977;

Goldstein 2006; Buikstra and Beck 2006).

Where it has taken place, the collaboration of osteology and mortuary archaeology has contributed to a more extensive perspective on life experience in many historic and prehistoric populations. The integrated approach has been shown to address a variety of subjects, including social organization and social status (Robb et al. 2001; Shimada et al. 2005; Pachenkina and

Delgado 2006; Torres-Rouff 2011), kinship relationships and biodistance (Corrucini and

Shimada 2002; Stojanowski and Schillaci 2006), and gender, social, and ethnic identities

(Ambrose et al. 2003; Buikstra et al. 2005; White 2005; Fay 2006; Knudson and Stojanowski

2008; Torres-Rouff 2008). Shimada et al. (2004) provides an excellent example of the beneficial integration between osteology and mortuary studies to understand social organization, elite status, kinship, and ethnic identity in the Middle Sicán population from the north coast of Peru.

The authors used an integrated approach of skeletal indicators including mitochondrial DNA, inherited dental traits, developmental health, dietary isotopes, and mortuary indicators, such as the placement of individuals and associated grave goods. They found that there was a relationship between skeletal indicators of kinship, diet, and health and the mortuary patterns, which demonstrated that the cemeteries were divided according to ethnic and kinship relationships, as well as status differentiations. The use of multiple lines of skeletal and mortuary evidence provided Shimada et al. (2004) an opportunity to further investigate their hypotheses and interpret their results from a variety of angles, thus making their conclusions more tangible.

While mortuary archaeology may provide contextual basis in the form of social organization and relationships among sex, age, and status groups, osteology may provide a biological perspective in the form of group differences in patterns of occupation, diet, and

disease. An integrated analysis that interprets the skeleton as an individual, and then places the individual within the grave and the grave within a spatial perspective can assist in interpreting the larger social questions, as well as help define the meaning and substance of mortuary artifacts and burial practices (Whitely 2009). The present study maintains this endeavor for a multidisciplinary approach by coupling a bioarchaeological analysis of skeletal indicators of health with a mortuary archaeological approach of both spatial and statistical analysis of burial patterning. The goal is to use osteological methodology and theory, mortuary archaeology, and ethnographic and historical context to fully understand the general health, quality of life, and death experience of the Mis Island community, as well as what it can tell us about the political, religious, and social structure of the population.

BIOARCHAEOLOGICAL APPROACHES TO HEALTH AND DISEASE

Paleopathology, or the study of ancient human disease, is the subfield of bioarchaeology that attempts to assess the general „health‟ of an archaeological population. Analyses of diet and nutrition, non-specific indicators of stress, indicators of infectious diseases, and growth and development are most commonly used to interpret health in past populations. The anthropological concept of health is based on the idea that both internal and external stressors can negatively affect the human body, causing nutritional disorders, infectious diseases, and disturbances in growth and development that in many cases can leave their signature on the skeletal remains. An understanding of the biocultural theory of stress and an ability to determine what natural and cultural factors intensify or mitigate certain stressors can help paleopathologists determine how a community responds and ultimately adapts to them.

Stress affecting the individual and the community is the result of three basic factors: environmental constraints, cultural systems, and host resistance (Larsen 1997). The external environment is a factor in the types and quantity of stressors impacting a community, but simultaneously it also provides the resources necessary to buffer these stressors. Furthermore, the way a community uses available environmental resources to enhance group survival is an example of how a cultural system can mitigate stressors affecting the community. On the other hand, a poor or unequal cultural buffering system can detrimentally impact how the larger population and certain subgroups are able to moderate the effects of these stressors. In addition, the individual‟s own biological response to these stressors is impacted by a number of causal factors, including age and/or sex differences in access to resources and inherent immunity to certain stressors (Ortner 2003). This ultimately has a vast impact on individual survivability and eventual adaptability of the group as a whole.

Chronic and episodic stress in the form of environmental or cultural pressures can negatively impact the individual and become expressed in the skeleton (Goodman et al. 1988;

Goodman and Armelagos 1988; Martin et al. 1991). Environmental constraints to human adaptation and an inability to gain access to basic resources, such as water, food, and shelter are causative factors leading to systemic stress in the individual and ultimately the community

(Goodman and Martin 2002). Certain environmental constraints like an insufficient diet, climatic extremes, parasitic infections, and high pathogen loads may impact the skeleton directly.

Furthermore, social stressors including one‟s occupation, low socioeconomic or gender status, political and social disruptions, or cultural stigma can affect a person‟s access to food and further exposure to a multitude of biological stressors. A prolonged inability to access necessary resources and a chronic exposure to both environmental and social stressors can eventually

overburden the system and lead to physiological perturbations, many of which can leave a permanent mark on the skeleton (Goodman and Martin 2002). Furthermore, the severity of the skeletal response can imply the degree to which the social and environmental stressors were affecting the populace, and the sufficiency of the community-wide cultural adaptations to these stressors (Goodman and Martin 2002).

Skeletal Indicators of Stress and Disease

Both acute and chronic episodes of stress can impact the human body and in a number of cases leave either a temporary or permanent mark on the dental and skeletal system. In bioarchaeology, these skeletal indicators of stress in subadults and adults typically have been studied to understand the social, political, and economic relationships within a community. For example, epidemiological studies have demonstrated a clear relationship between deprived living conditions, malnourishment, poor health and an increased prevalence of non-specific indicators of stress (Goodman and Rose 1991; Goodman et al. 1991; May et al. 1993; Larsen 1997; Ortner

2003; Slaus 2008). Poor nutrition and health are often the result of a number of causative factors, including social or political changes, economic decline, and low socioeconomic or social status within a given community. For instance, lower class individuals tend to have more incidences of linear enamel hypoplasias, cribra orbitalia and porotic hyperostosis, and infectious disease than their wealthier or higher status counterparts (Palubeckaite et al. 2002; Bennike et al. 2005;

Buzon 2006; Redfern and DeWitte 2011).

A number of epidemiological and bioarchaeological studies have also correlated transitions in social, political, and subsistence frameworks with a decrease in overall health status of the population. Many publications have shown that with the transition to agriculture and

later industrialization there is a demonstrated increase in the incidence of skeletal indicators of stress and a decline in overall population health (Goodman et al. 1984b; Larsen and Harn 1994;

Costa and Steckel 1997; Lewis 2002; Larsen 2006b) Furthermore, communities enduring large- scale political and cultural changes are more susceptible to nutritional deficiencies, incidences of physiological perturbations, and infectious disease (Walker 1989; Goodman et al. 1992; Schultz et al. 2007; Jennings 2010).

Non-Specific Stress: Linear Enamel Hypoplasias

Many indicators of stress vary in the timing of their development in a person‟s life cycle, and in their impact on quality of life. Linear enamel hypoplasias reflect periods of physiological stress during childhood, however their presence in both subadults and adults can be an implication for stressors affecting the overall population (Larsen 1997). Linear enamel hypoplasias are a result of the disruption of enamel development in times of acute and chronic stress during childhood and are evident in teeth for the remainder of one‟s life (Goodman et al.

1984a). Enamel hypoplasias can be suggestive of a number of health indicators, such as starvation, episodic stress, fever, parasites, congenital infection, or any combination of these factors (Lewis and Roberts 1997). Tooth enamel is especially sensitive to physiological perturbations and because enamel does not remodel, will maintain a record of these growth disturbances throughout the life of the individual (Larsen 1997).

Despite the fact that linear enamel hypoplasias are indicators of childhood stress they can still be particularly informative when studied in the adult dentition. For example, an analysis of sex-specific prevalence rates of linear enamel hypoplasias in adults can help determine whether there are differences in access to dietary resources or incidences of episodic or chronic stress of

males and females during childhood (Goodman et al. 1991; Danforth et al. 1997; Vanna 2007).

In addition, prevalence rates of enamel hypoplasias in varying age groups among juveniles and adults can have further implications for how hypoplasias influence overall life expectancy and mortality rates (Rose et al. 1978; Cook and Buikstra 1979; Simpson et al. 1990; Goodman and

Armelagos 1988; King et al. 2005). An inverse relationship between the age-at-death of the individual and the presence of a hypoplasia can signify that those individuals with hypoplasias early in life have lowered immune systems through adulthood and ultimately have lower life expectancies (Larsen 1997).

Non-Specific Stress: Porotic Hyperostosis and Cribra Orbitalia

Porotic hyperostosis and cribra orbitalia are also strong indicators of childhood stress and are the result of a number of intersecting nutritional and disease factors. Porotic hyperostosis is a thinning of the outer table of the skull with associated diploic expansion, resulting in pitting and porosity on the cranial vault, and in its most severe form, exposure of the trabecular bone

(Walker et al. 2009); while cribra orbitalia appears as the same expression of porosities and trabecular expansion on the superior surface of the eye orbits. Although adults do not often exhibit active cribra orbitalia or porotic hyperostosis, the presence of these healed lesions in adults can highlight a childhood history of metabolic disorders and high pathogen loads within the population.

The exact etiology for porotic hyperostosis and cribra orbitalia is still a matter of strong debate. Historically, bioarchaeologists argued that cribra orbitalia and porotic hyperostosis were manifestations of the same metabolic processes (Stuart-Macadam 1989) and that cribra orbitalia was the earlier, more common expression of porotic hyperostosis (Angel 1967; Mensforth et al.

1978; Stuart-Macadam 1985, 1989). More recently this hypothesis has been called into question and it appears that although they might be responses to the same systemic problem, it is more likely they are independent reactions without a direct correlation (Walker et al. 2009).

Historically, iron deficiency anemia was the most commonly cited cause for porotic hyperostosis and cribra orbitalia in the bioarchaeology literature (Carlson et al. 1974; El-Najjar et al. 1975; Stuart-Macadam 1987, 1989, 1992; Grauer 2005). More recently however, a number of scholars have begun to question this hypothesis. Walker et al. (2009) argues that iron- deficiency anemia actually inhibits the production of red blood cells in the marrow and therefore could not possibly cause the hematopoietic expansion of the cranial vault and eye orbits characteristic of porotic hyperostosis and cribra orbitalia. On the other hand, both megaloblastic and hemolytic anemia cause red blood cell destruction with subsequent marrow hypertrophy and expansion of the diploe in an attempt to quickly produce more blood cells (Antony 1995) and thus, would be more probable etiologies for the formation of porotic hyperostosis (Rothschild

2002; Walker et al. 2009).

Recent research also indicates that both porotic hyperostosis and cribra orbitalia are probably linked to multiple causative factors (Larsen 1997). High pathogen loads and a poor diet

(Lallo et al. 1977; Holland and O‟Brien 1997; Fachinni et al. 2004), bony inflammation (Wapler et al. 2004), Vitamin B12 or folate deficiencies, endemic malaria and hereditary conditions such as sickle cell anemia and thalessemia, chronic parasitic infections, and prolonged infant diarrhea have all been identified as likely causative factors (Sullivan 2005; Walker et al. 2009). For example, parasitic infections in the form of malaria, schistosomiasis, and hookworm have been associated with the malabsorption of multiple key nutrients into the gut, acquired hemolytic or

megaloblastic anemia, and the subsequent formation of cribra orbitalia and porotic hyperostosis in several studies (Ubelaker 1992; Massa et al. 2000; Buzon 2006; Lagia et al. 2007).

To further confound an interpretation of etiology, cribra orbitalia and porotic hyperostosis are also responses to a number of other metabolic disorders, such as Vitamin C deficiency

(Ortner et al. 1999; Ortner et al. 2001; Ortner and Erickson 1997) and Vitamin D deficiency

(Ortner 2003; Brickley and Ives 2008). Vitamin C deficiency causes scurvy, which often results in porosity and bony deposition on the cranial vault and eye orbits similar to cribra orbitalia and porotic hyperostosis. However, scurvy results in the deposition of new bone formation on the orbital roofs, as well as diagnostic lesions on other areas of the cranial vault, including the greater wings of the sphenoid, the maxillae and the mandible, and is therefore increasingly possible to differentially diagnose (Ortner 2003). Severe Vitamin D deficiency, which can cause rickets or osteomalacia also produces differentially diagnostic features, such as bending of the long bone shafts and metaphyseal swelling (Brickley and Ives 2008). It is possible to have a synergistic interaction of multiple causative factors, such as dietary insufficiencies, parasitic infections, as well as scurvy and rickets, and therefore one must be cautious when making determinations of the etiology of cribra orbitalia and porotic hyperostosis. Therefore, further information regarding dietary and pathogenic factors affecting a population must always be taken into careful consideration.

Non-Specific Stress: Periostitis

Another non-specific indicator of stress, such as periostitis, is significant when evaluating health, infectious disease, and quality of life in both subadults and adults. Periostitis is an inflammation of the periosteal bone surface in response to a number of factors, including chronic

vitamin deficiency, ulcers, continual exposure to infectious disease pathogens, and through the introduction of bacteria via localized traumatic injuries (Ortner and Putschar 1985; Walker et al.

1997; Larsen 1997). The tibia is most commonly affected by periostitis, most likely due to its proximity to the outer surface of the skin (Ortner 2003), as well as the fact that it is a less vascularly active area (Larsen 1997).

A periosteal inflammation typically manifests as an area of woven bone formation on the cortical surface with an appearance of bony striations, plaque-like bone deposits, and sometimes pitting (Roberts and Manchester 2007). As the periosteal reaction heals, the areas of woven bone become incorporated into the underlying bony matrix and remodel into lamellar bone, thus having a more smooth appearance (Ortner 2003). While there are not any qualitative or quantitative characteristics that can link periostitis to a specific disease process (Weston 2008), when widespread and/or on bilateral skeletal elements, its presence can indicate chronic, systemic stress, infection, or suppressed immunological response that certainly had a negative impact on the quality of life and life expectancy (Ortner 2003; Lewis and Roberts 1997).

Specific Infection: Osteomyelitis

Osteomyelitis was a widespread ailment in the pre-antibiotic era, most frequently affecting children between the ages of 3 and 12 years old; however, it is also common for people of all ages to contract the infection (Aufderheide and Rodriguez-Martin 1998; Ortner 2003;

Roberts and Manchester 2007). Osteomyelitis is an introduction of bacteria to the marrow cavity through a number of mechanisms: via direct infection through a traumatic lesion, by association with a soft tissue infection above the bony surface, and through septic transmission of an infection in another part of the body (Ortner 2003). Osteomyelitis is differentiated from

periostitis by the presence of a narrowed marrow cavity, a cloaca, or an involucrum.

Osteomyelitis, while exceedingly rare, is also more lethal than periostitis, and can lead to septicemia of the blood via the circulatory system.

Although it is impossible to diagnose the exact cause of osteomyelitis in skeletal remains,

Staphylococcus aureus and streptocaucus are the most common contributing bacterial agents

(Ortner 2003). The result is an infected bone shaft with pitting and porosity and subsequent destruction of the bony interior (Roberts and Manchester 2007). Destruction of the marrow cavity will often produce a buildup of pus and necrotic bone that drains through a cloaca that forms on the outer shaft surface. As the bone shaft heals, new bone is deposited on the original outer cortical surface, creating an involucrum. With further healing, the outer bone surface may eventually remodel and regain limited use and mobility, although signs of the infection may remain for years (Roberts and Manchester 2007).

Specific Infection: Maxillary Sinusitis

Maxillary sinusitis is a chronic respiratory disease that affects millions of people around the world and is a widespread cause of morbidity and mortality (Roberts 2007). Although maxillary sinusitis is an inflammation of the mucous membranes of the sinus, chronic cases can create bony destruction and proliferation along the sinus walls and posterior maxillae (Roberts

2007). Although a common medical complaint, maxillary sinusitis has not been extensively studied in bioarchaeology because it is difficult to assess in intact skulls and a suitable method for examination was not proposed until the mid 1990‟s (Boocock et al. 1995).

There are a variety of environmental and cultural etiologies for maxillary sinusitis that include both “indoor” and “outdoor” factors. “Indoor” factors include poor air ventilation and

exposure to dust, mites, and mold, as well as exposure to smoke from indoor cooking fires and smoke-producing occupations (Roberts 2007; Jones 1999; Mercer 2003; Rinne et al. 2006).

“Outdoor” factors include climate, weather, pollen, pollution, and dust exposure (Roberts 2007;

Mercer 2003, Haines et al. 2006; McCurdy et al. 1996). In addition, direct infections via dental abscesses into the sinus can cause maxillary sinusitis.

Specific Infectious Diseases

Although the etiologies of certain diseases are nearly identical, bioarchaeologists are increasingly able to pinpoint specific diseases and understand population distribution and resistance. Tuberculosis, brucellosis, leprosy, and syphilis are infectious diseases that have become increasingly easier to identify in ancient skeletal populations (Ortner 2003; Aufderheide and Rodriguez-Martin 1998). Larsen (1997: pg 107) argues that infectious disease is density- specific and that “increased density of a population [such as in urban areas or sedentary villages] enhanced disease transmissibility, and poor sanitation increased the burden of disease.”

Therefore, identification of specific diseases is an important part of any investigation because it contributes to an understanding of both group health status and overall living conditions.

Infectious disease was a prominent problem for populations in the pre-antibiotic era and was a major contributor to widespread community morbidity and mortality (Roberts and

Manchester 2007). Infectious disease processes like tuberculosis, brucellosis, leprosy, and treponematosis were common causes of death in pre-modern and historical communities, especially among infants and children (Ortner 2003). However, despite the large range of infectious diseases that can elicit a biological response, the skeletal system is not easily nor always impacted. Most diseases will never directly affect the human skeleton, and for those that

do, it is often the chronic or prolonged incidences that leave any indication of their existence on the skeletal remains (Larsen 1997; Buikstra and Cook 1980). For example, it is estimated that only 5-7% of individuals infected by tuberculosis in the pre-antibiotic era ever showed skeletal involvement of the disease (Steinbock 1976; Aufderheide and Rodriguez-Martin 1998).

Furthermore, those specific infections that do affect the skeleton may not be the immediate cause of death to the individual (Ortner 2003). However, while the skeletal health record is incomplete due to the inability to observe all indicators of infectious disease, it is the presence of such skeletal indicators that can specify prolonged individual and community resistance to chronic health conditions (Ortner 2003).

To further complicate the matter, the skeletal response to a variety of infections produces only two possible bony changes: bone removal and bone deposition. For example, periostitis is a common bony response for multiple infectious diseases, and as such, cannot be attributed to a specific cause (Weston 2008). This limited bony response makes the differential diagnosis of many infections very difficult for skeletonized remains. Despite this limitation there have been a number of advances in clinical biology, epidemiology, and bioarchaeology that have aided in the differential diagnosis of a small subset of non-specific infections and specific infectious diseases

(Buikstra and Cook 1980; Aufderheide and Rodriguez-Martin 1998; Lovell 2000). Clinical studies have demonstrated that there are a number of specific infections with enough distinction in the type of bony response and the distribution of lesions throughout the body (Ortner 2003).

For instance, specific infections like tuberculosis and brucellosis more commonly affect bones of the spine, ribs, and innominates, while leprosy may cause bony destruction to the face, hands and feet.

On the other hand, distinguishing specific infections is particularly difficult for paleopathologists. Buikstra and Cook (1980) advise a multifaceted approach for establishing a differential diagnosis. The first phase includes developing a diagnostic model based on known cases from clinical research and museum collections. The second phase includes a thorough and detailed observation of the distribution of lesions throughout the skeletal collection, with a focus on affected individuals. Knowledge of lesion distribution can help narrow down possible differential diagnoses into more specific categories. The final phase is to compare the findings of lesion type and distribution with empirical data on patterning specific to particular diseases and biological onset. Some diseases are more age and/or sex-specific than others, and can provide further clues as to what is infecting the individual. Even with such a detailed approach to paleopathological observation and analysis a differential diagnosis will not always be possible.

In such cases the best approach is to provide a detailed description of lesion type and distribution within the individual and the population (Lovell 2000). With new scientific advances of molecular DNA, microscopy, and magnetic resonance imaging a differential diagnosis might be possible in the future.

Specific Infection: Tuberculosis

Tuberculosis is a considerably ancient disease and throughout the centuries has been the cause of high morbidity and mortality rates for a large number of populations (Roberts and

Manchester 2005). As such, indicators of the infection are a relatively common finding in many paleopathological studies, and thus were of particular focus to the present study. The identification and diagnosis of tuberculosis is especially important in the Mis Island remains, because it has been identified through both paleopathological analyses and molecular DNA at

numerous sites throughout antiquity in both Egypt and Nubia (Strouhal 1991, 1995; Waldron

2000; Spiegelman et al. 2005; Zink et al. 2001, 2005). In addition, there have been many advances in paleopathological and clinical research that has allowed a more confident differential diagnosis of tuberculosis that is not possible with most other infectious disease processes.

Tuberculosis is a chronic respiratory infection caused by exposure to the Mycobacterium organism. There are a number of different variants of the disease that are transmitted through interaction with either infected animals or humans. Although it can at times be a relatively progressive disease, tuberculosis does not commonly affect the skeleton, with only 2-3% of clinical cases showing any bony involvement (Ortner 2003). In many severely chronic cases of the infection however, skeletal involvement does occur and most often in the bones of the spine, ribs, and hips (Clark et al. 1987). The most common site of vertebral tuberculosis is the first lumbar vertebra, with the lower lumbar and thoracic vertebrae also frequently affected (Resnick and Niwiyama 1995). These areas of skeletal involvement are unsurprising as pulmonary tuberculosis is the most common type of infection in the human-borne spread of the bacterium

(Roberts and Manchester 2005). As such, multifocal lytic lesions concentrated on the lower spine, ribs, and hips, as well as bony proliferation along the visceral surfaces of the ribs are often investigated as possible cases of tuberculosis.

Limitations in Paleopathology Research

Early paleopathology researchers interpreted their results in a straightforward manner with little understanding of the underlying biases of skeletal samples and their ability to accurately predict heath and disease for an entire population (Parker Pearson 1999; Ortner 2003).

There are many confounding factors that are often unknown or difficult to control for, and recent

studies have tried to reveal the inherent biases in bioarchaeological analyses (Ortner 1998; Wood et al. 1992). Problems associated with the overall representativeness of the mortuary sample, postmortem taphonomic damage to the remains, the accurate estimation of age and sex, and the difficulty of identifying and differentially diagnosing diseases have all been discussed as inherent confounding factors in bioarchaeology research.

The representativeness of the mortuary sample is one of the most basic and difficult concerns that an osteologist must confront in every study. In bioarchaeological studies, it is impossible to know how well the skeletal sample truly represents the total living population at the site (Hinkes 1983). A mortuary sample is a subset of the population who did not survive, and thus are more likely representative of those who were the least healthy. Furthermore, the biological selectivity of individuals within a cemetery sample may produce elevated levels of non-specific indicators of stress and mortality in comparison with the actual population (Wood et al. 1992; Larsen 1997). Therefore, osteological analyses cannot assume that the mortality and morbidity rates of the skeletal sample accurately reflect the frequencies of individuals living with certain pathologies and conditions (Cook and Buikstra 1979). In essence, many bioarchaeologists argue that all skeletal samples are likely biased reflections of the populations they represent

(Bocquet-Appel and Masset 1982; Wood et al. 1992).

In addition, the ability to accurately estimate age and sex in a skeletal population can further bias the mortality and morbidity rates of the sample. Many skeletal indicators, such as osteoarthritis, hyperostosis frontalis interna, and ankylosing spondylitis, are age and/or sex- dependent and affect particular demographic groups more readily than others (Wood et al. 1992;

Ortner 1999, 2003). As such, deaths are generally mediated by sex or age-specific disease onset and a relatively “normal” sample would be a u-shaped curve demonstrating the greatest mortality

impact among the youngest and the oldest of the population (Jackes 2011). Consequently, correct sex and age-group estimations are an important component of paleopathological diagnosis and interpretation. Unfortunately, a number of factors affect the accurate estimation of sex and age within an archaeological sample including poor skeletal preservation; differential recovery of particular age or sex groups; the availability of population-specific age and sex estimation methods; and the difficulty in estimating age in older adults (Walker et al. 1988; Ortner 1998;

Roberts and Manchester 2007; Jackes 2011).

There is ongoing debate about whether non-specific indicators of stress and disease signify a population of truly unhealthy individuals, or a population of relatively healthy individuals who have survived long enough to exhibit a skeletal response (Wood et al. 1992;

Wright and Yoder 2003). The “osteological paradox” argues that stress and disease found in the skeleton are the result of adaptation to chronic pathogen loads or malnourishment and are therefore the result of continued survival (Harpending 1990; Wood et al. 1992; Roberts and

Manchester 2007). According to this approach an unhealthy individual would die more quickly from a particular disease and consequently, be unlikely to sustain skeletal involvement.

Therefore, an individual with a skeletal indicator of stress might actually have a stronger immune system and could be considered healthier than non-affected counterparts (Wood et al. 1992).

However, as Ortner (2003) points out, the most ideal immunological response would be to remove the pathogens from the body before the skeleton has had a chance to respond, thus somewhat complicating the argument made by Wood et al. (1992).

One of the strongest arguments that bioarchaeologists use to defend against the

“osteological paradox” is the clear trend in increased skeletal indicators of health with the adoption of agriculture (Goodman 1993; Cohen and Armelagos 1994; Cohen 1994; Cohen

1997). Multiple independent studies have clearly linked the transition to agriculture and a sedentary lifestyle with a decrease in skeletal health and an increase in mortality rates (Lallo et al. 1977; Cohen and Armelagos 1985; Cohen 1994; Larsen 1995). In addition, many studies have also shown that lower status groups who are invariably battling increased stressors than higher status cohorts exhibit greater frequencies of skeletal lesions (Goodman and Armelagos 1988;

Cucina and Tiesler 2003; Sullivan 2005). It would be difficult to argue for the “osteological paradox” in this case, and that the lower status individuals have better health than higher status individuals with more access to a varied and consistent diet. Furthermore, Steckel et al. (2002) argue that if the “osteological paradox” were indeed true, then one would expect that a longer life expectancy would be negatively correlated with skeletal health; however, according to findings of the World Health Index, every year there is an increase in life expectancy there is also an increase in skeletal health. As such, the notion of the “osteological paradox” has been challenged in numerous paleopathological studies.

Obviously, the interpretation of skeletal indicators of stress and disease is complicated by many confounding factors. Accurate interpretation of human skeletal remains begins with a knowledge of the limitations of the data and an effort to reduce potential sources of error whenever possible. Cohen (1997) argues that by using a mutidimensional biocultural perspective to look for larger patterns and trends in skeletal data, researchers can make meaningful conclusions when comparing health and disease within a community or between communities.

The use of different lines of evidence including multiple paleopathological indicators (Goodman et al. 1984), archaeological findings (Goldstein 2006), and historical context can help researchers negotiate the representativeness of a sample and the “osteological paradox” to understand the concept of health (Steckel et al. 2002; Armelagos 1993). Further, an age-specific analysis of

skeletal lesion prevalence rates will adjust for the age distribution of mortality and morbidity rates and aid in a more accurate reflection of the overall health of a population (Steckel et al.

2002; Milner et al. 2008). In addition, more advanced paleodemographic statistical modeling of morbidity and mortality rates allows researchers to gain a more balanced perspective on disease in different age and sex cohorts (Wright and Yoder 2003; Jackes 2011). Although the analysis of skeletal indicators of stress and disease will continue to be a precarious balance between understanding biases and accurately interpreting results, it remains a meaningful contribution to the fields of bioarchaeology and mortuary archaeology and provide significant information that cannot be obtained from any other source (Milner et al. 2008).

MORTUARY ARCHAEOLOGY THEORY

The provision of a final resting place for someone’s mortal remains is generally a carefully thought through procedure which may have taken days, months, or even years to plan and execute. Burial is thus a deeply significant act, imbued with meaning (Parker Pearson 1999: 5)

Burials and associated mortuary rituals have long been of interest to archaeologists since the inception of the field. The mortuary rite of passage and manipulation of the burial and body is permeated with such meaning about cultural and social relationships that it “represents a nexus of anthropological interests” (Rakita and Buikstra 2005: 1). Furthermore, the final product of the deliberate act of a funerary rite represents one of the most carefully prepared archaeological deposits for study and can tell us about much more than just the death of the individual (Parker

Pearson 1999; Charles 2005). As Goldstein (2001: 251) points out, mortuary ritual “represents the social and symbolic aspects of societies.” Mortuary archaeology and the study of such

aspects of burial structure as the spatial location and orientation of graves, body arrangement, burial memorials, and the inclusion of grave goods have been useful in interpreting cultural relationships in past societies. Social organization, social status, political rank and power, gender and kinship, and religious ideologies have all been studied through the realm of mortuary archaeology (Parker Pearson 1999; Martin and Atkins 2001). As such, the study of burial patterns and human remains can provide an essential perspective of a past society that remains unapproachable from other sources.

Mortuary Archaeology: A Historical Review

Mortuary studies first came into the American limelight in the 1960‟s with the English translations of French publications by Hertz (1960) and van Gennep (1960). These works in particular were so influential because they introduced the idea that mortuary rituals are culturally constructed phenomena and therefore, can provide clues about the social significance of death and funerary rites. Prior to this, many anthropologists had remained cautious when approaching the social interpretations of mortuary behavior. However, this new approach provided renewed incentive for cross-cultural studies of funerary behaviors (Forde 1962; Goody 1962; Bloch

1971), and the field of mortuary archaeology emerged in a transformed state.

The beginning of the processual movement in mortuary archaeology really began in the

1970‟s with the dissertation of Arthur Saxe (1970) and a 1971 publication by Lewis Binford shortly thereafter. Saxe argued for a model to interpret mortuary rituals as an examination of the social organization and complexity of a society. He developed eight hypotheses based on cross- cultural ethnographic research to correlate the index of social complexity and human identity with the mortuary archaeological data. One of the most interesting and most cited hypotheses

produced by Saxe was his Hypothesis 8, which stated that formal burial grounds were maintained by corporate groups legitimizing their rights over restricted resources (natural and otherwise) through the descent of the ancestors. Goldstein (1980) confirmed this hypothesis, but also added the observation that the absence of a delineated disposal area could not determine anything about social structure and the existence of corporate groups. The combination of these two ideas, known as the Goldstein-Saxe Hypothesis was reaffirmed and further explored by various researchers (Morris 1991; Charles and Buikstra 1983) and has become fundamental to mortuary studies and interpretations of social structure.

Independently, Binford (1971) also argued that sociopolitical complexity as well as an individual‟s „social personality‟ is symbolized through differential burial treatment of the dead.

He wrote that, “the form and structure which characterize the mortuary practices of any society are conditioned by the form and complexity of the organizational characteristics of the society itself” (Binford 1971: 23). In addition, he contended that individual status differences are directly reflected through the number of grave goods included in a burial. Along these same lines, Brown

(1971) argued that there was a direct correspondence between the rarity of a grave good and the high status of the deceased individual.

The “Saxe-Binford” approach (Brown 1995) provided the foundations of mortuary archaeology and the study of social organization and status through mortuary remains. The theory of social complexity and social status was taken even further with hypotheses on the correlation between energy expenditure on a particular burial and the rank or status of the deceased individual. Tainter (1978) hypothesized that the amount of corporate involvement as well as disruption to the community is directly related to the amount of energy expended on a particular burial. Thus, higher ranked individuals will have more energy expenditure reflected in

their burials, in the form of placement of the tombs, treatment of the body, and the presence of human sacrifice.

The Saxe-Binford approach and Tainter‟s ideation of energy expenditure have remained integral aspects of mortuary studies since their inception (Peebles and Kus 1977; Braun 1979;

Crown and Fish 1996; Hohman 2001; Whittlesey and Reid 2001). Further, ensuing modifications of the Saxe-Binford approach (Goldstein 1976, 1980; Saxe and Gall 1977; Morris 1991; Brown

1995; Charles and Buikstra 2005) have demonstrated that the basic premise of the method can be reasonably applied to many societies. Brown (1995) argues that the Saxe-Binford approach, while somewhat narrow in its original form, is applicable when drawn from a wide range of principles and in conjunction with a regional, context-driven perspective. This has shifted mortuary archaeology from a site-specific analysis to a more regional approach allowing for a broader understanding of cultural context, as well as diachronic variability in the mortuary ritual

(Goldstein 1995; Charles 1995, 2005; Larsen 1995b; Rakita and Buikstra 2005).

The critiques of the Saxe-Binford approach cannot be ignored, however. Many argue that

Saxe and Binford, in their focus on social structure and status, completely ignored the role of other influences on burial, such as human agency, religion, belief, ritual, and the manipulations of surviving mourners in negotiating the mortuary ritual (Parker Pearson 1982). This

“postprocessual” approach was born out of an effort to assert that, “mortuary rituals are frequently used by the living to negotiate, display, mask, or transform actual power or social relationships” (Rakita and Buikstra 2005: 7; Hodder 1980, 1982; Parker Pearson 1982; Shanks and Tilley 1982; McGuire 1988). Parker Pearson (1982) argues that a mortuary ritual should not be considered a direct reflection of the status of the deceased, but rather an ideological legitimization by the living descendents of their own status and power within the community.

The mortuary ritual should be viewed as an “agent of social change” where status and social distinctions between groups is further negotiated, reasserted, and legitimized (Rakita and

Buikstra 2005: 7; Hodder 1982; Porubcan 2000). Further, these agents of social change are context-specific and cannot be extended cross-culturally or as a constant over time, as individual societies negotiate social structure in very specific ways (Braun 1981; Miller 1982; Hodder

1984; Cannon 1989). For example, in some societies the variables of social status reflected in mortuary practice may not represent vertical differentiation, but rather aspects of horizontal relationships, such as age, sex, gender, achievement in life, or membership within a sodality

(Parker Pearson 1999).

The postprocessual approach to mortuary rites as an active sphere for the manipulation of social, political, and ethnic relationships has produced many new avenues of research in the quest to better interpret mortuary ritual in past societies (Rakita and Buikstra 2005). An increase in the use of context-specific ethnographic and historical background data enriched the presentation of archaeological case studies from a number of sites (Goodale 1985; Curet and

Oliver 1998; Hill 1998; Beck and Sievert 2005). As an example, Chesson (1999) uses the ethnographic literature on the symbolism of secondary burials and multiple lines of archaeological data from Bab edh‟Dhra to demonstrate that charnel houses were used as a sort of library repository for deceased kin group members to negotiate membership and standing within the greater community. Around the same time gender archaeology also began to establish its own place in the field and engendered studies of mortuary ritual and burial patterns emerged as a fundamental perspective in mortuary archaeology (Conkey and Spector 1984). The edited volumes “Reading the Body” and “Gender and the Archaeology of Death” introduced gender studies as a subject of systematic study in archaeology and mortuary studies (Rautman 2001;

Arnold and Wicker 2001), and previous ethnocentric notions of the role of women in the archaeological past were vigorously challenged (Crown and Fish 1996; Meskell 1998, 2001;

O‟Gorman 2001; Cannon 2005). In addition, the concept of agency, especially in reference to engendering social organization and status in past societies, has been a topic of increased interest with the postprocessual movement. Using examples from Victorian England and the sixteenth and seventeenth century Seneca tribe, Cannon (2005) argues that women were actually the agents of social change in mortuary ritual, making important decisions on funerary fashion and elaboration. Cannon‟s engendered interpretation provided a new perspective on female status in these communities and how an investigation of human agency can provide a new viewpoint on the meanings of mortuary fashion and burial patterns.

The concepts of human agency, social memory, and the emotional impact of death in negotiating the mortuary ritual has been an important extension of the postprocessual movement in archaeology. As Joyce (1999) and Parker Pearson (1982) argue, funerary rites are more likely about the interaction between the survivors themselves and the deceased and ancestors. Further, mortuary contexts should be interpreted as “charged sites where living survivors inscribed the dead into social memory in particular ways, as part of an ongoing process of spinning webs of social relations between themselves and others” (Joyce 2001: 13). The mortuary site is not simply a reconstruction of the social organization or hierarchy of society, but also a place for the surviving to memorialize and create meaning from the death of an individual in the community.

It is this notion of human intentionality, emotion, and the formation of social memory that many archaeologists believe was missing from past mortuary archaeological studies (Meskell 1996;

Tarlow 1999).

It is important to remember that death is an emotional experience for those performing the mortuary ritual and an understanding of this emotion and the need to create social memory of the deceased should be a fundamental part of interpreting past mortuary practices (Willams

2003). For example, Tarlow (1999:183) argues that, “death is necessarily an emotional experience, but the nature of the emotions associated with it, and responses to those emotions are culturally constructed.” Tarlow believes that material remains can be a reflection of culture- specific emotion and can help archaeologists gain perspective on how the emotional experience formed a mortuary ritual of greater social meaning. An example from historical Orkney demonstrates how the location and form of war memorials “not only reflected the grief of the bereaved, but also shaped the expression and understanding of bereavement in war by establishing spatial and figurative structures of remembering” (Tarlow 1999: 183).

As these theories of agency, emotion, and social memory have demonstrated, mortuary rituals may have nothing to do with the actual socio-economic status of individuals and therefore grave goods do not necessarily identify social categories within a culture (Tarlow 1999).

Goldstein (2001: 251) argues that, “one cannot assume that grave goods are the key distinguishing attribute, especially when so many burials have no grave goods at all.” In many religious societies, status is not dependent on relative wealth and the inclusion of grave goods.

This issue is most pressing in cultures where religious beliefs influence the mortuary ritual and preclude the inclusion of grave goods, as in Christian burial rites. Geake (1992) argues that the absence of grave goods in most Christian cemeteries is an indication of the allegiance to the

Christian Church and the less varied burial practice provides the church with a more unified domain of power. In this instance the processual approach to mortuary remains as a reflection of status and social organization is unachievable and another method of inquiry is necessary.

Spatial analysis is one approach that archaeologists have used to interpret social structure, social memory and identity. Goldstein (1981) first introduced the benefits of applying spatial analysis to the mortuary record by arguing that ethnographic data and the Saxe-Binford approach have proven that, 1) “the variables within a mortuary site cluster so that they partition the universe of mortuary practices, and these partitions represent different social statuses or classes; and 2) the principles which organize the sets of statuses are the same as the organizing social relations of the general society” (54). Using examples from a number of mortuary sites, including the Mississipian culture of the lower Illinois Valley, Goldstein demonstrates that the spatial component of mortuary structure is an important aspect of mortuary ritual, and presents five main conclusions based on case studies:

1) the mortuary system is a multidimensional system which includes the spatial component, 2) the spatial component is also multidimensional, and may reflect different levels of relationships and interactions, 3) the most profitable way to begin an analysis of the spatial component is to employ simple visual techniques, 4) the spatial component, when used as a framework for examining the results of „substance language‟ approaches can yield an understanding of the meaning and interrelationships of the groups or statuses represented, and 5) it is the interplay between the „substance‟ and spatial components which provides the maximum information about the cultural elements represented in a mortuary site (67).

Larsen (1995b) also argues for the importance of spatial analysis by stating that previous mortuary studies focused so much on individual burials within individual sites that interpretations could only provide a partial view of the mortuary landscape. With the introduction of spatial analysis to the mortuary sphere, archaeologists can now broaden their focus to include not only the entire mortuary site at once, but also the comparison of multiple sites within a larger landscape.

Knapp and Ashmore (1999: 1) argue that the landscape has deeper symbolic meaning and

“is an entity that exists by virtue of its being perceived, experienced, and contextualized by

people.” Moreover, spaces are created discursively and have a long history of meaning based on politics and economics, as well as gender, class, and ethnic identities (Allen et al. 1998: 9). As

Goldstein (1981) has demonstrated, this symbolic meaning can often be reflected through the location and spatial organization of mortuary sites. Most importantly, the systematic study of space in a mortuary context has moved archaeologists into a new realm of thinking about the deeper iconological significance of mortuary behavior (Silverman 2002). As such, spatial analysis and landscape archaeology have been used in a variety of mortuary studies to interpret social organization and status, kinship and corporate identities, gender, age and social identities, and social collectivity and memory (Tilley 1994; Goldstein 1995; Buikstra and Charles 1999;

Richards 1999; Tarlow 1999; Hendon 2000; Cannon 2002; Hutchinson and Aragon 2002;

Shimada et al. 2004; Naji 2005; Ashmore and Gellar 2005).

Innovative methodological avenues of analysis, as well as newer understandings of human agency and social memory in the construction of mortuary sites and mortuary rites have provided a stable basis for interpretations of the past based on the evidence of burials. As new theories are introduced and more multidisciplinary approaches are utilized, the study of mortuary archaeology becomes more complex, but also, more truthful and more enriched in its interpretations. As many authors have demonstrated, the multidisciplinary approach using historical context, archaeological theory, and ethnographic literature adds an enhanced view of past life experience that can be established from a variety of perspectives and multiple lines of evidence. However, this multidimensional approach has yet to consider the evidence of human osteology and the study of human skeletal remains in the mortuary context. A new integrated approach of all of these lines of evidence can only further clarify the meanings of funerary rites and mortuary patterns in the past.

CHAPTER THREE: MEDIEVAL NUBIA

The Nile corridor, linking Egypt and Nubia, provided extraordinary opportunity for political, religious, and social interactions within northeast Africa. Ancient Nubia, situated from the First Cataract of the Nile River to south of modern day Khartoum, was at the heart of contact between indigenous African societies and international empires (Edwards 2007). The culture- history of Nubia began with human occupation in the Paleolithic and moved through multiple cultural phases, including, but not limited to, the Kerma Empire, the Kingdom of Kush, the X-

Group, the Medieval Nubian Kingdoms, and the Muslim Empire.

The research presented here focuses on the medieval Nubian kingdoms, spanning roughly

1,000 years from the mid-sixth century to the early sixteenth century AD. There were three distinct Nubian kingdoms situated along the Nile River from north to south: Nobadia (First-Third

Cataract), Makuria (Third-Fifth Cataract), and Alwa (Upstream of the Fifth Cataract). Very little is known about early Makuria and Alwa with the majority of our knowledge from the kingdom of Nobadia in Lower Nubia. Much of this bias in knowledge stems from the construction of the

Aswan High Dam and the establishment of UNESCO salvage archaeology campaigns in northern Sudan during the 1960‟s and 1970‟s (Adams 1977; Welsby 2002). However, with the recent construction of the Merowe Dam upriver of the Fourth Cataract there has been increased archaeological interest in the area, and as the work is published more information about this region of the Nile River will contribute to our understanding of Upper Nubia.

All three Nubian kingdoms emerged in the mid-sixth century and show a high degree of cultural and biological continuity with the previous Kushite state (Trigger 1965; Welsby 2002;

Greene 1982; van Gerven et al. 1976). By the mid-sixth century the three kingdoms

independently converted to Christianity, maintaining close political and economic ties with

Egypt (Adams 1977). However, in the seventh century, the Roman Byzantine Empire collapsed and Arab Muslims conquered most of northeast Africa, leaving Nubia as one of the last political strongholds of Christianity.

Arab invasions into Nubia in the mid-seventh century were rebuffed by the Nubian military. Although it is unclear, it is possible that these increased political tensions with Arab

Egypt led to unification of the kingdoms of Nobadia and Makuria under the Makurian king, and creation of the Nubian-Arab Baqt Treaty in AD 651. For the next few centuries, Egyptian and

Nubian relations were peaceful and the societies prospered. By the ninth century, economic and political ties resulted in a free-trade zone between northern Makuria and Egypt.

However, in the late eleventh and early twelfth centuries, the political situation in Nubia deteriorated. Archaeological and historical documents (Monneret de Villard 1938) demonstrate that in the Late Medieval period the entire Kingdom of Makuria was plagued by a number of internal power struggles. At the same time increasingly violent invasions from Egypt sapped the strength of Nubia (Hasan 1967). By the end of the twelfth century the medieval kingdoms were politically unstable, and the continuous trading contacts with Egyptian Muslims resulted in an influx of Islamic and Arab religion and culture (Hasan 1967). Furthermore, Egyptians under the

Muslim/Christian intermarriage likely caused the final demise of the Medieval Nubian kingdoms

(Vantini 1970). An increase in Muslim opposition to the Coptic Christian community in Egypt

and an inability of the Patriarch of Alexandria to send educated priests to the Nubian Church led to the final demise of canonical Christianity in Nubia (Wilfong 1998; Anderson 2004). By the mid-fourteenth century Muslims ruled Makuria and Alwa was in a state of decline and on the defense from Arab infiltration. The weakened Alwan capital of Soba was finally conquered by the Funj Sultanate in the early sixteenth century AD.

THE MEDIEVAL NUBIAN PHASES

The Medieval Nubian period has been roughly divided into five chronological phases:

Transitional, Early, Classic, Late, and Terminal (Adams 1970; 1979; Adams et al. 1999) (Table

1). Although these chronological phases were initially established based on changes in Nubian pottery typologies, they also relate to changes in the religious, political, and economic environments of Medieval Nubia. An in-depth discussion of the religious, political, economic, and social events of each medieval phase will highlight the reasons these phases were created and how archaeologists and bioarchaeologists have been investigating how variations among these phases affected life in Nubian communities.

Transitional Phase (AD 550-600)

There is no concrete evidence to determine exactly where the Nubians originated from and how they came to occupy this section of the Nile Valley once ruled by the Kushite state.

Tribes known as the Noba, Nubae, Nubai, and Nobadae have been identified in sources dating to the Kushite and Roman Egyptian periods, and it is believed that these peoples coalesced into the three Nubian kingdoms to emerge sometime during the sixth century AD (Welsby 2002). Many researchers agree that although it appears the Nubians might have been a separate population

from their Kushite predecessors, there is evidence for marked cultural, social, and ancestral continuity with the previous state. Archaeological findings have indicated a strong cultural tradition of pottery and structural architecture from the Meroitic through the Nubian medieval period (Edwards 2004; Zarroug 1991; Shinnie 1985). Bioarchaeologists have also confirmed that there does not appear to be a large biological shift from the earlier groups to the medieval populations, as evidenced through similar cranial morphological characteristics among the Nile

Valley populations through time (Greene 1982; van Gerven 1976).

Table 1: Sudanese Chronological Phases. Adapted from Welsby (2002), pg 13. Culture Phase Dates th th Kushite Napatan 9 -4 century BC th th Meroitic 4 century BC-4 century AD th th Post-Meroitic Post-Meroitic 4 -6 century AD

th th X-Group Ballana Culture 4 -6 century AD

Transitional AD 550-600

Early I AD 600-750

Medieval “Christian” Early II AD 750-850

Classic I AD 850-1000

Classic II AD 1000-1100

Late I AD 1100-1300

Late II AD 1300-1400

Terminal AD 1400-1500

Shortly after the three Nubian kingdoms of Nobadia, Makuria, and Alwa emerged in the sixth century AD they were independently converted to Christianity. Some researchers argue that

Christianity was introduced by Coptic monks and Egyptian merchants in Nubia prior to the official conversion of the three kingdoms (Vantini 1970; Kirwan 1984). At the time of the political conversion of the Nubian kingdoms there were two forms of Christianity being practiced in the Byzantine Empire: Monophysite Christianity and Melkite Christianity. Historical sources (Monneret de Villard 1938) indicate that both Nobadia in the north and Alwa in the south were converted to Monophysite Christianity by missionaries sent by Empress Theodora, the Byzantine Queen and a Monophysite Christian. However, there is still debate as to whether the middle Kingdom of Makuria was officially converted to Monophysite or Melkite

Christianity, as there are archaeological and linguistic symbols of both Melkite Byzantine, as well as Monophysite influences in Makuria (Monneret de Villard 1938; Vantini 1970; Gardberg

1970; Kirwan 1984; Welsby 2002). Regardless of the debate about early Christian Makuria, all three of the Nubian kingdoms were considered Monophysite by the mid-to-late seventh century

AD, establishing a close religious relationship with the Egyptian Coptic Bishopric in Alexandria.

Early Phase (AD 600-850)

By the beginning of the Early Medieval Phase, Nobadia, Makuria, and Alwa were politically stable and independent Christian kingdoms. A large government-sanctioned push for

Christianity occurred and pagan temples were closed or converted into churches and hundreds more churches were constructed throughout the entire Nubian region. As population growth continued, large political, economic, and religious urban centers emerged throughout the Nile

Valley at sites like Faras, Wadi Halfa, and Qasr Ibrim in Nobadia, Old Dongola in Makuria, and

Soba in Alwa.

As the power of the Nubian kingdoms grew and they asserted their sovereignty over the people of the Nile Valley, the government also began to take responsibility for protection of the people and the land. Large defensive systems were put into place in both Nobadia and Alwa, and defensive walls were built around many towns along the Nile River Valley (Welsby 2006). It is unclear whether these defenses were intended for protection from one another, the Egyptians to the North, or various desert tribes to the west and south of Nubia however it appears that there was possibly some aggression from all directions (Welsby 2006).

The need for defense became clear after Egypt was conquered by Arab Muslim armies of the Second Caliph in the early 640‟s AD. Shortly thereafter, the Muslim armies marched on the

Kingdom of Makuria, reaching as far south as Old Dongola situated between the Third and

Fourth Cataracts of the Nile. The Nubian kingdoms were well established by this time, however, with a strong government and powerful army and they were successful in pushing the Muslim armies back to Egypt.

As a result of these military clashes, the Baqt Treaty was created in AD 652 to restore peace between Egypt and Nubia. More of an exchange of gifts or goods of equal value, the Baqt

“was a bilateral agreement of non-aggression and non-intervention rather than a formal treaty”

(Welsby 2002: pg 70) and regulated the relationship between Muslim Egypt and the Christian

Kingdom of Makuria. In exchange for slaves and sometimes luxury items from the heart of

Africa, Makuria received items of food and drink, pottery, and textiles from the Egyptian

Muslims. Although later Arab sources believed that the Baqt was established to place the

Nubians in a subservient position to the Muslims, it appears that the Baqt was likely an equal

agreement between the two states. Spaulding (1995) argues that the Baqt was in fact a typical expression of Makurian diplomatic gift exchange and was most likely an acceptance by the

Nubians of the new Muslim regime in Egypt. Welsby (2002) agrees and argues that it was also a

Muslim acceptance of the independent Christian Makurian Kingdom. The Baqt established a peaceful and prosperous relationship between Egypt and Nubia that was to last for many centuries and likely set the stage for political and economic prosperity in Nubia during the

Classic Medieval period.

Sometime during the Early Medieval Phase the kingdoms of Nobadia and Makuria united to form one large territory under the power of the king of Makuria. It is quite possible that the two kingdoms were united around the time of the Baqt treaty in AD 652, as a response to the

Arab expeditions against Nubia (Kirwan 1980; Godlewski 1994). However, the first written indication of a united kingdom under king Merkurios of Makuria does not appear until AD 707

(Gardberg 1970). It is believed that both Nobadia and Makuria were Monophysite at this time, and King Merkurios was hailed as the “New Constantine”, suggesting his important role in spreading Christianity throughout the kingdom (Shinnie 1996). Although under the power of one king, it appears that the regional differences of culture and language between former Nobadia and Makuria remained, and that Nobadia retained some power in Nubian military matters, civil affairs, economic life, and judicial rights through the position of the Nubian Eparch (Jakobielski

1987). This union of two great Nubian kingdoms and the introduction of the Baqt Treaty set the tone for the affluent and amicable relations between Egypt and Nubia during the Classic

Medieval Nubian period.

Classic Medieval Phase (AD 850-1100)

The Classic Medieval Phase was a period of urban growth, religious expansion, economic prosperity, and cultural development for Nubia. The kingdoms were at the height of their prosperity and political importance, as towns and villages flourished along the Nile Valley and indigenous Nubian language, art, and architecture developed (Shinnie 1996). The profitable relationship with Egypt grew exponentially, and major urban settlements at Qasr Ibrim, Faras,

Aswan, and Soba developed into large economic centers with increased production and trade of

Nubian wares, such as pottery (Welsby 2002). As the economic relationship between Nubia and

Egypt grew in the tenth century, a free-trade zone was established in the region between the First and Second Cataracts that allowed for more lax immigration into Lower Nubia, and an open market between Makuria and Egypt.

Further, a rise in the levels of the Nile allowed for better irrigation conditions, which improved agricultural production and most likely aided in the increase of prosperity for the entire

Nile region (Gardberg 1970). As a result of all of these factors the later Classic Phase saw a spirit of urban renewal as old towns were rebuilt and new towns emerged throughout the Nubian Nile

Valley (Adams 2001). Archaeological findings confirm that this was a time of prosperity as larger grain and date storage facilities far exceeding those in any other period were found in various towns, such as Meinarti located in the Second Cataract (Adams 2001).

Although the Classic Phase is known as a period of peace and mutual political, social, and cultural openness between Nubia and Egypt (Godlewski 1994), it was intermittently interrupted by military clashes between the two states. Most clashes were the result of a failure to honor the established Baqt Treaty, either through an inability to pay the full tribute amount or a failure to respect the shared borders. Various raids, initiated by both the Nubians and the

Egyptians, briefly plagued diplomatic relations in the ninth and tenth centuries (Edwards 2004),

however none of them escalated into full-out war. Nubia remained politically stable with a powerful army and thus was able to continue to protect the interests of the kingdom and the safety of the people. Regardless of the intermittent raiding, archaeological and historical sources demonstrate that throughout the Classic Period Muslims and Christians continued to live side-by- side in peace, as evidenced by a Muslim minority living within towns such as Soba East,

Meinarti, Old Dongola, and Wadi Halfa during the most flourishing period of Nubian

Christianity (Shinnie 1965; Welsby 2006; Insitar Soghayroun el-Zein 2004; Gardberg 1970). The beneficial relationship between Muslim Egypt and Christian Nubia, as well as the affluent economic ties and trade connections allowed Nubia to prosper during the Classic Phase, leading some researchers to call this time the peak of the Medieval Nubian era (Adams 1977; Welsby

2002).

Late Medieval Phase (AD 1100-1400)

The Late Medieval Phase represented a shift in the political stability and power of

Makuria and an increase in aggression from Egyptian Muslims and Arab desert tribes. Open economic relationships during the Classic Medieval period further exposed the Nubians to outside interest in their economic resources, such as slaves from the interior of Africa; power over trade along the Nile River and through cross-desert routes; Nubian grazing lands to the south of their territory; and Nubian gold mines in the eastern deserts (Hasan 1967; Jombi 1989).

A renewed interest in the rich Nubian resources and an increased influx of Arab Muslim merchants began to put the Nubians on the defensive.

Clashes with the Ayyubid and Fatimid Dynasties in Egypt in the mid-twelfth century AD increased political tensions in Nubia, and with the succession of the Mamluks in the mid-

thirteenth century AD, the relationship with Egypt began to steadily deteriorate (Gardberg 1970).

At the same time the kingdom of Makuria was struggling with political infighting, and arguments over royal succession to the throne began to weaken government control. As civil wars erupted and the kingdom was intermittently attacked by Egyptian Muslims and Arab tribesman, the capital at Old Dongola was routinely abandoned and government oversight was uprooted and relocated upstream for long periods of time (Osman 1973; Anderson, personal communication).

Towards the end of the Late Period with the continued lack of political authority the people of Makuria were forced to safeguard their own interests. Communities began to gather into smaller areas for the purposes of defense (Osman 1973) and within Lower Nubia there was more of an emphasis on fortified homes, known as „castle houses‟ (Adams 1994). The family and community rather than the government were responsible for their own safety, indicating the inability of the government to protect the populace (Welsby 2006).

As the Makurian kingdom began to crumble, the Muslims became more aggressive in their pursuit of Nubian lands. Egyptians and desert Arabs began immigrating into the region in larger numbers. The collapse of central authority allowed more diverse outside regional cultures to develop, further weakening government control (Edwards 2007). By the early fourteenth century the Makurian throne was defeated by the Muslims and recaptured by the Nubians a number of times. In AD 1323, Kanz ed-Dawla, the first Muslim ruler of Makuria was installed on the throne and Christian rule of Makuria was essentially over. The capital at Old Dongola was officially defeated in AD 1365 and the Kingdom of Makuria collapsed. Shortly thereafter, the splinter Christian kingdom of Dotawo was formed near Jebel Adda, although very little is known

about its history. The Kingdom of Dotawo appears to have vanished sometime in the late sixteenth century, during the Terminal Period.

Terminal Medieval Phase (AD 1400-1500)

The kingdom of Alwa remained in power and Christianity continued to be state-sanctioned after the fall of Makuria into the early sixteenth century. Alwa, located far south of the Egyptian border, was isolated from the Mamluk aggression endured by the Makurians, however, Alwa was still vulnerable to attacks from tribes to the east and the south of their borders (Welsby 2002).

Very little is known about the later years of Alwa and the ultimate collapse of the kingdom in the early sixteenth century however, archaeological excavations at the capital of Soba indicate that the kingdom was most likely in a state of decline from as early as the thirteenth century

(Edwards 2004). Alwa was ultimately captured by the Funj Sultanate in AD 1502, officially ending the Christian era of Medieval Nubia.

A number of theories have been hypothesized about the rapid decline and ultimate fall of the Nubian kingdoms and the extinction of Nubian Christianity. Most researchers agree that a combination of factors caused the final collapse of the Medieval Nubian Kingdoms. Political instability and ongoing dynastic struggles weakened the Medieval Kingdoms, leaving them open to foreign invaders (Edwards 2007). Arab interest in Nubian grazing lands, the Nile River trade route, and Nubian gold mines increased immigration and aggression from the north, south, and west of Nubia (Hasan 1967). Furthermore, ongoing Egyptian Mamluk political and military aggression, coupled with increased immigration of Arab desert tribes allowed Muslim influences to slowly infiltrate the Nubian community (Wheeler 1991). Finally, a recession of Nubian Nile trade and an increase in cross-desert routes that bypassed the Nubian trade centers placed

Makuria into political and economic decline (Vantini 1970). With the influx of Muslim immigrants and the inability to maintain ties with the Coptic Christian Bishopric in Alexandria,

Christianity in Nubia quickly followed the demise of the kingdoms of Makuria and Alwa, and large numbers of people began converting to Islam by the fifteenth century AD (Vantini 1981).

MORTUARY ARCHAEOLOGY OF MEDIEVAL NUBIA

A great majority of medieval Nubian mortuary studies have concentrated on the conversion of pagan Nubians to the Christian faith sometime in the sixth to seventh centuries

AD. The introduction of Christian symbolism and the adoption of Christian mortuary patterns, such as east-west burials without grave goods, have been used over the years as a reflection of the general cultural conversion of the Nubian peoples (Edwards 2004). The appearance of more generalized religious burial architecture, community-wide use of burial grounds, Christian treatment of the dead through body orientation, positioning, and shrouding, as well as the absence of burial goods indicated to many researchers a quick and thorough Christian transformation of the Nubian population (Adams 1977, 1993; Monneret de Villard 1938); however, it appears to be more complicated.

It is more likely that the conversion of the Nubian peoples to Christianity was a lengthy and continuous movement, occurring over many years (Kirwan 1982). A gradual shift towards

Christianity can be confirmed through archaeological analyses of the burial practices, which remain variable over significant amounts of time and according to the region of the Nile. For example, according to mortuary patterns the transition to Christianity was more absolute first in the core areas of Nobadia, north of the Second Cataract, and then filtered through Makuria and

Alwa as they were converted at later dates (Edwards 2001). Furthermore, mortuary patterns

indicate that the abandonment of pagan burial practices and the adoption of Christian practices were not immediate upon the official conversion of the kingdoms (Edwards 2004). Throughout the region, some early cemeteries contain pagan and Christian burials side-by-side, as well as some burials with a mixture of pagan and Christian customs (Edwards 1994). Examples of

“transitional” burial forms include Ballana style tombs with both pagan and Christian items

(Kirwan 1984), Post-Meroitic tumulus superstructures with Christian burials, Christian east-west burials with either X-Group blocking stones or Post-Meroitic ceramic grave goods, and pagan burials containing Christian symbolism, such as the cross (Edwards 2001). Furthermore, to add to regional and local variability, it is quite possible that the conversion of the elite occurred earlier than the popular conversion recorded in historical texts (Edwards 2004).

Archaeologically, this is reflected in the abrupt abandonment of royal or elite tumulus burials at the end of the Ballana period, before the „official conversion‟ of the Nubian kingdoms in the sixth century AD. The disappearance of large royal or elite burials at this time could indicate that the elite began to be buried according to Christian tradition, without any indication of status or wealth to differentiate them.

Medieval Nubian Mortuary Patterns

Superstructures

Grave superstructures are a very common feature of Christian Nubian burials, especially during the Early and Classic Phases. Usually measuring the length and width of the burial, superstructures covered the grave cut and often acted as a marker for the underlying burial. A diversity of superstructures were used throughout Christian Nubia. Differences were based upon

local variability, regional distinctions, and changes in style through time. Although there is some variation in the type and size of superstructures across and within sites, their use appears to be universal for both adult males and females, and to some extent subadults (Adams 1998).

Mastabas and pavements are the most widespread superstructures throughout Medieval

Nubia (Adams 1998). Mastabas, most frequently found in Lower Nubia, are rectangular constructions of stone or mud brick masonry capped by a dome or vault. The most common form of mastaba is round-topped with whitewashed stone masonry, but flat-topped, cross-topped, and cruciform-shaped mastabas are also recognized. Pavements, on the other hand are most frequently found throughout Upper Nubian sites, and consist of a flat layer of stones or mud bricks covering the burial. Earlier Christian burials were usually covered with stone pavements, stone outlines, or stone alignments, but it is possible this changed sometime during the latter half of the Early Christian period, and throughout the Classic and Late Phases mud brick pavements were more commonly used.

It is not inherently clear whether variability in the use and type of superstructures is directly related to wealth or status for the deceased buried beneath them. At Old Dongola in

Upper Nubia, there were few differentiations in burial superstructures, and only the burial stelae recorded any minor differentiation in the social status of the deceased (Żurawski 1986). Adams

(1998) argues that although the simple pavements of Upper Nubia are indistinguishable, the ornateness of many of the mastaba superstructures in Lower Nubia could be an indication of wealth of the buried individual. At the site of Meinarti the most elaborate mastabas were for females and juveniles, causing Adams (2003) to believe that they are most likely not a sign of status, as only Nubian men were involved in government and other high status activities.

Body and Head Coverings

It was common for many Christian Nubian burials to have a type of body or head covering of either stone or mud brick. In many medieval cemeteries, and especially in Lower

Nubia, bodies were sometimes covered by stone slabs or mud bricks along the entire length of the body (Adams et al. 1999). Side-niche or bottom-niche graves might have stones laid diagonally across the grave cut, so as to seal off the niche and the body within it. This would serve to protect the body from being directly covered by the earth, creating an unfilled air chamber. This practice was most likely a survival of a pre-Christian Nubian custom of enclosing the body within a chamber to protect it from the pressure of the earthen grave fill (Adams et al.

1999; Żurawski 1986, 1987).

At sites further south, such as Meinarti and Kulubnarti, a great majority of the burials had a covering over only part of the body, most commonly over the head and face (Adams 2003).

The most frequent pattern was two large stones or mud bricks set upright along the sides of the head and a third stone or mud brick bridging across the two, thus covering the face. The covering of the head with stones or bricks was also found in burials at sites in the kingdom of Alwa, as far south as the capital at Soba (Filer 1998). This practice of covering part of the body or head was also common in large crypt burials, such as that below the Church of the Stone Pavement in Old

Dongola (Jakobielski 1978), indicating its continuing traditional or ritual significance in medieval Nubian burials (Żurawski 1987). It is possible that this stems from a long-held conception that the head is the essence of the deceased and therefore shielding the head is protecting the deceased into eternity (Zurawski 1986; Michalowski 1963).

Symbolic head covering was a well-established burial tradition known throughout Egypt and greater North Africa from prehistoric times. Historically, head covering was essentially a means to protect the most important and representative element of the deceased individual from malicious entry by evil spirits (Junker 1925; Żurawski 1986). Żurawski (1986) hypothesizes that in Nubia this tradition was introduced during Graeco-Roman times with elaborate face masks, and possibly evolved into the more simple stone or mud brick head coverings seen during the medieval Christian era. Therefore, the head and face coverings in medieval burials could provide evidence for the endurance of superstitious beliefs among Nubian Christians. Furthermore,

Żurawski argues that their presence in the majority of bishops‟ tombs at Faras indicate their survival among not only the common populace, but also among Nubian Christian holy men.

Along the same lines, it was common practice for medieval Nubian fetuses and infants to be buried in pottery vessels, including Egyptian wine amphorae and hand-made pots. At many sites, such as Kulubnarti and Meinarti, these pottery burials were included within the community cemetery. However, at other sites, such as Qasr Ibrim, fetus pot burials were found beneath the floors of Christian period homes (Barnard 1994; Adams et al. 1999; Adams 2003), following both Coptic and Nubian superstitions to ensure the mother has another child (Welsby 2002). The practice of fetal pot burials appears to have been common throughout Nubian history, appearing well before the Christian period and continuing to the present day (Adams et al. 1999), indicative of another Nubian tradition carried on despite the community‟s conversion to Christianity.

Body Orientation, Body Position, and Head Position

During the medieval period Christian Nubian graves were oriented roughly along the east-west axis in accord with long-standing Christian tradition. The head was placed at the

western side of the grave, facing the rising sun in the geographical east, and thus awaiting resurrection into heaven (Rush 1941; Żurawski 1987). Any small variations in the nature of how true east-west the grave shafts are is most likely explained by the directionality of the Nile River and the variability of the sun season to season. Without the help of a compass, grave diggers had to orient themselves according to the location of the Nile River and the sun as well as to earlier grave superstructures, sometimes slightly drifting them from a true east-west orientation (Adams et al. 1999).

According to Christian custom, the most common position of the body was in the extended position on the back with the legs straight or sometimes slightly flexed to fit within the length of the grave cut. Most often the head would either face straight upwards, or would be turned to the north side of the grave (Adams 1998), although in rare instances with the head facing south (Adams 2003). The majority of burials within both Upper and Lower Nubia conformed to this burial style (Żurawski 1994; Adams 1998, 2003), however there were also a number of variations. At Kulubnarti the majority of individuals in both cemeteries were placed on their left sides with the head facing towards the north (Adams et al. 1999). However, at sites within Lower Nubia it was more common to place individuals on the right side, again with the head facing north (Adams 1998). The continued placement of the head towards the north, regardless of the position of the body “strongly suggests a canonical significance of the north”

(Adams 1998: 28).

Grave Inclusions

One of the most common features of Nubian Christian burials is the general lack of grave goods, particularly of the average populace (Welsby 2002). Unlike the burials of the Meroitic

and Post-Meroitic periods the Christian burials were often simple with few elaborate grave goods or mortuary offerings (Geus 2004). Even among those Christian burials that did contain grave inclusions, most items were of personal adornment, such as clothing, footwear and jewelry, or simple ceramics, such as bowls, water jars, cups, and lamps (Welsby 2002). Cemetery excavations at medieval sites such as Kulubnarti (Adams et al. 1999), Meinarti (Adams 2001), and Old Dongola (Żurawski 1995, 1997) document very few burials with any grave inclusions at all. Of those that did include anything, the majority were items of personal adornment, such as crosses worn on a cord around the neck, belonging to infants and adolescents (Adams 1998).

The presence of grave goods is often considered an indication of a “transitional” burial form during the Early Christian period, before the strict adherence to Christian burial custom was fully adopted (Edwards 2001; Adams 1998). Most common for many Early Christian burials was the inclusion of a lamp box located at the western side of the grave shaft (Żurawski 1986; Adams

1998). The lamp boxes often contained either bowls or ceramic lamps that were most likely used as receptacles for water or as receptacles for the burning of incense or votives (Żurawski 1986).

It is unclear what the purpose of these lamb boxes and ceramic lamps served, however with the full adoption of Christianity in Nubia lamp boxes and grave goods became rare eventually completely disappearing from the burial record. The lack of grave goods in Christian burials is a well-established practice common throughout time and space, and has been attributed to the

Christian beliefs in human equality in the afterlife (Welsby 1992), and belief in the emigration of the soul, but not of the physical body (Adams 1998).

Table 2: Lower vs. Middle Nubian Mortuary Complex. Adapted from Adams (1998), pg 33-34. Type Lower Nubia Middle Nubia Superstructure Mastaba Pavement Tombstone Rare Never present Grave Orientation Nile west Nile west Grave Shaft Mostly slot, some bottom- Mostly slot and side-niche, niche and side-niche in rarely bottom-niche south Body Covering Stone slabs or bricks Stone slabs; less common than Lower Nubia Head Covering None Three stones or bricks Body Position Extended, mostly dorsal, Extended, mostly dorsal, sometimes on right side sometimes on left side Head Position Turned north Turned north Hand Position At pubis or sides At pubis or sides Lamp Boxes and Niches Common with all Not common; only with superstructures stone pavements

PALEOPATHOLOGY STUDIES OF MEDIEVAL NUBIA

The life experience of medieval Nubian populations has long been of interest to bioarchaeological researchers. Studies on health and disease in these populations have been undertaken at a number of sites, including Meinarti, Wadi Halfa, and Kulubnarti in the north, and

Soba in the south. Although research at each site has contributed to our understanding of mortality and morbidity in the medieval Nubian populations, the most extensive studies have

been completed at Kulubnarti, which forms the majority of our knowledge of life and death during the medieval era.

Just after the Meroitic period the entire Nubian Nile region witnessed an improvement in health and life expectancy. At sites like Wadi Halfa in Lower Nubia, an increase in life expectancy and a lower probability of dying was demonstrated from the Meroitic through the X-

Group and most strikingly in the medieval Christian populations (Armelagos 1968, 1981). Many researchers were baffled by this change, because it was assumed that the Meroitic Kingdom represented the height of Nubian culture and development, and the proceeding X-Group populations evidenced a serious decline in cultural development (Armelagos 1981). Although this improvement in health was attributed to an increase in political autonomy and self- sustainment after the fall of Meroe, it cannot be ignored that it also coincided with great developments in agricultural technology and a sizeable increase in the Nubian population. The introduction of the saqia wheel towards the end of the Meroitic period greatly increased agricultural productivity throughout the Nile Valley, allowing more crops to be harvested year- round, regardless of the Nile levels (Trigger 1965). Furthermore, in areas of naturally occurring basins, such as the Kerma basin located just below the Third Cataract, and the Letti basin located in the Dongola Reach, natural irrigation was highly effective, and although required a substantial workforce (Lobban 2003), must have been substantially easier. This agricultural development most likely afforded Nubian populations with a more consistent and varied food source, contributing to the increase in health and life expectancy from the Meroitic through to the medieval Christian period.

The improvements in health appeared to level out during the medieval phase in Nubia.

Mortality patterns were typical of pre-modern developed societies, with high infant mortality

rates that evened out into adulthood, and then spiked again as one reached old age (Welsby 2002; van Gerven 1981; Armelagos 1969). This pattern for pre-industrial societies suggests that 20% or more of newborns were expected to die within their first year and for most remaining individuals the chance of surviving was only 50% (Kiple 1993). Accordingly, in medieval Nubia, infants and children were the most affected by disease and nutritional deficiencies, followed by young adult females of child birthing years. This pattern of high infant and young adult female mortality seems to have been persistent in Nubia for more than 1,000 years, and indicates that infants and children of weaning years, as well as pregnant and nursing women were not maintaining adequate nutrition to endure the risks of disease and infection (Martin et al. 1989). At Soba, within the kingdom of Alwa, about a third of individuals (26/67) were subadults, most who died between the ages of one to thirteen years, with the average age group between three and four years old (Filer 1998). The burials at Soba also demonstrated a high female mortality rate during fertile years, further demonstrating inadequate nutritional intake or high pathogen loads for these demographic groups.

One of the telltale signs of chronic nutritional deficiency is the high incidence of porotic hyperostosis and cribra orbitalia in both subadults and adults in all of the studied medieval

Nubian populations. For example, at Kulubnarti upwards of 45% of individuals exhibited some form of cribra orbitalia. Even more striking is the fact that 100% of infants under the age of one and 70% of children ages one to thirteen were affected (Mittler and van Gerven 1994). It is important to note that Kulubnarti is located in a particularly harsh region of the Nile River and likely struggled more than other regions with low crop yields and higher incidences of malnourishment (van Gerven et al. 1990a). However, a study of 285 Nubians from the Meroitic,

X-Group, and Christian periods at Wadi Halfa also exhibit high incidences of cribra orbitalia

with 21% of the total sample and 32% of subadults from birth to ten years affected (Carlson et al. 1984).

Carlson et al. (1984) argues that the incidence of cribra orbitalia in the Nubian population is most likely iron deficiency anemia caused by a combination of a poor milled cereal grain diet combined with a high incidence of weanling diarrhea and parasitic infections. Given that infants and young children are most affected by cribra orbitalia and porotic hyperostosis it is likely that poor nutritional intake, parasitic infection, and weanling diarrhea contributed to the high incidence of anemia. In addition, an increase in the lesion in older adults who are less resistant to various infections suggested to Carlson et al. (1984) an iron deficiency anemia etiology.

Furthermore, a high rate of the parasitic infection schistosomiasis has been found in both ancient and modern Egyptian and Nubian populations (Kloos and David 2002; Khoby et al. 1998;

Alvrus 2006), indicating a high probability that medieval Nubians were suffering effects from the same parasitic infection. Alvrus (2006) found that individuals in ancient Nubia who had higher levels of the circulating schistosome antigen were more likely to also exhibit signs of skeletal anemia. Clearly, this would have been an issue for the medieval Nubians and likely shared some responsibility for the high levels of anemia recorded in the skeletal populations.

Political and social changes during the medieval Christian time period might also have further affected mortality and morbidity rates of many Nubian populations throughout the region.

Swedlund and Armelagos (1969) and Greene et al. (1986) found that at Meinarti in Lower

Nubia, infant mortality rates increased during the late medieval period, from AD 1050 to 1300. A comparison of two groups, one from AD 1050-1150 and one from AD 1150-1300, demonstrated that in every age cohort there was more than a two year decrease in life expectancy from the earlier to later samples. Furthermore, at age ten the difference in life expectancy was more than

three to five years lower in the later group (Armelagos 1981). These changes from the early to late groups correlate with archaeological findings of a village in decline and on the defensive

(Adams 1967), coinciding with a political atmosphere of instability and warfare during the Late

Medieval Phase.

Furthermore, differences in population groups, family groups, or social status might have had an effect on indicators of stress and disease among the Nubian populations. At Kulubnarti there has been considerable paleopathological research investigating differences in non-specific indicators of stress between two cemeteries located at the site, 21-R-2 and 21-S-46. Original archaeological analysis indicated that cemetery 21-S-46 was probably in use during the early period (AD 550-750) and cemetery 21-R-2 was likely in use during the late period (AD 1000-

1550) (van Gerven et al.; Green et al. 1974). However, more recent considerations of burial style, grave goods, and textiles have indicated that both cemeteries likely date to the early period

(AD 550-800) (Adams et al. 1999). Initially, increased mortality rates and paleopathological indicators in the 21-R-2 cemetery was associated with diachronic change and an increased incidence of stress in the “later” group. Reconsideration of the cemetery chronology, however, indicates that the differences are possibly a distinction in population groups, family groups, or even status (Turner 2007).

van Gerven et al. (1981) and Green et al. (1974) found that mortality rates differed between the two cemeteries, especially among the infants and children. Improved life expectancy in the 21-R-2 cemetery also coincided with an overall reduction in cranial lesions associated with cribra orbitalia. However, isotopic dietary studies at Kulubnarti conclude that there were no substantial differences in the diet and macronutrient intake between the two cemetery groups

(Turner et al. 2007). The concordance between cribra orbitalia and mortality, and evidence that

there was no distinction in diet between the two groups suggests that differences between the cemeteries is likely due to higher biological stresses or parasitic infection affecting the 21-S-46 group.

The link between lower mortality rates and a decrease in biological stressors in the 21-R-

2 sample at Kulubnarti has been independently verified by multiple studies. An increase in cortical bone growth (Hummert 1983), long bone length (Hummert and van Gerven 1983), femoral growth curves (van Gerven 1990a), and a smaller disparity between dentally and skeletally assessed age (Prendergast Moore et al. 1986) in subadults demonstrates a decrease in biological stressors in the 21-R-2 group. In addition, a decrease in patterns of enamel hypoplasias

(van Gerven et al. 1990b) and the incidence of cribra orbitalia (Mittler and van Gerven 1994) at

21-R-2 demonstrates a distinct difference in skeletal indicators of stress at Kulubnarti. Finally, a decrease in fluctuating asymmetry of the craniofacial skeleton (DeLeon 2007) and patterns of age related bone loss (van Gerven et al. 1990a) among adults in the 21-R-2 group further confirms this distinction between the two samples. No new hypotheses regarding the reason for the health disparities at Kulubnarti have been proposed, but future research should further explore this question.

The extensive research throughout Medieval Nubia, and specifically at Meinarti and

Kulubnarti, indicate that health and nutrition of the population was a regional or local struggle.

Although communities along the Nile River were subjects of the same governmental regime and the same political system it is likely they were experiencing different external and internal factors affecting their overall health and nutrition. It is unclear how much the external political environment impacted each site differently or how much other factors affected population health at Meinarti and Kulubnarti, however it does indicate that all populations along the Nile River

should be studied as separate entities with differing political, environmental, and social life experiences.

The Natural Environment as it Relates to Health in Medieval Nubia

While the Nile Valley has a long history of supporting the survival of a number of communities in the midst of a harsh and arid desert landscape, it is not a particularly hospitable environment. For those communities living during the medieval period, the conditions of the

Nile Valley are not unlike what we know about the region today (Trigger 1968). Located just to the east of the Sahara Desert, the region is inhospitable for the subsistence of plants, animals, and humans alike, with the exception of a thin strip of arable land running just along the banks of the river (Welsby 2002). Furthermore, throughout history there have been incredible regional and seasonal variations in precipitation volume and the levels of the Nile River, which continues to be particularly important for communities attempting to produce adequate food resources along the riverbank (Adams 2001; Welsby 2006). Traditionally, ancient Nubian farming was most reliant upon seluka land, that is, areas of land that were seasonally flooded by the naturally high levels of the Nile River (Welsby 2002). The livelihood of communities thus relied almost entirely on the unpredictable seasonal changes of the Nile River and could be particularly stressful in times of minimal precipitation and low Nile flood levels. The introduction of the saqia wheel and irrigation farming in the post-Meroitic period allowed year-round agricultural production of seasonal varieties of grains and vegetables that greatly increased the nutritional potential of these Nile-based farming communities (Trigger 1965). However, even with the added benefit of saqia farming technology, agricultural production in the post-Meroitic era was

still largely reliant on the seasonal levels of the river, as communities would have to work more laboriously to lift water through the irrigation channels during low Nile levels.

The Fourth Cataract is a particularly harsh example of this, as it is a relatively inhospitable region, supporting small populations with slim agricultural zones along the edges of the Nile waters (Welsby 2006; Naser 2007). Dotted with numerous islands of variable size, the

Fourth Cataract is comprised of landscapes of large hills, stony plateaus and high rocky riverbeds, thus earning itself a reputation as the “badlands” of Nubia (Grzymski 2004: 25; Naser

2007). Mis Island during the modern era and just before the flooding of Lake Nubia continued to be a very remote and arid landmass with the Nile River serving as the only source of water for the local community (Catherine Bird 2011, personal communication). Furthermore, with the unpredictability of the Nile, the majority of modern agriculture was conducted through irrigation farming where water was pumped up the banks of the Nile and funneled through channels that traversed the interior of the island (Catherine Bird 2011, personal communication). Accordingly, for the medieval community at Mis Island, an agricultural existence based on the Nile levels was likely necessarily supplemented by irrigation farming through the use of the saqia wheel.

Unfortunately, no archaeological evidence for the use of the saqia has been found at Mis Island and an exact confirmation of its use in the medieval period is untenable. Nevertheless, even though the use of the saqia would likely have increased the potential for year-round harvest production and a larger variety of crop types, it might not have greatly reduced an overreliance on the Nile River for the agricultural potential of the community.

As a consequence, the mainstay of agricultural production throughout medieval Nubia was seasonally variable, but substantially based on cereal grains, such as sorghum, barley, bread wheat, and millet (Fuller and Edwards 2001). Extensive isotopic studies at Wadi Halfa in Lower

Nubia indicate the highest reliance upon C3 plants such as wheat and barley during the winter months and C4 plants such as sorghum and millet during the summer months when the temperatures were at their highest and the Nile levels were likely at their lowest (White and

Schwarcz 1994; Schwarcz and White 2004). Thus, a higher reliance on C3 plants could indicate increased Nile flood levels, while a higher reliance on C4 plants could indicate lower Nile flood levels (White and Schwarcz 1994). Throughout Nubian history C4 plants tend to dominate the archaeological record, indicating a higher reliance on millet and sorghum than any other agricultural product (White and Schwarcz 1994; Clark and Stemler 1975; Stemler and Falk 1981;

Klichowska 1982; Clark 1984; Rowley-Conwy 1989). These grains, and millet in particular, are the least susceptible to the vagaries of Nile levels and seasonal drought, and are thus ideal for surviving seasonal and climatic fluctuations (Fuller and Edwards 2001).

In the middle Nile regions, such as the Fourth Cataract, diminished precipitation likely resulted in an increased reliance on the more resilient C4 plants of millet and sorghum. These substantial grain crops were often supplemented with secondary crops such as legumes, dhurra, okra, and on occasion fruit such as melons, dates, doum palm fruit, figs, and in some regions of the Nile, bananas and grapes (Fuller and Edwards 2001; Welsby 2002; Fuller 2004). The secondary crops however, are more reliant on the levels of the Nile River and were likely a seasonal contribution to the overall staple diet. As a result, sorghum and millet continue to be the dietary staple of modern populations in Africa and Asia and are still the largest source of protein, vitamins and minerals for many of the poorest communities in these regions (FAO Food and

Nutrition Series, 1995). Although these grains are generally deficient in many other micronutrients, such as Vitamins A, C, D, and E, both are known to be relatively high in calories,

and some of the B-Vitamins, such as B6. Millet is also known to be high in protein and many other micronutrients such as zinc and iron, as well as folic acid (FAO Food and Nutrition Series,

1995). In addition, the crops are relatively cheap and easy to harvest, and when coupled with a variety of other fruits and vegetables can provide many essential vitamins and minerals. For example, date fruits from the date palm tree are a good source of sugars, Vitamins A and C, as well as minerals and fiber (El-Sohaimy and Hafez 2010), while legumes, tomatoes, onions and okra would provide additional resources of protein, Vitamins A, C and E, B6 and folate, fiber, potassium, and antioxidants.

While a mixture of these vegetarian food sources would have been adequate for many micronutrients, it would not have provided all of the amino acids and vitamins essential for immune response, as well as growth and development. Most noticeably absent from these food sources is Vitamin B12, an essential nutrient critical for cell metabolism, red blood cell production, neurological function, and DNA synthesis (NIH Office of Dietary Supplements

2011). Severe deficiency in Vitamin B12 can lead to megaloblastic anemia, which causes a hematopoietic response in the bone marrow, and as has recently been suggested, the formation of cribra orbitalia and porotic hyperostosis on the cranium (Walker et al. 2009).

The best sources of Vitamin B12 are from animal-based proteins, such as fish, meat, poultry, eggs, milk, and milk products (NIH Office of Dietary Supplements 2011). Nevertheless, it appears that the consumption of animal proteins was not a considerable proportion of the

Nubian diet, with only intermittent intake of milk and domesticated animal meats such as goat, camel, sheep, and chicken (White and Schwarcz 1994; Welsby 2002). At the medieval sites of

Kulubnarti and Wadi Halfa, isotopic indicators have demonstrated a higher reliance on plant

based foods and legumes, with minimal consumption of animal and marine-based proteins

(Turner et al. 2007; White and Schwarcz 1994). This is not unlike the dietary intake of modern residents on Mis Island, who subsisted mainly on a vegetarian diet of flatbread made from sorghum and millet, a staple dish made of mashed fava beans, dates harvested from the date palm tree and an assortment of vegetables, such as potatoes, okra, tomatoes and onions. Meat and fish proteins were only rarely consumed, typically on special occasions or during large community feasts (Catherine Bird 2011, personal communication). It is assumed that the medieval community at Mis Island was likely dependent on the same kind of vegetarian diet with only sporadic protein consumption. As such, Vitamin B12 deficiency could have been a substantial factor contributing to the formation of porotic hyperostosis and cribra orbitalia in the present skeletal sample.

Therefore, in times of a seasonal low Nile or a prolonged drought, without the essential nutrients from meat-based sources, as well as a reduction in the vitamins present in the typical plant based-sources, the Mis Island community would have been particularly vulnerable to starvation and malnutrition. The extended storage of the staple grains such as sorghum and millet can be somewhat difficult and they tend to be relatively susceptible to high temperatures, humidity, and depredation of insects and pests (FAO Food and Nutrition Series, 1995). The longer the grains are stored the more susceptible they become to germination and destruction, thus making storage an increased struggle during times of prolonged drought or crop failure.

Unfortunately, the occurrence of low river levels resulting in the high possibility of drought is all too familiar in the Nile Valley. Flood levels of the Nile River are available from the year AD 622 to AD 1970 and demonstrate the cyclic nature of the Nile River and the relatively common occurrence of a “low Nile” and substantial droughts (Fairbridge 1984). In

fact, Fairbridge (1984: 185) found that there were at least 14 or 15 notably low levels of the Nile

River during the medieval period, between the years of AD 650 and AD 1404. Even in modern times, the unpredictability of the Nile levels, the struggle for adequate fresh water resources downstream, as well as the inability of people to irrigate large tracts of land were large contributing factors for the construction of many of the modern dams along the Nile River, such as the Aswan dam and the Roseires dam (Schiffler 1998). Thus, during these periods of low Nile and possible inadequate diet there could have been sustained difficulty in maintaining the key nutrients of immune response, such as zinc, selenium, iron, copper, Vitamins A, C, E, B6 and B12, and folic acid (Chandra 1997).

To further exacerbate the possibility of decreased immune protection from a seasonally deficient diet and the risks of extended low Nile levels there were many other environmental factors that would have made survival for the community at Mis Island a struggle. The hot and arid Nile climate is an ideal habitat for many deadly and venomous creatures including crocodiles, snakes, poisonous lizards, bats, camel spiders, and scorpions. Even the contemporary community at Mis Island struggled daily with the threat these creatures posed, as they were found in the fields where the locals farmed, in the neighboring Nile River where the locals obtained their drinking, cooking, and agricultural water, and even inside their own homes

(Catherine Bird 2011, personal communication). As a remote and isolated community, the population at Mis Island did not have easy access to outside help and many individuals were known to die from venomous stings and poisonous bites from a variety of insects and creatures

(Catherine Bird 2011, personal communication).

Even more dangerous than these creatures, however, were the numerous parasites passed to human hosts via contaminated Nile waters or through infected insects, such as snails,

nematodes, mosquitoes, and sand flies, all of which are known vectors for many chronic and fatal diseases. Even for the Nile populations today, the World Health Organization (2009) lists the greatest environmental risk factors for disease and death in the Sudan as poor water sanitation and resulting diarrheal disease, malaria, leishmaniasis, schistosomiasis, hookworm, lymphatic filiariasis, and respiratory diseases from poor indoor and outdoor air quality. These environmental health factors were ever present at Mis Island during the excavations of 2006 and

2007, as local leaders revealed the deaths of many in the community due to malaria, diarrheal disease caused by parasitic infections, as well as respiratory illnesses, such as tuberculosis

(Catherine Bird 2011, personal communication). The most common complicating factors for each of these diseases are fatigue, fever, diarrhea, and ultimately malabsorption of specific vitamins with acquired anemia in the form of iron, B12, or folate deficiencies. All of these infections and resulting deficiencies can be either acutely or chronically debilitating, but eventually become life threatening if left untreated. The endemic presence of any of these indicators would have been injurious to the Mis Island inhabitants, but the combination of all of these factors, as well as the probable nutritional deficiencies due to seasonal harvests and the lack of animal proteins could have been particularly difficult for the community.

It is quite likely that the medieval community at Mis Island also battled all of these agents simultaneously, as the endemic presence of each of these parasitic and infectious diseases have been identified in the modern, skeletal, and archaeological records. One of the most widespread parasitic infections described in the literature, malaria, still continues to be a dangerous and often fatal disease that effects large numbers of the Sudanese population, accounting for more than one-third of all modern hospital visitations in the Nubian Nile region (Malcom et al. 2007).

Malaria is commonly reported in both the modern and historical literature and likely affected

multiple generations of Nubians and Egyptians (Miller et al. 1994; Cerutti et al. 1999; Massa et al. 2000; Brier 2004; Nerlich et al. 2008; Bianucci et al. 2008; Ziskind 2009a). It is believed that malaria was especially problematic in Nubia during the medieval period when the introduction of the saqia wheel allowed more areas of the Nile region to be cultivated and the Nubian population to increase (Malcom et al. 2007). This increase in human occupation and the presence of more standing fresh water from the saqia wheel and irrigation farming likely contributed to a substantial boost in the more dangerous malaria-carrying mosquito species, such as Anopheles arabiensis (Coates and Redding-Coates 1981; Malcolm et al. 2007).

Malaria is caused by a bite from an infected mosquito species carrying one of the many

Plasmodium parasites. Symptoms of the disease include an acute fever, headache, chills, and vomiting. A chronic or particularly severe form of malaria may lead to life threatening complications, such as cerebral malaria, respiratory distress, and acquired anemia. Severe malarial anemia in conjunction with nutritional deficiencies is particularly dangerous and is likely one of the leading causes of morbidity from the condition in Africa (Ehrhardt et al. 2006).

The presence of endemic malaria is particularly dangerous for individuals with inadequate or suppressed immunity, such as pregnant women and young children, and it is currently the cause of nearly 20% of all childhood deaths in Africa (World Malaria Report 2010). As such, the presence of endemic malaria within the medieval community at Mis Island could have caused high infant and childhood mortality rates, as well as high morbidity rates for the remainder of the population. As a result, various types of anemia stemming from the high prevalence of malarial infection could have been a relatively common source of illness for the medieval community.

In addition to malaria, parasitic infections such as schistosomiasis, leishmaniais, and hookworm have all been identified as likely causes for infection, morbidity, and mortality in the

Nile region throughout the centuries. Schistosomiasis, in particular, has been a significant public health issue for many modern African populations, which contributes significantly to morbidity along the Nile River in endemic proportions (Chitsulo et al. 2000; Vennervald and Dunne 2004).

Schistosomiasis is a chronic parasitic infection caused through ingestion or skin contact with the

Schistosoma blood fluke found in contaminated fresh waters and can cause extensive damage to the human body. Intestinal schistosomiasis may result in abdominal pain, diarrhea, blood in the stool, and in severe cases enlargement of the liver and/or spleen. Urogenital schistosomiasis can result in bloody urine, as well as bladder, ureter, and kidney damage, and infertility (World

Health Organization 2010). The intensity of infection tends to peak in childhood and adolescence and decreases into adulthood, thus making it most dangerous for the youngest segments of the population (Toletino and Freidman 2007). Furthermore, either variant of the parasitic infection can be particularly dangerous for children, because it causes growth stunting, mental and developmental disabilities, severe anemia, and sometimes death. To further add to the danger of such parasites, in endemic situations re-infection is common and can last from 1/3 to 1/2 of a person‟s lifetime (King et al. 2005).

Iron deficiency anemia, megaloblastic anemia, and anemia of inflammation (chronic disease) can result from severe forms of schistosomal infections (Toletino and Freidman 2007).

There are many confounding factors related to the type of anemia acquired from schistosomiasis and is often correlated with the severity and type of infection, as well as the socioeconomic status and dietary intake of the infected individual (Jamra et al. 1964; King and Dangerfield-Cha

2008). As a result, megaloblastic anemia more often co-occurs in individuals that also have low dietary intake of Vitamin B12, while iron deficiency anemia occurs in individuals with more than adequate ingestion of these micronutrients (Jamra et al. 1964). Research shows that iron

deficiency anemia probably has a more direct correlation to schistosoma infections due to blood loss through gastrointestinal bleeding and blood in the urine and stool (Foy and Nelson 1963;

Farid et al. 1967, 1969). However, few studies have adequately differentiated among the many confounding factors that can also cause anemia in infected individuals (King and Dangerfield-

Cha 2008). Schistosomiasis is most often associated with nutritional status, as common symptoms of schistosomiasis include loss of appetite and reduced absorption of micronutrients due to diarrhea (Stephensen 1993; McGarvey et al. 1996). Furthermore, all types of acquired anemia can become particularly problematic in individuals with heavy schistosomal parasitic loads, as damage to the gastrointestinal mucosa can lead to loss and malabsorption of many of the key micronutrients (El Rooby et al. 1963; Amechi Akpom 1982).

The contributing factors for schistosomiasis were likely present in ancient Egypt and

Nubia, as the environmental and cultural conditions were quite similar to the modern era for many communities along the Nile River, including Mis Island. Schistosomiasis is most widespread in tropical and sub-tropical climates, agricultural or fishing communities, and in poorer communities without clean drinking water or adequate sanitation (World Health

Organization 2010). It is especially prevalent in areas that practice irrigation agriculture, as irrigation canals are an ideal habitat for the species of fresh water snails that host the

Schistosoma blood flukes (Kloos and David 2002; Hibbs et al. 2011). In addition, for many communities that rely exclusively on the contaminated Nile River for irrigation farming, drinking and cooking water, bathing, and laundering there would be an increased danger for regular contact with the parasites (Kloos et al. 1983; El-Khoby et al. 2000). Thus it is no surprise that schistosomiasis has been positively identified in archaeological and biological studies focused on ancient Nile populations, including in Egypt and the medieval Nubian sites of

Kulubnarti and Wadi Halfa (Wendorf et al. 1976; Miller et al. 1992; Beadle 1981; Brown 1994;

Ziskind 2009b; Hibbs et al. 2011). Hibbs et al. 2011 conducted enzyme-linked immunoabsorbent assay tests on mummified tissues from a sample of human remains from both Wadi Halfa and

Kulubnarti and found direct evidence of the Schistosoma mansoni infection in both samples.

Prevalence of the parasite among the Wadi Halfa sample was as much as 26.1%, while the prevalence among the Kulubnarti sample was 9.4%. The authors hypothesize that the use of the saqia wheel and irrigation agriculture at Wadi Halfa likely contributed to a higher prevalence rate of schistosomiasis in contrast to the sample from Kulubnarti, where there is no archaeological or historical evidence for irrigation farming. In comparison to Wadi Halfa and

Kulubnarti, the medieval community at Mis Island likely had to rely heavily upon the saqia wheel and irrigation agriculture as the population was known to in the modern era, and thus it could be hypothesized that there would be a higher prevalence of these fresh water parasites at

Mis Island, as well.

In addition to schistosomiasis and malaria, a variety of parasitic infections such as leishmaniasis and filariasis as well as diseases from a number of helminthes, such as hookworm and tapeworm have also been acknowledged in studies from ancient Egypt and Nubia. All of these parasites have been scientifically identified in a number of investigations on mummified human remains and coprolites, and through studies of latrine soils and trash middens, indicating their antiquity in the Nile Valley region (Cockburn et al. 1975; Hart et al. 1977; David 1978;

Cockburn and Cockburn 1980; Reinhard 1992; Tapp and Wildsmith 1992; Shafik and Elseesy

2003; Zink et al. 2006). Leishmaniasis, hookworm, and filariasis are most common in the tropical and subtropical regions of Africa and particularly Egypt and Sudan, and are more often found in disadvantaged communities with poor diets, a lack of clean water, and inadequate

sanitation schemes (World Health Organization). Furthermore, many of these infections are directly related to environmental changes, such as deforestation, the building of dams, and the introduction of irrigation schemes and urbanization (World Health Organization; Desjeux 2001).

A number of these factors were quite possibly present in the medieval Nubian community at Mis

Island, as there was likely irrigation agriculture, poor nutrient intake from a seasonal and B12 deficient diet, and an overreliance on the contaminated Nile River for drinking and cooking water.

Even today, populations of Egypt and Sudan struggle with the effects of infection from these parasitic agents, which can cause a large number of health complications and in extreme cases death. Leishmaniasis in particular is considered one of the most deadly infections in the world, second only to malaria, and today is responsible for nearly 500,000 deaths annually worldwide (Desjeux 2001). The visceral form of the disease is significantly detrimental as it can cause, among other things, irreparable damage to the liver and the spleen. However, infection from any of these parasites can result in severe health complications including chronic fever, extreme weight loss, malabsorption of various micronutrients and subsequent malnutrition, ulcers, fatigue, vomiting, diarrhea, and anemia. To further complicate the health effects of these parasitic infections is the extreme likelihood for a combination of a poor diet and malnutrition, as well as co-infection from multiple parasitic agents, malaria, and HIV/Aids (Alvar et al. 2006;

Spiegel et al. 2003; Brooker et al. 2006, 2007; Mwangi 2006).

As demonstrated, a combination of inadequate nutrition and the possibility of endemic parasitic infections from malaria, schistosomiasis, leishmaniasis, filariasis, and hookworm would have been enough to cause a public health crisis and overwhelm the medieval community at Mis

Island. In addition to these infections, however, it appears that the population also had to worry

about the presence of bacterial infections, such as tuberculosis and leprosy. Indications of both of these infectious diseases were found within the present skeletal sample and have also been identified in studies from throughout ancient Egypt and Nubia (Elliot Smith and Ruffer 1910;

Elliot Smith and Dawson 1924; Rowling 1961; Moller-Christensen 1961; Morse et al. 1964;

Moller-Christensen and Hughes 1966; Morse 1963; Sandison 1968; Zimmerman 1977; Strouhal

1991; Nerlich et al. 1997; Zink et al. 1999; Spigelman et al. 2005; Dabernat and Crubézy 2010).

Tuberculosis in particular has been a public health issue for multiple generations of ancient

Nubians and modern Sudanese populations, with relatively high morbidity and mortality rates

(USAid 2009). Currently the highest number of infections from tuberculosis occurs in sub-

Saharan Africa, with more than 350 cases per 100,000 people and more than 50 per 100,000 resulting in death (World Health Organization 2010b). It appears that the modern population at

Mis Island also battled the dangers of tuberculosis, and a number of deaths from the disease were reported in the local community (Bird 2011, personal communication).

As discussed in Chapter Two: Bioarchaeology and Mortuary Theory, tuberculosis is a result of the Mycobacterium tuberculosis bacterium and can be spread from human to human through respiratory exposure with infected individuals (World Health Organization 2010b).

Symptoms of the bacterial infection include extreme coughing with blood, chest pains, weakness, weight loss, and fever (World Health Organization 2010b). Pulmonary tuberculosis is the result of primary infection to the lungs and lymph nodes, while intestinal tuberculosis focuses on the intestinal wall and lymph nodes (Roberts and Buikstra 2003). The most problematic aspect of the disease is the fact that re-infection is possible and may lead to reactivation of the dormant bacterium many years after the initial infection (Roberts and Buikstra 2003).

Furthermore, there have been a number of studies indicating the co-existence of tuberculosis

with chronic anemia and malnutrition, further complicating the effects and ultimate mortality of the disease (Glasser et al. 1970; Murray 1978; Baynes et al. 1986; McCallan 1999; Kuo et al.

2000; Zacariah 2002; Lee et al. 2006).

Leprosy, on the other hand, does not continue to be such a substantial health problem in the Nile Valley today, but has been observed in small numbers in historic populations from

Egypt and Nubia (Moller-Christensen 1966; Hughes 1966). It is not likely that leprosy was endemic to the region, nor to Mis Island and the present sample, however its presence within the current skeletal sample and within other regions of Egypt requires some attention. Leprosy is caused by exposure to the bacillus Mycobacterium leprae and can also be spread via respiratory exposure to infected individuals (World Health Organization 2010c). It is a chronic illness that infects the skin and peripheral nerves, as well as the upper respiratory tract (World Health

Organization 2010c). Although leprosy can cause permanent damage to the skin, nerves, limbs, and eyes, it is not necessarily highly contagious, nor a particularly deadly infection (Wikipedia).

Therefore, the presence of indicators of the disease in ancient Nubia and at Mis Island, while informative of the various bacterial agents exposed to the population, does not necessarily contribute to the overall morbidity and mortality rates, as many of the other bacterial and parasitic agents.

CHAPTER FOUR: RESEARCH SAMPLE, QUESTIONS, AND HYPOTHESES

In this study data was collected from 406 graves excavated from two medieval Christian cemeteries on Mis Island. From these burials skeletal data from a sample of 219 adults at Mis

Island was collected and compared to published data from a skeletal sample of 148 adults excavated from two medieval Christian cemeteries at Kulubnarti (Tables 3 and 4). Both the skeletal and burial samples from Mis Island and Kulubnarti will be discussed in more detail below.

Table 3: Mis Island Burial and Skeletal Samples. 3-J-10 3-J-11 Totals Males 39 62 101 Females 34 69 103 Indeterminate 3 12 15 Total Adults: 76 143 219

Subadults 50 137 187 Total Sample: 126 280 406

Table 4: Kulubnarti Adult Skeletal Sample. 21-S-46 21-R-2 Totals Males 25 38 63 Females 30 53 83 Indeterminate 0 2 2 Total Adults: 55 93 148

THE MIS ISLAND RESEARCH SAMPLE

This research focuses on a medieval Christian burial assemblage and skeletal collection from Mis Island, located in Upper Nubia in the Fourth Cataract of the Nile River (Figure 1).

Figure 1: Medieval Nubia. Adapted from Welsby DA and Anderson JR (2004), pg 13.

st 1 Cataract

Kulubnarti nd 2 Cataract

rd 3 Cataract

th Mis Island 4 Cataract th 5 Cataract

Mis Island was excavated in 2005-2006 and 2007 as part of the Merowe Dam

Archaeological Salvage Project, under the auspices of the National Corporation for Antiquities and Museums, Sudan (NCAM). In 1999 NCAM made a worldwide appeal for archaeological teams to travel to Sudan, and help save the antiquities of the Fourth Cataract region before completion of the dam in 2009. The Merowe Dam, the largest dam project in Africa, was

anticipated to result in the flooding of 170 kilometers along the Nile Valley from Hamdab to Abu

Hamed. The flooding would not only require the resettlement of several thousand Sudanese people, but also the permanent loss of thousands of years of invaluable cultural heritage. The

Sudan Archaeological Research Society (SARS) and the Department of Ancient Egypt and

Sudan at the British Museum worked alongside international teams from the United States,

Hungary, and Poland to survey and excavate as much archaeological material as possible (Figure

2). Mis Island was only one of the many archaeological sites within the SARS concession to be excavated throughout the ten years of salvage archaeology conducted in the Fourth Cataract region.

Although archaeological findings at Mis Island demonstrated a long, dense history of occupation from the Kerma, Meroitic, and medieval time periods, the rescue nature of the project allowed only enough time to concentrate efforts on the medieval Nubian artifacts and human remains. The 2005-2006 and 2007 field seasons resulted in the excavation of a Late Christian church, a few settlements, and three cemeteries: 3-J-18, 3-J-10, and 3-J-11 (Ginns 2006, 2007).

Cemetery 3-J-18 was associated with the Late Christian church and consisted of 219 burials of individuals of both sexes and variable ages. Although contemporaneous with cemeteries 3-J-10 and 3-J-11, Ginns (2006, 2007) believes that 3-J-18‟s association with the church signifies its sacred position in society and an area of burial for more „prestigious‟ individuals (pg 22). The mummified nature of a majority of the burials precluded it from shipment to Michigan State

University and inclusion in the present study. Therefore, this research focused on the human skeletal remains and mortuary patterns of two burial grounds, 3-J-10 and 3-J-11, located a short distance away from the medieval settlements and the Christian church.

Figure 2: Map of the Fourth Cataract Archaeological Concessions. From the Sudan Archaeological Research Society website: http://www.sudarchrs.org.uk/. *

*For interpretation of the references of color in this and all other figures, the reader is referred to the electronic version of this dissertation.

Figure 3: Cemetery 3-J-10 site map. From Andrew Ginns, personal communication.

Cemetery 3-J-10 is located in a naturally enclosed area about 300 meters northwest of the

Christian church, and dates to the Late Medieval period, c. AD 1100 to AD 1400. About half of the graves in 3-J-10 were randomly excavated from different regions of the cemetery for a total skeletal sample size of 126 individuals (Ginns 2006, 2007) (Figure 3). The eastern edge of

cemetery 3-J-10 demonstrates a distinct change from Christian east-west oriented burials with large stone monuments, to north-south oriented Muslim burials with small single stone monuments. Due to religious considerations, no Muslim burials were excavated and this research focused exclusively on the Christian burials.

Two main Christian burial styles are apparent at 3-J-10. About one-half of the individuals were placed either on their backs or on their sides with no structural elaboration. The second half of Christian burials are associated with stone box monuments and individuals interred on their backs with square rocks or mud bricks placed on either side of the head and over the face. Grave goods are generally absent from the burials at 3-J-10.

Cemetery 3-J-11 is the largest Christian burial ground on Mis Island with over 500 burial monuments and it appears to have been much larger before the encroachment of modern farming. Its use began around AD 300, during the Post-Meroitic period and was likely used into the Late Medieval period, around AD 1400. A total of 294 burials were excavated from 3-J-11, accounting for approximately 50% of the complete burial assemblage (Figure 4). Other than a few Post-Meroitic graves interspersed at 3-J-11, all burials were Christian east-west oriented, stone-lined box graves. Burial orientation and grave type appeared relatively consistent over the entirety of the cemetery however, there were noted differences in monument type, size, style, and state of preservation (Ginns, personal communication). Although there is variation within each, three general phases of medieval burials can be characterized by their location within the linearly oriented cemetery and differences in burial practice. Type 1: Individuals from this burial phase are generally lying on their backs with large flat stones placed on ledges above the body, with ceramic grave goods often present. Type 2: Individuals are placed on their backs with rectangular stones or mud bricks alongside the head, and a third placed over the head. Type 3:

Individuals are placed within grave cuts without any structural elaboration. They are situated either on their sides or more commonly on their backs (Ginns 2006).

Figure 4: Cemetery 3-J-11 site map. From Andrew Ginns, personal communication.

THE KULUBNARTI COMPARATIVE RESEARCH SAMPLE

Kulubnarti is a large island located between the Second and Third Cataracts of the Nile

River, about 80 miles upstream of Wadi Halfa (Figure 1). Kulubnarti was not always a true island, however, and prior to the formation of Lake Nubia only became an island during the yearly Nile flood seasons (Adams et al. 1999). The land surrounding Kulubnarti is referred to as the Batn el Hajjar, or “belly of stones”, and is a region of rocky outcrops with little arable land.

Seated in such an inhospitable area and stuck halfway between the Nubian trade centers and

Egypt to the north, and the Nubian political powers to the south, Kulubnarti was a relatively isolated zone of few resources (Van Gerven et al. 1990a).

Archaeological findings reveal that the site of Kulubnarti was occupied throughout the entire medieval era, from about AD 600 to about AD 1400. Early settlement patterns of open areas and a lack of fortifications or city walls demonstrate that the town was most likely provided a secure and peaceful existence (Adams et al. 1999). However, towards the end of the medieval period, as the Nubian political centers began to crumble and foreign invasions increased,

Kulubnarti fortified its houses into castles and turned into a relatively inaccessible feudal society

(Adams 1994).

A team of archaeologists and physical anthropologists from the University of Kentucky and the University of Colorado led surveys and excavations at Kulubnarti in 1969, 1970, and

1979. Over the course of the excavations archaeologists documented the remnants of twenty different medieval structural sites, such as habitations and churches, as well as two medieval

Christian cemeteries. The comparative sample for this research derives from the skeletal remains from two medieval cemeteries, 21-S-46 and 21-R-2.

Cemetery 21-S-46 is located at the western side of Kulubnarti, about halfway between the northern and southern ends of the island. The inclusion of pre-Christian graves, a number of fetal

burials in distinctive Early Christian ceramic pots and a lack of Late Christian superstructures indicate that cemetery 21-S-46 was used during the Early Medieval period, or about AD 600 to mid AD 800. Out of the 300 identifiable graves located at 21-S-46, a total of 218 individuals of both sexes and various age ranges were excavated. Demographic and paleopathological data collected by the University of Colorado on all adults (n= 55) from 21-S-46 were chosen for comparison.

Cemetery 21-R-2 is located on the west bank of the Nile River, just upstream of the southern end of the island, near the hamlet of Kulbincoing. The largest cemetery on the island,

21-R-2 contained an estimated 500-600 graves. A total of 188 individuals of both sexes and various age ranges were excavated during the two field seasons. Out of the 188 individuals, 93 were adults and 95 were subadults. Demographic and paleopathological data collected by the

University of Colorado team on all adults (n= 93) at cemetery 21-R-2 were chosen for a regional comparison with the Mis Island sample.

The chronology of cemetery 21-R-2 is more complicated. The cemetery appears to have been associated with a Classic Christian Church, as well as a nearby walled settlement, however it was more likely used primarily during the Early Medieval period, with some Classic Christian tombs situated near the church. A difference in superstructure type and burial style from cemetery 21-S-46 led archaeologists to believe that the cemetery might have been in use during the Classic to the Late Medieval periods and represented a continuation from cemetery 21-S-46

(van Gerven et al. 1981; Mittler and van Gerven 1994; van Gerven et al. 1995). A more recent reanalysis however, indicates that textiles recovered from the burials are more consistent with

Early Medieval types and comparable to those found in 21-R-2 (Adams et al. 1999). On the other hand, a more recent graduate thesis on isotopic indicators at Kulubnarti determined that cemetery

21-R-2 could possibly be from the Late Medieval period due to the presence of highly variable oxygen isotopes among the individuals buried there (Sandberg 2006). Sandberg argues that highly variable oxygen isotopic indicators from a group would indicate the presence of migrants, or individuals not indigenous to the area, which was common during the episodes of warfare and subsequent resettlement during the Late period. It is possible that the oxygen isotopes merely indicate two different population groups living in the same area during the early period as opposed to a different group migrating in during the late period. At this time it is unclear what the exact chronology of 21-R-2 is because neither the early nor the late period hypotheses have been further confirmed. Therefore, for the purposes of this research 21-R-2 and 21-S-46 will be grouped together to determine if anthropological analyses can help clarify the matter of chronology at Kulubnarti. If no clear distinctions exist then the cemeteries will remain as a single group for comparison with Mis Island.

RESEARCH QUESTIONS AND HYPOTHESES

This research uses both skeletal biology and archaeology to assess the relationship between health and mortuary practices of a medieval population in Nubia. By examining changes in skeletal indicators of stress and disease and burial assemblage, coupled with a contextual knowledge of historical events and living conditions, this research provides a perspective on quality of life in a medieval Nubian population. Furthermore, the Mis Island skeletal population is a unique opportunity to study the effects of environmental and political stress upon a Nubian community. In many skeletal populations contributing factors of health and disease, such as social and religious ideology, physical environment, a sedentary lifestyle, population aggregation, and diet change dramatically over time. In this case, however, these factors remain

relatively constant throughout the medieval Nubian era, allowing the isolation of political change and its effect on health. Further, a comparison with another medieval Nubian site, Kulubnarti, located in the Batn el Hajjar area of the Nile allows a regional comparison of life for inhabitants of medieval Nubia.

Question 1: Is the treatment of males and females at Mis Island different as expressed in the skeletal biology and mortuary archaeology of the site? Will there be sex-based disparities in the skeletal health of males and females at Mis Island? Furthermore, will burial patterns at cemeteries 3-J-10 and 3-J-11 reflect differences in mortuary treatment?

Expectation 1:

Prevalence rates of non-specific indicators of stress and disease will not be significantly

different between males and females at 3-J-10 or 3-J-11.

Mortuary patterns will not differ according to sex at either 3-J-10 or 3-J-11.

Comparing evidence of disease, nutrition, childhood stress, mortality and mortuary patterns between males and females, is one way to measure sex-based differences in health experience in past societies (Cohen and Bennett 1993). At Mis Island I do not expect to see a significant difference in neither the non-specific indicators of stress and disease nor the mortuary treatment of males and females. Historical literature demonstrates there was not a considerable difference in access to resources between men and women in medieval Nubia. In fact, women were known to own property in their own name, were active in finances, and were patrons of the church (Edwards 2004). Documentary research at a similar Coptic site in Egypt indicates that

females enjoyed relative economic and social autonomy within their marriages and within the community (Wilfong 2002). Furthermore, isotopic indicators of diet at the Nubian site of

Kulubnarti found no measurable difference in diet between the sexes (Turner et al. 2007). These lines of evidence suggest the same would hold true at Mis Island.

Question 2a: Cemetery 3-J-11 was in use from the Post-Meroitic (AD 300) through the Late

Medieval period (AD 1400). Will the burial patterns within cemetery 3-J-11 reflect changes in mortuary treatment over time, such as a stricter adherence to Christian tradition in the Classic and Late Christian burials?

Expectation 2a: A spatial analysis coupled with a statistical investigation of grave superstructure, substructure, body orientation, and the presence of grave goods will demonstrate that there is a transformation in burial patterns at 3-J-11 that are indicative of diachronic change.

Mortuary archaeology and spatial analysis provide the tools to understand how mortuary space and burial patterns change through time as a reflection of the political, social, and religious changes affecting the community. The mortuary facility and the burials themselves are symbolic to a population and can be used to reflect religious affiliation and to establish communal ties and strengthen group integration (Goldstein 2002). As political, economic, and social institutions begin to collapse communities may react by placing more emphasis on mortuary ritual in an effort to enforce a more organized structure on the group (Goldstein, personal communication).

This could be reflected through a transition from less structured, more diverse burials in communal or family groups, to more organized, identical burials in individual plots. However, in

Medieval Nubia there is also the question of community adoption of Christian burial practices, as the Christian religion became more internalized by the community. Therefore, I expect to see a shift in burial patterns reflective of the further adoption of Christian burial tradition in the later burials. As the Christian religion became more integrated into the general population there will be a change in the burial pattern from “transitional” burials with grave goods and blocking stones over the bodies, to thoroughly Christian burials without grave goods nor blocking stones. This will allow a distinction between “transitional” or Early Christian burial patterns from Classic and

Late burials. I further expect to see another later mortuary shift from varied burial clusters to more independent and structured burials, as a reflection of the further adoption of Christian mortuary ritual. As Christianity was further adopted it is possible that the Mis Island population began to identify as a single unified community, as opposed to a variety of family or clan groups living within the region.

Question 2b: Will there be a correlation between the transformations of mortuary ritual in the transitional/early burials and the later group of Christian burials, and the presence of non-specific indicators of stress in the individuals buried at cemetery 3-J-11?

Expectation 2b: There will be a change in the prevalence of periostitis, osteomyelitis, linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis and disease over time in individuals buried at 3-J-11.

Multiple bioarchaeological (Larsen 1997; Buzon and Bombak 2009; Slaus et al. 2002;

Goodman et al. 1988) and medical (Pederson 2002; Ellman 1994; Wilson 1995; Roman 1995)

studies have demonstrated the negative impact of political and economic instability and collapse upon community health. Although specifics of the experience at Mis Island are not known, general characteristics of a collapsing society include: citizen uprisings and local power struggles; depleted communities attempting to meet economic and agricultural demands of instability and warfare; lawlessness; and more successful attempts to seize power by foreign challengers (Tainter 1988). These kinds of political and economic events can put strain on the local community through depletion of food resources often resulting in starvation and malnutrition; increased disease as communities are exposed to outsiders; and increased psychological stress. Further, when communities aggregate for the purposes of safety and defense, problems of proper sanitation, clean accessible water, and infectious disease and parasite transmission can cause additional strain on the community (Walker 2009). Based on these findings and due to the nature of prolonged political and economic decline and ultimate collapse of Makuria in the Late Medieval phase, it is likely there will be a distinction in the prevalence of non-specific indicators of stress and disease in individuals buried at 3-J-11.

Further, a clear distinction in both biological and mortuary indicators among individuals at 3-J-

11 might make it possible to roughly divide burial clusters into Early and Late burial groups.

Question 3: Cemetery 3-J-10 and the later phase of cemetery 3-J-11 are contemporary, spatially distinct (about 91 meters apart) cemeteries on Mis Island. Will the skeletal assessment of indicators of health and a mortuary analysis denote that these differences correlate with two distinct populations or variable social groups of the same population?

Expectation 3a: There will not be a significant difference in adults between 3-J-10 and 3-J-11 in the prevalence of osteomyelitis, periostitis, linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis, and specific disease.

Expectation 3b: Cemeteries 3-J-10 and 3-J-11 will not have a significant difference in the style or size of grave monuments; the type of surface and subsurface structures; the number of grave goods; the spatial layout of graves; or the position of bodies within the grave.

A direct comparison of skeletal indicators of stress and disease can elucidate whether distinctions in group health reveals differences in status or access to resources (Shimada et al.

2004). If the two cemeteries represent two community groups with different status, then one would expect a marked disparity in the prevalence of skeletal indicators of stress. If the groups are equal in their access to resources however, then one would expect no such differences in skeletal indicators of stress. In addition, mortuary archaeology has been used in a number of capacities to understand past social structure as reflected in the mortuary ritual (Binford 1971;

Tainter 1978). Spatial analysis of cemeteries is a method used to visualize mortuary patterns and understand the significance for overall social organization (Saxe 1970; Goldstein 1981; Charles and Buikstra 1983; Ashmore and Gellar 2005). Spatial analysis can reveal correlations between subpopulations and the spatial layout of the cemetery (Goldstein 1981). There is not expected to be a significant difference in the prevalence of non-specific indicators of stress and disease or the use of mortuary space among the two cemeteries. Both cemeteries appear to represent a typical community burial ground, with a relatively equal number of males, females, and subadults.

Further, there is no overt difference between the structure or profile between the two cemeteries that would indicate a difference in community subgroup or social class.

Question 4: How does the prevalence of skeletal indicators of stress and disease at Mis Island compare to health at Kulubnarti, another medieval population in northern Nubia?

Expectation 4: There will be a difference in the prevalence of linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis, osteomyelitis and periostitis, and specific disease between populations at Mis Island and Kulubnarti throughout the medieval period.

This study utilizes published comparative data from the northern Nubian site of

Kulubnarti. The health of this population has been extensively studied and reported in the literature. Kulubnarti is a community living in a rocky, depleted climate with little cultivable land and few food resources. As a result, the analyses at Kulubnarti depict a poor and hungry population, which are most likely not representative of all medieval communities (Anderson, personal communication). Researchers at Kulubnarti (Hummert and Van Gerven 1983; Van

Gerven et al. 1990; 1995, and Mittler and Van Gerven 1994) found a high prevalence rate of non-specific indicators of stress and disease.

I expect to see fewer non-specific indicators of stress and disease in adults at Mis Island in comparison to Kulubnarti. Archaeological and historical sources indicate that the experience of northern Nubians was markedly different from that of Nubians from Upper Nubia and Central

Sudan (Welsby 1992). Lower Nubians were closer to Egypt, which in Classic Medieval times might have increased local prosperity, but in the Late phase would have introduced increased

violence and economic instability during the Muslim invasions. Mis Island, located in the Fourth

Cataract, was more remote and defensible insulating it from many of the economic and political factors affecting Kulubnarti in northern Sudan (Welsby 2002). Furthermore, Mis Island has a larger area of arable land, allowing it more constant and varied food resources increasingly protecting the inhabitants from nutritional deficiencies that would diminish their ability to fight infection and disease.

CHAPTER FIVE: RESEARCH METHODS

OSTEOLOGICAL DATA COLLECTION

All osteological data were collected using the “Human Bioarchaeological Database 1.0” copyrighted by the British Museum. The database was created specifically for the Mis Island skeletal collection, based on American (Buikstra and Ubelaker 1994) and British (Brickley and

McKinley 2004) standards for data collection on human remains, and perfected based on software created for osteological analysis at Spitalfields Cemetery in London (Redfern, personal communication). The database guaranteed a thorough and standardized collection of all osteological data. At the end of each week, collected skeletal data were converted into a numerical scoring system and entered into an excel spreadsheet for statistical analyses.

The Biological Profile

Sex Determination

Sex determination is one of the key factors of analysis in bioarchaeology research because it can highlight differences in the life experiences of males and females. Comparing evidence of disease, nutrition, childhood stress, mortality, and mortuary patterns between males and females is an appropriate way to measure differences in cultural construction of sex and gender in past societies (Grauer and Stuart-Macadam 1998). Furthermore, a chronological comparison of sex differences in patterns of health, disease, and burial can clarify how sex and gender roles may have changed over time for a particular population (Cohen and Bennet 1993).

The skeletal determination of sex is based on sexual dimorphism in body size and inherent morphological differences between males and females. The estimation of sex in skeletonized remains is relatively straightforward; however the age and the population from which the individual derives can have an impact on accuracy. Despite many attempts to estimate sex in juvenile remains, researchers agree that subadults cannot be sexed with any degree of certainty or accuracy (White 1991; Lewis 2007; Saunders 2000). Sex characteristics of the pelvis and cranium are secondary characteristics of puberty and sexual maturation, and subadults have not yet acquired the sexually dimorphic bony characteristics visible in adult remains. Variations in population genetics can affect the degree of sexual dimorphism between males and females of a particular ancestral group and may affect our ability to accurately estimate sex in different populations (Walrath et al. 2004). Coupled with biases in the preservation of human remains

(Walker et al. 1988), the accurate determination of sex in past populations can sometimes be complicated. However, the visual assessment of sex-based morphological characteristics

(Walrath et al. 2004), as well as the use of population-specific analyses, and the use of multiple morphological features and long bone metrics can make sex estimations fairly accurate (Rogers and Saunders 1994).

Differences in pelvic and cranial morphology were used to estimate sex in this study.

Morphologic features of the pelvis, including the subpubic concavity, the ischiopubic ramus, ventral arc, subpubic angle, greater sciatic notch, obturator foramen, and preauricular sulcus, were the principle features used to establish sex (Phenice 1969; Buikstra and Ubelaker 1994).

Morphological features of the cranium and mandible were used to complement estimations of sex using the pelvis and when pelvic features were unobservable. Specific sexually dimorphic characteristics of the cranium included the nuchal crest, mastoid processes, supraorbital margins,

supraorbital ridges, and the mental eminence (Buikstra and Ubelaker 1994). In all cases, multiple pelvic and cranial features were assessed to place individuals into one of the following categories: male, probable male, indeterminate, probable female, or female.

Age Estimation

Age estimation is a vital component of any bioarchaeological study because many indicators of stress and disease are age-dependent. For example, much older individuals often display a higher prevalence of infectious lesions and degenerative disorders (Larsen 1997), while younger individuals typically display a higher prevalence of nutrition dependent diseases, such as cribra orbitalia and porotic hyperostosis. The estimation of age in both adults and subadults can greatly affect the demographic interpretation of health and disease in a population; however, there are many limitations to the accurate osteological estimation of age, particularly in adults.

Interobserver error and methodological flaws in the estimation of age in archaeological populations (Saunders 2000; Jakes 2000), as well as problems of preservation and excavation strategies of a burial assemblage, can greatly affect the demographic profile of a population

(Walker et al. 1988). However, with that in mind, it may be possible to accurately estimate age and paleodemography through a conscientious application of multiple methods of age estimation and the use of broad age categories (Saunders 2000; Lovejoy et al. 1985a; Bedford et al. 1993;

Brickley and McKinley 2004).

The estimation of age in adults is an important component of this study for both paleopathological and mortuary analyses. Adults were classified as individuals over the age of twenty, as recognized by anthropological standards (Buikstra and Ubelaker 1994). An individual was determined to be an adult if the third molars were fully erupted and all of the long bone

epiphyses were fully fused. Any individual without fully fused long bone epiphyses (except the clavicle) was considered to be an adolescent, regardless of the status of the third molars. Since the main focus of this study was on adult health and life experience at Mis Island and another concurrent study at Michigan State University is focusing on the juvenile population (Hurst, personal communication), specific age categories were not further estimated for the subadult sample. However, for the purposes of the mortuary analysis subadults were grouped into two categories: neonates or infants, and children and adolescents between the ages of two and nineteen.

Adult age was estimated through a multifactorial approach that combined a number of skeletal indicators of age-based developmental and degenerative changes (Lovejoy et al. 1985a;

Buikstra and Ubelaker 1994). The skeletal features most commonly consulted included the medial clavicle, iliac crest, pubic symphysis, auricular surface of the ilium, the sternal ends of the ribs, and occlusal tooth wear. Eruption of the third molars, as well as epiphyseal union and obliteration of the medial ends of the clavicles, iliac crest, and ischiopubic ramus were relied upon to narrow down the age range in young individuals. Due to the sandy environment and the extreme nature of tooth wear in the Mis Island population, an established method for occlusal tooth wear was not appropriate to determine narrow age ranges. Therefore, occlusal tooth wear was broadly used to help seriate individuals within this collection and narrow down an appropriate age category, especially in older adults.

Degenerative changes of the pubic symphysis were recorded based on standards formed on modern forensic populations established by Brooks and Suchey in 1990 and published by

Suchey and Katz in 1998. Although relatively accurate in younger adults, estimating age-at-death from just the pubic symphysis can be problematic due to its inability to accurately estimate age

in individuals more than forty years old. Furthermore, it is rarely as well preserved in an archaeological context as other skeletal elements. Therefore, the auricular surface of the ilium was also consulted and age-related degenerative changes were recorded based on the method described by Lovejoy et al. (1985b) and improved upon by Buckberry and Chamberlain (2002).

When available, age-related changes of the form, shape, texture, and overall quality of the sternal rib ends were also considered for age-at-death estimations. Periosteal deposition of new bone and perichondral mineralization will age in a chronological fashion that can be easily recorded in phases. According to Iscan and Loth (1984, 1985), a nine-phase system can be employed to record changes in pit formation, wall formation and width, boney projections, and overall texture and weight. In addition, Dudar (1993) found that there are no significant age- related changes in ribs 2-9, and the technique can be applied to the sternal end of any rib between

2 and 9. Due to the well-preserved nature of the Mis Island remains, the Iscan and Loth (1984,

1985) method was consulted as a viable technique for age-at-death estimation in the adult remains.

Age estimations were also made based on the chronological obliteration of the cranial sutures of the ectocranial vault. Cranial suture closure is based on the assumption that there is a basic correlation between suture closure and chronological age progression. Although age estimations using cranial suture closure have often been considered unreliable, this method may be employed when no other indicators of age are available or when used in conjunction with other methods (Nawrocki 1998). In this study, cranial suture closure was consulted only in conjunction with other methods or when no other indicators were available. Suture closure was recorded for 17 different sites on the ectocranium and scores were summed for an age range for each individual (Buikstra and Ubelaker 1994).

To allay problems with the inherent limitations of age estimation, this study used a multifactorial approach with an assignment of individuals to broad age categories. Multiple age indicators were consulted for each individual and a summary age estimate was composed, with a minimum and maximum range (Buikstra and Ubelaker 1994). Individuals were then assigned to broad age categories for comparison with research from the site of Kulubnarti (van Gerven et al.

1981; Adams et al. 1999), and for future research according to standards produced by Buikstra and Ubelaker (1994)(Table 5). Individuals that could not be aged due to poor preservation or missing skeletal elements were placed within generic adult or subadult categories.

Table 5: Age groups, associated summary age ranges, and Kulubnarti comparative age ranges. Age Group Summary Age Range Kulubnarti Age Range

Neonate/Infant Neonate – 3 years Neonate – 2 years

Subadult 3 – 20 years 3 – 20 years

Young Adult 20 – 35 years 20 – 30 years

Middle Adult 35 – 50 years 30 – 40 years

40 – 50 years

Old Adult 50+ years 50+ years

Paleopathology and Indicators of Stress and Disease

Linear Enamel Hypoplasias

In this study, linear enamel hypoplasias were analyzed for presence or absence on all teeth; however, prevalence rates were only calculated for permanent maxillary and mandibular

incisors and canines. The anterior teeth were chosen for the likelihood of data comparison with other studies and because anterior teeth are the most easily identifiable and commonly affected by linear enamel hypoplasias (Steckel and Rose 2002). Based on more recent research standards, the presence of a linear enamel hypoplasia was defined as a clearly visible line that could be seen macroscopically, without the aid of a handheld lens, and that could be felt with a fingernail

(Steckel et al. 2006). All teeth were macroscopically observed using strafing light from natural sunlight or bright desk lamps, and a handheld lens was consulted when necessary. Previous studies have demonstrated that macroscopic observations provide sufficient information on health (Hillson 2002; Larsen 1997) and therefore, a macroscopic observation was considered adequate for this study.

Each anterior tooth was documented for presence or absence of linear enamel hypoplasias and the total number on each tooth. Each linear enamel hypoplasia present on a tooth was recorded separately. Teeth for which more than 50% of the crown surface was missing either due to occlusal wear, crown breakage, or carious destruction were not scored.

Measurements on the exact location of linear enamel hypoplasias in relation to the cemento-enamel junction were not taken for this study for a number of reasons. Previous studies on the correlation between hypoplastic location and specific ages are problematic because they make a number of faulty assumptions: 1) they are based on a constant growth rate for formation of all tooth crowns, 2) they are based on a single set of dental formation standards despite proven population and socioeconomic variation in development, and 3) they assume that the exact position and length of the defect directly correlate to the time or duration of the growth disruption (Goodman and Rose 1990; Hillson 1992, 2002). Furthermore, the dental formation rates for Medieval Nubian populations are unexplored, and there are no known developmental

charts with which to compare the location of a hypoplasia. Therefore, the effects of linear enamel hypoplasias at Mis Island were simply based on prevalence rates.

Cribra Orbitalia and Porotic Hyperostosis

Due to the debate of whether cribra orbitalia and porotic hyperostosis are the result of identical causal factors (Larsen 1997; Stuart-Macadam 1989; Walker et al. 2009), this study analyzed cribra orbitalia and porotic hyperostosis as two separate conditions. All adults with at least one eye orbit were evaluated for cribra orbitalia, and all adults with at least a sizeable portion of the cranial vault (frontal, parietals, or occipital) were examined for porotic hyperostosis. All cranial and orbital lesions were macroscopically observed and scored for three factors: presence or absence; stage of activity; and severity (Stuart-Macadam 1991). Presence was defined by the existence of patterns of scattered foramina or any capillary-like impressions on the bone. The stage of activity was concluded to be healed, active, or a mixed response, based on the nature of the bone lesion and the edges of the foramina. Severity was determined based on

Stuart Macadam (1991), which ranges from scattered fine foramina, to capillary-like impressions on the bone, and in more severe cases the outgrowth of trabecular bone.

Since cribra orbitalia and porotic hyperostosis can be indicators of multiple conditions, this study attempted a differential diagnosis between possible anemia and scurvy. If an individual had evidence of either cribra orbitalia or porotic hyperostosis, then the sphenoid and long bones were analyzed for the presence of lesions that are associated with scurvy (Ortner et al. 1999;

Ortner et al. 2001; Ortner and Erickson 1997; Maat 2004; van Der Merwe et al. 2010). Although lesions indicative of scurvy are not commonly found in adults, it was important to conduct a

thorough study of all affected bones to gain a more complete perspective on the etiology of the cranial lesions.

Periostitis and Osteomyelitis

Periostitis and osteomyelitis are a reaction to localized or widespread infection or disease.

In this study, all long bones and the visceral and ventral surfaces of the ribs were macroscopically assessed for the presence of periostitis, and all long bone shafts were assessed for the presence of osteomyelitis. Periostitis was evaluated as either an active (woven), healed

(sclerotic), or mixed reaction. Active lesions were defined as areas of woven bone deposition with sharp, largely defined, and raised edges, while healed lesions consisted of areas of bony deposition with smooth remodeled walls and margins (Buikstra and Ubelaker 1994). Mixed reactions were a combination of both active and healed lesion types. Further information regarding what bones were affected, the specific anatomical location on each bone, and the relative size of the lesions (when possible and appropriate) was also collected (Lovell 2000). The overall distribution of periostitis on each individual was considered to determine whether a reaction was likely systemic or localized. Any periosteal reaction secondary to a traumatic episode was not considered in this study, because of the differential nature and interpretation of such lesions. Osteomyelitis was determined based on presence or absence of medullary narrowing, a cloaca, or involucrum. Specifics on the skeletal element and anatomical area affected were also considered. For both periostitis and osteomyelitis the severity of the lesion was assessed based on a simple scale of barely discernible, moderate expression, and severe expression.

Maxillary Sinusitis

In this study, all adults with at least one observable maxillary sinus were assessed for presence or absence of the disease, as presented in Boocock et al. (1995). No scopes were used in this investigation and therefore, only individuals with incomplete crania and exposure of the maxillary sinuses could be included in the present analysis. Bony destruction and proliferation within the sinuses were categorized as pitting, active spicule formation (thin spicules of bone applied to the bony surface), remodeled spicules (spicules appear merged and more plaquelike), and white pitted bone. Accordingly, all bony change was described as either active or healed at the time of death. The posterior maxillary walls were also evaluated for pitting and/or bony plaque deposits and remodeling, as well as for large foramina leading into the maxillary sinuses.

The maxillary alveolus was evaluated for the presence of dental abscesses introduced into the maxillary sinus, because a direct connection between the two could point to a dental disease as the origin of the sinusitis (Roberts 2007).

Specific Infectious Disease

This sample was investigated for infectious disease processes based on the ability to differentially diagnose diseases such as tuberculosis, leprosy, brucellosis, and treponemal disease. Ortner (2003), Aufderheide and Rodriguez-Martin (1998), and Roberts and Manchester

(2007) were consulted to determine the presence of specific infectious diseases based on distinct pathological changes of the long bones, vertebrae, ribs, cranial vault, and midface region.

Specifically, the vertebrae were analyzed for presence of cavitating lesions and collapse, and the visceral surfaces of the ribs were analyzed for the presence of porosity or cortical expansion common in tuberculosis and brucellosis. Although a specific disease diagnosis could only be

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made on a small number of cases, many deleterious changes could be narrowed down to a couple of possible infectious processes.

All pathological lesions were recorded based on several factors, such as the specific bone affected, anatomical location on the bone affected, extent of bone affected, severity, a detailed description of the pathological lesion, and when appropriate, the distribution of the lesions throughout the body (Lovell 2000). All pathological lesions were photographed for possible differential diagnosis in the future, with the inevitable introduction of new methodologies.

Tuberculosis

In this study, Ortner (2003) and Aufderheide and Rodriguez-Martin (1998) were consulted when there were indications of lytic bony destruction to the vertebrae, ribs, or os coxae. There are a number of features that would indicate tuberculosis in skeletal remains. These features are: multifocal lytic lesions affecting the lower thoracic or upper lumbar vertebral bodies; subsequent destruction and collapse of the vertebral bodies leading to vertebral kyphosis, also known as Pott‟s Disease; lytic destruction of proximal rib heads adjacent to affected vertebral bodies; and unilateral or bilateral proliferative bony buildup along the visceral surface of multiple ribs (Ortner 2003; Roberts and Manchester 2005).

Despite these diagnostic features of tuberculosis, there are a number of other infections or disorders that can cause similar lytic destruction of the vertebrae and ribs. Septic arthritis, brucellosis, traumatic crush fractures, and mycotic infections have been identified as conditions that can mimic the skeletal features of tuberculosis. As such, as careful differential diagnosis is difficult and cannot always be attempted. However, the multifocal lytic destruction of vertebrae and subsequent collapse and kyphosis of the vertebrae are more indicative of tuberculosis than

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any other condition and are used in this dissertation as a definitive indication of the disease.

Destructive analyses using molecular DNA could not be attempted on the remains at the time this study was conducted, but future studies can further determine whether the features of tuberculosis identified here are indeed indicative of the disease within the skeletal sample at Mis

Island.

Paleopathology Prevalence Rates and Statistical Analyses

Prevalence rates for all recorded pathologies were calculated according to Waldron

(2007), by dividing the number of skeletal elements with lesions by the total number of the skeletal element present in the group under analysis. For instance, if an individual had a linear enamel hypoplasia on the left maxillary central incisor, then this linear enamel hypoplasia would be divided by the total number of observable left upper central incisors in the sample. This accounted for antemortem and postmortem skeletal loss and destruction, and produced a more accurate estimation of paleopathology within the population. Prevalence rates were compared according to age, sex, and cemetery cohorts. Comparisons between age and sex groups, as well as between cemeteries and sites were conducted through Pearson‟s chi-square tests, Fisher‟s

Exact Tests, and proportional reduction in error tests, such as Phi and Cramer‟s V. In addition, common odds ratios were calculated for comparisons between the Mis Island adult sample and results found from the site Kulubnarti.

MORTUARY DATA COLLECTION

Analysis of the Mis Island materials utilized raw mortuary data consisting of detailed burial context sheets, site maps, as well as grave drawings and photographs obtained from the

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Sudan Archaeological Research Society and British Museum archaeological team. Two excavation seasons produced copious data on the location of each burial, types of superstructures and head stones, as well as the detailed position of the bodies and the inclusion of personal adornment and grave goods. Raw data from Mis Island were used in two capacities to evaluate the relationships between mortuary practice and sex, status, and possible familial or population groups. First, archaeological maps were created using ArcGIS 10.0 to visually assess whether there were any clusters or relationships between subgroups of individuals buried at cemeteries 3-

J-10 and 3-J-11. The spatial analysis included differences in grave location, grave monuments and body coverings, body position, presence and type of grave goods, and burial clustering according to Goldstein (1981). These spatial analyses were then overlain with the biological profile and paleopathology to determine patterning in age, sex, or disease prevalence within the cemeteries, burial clusters, and body positions.

The Mortuary Variables

Burial Location

At Mis Island, the location of each burial was recorded during excavation and assigned a burial number. All burial locations were then documented using a total station, and the lead archaeologist, Andrew Ginns, created scaled maps indicating the location of each specific burial within cemeteries 3-J-10 and 3-J-11. Mr. Ginns generously provided these maps for inclusion in the GIS portion of the present study.

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Grave Monument/Superstructure

Grave monuments or superstructures are a common feature of Christian Medieval burials among all the Nubian kingdoms. As discussed in Chapter Two, the most common form within both Lower and Upper Nubia was the stone or brick pavement (Adams 1998). While it is still unclear whether the existence and type of a grave superstructure is a sign of social status (Adams

2003), it has been suggested that the type of superstructure represents local variability, regional distinctions, and changes in style through time (Adams 1998).

For the present sample, burial superstructures were divided and coded according to presence or absence and superstructure type. Ginns (2010a, b) groups the grave monuments into five main Merowe Dam Archaeological Salvage Project (MDASP) categories: FF03c, FF03a,

Rock Rubble, X10, and X11 (MDASP FF02f). FF03c superstructures were the most commonly found at Mis Island and were rectangular shaped with three to four courses of stone blocks infilled with loose earth and gravel (Borcowski and Welsby 2009). FF03a grave monuments were also commonly represented at Mis Island and were rectangular shaped, marked out by only one course of stone blocks, and filled in with earth and loose gravel (Borcowski and Welsby

2009). A single burial of an infant had an X10 type of monument, which is described as “a single row of four mud-brick headers” lying across the grave (Ginns 2010b: page 4). Finally, the X11

(MDASP type FF02f) grave monument was found in several burials at cemetery 3-J-11 and is described as “stone slabs set as headers over the grave cut” (Borcowski and Welsby 2009: page

6). See Figure ## for schematic drawings of monument types FF03a, FF03c, and X11 (FF02f), and Figure ## for a photograph of monument type X10.

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Figure 5: MDASP Grave Monuments. From Borcowski and Welsby (2009), pg 8-9.

Figure 6: Grave Monument Type X10. From Ginns (2010b), pg 4.

Grave Orientation and Head Location

An east-west orientation of the grave and placement of the head of the deceased on the west side of the grave is a traditional Nubian Christian mortuary practice. All burials at Mis

Island were placed roughly east-west in accordance with the location of the Nile, and therefore

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the orientation of the grave was not included as a variable in this study. However, although placement of the head of the deceased on the west side of the grave is well documented in

Christian doctrine (Rush 1941; Zurawski 1987), there are a small subsample of burials at Mis

Island that contradicted this practice. Therefore, head location was considered an important variable at Mis Island and was coded as either on the west or the east side of the grave.

Head Covering

A large majority of burials in both Upper and Lower Nubia had a covering over the head and/or face of the deceased (Adams 2003). Symbolic covering of the head in some form is a long-standing tradition typical of historic burials in Egypt and greater North Africa, and it is likely that head coverings in medieval Nubian burials persisted from a Greco-Egyptian belief system (Zurawski 1986). Interestingly, there does not appear to be much use of head coverings in the pre-Christian Nubian Ballana phase, and the lack of a head covering was used at Mis Island

(Ginns 2010b) to indicate a possible pre-Christian or transitional burial form. At cemetery 3-J-

11, Ginns (2010b) argues that the burials without a head covering tend to group on the western end, which is considered the earlier phase of the cemetery. However, he also notes that there are burials without head coverings interspersed throughout cemetery 3-J-11, which may indicate that either both burial customs were used concurrently or that the cemetery developed from multiple areas or plots throughout the cemetery. To further complicate the argument, there are also a number of burials at 3-J-10 without head coverings. Cemetery 3-J-10 is considered to be Late

Medieval and therefore, it is not likely there would have been early or transitional burials at 3-J-

10. Furthermore, the majority of burials without head coverings at 3-J-10 were associated with infants and children, signifying an age or status association with head coverings. Although the

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reason remains unclear, it is possible that the use of head covering is an important component of a medieval Nubian mortuary analysis and as such, has been included in this study. Four different variables were separately coded for the use of head coverings: 1) presence or absence, 2) the type of materials used, 3) the number of materials used, and 4) the location of the materials around the head.

Type of Head Covering

The type of head covering was coded as either none, mud brick, stone, or a mixture of stone and mud brick. At Mis Island it appears that there was no real distinction between the use of stones or mud bricks, and they were used concurrently and interchangeably throughout both cemeteries (Ginns 2010a, b).

Head Covering Location and Number of Materials Used

The most frequent form of head covering in Medieval Nubia was the placement of two stones or mud bricks on either side of the head, with a third stone or mud brick bridging the two and covering the face of the deceased (Adams 2003). While this pattern was widespread throughout the region, many other combinations of stones or mud bricks were used to cover the face of the buried individual at Mis Island (Ginns 2010a,b). Furthermore, it was possible to find anywhere from one to four stones or mud bricks at the side of the head, above the head, or over the face of an individual. Two separate scoring categories were established to reflect these variations: 1) the number of materials used (none, one, two, three, or four) and 2) the placement of the materials about the head. The following classifications were used for the placement of

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head coverings: none, one on each side of the head and one over the face, and other, which included a number of variations of single stones or multiple stones over the head and face.

Body Covering

Although covering the body with blocking stones or bricks is a relatively common feature in Early Christian Lower Nubian burials (Adams et al. 1999), only a small number of interments at Mis Island had stone slabs either completely or partially covering the deceased. At Mis Island, burials that contained blocking stones had a vertical grave cut with stepped sides to allow the blocking stones to lie above the body, creating a void in the grave (Ginns 2010a,b). Thus, all earthen fill was kept above the blocking stones, protecting the body from the soil. All burials without blocking stones or bricks had grave cuts that were straight and vertical without any stepping on the upper surfaces, and soil was placed directly onto the body. Most of the burials with blocking stones at 3-J-11 were concentrated on one edge of the cemetery and contained grave goods, which might be indicative of transitional or Early Christian interments. To further this hypothesis, there were no burials with blocking stones in Late Christian cemetery 3-J-10.

Body coverings at Mis Island were coded and placed into the following categories for comparison: none or stone slabs covering either the entire or a portion of the body.

Body Position, Head Orientation, and Hand and Leg Position

The most common practice in Christian Nubian mortuary ritual was to place the individual flat on his or her back with legs fully extended or slightly flexed to fit within the grave cut (Żurawski 1994; Adams 1998, 2003). Typically, the head faced straight upwards, or was turned toward the north side of the grave (Adams 1998), and the hands were placed either over

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the pelvis or along the sides of the body (Adams et al. 1999). Despite the tendency for most

Christian Nubian burials to ascribe to this pattern, there was some variation in body and head orientation in the present sample. At Mis Island, while most individuals were buried on their backs in an extended position with their legs straight and their heads facing upwards, there were also a number of burials with individuals on either their right or left sides, facing north or south, with legs either extended or flexed, and with their hands in a variety of positions. There were also a few cases of individuals buried face down.

Body orientation, head orientation, hand position, and leg position were each scored separately for each burial. Body orientation was scored as one of the following: supine/dorsal, prone/ventral, right side, left side, or as a disturbed burial. Head orientation was scored as facing upwards (towards the sky), downwards (towards the bottom of the grave), north, south, with the head resting on the back of the grave, or disturbed. There were a variety of hand position combinations and to determine if the variations had significance it was important to score each hand placement combination as a separate category. There were eight different categories for hand position, including: at the hips; over the chest; along the sides of the body; one arm over the chest and one arm along the side; one arm at the hip and one arm along the side; one arm over the chest and one arm over the hip; right arm over the hip and the left arm below the hip; and miscellaneous. The position of the legs was more simply scored as extended, slightly flexed (to fit within the grave cut), one leg extended and one leg flexed, and fully flexed (with knees towards the chest).

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Grave Goods and Items of Personal Adornment

Historically, the inclusion of grave goods and items of personal adornment in a burial have been considered a reflection of the ranked social status of the deceased (Saxe 1970; Binford

1971; Brown 1971). The number of grave goods, the rarity of the materials used to make the grave goods, the function of the grave goods, and how grave goods were obtained have all been used in mortuary studies to understand social structure in a community and the ranked social status of certain groups and individuals within the community (Binford 1971; Brown 1971;

Peebles and Kus 1977; Tainter 1978; Appadurai 1986; Rakita and Buikstra 2005). In ancient

Nubia during Pre-Christian times the number and type of grave goods and the grandiosity of a burial were interpreted as reflections of the political, social, or royal status of an individual

(Trigger 1969; Welsby 1996; Edwards 2004). However, with the conversion to Christianity and the ideal of equality in the human soul at death (Welsby 2002), grave goods all but disappeared from the mortuary sphere. In Medieval Nubia, the inclusion of grave goods has been interpreted less as an indication of social status, and more as an indication of a transitional burial form and the continued adherence to a pre-Christian burial tradition (Edwards 2001).

There are a number of individuals at Mis Island buried with items of personal adornment and/or grave goods. Those burials with grave goods may also contain blocking stones, another indication that the burials are of the Early Christian period. The majority of grave goods are utilitarian ceramic vessels such as jars, bowls, cups, pots, and lamps (Ginns 2010b). Some individuals have items of personal adornment, such as beaded necklaces and bracelets, cowrie shell necklaces, metal anklets, and even metal crosses tied around the neck with leather cord

(Ginns 2010b). Most of the items of personal adornment are found within the interments of juveniles, indicating an age-related significance to these burial inclusions. Unfortunately, none of

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the grave goods nor items of personal adornment has yet to be studied by a material expert, and therefore, the only available data about these items comes from basic descriptions included in the site report (Ginns 2010a, b). For this reason the analysis of grave goods and items of personal adornment for the sample at Mis Island is very basic. Grave goods were coded based on the type of grave good present and the total number of grave goods present. Items of personal adornment were scored for the type of material, such as beads, cowrie shells, or metal jewelry, and the location of the personal adornment on the deceased‟s body.

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CHAPTER SIX: MORTUARY RESULTS

Chapter Six presents the results of a spatial and statistical analysis of mortuary patterns in cemeteries 3-J-10 and 3-J-11 at Mis Island. The goal of this chapter is to document fully and understand the nuances of Christian burial practices at Mis Island during the medieval period.

The chapter will include a detailed description of spatial patterns and their statistical significance, as well as an interpretive analysis of the social, religious, and socioeconomic implications of the mortuary patterns. Subsequently, Chapter Seven: Paleopathology Results will report the osteological findings of health from burials presented in this chapter, and Chapter

Eight: Discussion and Conclusions will present the implications of all of the results and what they ultimately signify about life for medieval Nubians at Mis Island. Chapter Six is divided into three sections. The first section focuses on the distribution of burial patterns at cemetery 3-J-10, while the second section presents the results of the mortuary analysis at cemetery 3-J-11. The third and final segment compares cemeteries 3-J-10 and 3-J-11.

The results from cemeteries 3-J-10 and 3-J-11 are reported in a similar fashion. Each section begins with a short description of the terrain within and adjacent to the cemetery prior to excavation, followed by a brief outline of the demographic profile of each cemetery. It should be noted that a more in-depth discussion of demographic profiles and a comparison of age and sex groups are reported in Chapter Seven: Paleopathology Results. Next follows a detailed presentation of ArcGIS maps and a discussion of the spatial distribution of burial patterns according to the position of the body and grave contents. Statistical results, such as chi-square and proportional reduction of error tests, are presented simultaneously to demonstrate the relationships between burial forms and groups as visualized in the ArcGIS maps. In addition,

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cluster and factor analysis tests were also run on the mortuary data from both cemeteries 3-J-10 and 3-J-11. Unfortunately, the burial data was too noisy and inconsistent, and these tests did not identify appropriate burial or variable groupings and therefore, the results are not included in this analysis.

CEMETERY 3-J-10

According to the lead archaeologist, Andrew Ginns (2010a), cemetery 3-J-10, likely in use from c. AD 1100-1400, was centrally located at Mis Island in an enclosed area about 300 meters northwest of the remains of a Christian church. The cemetery was surrounded on the northern and western edges by natural bedrock outcrops, which effectively imposed limitations on its size, but also preserved it from the intrusion of agricultural activity (Figure 7). The eastern edge of cemetery 3-J-10 was bordered by a Muslim cemetery, which was clearly delineated from the medieval burials and still in use at the time of excavation.

A total of 262 medieval Christian burials were identified at cemetery 3-J-10 based on the presence of box-grave monuments aligned roughly east-west. Due to the limitations of time only a small sample of burials (n= 126) were excavated during the two field seasons. However, in order to obtain a fairly distributed sample of burials across time and space, archaeologists attempted to select individual graves from across the entire site for excavation (Ginns 2010a)

(Figure 7). Although a minimal number of these burials (n= 6) were disturbed by later activity, a large majority (n= 120) were intact at the time of excavation. The entire sample of 126 burials of both adults and subadults is included in this mortuary analysis.

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Figure 7: Overview of Excavated Burials at Cemetery 3-J-10.

Cemetery Demography

Although the selection of graves did not follow a systematic sampling strategy, the individuals excavated at cemetery 3-J-10 represent a relatively equivalent sample of subadults and adults, as well as males and females. Individuals were grouped into subadult and adult age cohorts, as well as groups differentiated by sex for further spatial and statistical analysis (Tables

6 and 7). Subadults make up approximately 40% of the sample and consist of a small group of neonates and infants (n= 7), as well as juveniles and adolescents (n= 43). The remaining 60%

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(n= 76) of the sample is adult, with an even mixture of males and females and individuals representing each adult age cohort.

Table 6: Cemetery 3-J-10 Age Demographics. Age Number (n) % Subadult Neonate/Infant 50 7 39.7 5.6 Juvenile/Adolescent 43 34.1 Adult Young 16 12.7 Middle 39 31.0 76 60.3 Old 13 10.3 Adult (>20) 8 6.3

Table 7: Cemetery 3-J-10 Sex Demographics. Sex Number (n) % Male 38 50.0 Female 35 46.1 Undetermined 3 3.9

Spatial and Statistical Analyses: Age and Sex

There are no indications of diachronic change in burial style at this site. As such, the first focus of examination was to understand the distribution of burials according to age and sex cohorts. An initial review of cemetery 3-J-10 (Figure 8) reveals a clear spatial distinction between the burials of subadults (seen in yellow) and adults (seen in green). In Figure 8 there is a rather large cluster of subadult burials on the eastern border of the cemetery. This cluster of 29 individuals consists of 7 neonates/infants, 21 juveniles above the age of two years, and 1 adolescent. The entire neonate sample from this cemetery is buried in this one area. This could signify the burial cluster on the eastern edge as an exclusive burial area within cemetery 3-J-10

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for the neonate/infant age group, but it is important to keep in mind that neonate burials did not always occur in a cemetery. As discussed in Chapter Three: Medieval Nubia, it was not uncommon for ancient and Christian Nubians to practice fetal or infant pot burials and inter them under the floor of the house to ensure future fertility (Bernard 1994; Adams et al. 1999; Adams

2003; Welsby 2002). It is uncertain whether this was practiced at Mis Island, however.

Regardless of the medieval burial practice for neonates/infants at Mis Island, it is clear that the eastern side of cemetery 3-J-10 is a special area of burial for subadults. Further, with the exception of one adolescent present on the northwest edge of the burial cluster, the burials in this section are almost exclusively young subadults. There could be a number of explanations for the formation of a young subadult burial cluster in this portion of the cemetery. It is possible that all of these individuals were part of a single, protracted death event, such as an acute outbreak of infectious disease that considerably affected the subadult population. It is also very likely that there was a significant social division between subadults and adults in this medieval Nubian group, which may have dictated the distribution of burials at cemetery 3-J-10.

There are a number of other patterns at cemetery 3-J-10 that might further the argument for a spatial division between subadults and adults in this burial sample. For example, there is another small cluster of subadult burials in the northwest portion of the cemetery, as well as a distribution of subadult burials around the edges of the cemetery. Although these subadults are not included in the largest burial cluster on the eastern edge of the cemetery, they are still grouped with one another and kept separated from the adult burial sample by being placed on the fringes of the cemetery.

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Figure 8: Spatial Distribution of Subadult and Adult Burials at Cemetery 3-J-10.

Moreover, when the spatial distribution of subadults and adults is reviewed in conjunction with the spatial distribution of the type of grave monument, a similar pattern emerges. Figure 9 illustrates the distribution of monument types, including the presence of

FF03c (seen in blue), FF03a (seen in green), and rock rubble (seen in purple). As a review, the

FF03c monument is a double revetment of stones formed into a rectangular monument and infilled with small rocks and pebbles. The FF03a monument is identical, but only a single course

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of stones high. Figure 9 demonstrates there is a cluster of FF03a monuments on the eastern edge of the cemetery in the same location as the subadult group. With the exception of five juvenile burials without any monument and a couple with FF03c or rock rubble types, all subadults buried in this cluster have an FF03a monument. Furthermore, Figure 9 also demonstrates that not a single adult in the cemetery has an FF03a monument type.

Figure 9: Spatial Distribution of Monument Types at Cemetery 3-J-10.

Based on the spatial distribution of monument types it appears that there was a distinction between the type of monument used and membership in an adult or subadult cohort

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(Table 8). A chi-square test with a proportional reduction of error test shows that there is a clear relationship between the use of FF03a monuments in subadult burials and FF03c monuments in

2 adult burials (x = 46.070, df= 2, p= .000), with a high level of association (Cramer‟s V= .647).

Furthermore, a closer look at the relative age ranges of those subadults with an FF03c monument demonstrates that 37.5% (n= 6) are adolescents, which accounts for the entire adolescent sample at cemetery 3-J-10. This could imply that there is a cut-off age range in adolescence when subadult individuals begin to receive FF03c monuments, instead of FF03a monuments. The argument would be further supported if the remaining 10 subadults with FF03c monuments are older juveniles, however the subadult remains were not able to be included in this study. The subadults are being extensively studied and reported on by another individual and thus will be published in a future dissertation.

Table 8: Age Distribution of Monuments at Cemetery 3-J-10. Age Cohort Monument Type Absent FF03a FF03c Rock (n) % (n) % (n) % (n) % Rubble Subadult 11 22.0 20 40.0 16 32.0 3 6.0 Adult 5 6.6 0 0.0 67 88.2 4 5.2 Total Total 16 20 83 7

The presence and type of head coverings also suggests that there was a symbolic differentiation between subadult and adult burial practices at cemetery 3-J-10 (Figure 10). A cluster marking the absence of head coverings (seen in red) appears once again on the eastern end of the cemetery, in the same location as the subadult burial group. An overwhelming majority of subadult burials in this cluster do not have any stone or mud coverings above their

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heads, as is typical in many medieval Nubian Christian burials. In addition, other clusters emerge on the northern edge of the cemetery and again on the southwestern corner. Although there is some overlap between the absence of head coverings and a small number of adult burials, most of the clusters in red also mark the location of subadult burials on the fringes of the cemetery borders.

Figure 10: Spatial Distribution of Head Coverings at Cemetery 3-J-10.

Table 9 summarizes absence or presence of head coverings by age cohort. Furthermore, head coverings for the few subadults and most adults are usually stone, but there are a few adults

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with different varieties, such as mud brick (n= 2) or a mixture of stone and mud brick (n= 1).

This could imply an adult age-related initiation in the use of different types of head coverings.

However, due to the rarity of different types of head coverings at cemetery 3-J-10, it is possible there is a different guiding principle to their use in specific burials, which cannot be clearly defined from such a small sample.

Table 9: Age Distribution of Head Coverings at Cemetery 3-J-10. Age Cohort Absent Present Total (n) % (n) % (n) Subadult 38 76.0 12 24.0 50 Adult 23 30.3 53 69.7 76 Total 16 110 126

A chi-square test demonstrates that there is a significant relationship between the

2 inclusion of head coverings and whether an individual is considered a subadult or an adult (x =

25.261, df= 1, p= .000), with a Cramer‟s V association of .448. Furthermore, of the 12 subadults with head coverings, 50% are adolescents, and the remaining subadults with head coverings also have FF03c (n= 5, 41.67%) or rock rubble (n= 1) monuments. As with the type of monument, this would again imply that there is a short period of time during adolescence after which subadult individuals begin to acquire adult burial symbolization.

A review of Figures 11, 12, and 13 demonstrates that there is also a spatial relationship between the location of subadult burials and the presence of variability in the position of the body, legs, and head within the grave. In all three maps there is a cluster of irregularity (shown by the presence of many different colors in one area) on the eastern boundary and along the outer edges of the cemetery, where the subadults are buried.

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Figure 11: Spatial Distribution of Body Position at Cemetery 3-J-10.

A comparison to Figure 8 (the distribution of subadult and adult age groups) also reveals that the adult burials are more likely to be consistent, with a supine body position, extended legs, and the head facing up. Subadults on the other hand exhibit less consistent body positioning, either buried on their backs, sides, or even prone with their heads facing a number of cardinal directions within the grave. In addition, five individuals at cemetery 3-J-10, all subadults within the eastern cluster, are buried face down in the grave. Another three subadults, also located

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within the cluster, are buried on either the left or right side with their heads to the east, as opposed to the common practice of head placement on the western side of the grave.

Figure 12: Spatial Distribution of Head Orientation at Cemetery 3-J-10.

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Figure 13: Spatial Distribution of Leg Position at Cemetery 3-J-10.

Contingency tables and chi-square tests confirm the significance in difference of the body position between subadults and adults. A comparison of body position demonstrates that the largest number of adults (n= 67, 88.2%) is placed supine and the remaining (n= 9, 11.8%) are placed on either the right or left side. Juveniles on the other hand are more variable with 50% (n=

25) on their sides, 40% (n= 20) lying supine, and the remaining 10% (n= 5) lying prone. This

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2 difference in body position is statistically significant (x = 34.003, df=2, p= .000, Cramer‟s V=

.519). Table 10 summarizes body position according to age cohort.

Table 10: Age Distribution of Body Position at Cemetery 3-J-10. Age Body Orientation Supine Prone Side Cohort (n) % (n) % (n) % Subadult 20 40.0 5 10.0 25 50.0 Adult 67 88.2 0 0.0 9 11.8 Total 87 5 34

There is also a significant difference in the position of the head and legs according to age cohorts (Tables 11 and 12). Although there are a substantial number of adults with a variety of different head orientations, the majority (n= 40, 52.6%) are positioned with the head centered in the grave. Another 28.9% of adults (n= 22) are placed with the head facing south, and the last

18.4% (n=14) with the head facing north. Juveniles on the other hand are more likely to have the head facing south (n= 21, 42%), followed by an equal likelihood of having the head facing north

(n= 13, 26%) or centered (n= 13, 26%). Another small number (n= 3, 6%) are face down in the grave. Most of these individuals also have head coverings, which likely kept the heads in place throughout the decomposition process. Thus it is likely that many of these head placements are intentional. This difference in head orientation between adult and subadult cohorts is statistically

2 significant (x = 11.959, df=3, p= .008) with a moderate association (Cramer‟s V= .308).

Likewise, there is a substantial difference in leg position between adults and subadults.

An overwhelming majority of adults at cemetery 3-J-10 are placed with their legs extended (n=

69, 90.8%), while only a small number have an alternative leg position. Subadults on the other

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hand have more variable leg positions, with only 50% (n= 25) with legs extended, 30% (n= 15) with legs slightly flexed, 12% (n= 6) with one leg extended and one leg flexed, and another 8%

(n= 4) with legs fully flexed (Table 12). Once again, the difference in position is statistically

2 significant at the p <0.05 level (x = 26.529, df=3, p= .000), with a moderate level of association

(Cramer‟s V= .459).

Table 11: Age Distribution of Head Orientation at Cemetery 3-J-10. Age Cohort Head Orientation Centered Down North South (n) % (n) % (n) % (n) % Subadult 13 26.0 3 6.0 13 26.0 21 42.0 Adult 40 52.6 0 0.0 14 18.4 22 28.9 Total 53 3 27 43

Table 12: Age Distribution of Leg Position in Cemetery 3-J-10. Age Cohort Leg Position Extended Slight Flex Fully Flexed Each Leg Different (n) % (n) % (n) % (n) % Subadult 25 50.0 15 30.0 4 8.0 6 12.0 Adult 69 90.8 4 5.3 1 1.3 2 2.6 Total 94 19 5 8

A spatial analysis of personal adornment at cemetery 3-J-10 also demonstrates an apparent association to overall age cohort. There is a grouping of items of personal adornment

(seen in blue) on the eastern edge of the cemetery where the majority of juveniles are buried

(Figure 14). Among the 15 individuals buried with personal adornment, 80% (n= 12) are subadults represented by infant, juvenile, and adolescent age groups and the majority are located

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within the subadult burial cluster. A chi-square test at the p <0.05 level confirms the existence of

2 a relationship between the presence of personal adornment in subadult burials (x = 11.563, df=

1, p= .001), with a moderate association (Cramer‟s V= .303). However, although there is a clear tendency for items of personal adornment to be buried with subadults, among the small number of adults with personal adornment there is no clear association to a particular age or sex cohort.

This, of course, may be the result of the sample size, for adults buried with personal adornment at cemetery 3-J-10 only include a young male, a middle adult female, and an old adult female.

Figure 14: Spatial Distribution of Personal Adornment at Cemetery 3-J-10.

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With the exception of one infant burial that also contained a cowry shell, the only form of personal adornment consisted of beads in a variety of colors and shapes. Here too, there appears to be an association between bead type and age at death. Subadult burials contain disc, cylindrical, and ostrich eggshell beads, while adults graves hold faience beads, tubular bone beads, and spherical beads. Although the sample is small, this association does appear to be significant, as there is no real overlap between the two groups.

Although there appears to be a relationship between age cohort and personal adornment, it is not clear whether there is a similar relationship with grave goods at cemetery 3-J-10 (Figure

15). Interestingly, none of the individuals with items of personal adornment also have grave goods. Four individuals are found with a single grave inclusion. However, of these four burials, only the burial of a juvenile with a ceramic pot placed over the hips involved an in situ grave good discovered at the time of excavation. The three other individuals were found with artifacts in the grave backfill, including an adolescent with an iron sickle, an adult male with a ceramic cup, and an adult female with a ceramic spice holder. It is unclear whether these individuals were buried with these grave goods or if the grave goods were somehow introduced into the fill at a later time. Unfortunately, further information regarding the dating or origin of the grave goods at

3-J-10 is unavailable at this time.

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Figure 15: Spatial Distribution of Grave Goods at Cemetery 3-J-10.

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Figure 16: Spatial Distribution of Adult Age Cohorts at Cemetery 3-J-10.

Although there are clear associations between the discussed burial patterns and age groups, there does not appear to be a relationship between either the location nor type of burial among the adult age or sex groups. Figure 16 is an illustration of the distribution of young adult

(seen in yellow), middle adult (seen in orange), and old adult burials (seen in green). Adults that could not be accurately assigned an age category are seen in orange. This figure demonstrates that there is a rather random distribution of adults at cemetery 3-J-10 and there does not appear

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to be a clear relationship between age cohort and where an adult is buried. Furthermore, chi- square tests of burial superstructure, body positioning, and the presence of grave goods or personal adornment demonstrates that there is not a statistical relationship between adult age cohort and burial patterning below the p <0.05 level (Table 13).

Table 13: Statistical Relationship Between Adult Age Cohorts and Burial Style.* 2 Variable Number x df p (n) Presence of Monument 64 .014 2 .993

Monument Type 63 2.082 2 .353

Presence of Head Coverings 68 .037 2 .981

Head Covering Type 47 2.104 4 .717

Body Orientation 68 3.917 2 .141

Head Orientation 68 .815 4 .936

Leg Position 68 4.668 4 .323

Hand Position 68 8.033 6 .236

Presence of Personal 68 .776 2 .679 Adornment Presence of Grave Goods 68 1.532 2 .465

* Only reported for non-disturbed burials and for adults that could be placed within a specific age cohort.

An examination of Figure 17 also demonstrates a random distribution of adult sex cohorts at cemetery 3-J-10. Males (seen in blue) and females (seen in pink) are uniformly scattered throughout the entirety of the cemetery and there do not appear to be any relevant clusters among either sex. An examination of relationships between sex cohort and burial style also reveals that

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there is little statistically significant difference in burial practices between males and females

(Table 14).

Figure 17: Spatial Distribution of Males and Females at Cemetery 3-J-10.

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Table 14: Statistical Relationship Between Adult Sex Cohorts and Burial Style.* 2 Variable Number x df p Cramer’s (n) V** Presence of 69 .053 1 .818 Monument Monument Type 68 4.508 1 .034 .257 Presence of Head 73 .136 1 .713 Coverings Head Covering Type 51 .001 1 .977 Body Orientation 73 5.581 1 .018 .276 Head Orientation 73 2.687 2 .261 Leg Position 73 4.126 3 .248 Hand Position 73 .351 3 .950 Presence of Personal 73 .439 1 .507 Adornment Presence of Grave 73 .003 1 .953 Goods ** Only reported for non-disturbed burials and for adults that could be assigned as either males or females. **Only reported for statistically significant variables.

As the table demonstrates, the only two burial features that significantly differ between sex cohorts at the p <0.05 level are body position and the presence of a rubble monument.

Although the sample size is relatively small, it tends to be more likely for a man (n= 8, 88.9%) to be buried on his right side, however the association is rather low (Cramer‟s V= .276). It also appears that only the burials of women are marked with a rock rubble monument (n= 4), while the burials of men are only marked with the FF03c monument. Once again the statistical relationship is rather low, with a Cramer‟s value of only .257. Unfortunately, due to the fact that the entire cemetery was not excavated and these are rather small sample sizes, it is difficult to tell whether these features demonstrate a true symbolic differentiation between the sexes or are a product of sampling error. Due to the fact that there are no other clear differentiations either

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spatially or statistically between males and females, it is possible that the sexes did not differ significantly in these two burial features. A further investigation of skeletal indicators of stress between males and females may help clarify whether there were any substantial differences between the way they were treated in life or in death.

Spatial Analyses: Skeletal Indicators of Stress

To understand the mortuary perspective on infection and disease within the medieval

Christian period at cemetery 3-J-10, a spatial analysis of burials according to skeletal indicators of stress was conducted. Specifically, maxillary sinusitis, periostitis, osteomyelitis, and tuberculosis were investigated for the presence of spatial patterning of individuals with these particular ailments. The grouping of individuals with specific disease processes could indicate a specific interment area for individuals that were thought to be particularly dangerous to the community. Furthermore, grouping of individuals with specific indicators could indicate a mass burial as the result of a particularly deadly infection that killed multiple members of the community within a protracted period of time. There were too few individuals with either tuberculosis or osteomyelitis to produce a significant pattern among individuals at cemetery 3-J-

10, however Figures 18 and 19 illustrate the distribution of individuals with maxillary sinusitis and periostitis. There is no clear pattern in either map that would indicate a preferred burial area for individuals with either of these disorders. Therefore, it is not likely that either of these skeletal indicators of stress were relevant in terms of spatial patterning of burials at cemetery 3-J-

10.

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Figure 18: Spatial Distribution of Maxillary Sinusitis at Cemetery 3-J-10.

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Figure 19: Spatial Distribution of Periostitis at Cemetery 3-J-10.

CEMETERY 3-J-11

Cemetery 3-J-11 was located on the northern side of the island, on a bank of alluvial pebble deposits about 150 meters from the Nile River (Ginns 2010b). Much larger than cemetery

3-J-10, this site contained nearly 500 medieval east-west aligned stone monuments and burials, and was possibly used for a much longer period of time, or from c. AD 300-AD 1400. It is likely

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the cemetery once contained many more than 500 graves, however agricultural activity had encroached on its eastern, western, and northern edges, thus destroying a large number of monuments and the underlying burials (Figure 20). In addition, a large area along the eastern border and another area extending from the northern aspect of the cemetery were being used for ongoing cultivation, and thus these areas were not surveyed or excavated for the remains of burials.

Limitations of time due to the construction of the Merowe Dam allowed only a small sample of the 500 burials to be excavated during the two field seasons. Burials were chosen in a random sample from across the site, without any real systematic or statistical strategy. In total,

259 complete burials and 29 disturbed burials were excavated from cemetery 3-J-11. As at cemetery 3-J-10, in order to obtain a fairly distributed sample of burials across time and space, individual graves were excavated in relatively equal density from across the entire site (Ginns

2010b) (Figure 20). Although a small number of these burials (n= 29) were disturbed by later activity, a large majority was relatively intact at the time of excavation. A few of the excavated burials from cemetery 3-J-11 dated from before the medieval period (Meroitic and Late Kushite periods) and were excluded from the present study. In addition, a number of disturbed burials did not contain human remains, or only had a single bony element and were also excluded from this sample. As such, from the 288 excavated graves, a total of 280 burials of both adults and subadults from the medieval period are included in this mortuary analysis.

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Figure 20: Overview of Excavated Graves at Cemetery 3-J-11.

CULTIVATION

At the time of excavation a number of burial types were recognized that the lead archaeologist, Andrew Ginns (2010b), believed to be associated with generalized burial phases.

The first phase consists of the remains of Later Kushite burials, which have been excluded from this analysis. The second phase is represented by individuals placed on their backs or sides, with large flat stone slabs placed over the grave cut, thus protecting the bodies from the earthen grave fill above. Most of these burials also contain grave goods, and thus Ginns (2010b) believes they

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likely represent the earliest phase of medieval Christian burial form at Mis Island. The last phase of burial has three subphases, which Ginns (2010b) argues likely represent the classic to later medieval Christian burials at Mis Island. The first subphase contains individuals with stone slabs either fully or partially sealing the burials, but with stone box monuments and no grave goods.

Ginns (2010b) argues that these burials might represent a transitional burial form from the early medieval burials with stone slabs and grave goods to the more classic medieval burial form with monuments and stone head coverings. The next subphase are individuals with three mud-bricks or stones placed on either side of the head and then across the face, while the final subphase of burials have no structural elaboration above either the body or face. At this time it is unclear whether the differences in burial style in Phase III represent diachronic change in burial style over time, or differences in burial practices used concurrently.

Cemetery Demography

The demographic profile at cemetery 3-J-11 is an evenly split sample of subadults and adults, as well as males and females. Individuals were grouped into subadult and adult age cohorts, as well as groups differentiated by sex for further spatial and statistical analysis (Tables

15 and 16). Subadults comprise 48.9% of the sample and consist of a small group of neonates and infants (n= 16), as well as juveniles (n= 99) and adolescents (n= 22). The remaining 51.1%

(n= 143) of the sample is adult, with an even mixture of males and females and individuals representing each adult age cohort.

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Table 15: Cemetery 3-J-11 Age Demographics. Age Number (n) % Subadult Infant 137 16 48.9 5.7 Juvenile/Adolescent 121 43.2 Adult Young 37 13.2 Middle 61 21.8 143 51.1 Old 33 11.8 Adult (>20) 12 4.3

Table 16: Cemetery 3-J-11 Sex Demographics. Sex Number (n) % Male 62 42.6 Female 69 47.6 Undetermined 14 9.7

Spatial and Statistical Analyses: Diachronic Change

Because of the hypothesized long-term use of cemetery 3-J-11, possibly continuing over one thousand years, the first level of this mortuary analysis focuses on the likelihood of diachronic change in burial practice. Working from a comparison with other excavated medieval

Nubian cemetery sites, Ginns (2010b) proposed a number of transitional or early burial forms, such as those with large blocking stones and grave goods and those without stone box monuments or head coverings. As such, initial spatial and statistical analyses concentrate on these features first before exploring differences in age or sex distributions among burials.

Figure 21 illustrates the use of blocking stones in burials at cemetery 3-J-11. This figure demonstrates that it is more likely for individuals with blocking stones (seen in blue) to be buried in the northern or eastern portions of the site, though there is no confined area at cemetery 3-J-11 specific to graves with blocking stones. Millet (1963) found similar blocking stone burials in pre-

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Christian X-Group burials at the site of Gebbel Adda. Adams et al. (1999: 17) argues that these blocking stones, present but uncommon at most medieval sites, such as Kulubnarti, are therefore likely a mortuary practice from the pre-Christian period that continued into early Christianity in transitional burials forms. Similarly, Ginns (2010b) contends that at cemetery 3-J-11 burials with blocking stones likely represents this same development.

If they do in fact signify an early Christian burial form, the fact that appearance of blocking stones throughout cemetery 3-J-11 could indicate that cemetery use in the beginning of the medieval period began in multiple areas and did not follow a specific growth trajectory.

However, when burials with blocking stones are reviewed in combination with other early period variables, there does appear to be a pattern in their location within the site. Out of the 27 individuals with blocking stones, 15 are buried with standard stone box monuments and 12 are buried without a superstructure. According to studies by Adams et al. (1999) and Edwards

(2001), stone box monuments are a typical Christian medieval burial style in Nubia, and the absence of a stone box monument might be an indication of pre-Christian or transitional burial style before Christianity was fully adopted.

While it should be kept in mind that the absence of a monument could also indicate the burial was disturbed and the monument destroyed by cultivation, flooding, human and animal traffic, or natural erosion, in the case of burials with blocking stones and without monuments at cemetery 3-J-11, it is likely that the absence of these monuments was in fact intentional. Figure

22 is an illustration of individuals with blocking stones that also have stone box monuments

(seen in blue and yellow), and individuals with blocking stones that do not have monuments

(seen in red). A clear pattern emerges, as those with monuments are confined to the northwestern portion of the cemetery, and those without monuments are confined to the east.

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Figure 21: Spatial Distribution of Blocking Stones at Cemetery 3-J-11.

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Figure 22: Spatial Distribution of Blocking Stones with Monuments at Cemetery 3-J-11.

Furthermore, a cross examination of burials with blocking stones to burials with grave goods reveals that individuals with both grave goods and blocking stones (seen in dark blue) are also confined to this eastern portion of the cemetery (Figure 23). There is a strong statistical relationship among burials that have blocking stones and grave goods, but do not have grave

2 monuments (x = 24.000, df= 1, p= .000, Cramer‟s V= 1.00). All burials with blocking stones and grave goods do not have a grave monument (n= 9), and in contrast, all burials with blocking stones and grave monuments do not have any grave goods (n= 15).

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Figure 23: Spatial Distribution of Blocking Stones with Grave Goods at Cemetery 3-J-11.

At sites throughout medieval Nubia, grave goods become increasingly rare as the practice of Christianity increases within the general population, and therefore, are considered to be an indication of a transitional or early Christian burial. At cemetery 3-J-11 this appears to be the case, as there is a strong statistical relationship between the presence of grave goods and burials with blocking stones, and of the 12 individuals with grave goods only 3 do not have a blocking

2 stone (x = 66.643, df= 1, p= .000, Cramer‟s V= .501).

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Two of these three individuals with grave goods but without a blocking stone are also located within the same eastern portion of the cemetery as those individuals without a grave monument. These two individuals do not have a grave monument either and are likely from the same early Christian phase as the burials with blocking stones and without grave monuments.

Interestingly, there is not a similar association between burials with blocking stones and burials with personal adornment. Out of the ten individuals with personal adornment, only two also have a blocking stone. It is possible that personal adornment is not necessarily associated exclusively with early Christian burials, as are grave goods.

Utilizing the evidence of early Christian practices, the spatial organization of burials with blocking stones at cemetery 3-J-11 begins to make more sense. The burials along the eastern edge of the cemetery likely represent the earliest transitional form with blocking stones, grave goods, but without a stone box grave monument. The burials on the northern edge possibly represent a further transition to Nubian Christian burial practice. Although blocking stones are still present, these burials also have the typical medieval stone box monuments and do not have any associated grave goods. Consequently, for the purposes of this study, all burials with blocking stones, as well as those burials with grave goods will be considered early or transitional burials and will be separated from the rest of the burials at cemetery 3-J-11 for subsequent mortuary and paleopathological analyses.

Other than these burials with a combination of early transitional Christian variables, such as blocking stones, grave goods and a lack of grave monuments, it is very difficult to distinguish diachronic change in burial style at cemetery 3-J-11. When the entire site is considered as a whole, there are no clear spatial patterns in the use of grave monuments (Figure 24), head coverings (Figure 25), personal adornment (Figure 26), body position (Figure 27), leg orientation

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(Figure 28), or head orientation (Figure 29). Furthermore, other than the previously discussed associations between blocking stones, grave goods, head coverings, and grave monuments, there are no statistically significant relationships among the many grave variables, such as the type of head coverings or grave monuments used. As many scholars have noted at other sites (Adams et al. 1999; Adams 2001; Edwards 2001) once Christianity took hold within a community burial practices became very consistent and unchanging for the duration of the medieval period. At this time it is difficult to tell whether the small distinctions in burial style at cemetery 3-J-11 are related to diachronic changes in burial practice or signify multiple burial practices being used simultaneously. It is also possible that the variation in grave monuments, head coverings, and body orientations at Mis Island could simply reflect regional variation in mortuary practice, as the simultaneous practice of numerous burial styles has been recorded at other medieval sites

(Adams et al. 1999; Adams 2001; Welsby 1998; Edwards 1998). Since only a test of radiocarbon dates in the remaining burials at cemetery 3-J-11 could definitively classify diachronic differences in burial styles, it is impossible to determine the time period of each burial.

Therefore, for the purpose of mortuary and paleopathological analyses the remainder of the burials will be treated as a whole.

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Figure 24: Spatial Distribution of Grave Monuments at Cemetery 3-J-11.

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Figure 25: Spatial Distribution of Head Coverings at Cemetery 3-J-11.

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Figure 26: Spatial Distribution of Personal Adornment at Cemetery 3-J-11.

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Figure 27: Spatial Distribution of Body Position at Cemetery 3-J-11.

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Figure 28: Spatial Distribution of Leg Position at Cemetery 3-J-11.

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Figure 29: Spatial Distribution of Head Orientation at Cemetery 3-J-11.

Spatial and Statistical Analyses: Age and Sex

The second portion of this analysis focuses on the influence of age and sex upon mortuary patterns at cemetery 3-J-11. Unlike cemetery 3-J-10 there are no clearly delineated burial spaces for the inhumation of subadults at cemetery 3-J-11, so that adults, infants, juveniles, and adolescents are intermingled throughout the entire cemetery site (Figure 30).

There does not appear to be any spatial organization in the burial of adults by specific age or sex

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cohorts (Figures 31 and 32), but there are a number of statistical relationships between specific burial patterns and age cohort in the burials at cemetery 3-J-11. Tables 17 and 18 summarize the statistical relationship between age and sex cohorts and mortuary patterns for the transitional burials with blocking stones (n= 27) and the Christian burials without blocking stones (n= 253).

Figure 30: Distribution of Subadult and Adult Burials at Cemetery 3-J-11.

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Figure 31: Distribution of Adult Age Cohorts at Cemetery 3-J-11.

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Figure 32: Distribution of Adult Sex Cohorts at Cemetery 3-J-11.

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Table 17: Chi-Square Tests Between Age Groups and Burial Style*. 2 Variable Number x df p Cramer’s (n) V** Monument Presence 27 10.800 1 .001 .632 Monument Type 15 .714 1 .398 Transitional Head Covering None Have Head Covering Body Orientation 21 1.644 2 .435 Head Orientation 20 .303 2 .859 Leg Position 21 4.667 3 .198 Hand Position 19 1.351 2 .509 Grave Goods 266 12.333 1 .000 .216 Personal Adornment 22 1.523 1 .217 Monument Presence 241 2.922 1 .087 Monument Type 202 23.708 3 .000 .343

Head Covering 241 9.895 1 .002 .203 Christian Head Covering 192 .109 2 .947 Body Orientation 241 5.297 3 .151 Type Head Orientation 240 1.133 3 .769 Leg Position 241 25.978 3 .000 .328 Hand Position 240 16.308 3 .001 .261 Personal Adornment 241 1.901 1 .168 * Only reported for non-disturbed burials. ** Only reported for statistically significant variables.

As Tables 17 and 18 demonstrate, there are a couple of variables that have a strong association to juveniles or adults and adult sex cohorts in the „transitional‟ burials. Foremost,

2 there is a strong statistical relationship between adults and the presence of grave goods (x =

12.379, df=1, p= .000, Cramer‟s V= .216). All 12 individuals with grave goods at cemetery 3-J-

11 are adults. Among the adult burials with grave goods however, there is not a statistical

2 2 relationship between buried objects and sex (x = 2.434, df=1, p= .119) or adult age cohort (x =

.970, df=2, p= .616). Despite this fact, there do appear to be differences in the number of grave

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goods distributed among adult sex cohorts. All three females for example, have only one ceramic grave good, while all males except one young adult have at least two and sometimes up to three or four grave goods. While it is possible that this could be a sampling error, it does appear that males are buried with more grave inclusions in general. Of the two adults buried with personal adornment at cemetery 3-J-11 both are males, and one individual happens to have grave goods as well. This could indicate a preference to bury male individuals in the Early Christian period with items of personal adornment, such as metal jewelry and beads, as well as ceramic grave goods.

Table 18: Chi-Square tests between Males and Females and Burial Style*. 2 Variable Number x df p Cramer’s (n) V** Monument Presence 15 7.350 1 .007 .700 Monument Type All have FF03c Monuments Transitional Head Covering None have Head Covering Body Orientation 10 2.857 2 .240 Head Orientation 10 3.750 2 .153 Leg Position 10 1.667 1 .197 Hand Position 9 1.102 1 .294 Grave Goods 125 2.434 1 .119 Monument Presence 113 .930 1 .335 Monument Type 100 1.718 3 .633

Head Covering 112 1.461 1 .227 Christian Head Covering Type 97 2.695 2 .260 Body Orientation 112 .576 2 .750 Head Orientation 111 .436 2 .804 Leg Position 112 1.879 2 .391 Hand Position 111 5.900 2 .052 (Personal Adornment not reported because the sample is too small (n= 2).) * Only reported for non-disturbed burials. ** Only reported for statistically significant variables.

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Tables 17 and 18 indicate that among the transitional burials there might also to be a relationship between the presence of a grave monument and age, as well as sex cohorts. A simple interpretation of the results would explain that juveniles tend to be more likely to have grave monuments (n= 9, 100%), while adults are slightly more likely to be buried without grave monuments (n= 12, 66.7%). Furthermore, the results of differences according to sex cohort, would indicate that males are less likely to be buried with a monument than females.

Unfortunately the sample sizes of juveniles (n= 9) and adults (n= 18), as well as adult males

(n=10) and females (n= 5) are rather small and it is difficult to determine whether the statistical relationships are actually due to small sample sizes. Furthermore, many of the transitional burials are disturbed and it is possible that a grave monument was in place at some point, but was somehow destroyed prior to excavation. Therefore, it is difficult to determine whether the relationships among age and sex and the presence of a monument is an accurate depiction of intentional mortuary practices in the transitional burials.

Among the Christian burial group however, there are no apparent relationships between sex cohort and mortuary patterns. Males and females are equally likely to be buried with FF03c grave monuments and with either stone or mudbrick head coverings. Furthermore, both males and females are often positioned supine with the legs extended, the hands over the hips, and the head facing up. Likewise, there are no statistically significant differences between young, middle, and old adult cohorts and burial style.

On the other hand, just as at cemetery 3-J-10, there are a number of variables affected by subadult or adult age cohort in the Christian burial group. For example, there is a statistical

2 relationship between type of monument and whether an individual is a subadult or an adult (x =

24.795, df=4, p= .000, Cramer‟s V= .349). Table 19 shows that 90.6% of adults and only 72.2%

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of subadults are buried with FF03c monuments. Further, of the 70 subadults buried with FF03c monuments, at least 17 are adolescents. Only one adolescent has a different grave monument, consisting of a ring of stones placed around the grave. Among the adults with an FF03a monument type (n= 2), only two females are represented- one young adult and one old adult.

There are no other variations in burial patterns for these individuals and it is unclear why they would they would have been buried with an FF03a monument. There are an additional five adults buried with the X11 grave monument, which appears to be exclusive to adults.

Table 19: Age Distribution of Monument Types in Christian Graves at Cemetery 3-J-11. Monument Type FF03c FF03a Rock Rubble X11 X10 (n) % (n) % (n) % (n) % (n) % Subadults 70 72.2 18 18.6 8 8.2 0 0.0 1 1.0 Adults 96 90.6 2 1.9 3 2.8 5 4.7 0 0.0 Total 166 20 11 5 1

There is also a statistically significant relationship between age cohort and whether the

2 individual is buried with head coverings (x = 9.895, df=1, p= .002, Cramer‟s V= .203). Table 20 shows that adults are slightly more likely than subadults to have head coverings and 29.3% of subadults do not have any head coverings. Among both adults and subadults with head coverings

2 though, there is no statistical difference between whether stones or mud bricks are used (x =

1.567, df=4, p= .815).

In terms of the arrangement of the body, there are statistically significant differences in

2 2 leg position (x = 25.978, df=3, p= .000, Cramer‟s V= .328) and hand position (x = 16.308, df=

3, p= .001, Cramer‟s V= .261) between adults and subadults. Despite these statistical

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associations, it is not entirely clear whether the differences are actually intentional. The only striking difference between adults and subadults is the smaller likelihood for adults to be buried with flexed legs. Out of the eight individuals buried with fully flexed legs, seven (87.5%) are subadults. Otherwise, slight variations in both the position of the legs and the hands are common amongst both adults and subadults and many of the variations are quite similar. Most individuals in medieval Christian Nubian burials were shrouded, thus making it difficult to readjust the limbs if they were shifted during transport and burial. Therefore, it is difficult to ascertain whether an individual buried with their hands at their sides versus hands at their hips was done purposefully.

Consequently, it is possible that the statistical differences in hand and leg position are largely due to chance.

Table 20: Age Distribution of Head Coverings at Cemetery 3-J-11. Absent Present (n) % (n) % Subadults 36 29.3 87 70.7 Adults 15 12.7 103 87.3 Total 51 190

Spatial and Statistical Analyses: Burial Clusters

Thus far the mortuary results for cemetery 3-J-11 have demonstrated that diachronic change, age category, and adult sex cohort are not significant guiding principles for the spatial organization of burials at the site. It is possible that there are other explanations for why the development and use of cemetery 3-J-11 does not have any clear spatially derived burial patterning, as is apparent with age categories at cemetery 3-J-10. This lack of spatial organization according to burial type could indicate that multiple burial areas were independently

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developed and utilized throughout the entire use of the site. One argument to support this conclusion is the already mentioned random distribution of burials with blocking stones across the cemetery, as was discussed in the previous section.

If the cemetery did not develop in a clear diachronic fashion however one possible rationale for multiple disposal areas developing over across the cemetery site simultaneously could be the use of such areas by family groups, as has been suggested for other Early Christian sites (Montserrate and Meskell 1997; Bowen 2003; Tulloch 2011). As such, it is quite possible that cemetery 3-J-11 originated from family burial plots, where extended relatives shared a specific disposal area within the cemetery site. These family burial plots would have been used over extended periods of time, as related descendents were buried next to their long-deceased ancestors. In addition, as the cemetery expanded, new burial plots might have been added as immigrants arrived to the area or new factions of local families selected unmarked disposal areas. As a result one would expect to see a mixture of burial clusters. The oldest clusters would have evidence of diachronic change as the plot was used over the course of many generations.

On the other hand, more recent clusters developed by new or extended family groups would not exhibit the same extent of diachronic change in burial style. A review of Figure 33 demonstrates that there are in fact a number of discrete burial clusters at cemetery 3-J-11 (circled in black and labeled). Burial clusters 1, 2, 3, and 4 in particular, appear to be the most spatially distanced from one another and from the rest of the burials. It is quite possible that these represent exclusive family burial plots that did not unite with the cemetery as it grew, or that they represent disposal areas that were created later in the use of cemetery 3-J-11. Further analysis of burial patterns within and between these clusters might reveal the significance for their seclusion.

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On the other hand, burial clusters 5, 6, 7, and 8 are a bit more difficult to distinguish as that portion of the cemetery is more crowded; however, it is possible that these clusters were at one time discrete disposal areas and as the cemetery grew over time the distinctions became less obvious. Regardless, it seems that burials within each of these clusters are grouped more closely with one another, and that the edges of each of burial cluster is curved, indicating that they were quite possibly circular in nature at one time. It is also quite likely that the burial clusters at one time extended into the areas that have since been cultivated, thus altering the overall burial cluster shape and the inclusion of a large number of graves.

Figure 33: Burial Clusters at Cemetery 3-J-11.

CLUSTER 8 CLUSTER 2

CLUSTER 7

CLUSTER 6

CLUSTER 1 CLUSTER 3 CLUSTER 5

CLUSTER 4

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To test the hypothesis that these burial clusters belong to discrete family burial groups, a comparison of demographic profiles and burial patterns within each cluster was conducted.

Tables 21 and 22 summarize the age and sex demographics of each of the burial clusters. While there is some variance in the frequency of subadult and adult age and sex groups included in each cluster, there is not a single cluster that is specific to any age or sex cohort. In fact, every cluster includes subadults and adults, as well as males and females, which would be expected with a typical family burial plot. As Tables 21 and 22 demonstrate, those burial clusters with the most uneven demographic profiles (Clusters 1, 2, 3 and 8) are clusters that were not fully excavated. It is possible that a complete excavation of all of the burials in these clusters would reveal a more balanced demographic profile, as is visible within the remainder of the burial clusters.

Chi-square tests and spatial analyses were conducted to better understand the nature of each burial cluster and whether they differ significantly from one another. An examination of monuments, head coverings, blocking stones, body, head, and leg orientation, and grave inclusions demonstrates that there are some distinguishing patterns between the burial clusters.

Chi-square tests of each burial feature show the following relationships: the presence of a

2 2 monument (x = 40.567, df=7, p= .000, Cramer‟s V= .390); monument type (x = 22.181, df=21,

2 p= .389); the presence of head coverings (x = 77.581, df=7, p= .000, Cramer‟s V= .542); head

2 2 covering type (x = 22.158, df= 14, p= .075); the presence of blocking stones (x = 19.826, df=7,

2 p= .006, Cramer‟s V= .268); body orientation (x = 35.915, df=7, p= .000, Cramer‟s V= .372);

2 2 leg position (x = 32.424, df=21, p= .053); head orientation (x = 31.286, df=21, p= .069); the

2 presence of personal adornment (x = 11.022, df=7, p= .138); and the presence of grave goods

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2 (x = 11.255, df=7, p= .128). A review of the statistically significant variables, such as the presence of a monument, head coverings and blocking stones, and body orientation demonstrates that there is a comparable correspondence with the spatial distribution of these variables in the burial clusters. Each of these variables is investigated in more detail.

Figure 34 illustrates the distribution of monuments among the eight burial groups.

Clusters 1, 5, 6, and 7 have a mixture of burials with and without monuments, while clusters 2, 3,

4, and 8 are almost exclusively burials with monuments. It is feasible that clusters 2, 3, and 8 also had a mixture of burials without monuments but it is impossible to determine the nature of these clusters as only a small sample of each was excavated. Cluster 4 on the other hand was almost entirely excavated and it is evident that all of the graves in this group have monuments, thus distinguishing it from the rest of the burial assemblages. In addition, cluster 4 has a very unusual grave monument located on the western edge of the burial group- a circular pavement of stones surrounding the burial of an adolescent. This unique type of monument was not found elsewhere at cemetery 3-J-11 and happens to be located in one of the most distinctive burial groups within the site. It is unclear what the monument signifies, but further exploration of cluster 4 is critical. Table 23 summarizes the presence and absence of monuments within each cluster. The type of grave monument among the burials clusters is not statistically significant.

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Figure 34: Distribution of Monuments in Burial Clusters at Cemetery 3-J-11.

CLUSTER 2 CLUSTER 8

CLUSTER 7

CLUSTER 6

CLUSTER 1 CLUSTER 3 CLUSTER 5

CLUSTER 4

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Table 21: Demographic Profiles of Cemetery 3-J-11 Burial Clusters. Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 6 Cluster 7 Cluster 8 (n) % (n) % (n) % (n) % (n) % (n) % (n) % (n) % Subadult 16 69.6 16 72.8 4 40.0 9 29.0 21 35.0 39 47.6 23 59.0 9 81.8 Young Adult 5 21.7 2 9.1 3 30.0 6 19.4 10 16.7 9 10.9 2 5.1 0 0.0

Middle Adult 0 0.0 1 4.5 2 20.0 9 29.0 16 26.7 23 28.0 8 20.5 1 9.1

Old Adult 2 8.7 3 13.6 0 0.0 7 22.6 6 10.0 8 9.8 5 12.8 1 9.1 Adult >20 0 0.0 0 0.0 1 10.0 0 0.0 7 11.6 3 3.7 1 2.6 0 0.0

Total 23 100.0 22 100.0 10 100.0 31 100.0 60 100.0 82 100.0 39 100.0 11 100.0

Table 22: Demographic Profiles of Cemetery 3-J-11 Burial Clusters. Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 6 Cluster 7 Cluster 8 (n) % (n) % (n) % (n) % (n) % (n) % (n) % (n) % Male 3 37.5 2 33.3 2 33.3 12 54.5 16 40.0 17 39.5 9 56.3 1 50.0 Female 4 50.0 3 50.0 2 33.3 10 45.5 16 40.0 25 58.1 6 37.5 1 50.0 Undetermined 1 12.5 1 16.7 2 33.3 0 0.0 8 20.0 1 2.3 1 6.2 0 0.0 Total 8 100. 6 100. 6 100.0 22 100.0 40 100.0 43 100.0 16 100.0 2 100.0

0 0

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Table 23: Frequency of Monuments in Burial Clusters at Cemetery 3-J-11. Present Absent Total (n) % (n) % Cluster 1 13 59.1 9 40.9 22 Cluster 2 21 95.5 1 4.5 22 Cluster 3 10 100.0 0 0.0 10 Cluster 4 31 100.0 0 0.0 31 Cluster 5 33 57.9 24 42.1 57 Cluster 6 55 71.4 22 28.6 77 Cluster 7 33 89.2 4 10.8 37 Cluster 8 11 100.0 0 0.0 11

As discussed in the beginning of the analysis of cemetery 3-J-11, there is also a significant organizing principle in the distribution of blocking stones. Blocking stones without grave monuments gather within the eastern portion of the cemetery, while blocking stones with grave monuments group in the northern portion of the cemetery. A review of this in relation to burial clusters reveals a further pattern of distribution, which is significant at the p <0.05 level

2 (x = 19.826, df=7, p= .006, Cramer‟s V= .268). Figure 35 demonstrates that graves with blocking stones are exclusively located within burial clusters 1, 2, 5, 6, and 7. Although it is quite possible that further excavation would reveal blocking stones within cluster 3, it is not likely there are any blocking stones in clusters 4 or 8, as they have been thoroughly excavated.

Table 24 summarizes the number and frequency of blocking stones within each of the burial clusters.

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Figure 35: Distribution of Blocking Stones within Burial Clusters at Cemetery 3-J-11.

CLUSTER 8 CLUSTER 2

CLUSTER 7

CLUSTER 6

CLUSTER 1

CLUSTER 3 CLUSTER 5

CLUSTER 4

Table 24: Frequency of Blocking Stones in Burial Clusters at Cemetery 3-J-11. Present Absent Total (n) % (n) % Cluster 1 2 8.7 21 91.3 23 Cluster 2 7 31.8 15 68.2 22 Cluster 3 0 0.0 10 100.0 10 Cluster 4 0 0.0 31 100.0 31 Cluster 5 4 6.8 55 93.2 59 Cluster 6 8 9.8 74 90.2 82 Cluster 7 6 15.4 33 84.6 39 Cluster 8 0 0.0 11 100.0 11

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Figure 36: Distribution of Head Coverings in Burial Clusters at Cemetery 3-J-11.

CLUSTER 8 CLUSTER 2

CLUSTER 7

CLUSTER 6

CLUSTER 1

CLUSTER 3 CLUSTER 5

CLUSTER 4

The presence of head coverings within burial clusters is also statistically significant at the

2 p <0.05 level (x = 77.581, df=7, p= .000, Cramer‟s V= .542). Figure 36 illustrates the correspondence of head coverings and inclusion within a burial cluster. All except one of the excavated burials within clusters 3 and 4 have head coverings, while clusters 1, 2, 5, 6, 7, and 8 have a mixture of burials with and without head coverings. Once again cluster 4 is set apart from the remainder of the groups, with all of the burials in the cluster conforming to a specific pattern

(almost all burials have head coverings) which is distinctive from the remaining clusters. Table

25 summarizes the number and frequency of burials with head coverings in each cluster.

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Table 25: Frequency of Head Coverings in Burial Clusters at Cemetery 3-J-11. Present Absent Total (n) % (n) % Cluster 1 3 13.0 20 87.0 23 Cluster 2 12 57.1 9 42.9 21 Cluster 3 10 100.0 0 0.0 10 Cluster 4 30 96.8 1 3.2 31 Cluster 5 43 79.6 11 20.4 54 Cluster 6 67 87.0 10 13.0 77 Cluster 7 20 54.1 17 45.9 37 Cluster 8 4 36.4 7 63.6 11

The orientation of the body within the grave is also significant among many of the burial

2 clusters (x = 35.915, df=7, p= .000, Cramer‟s V= .372). Figure 37 illustrates the spatial organization of body orientation within each of the burial clusters. Although there is very little variation in body orientation at cemetery 3-J-11, the groups with any variation are once again clusters 1, 2, 5, 6, and 7. Cluster 3, 4, and 8 have consistent burial patterns with the largest majority of individuals buried supine, while the remaining clusters have a mixture of individuals buried supine, on their right or left sides, and even prone in a few cases. Table 26 summarizes the number and frequency of the various body positions.

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Figure 37: Distribution of Body Orientation in Burial Clusters at Cemetery 3-J-11.

CLUSTER 8 CLUSTER 2

CLUSTER 7

CLUSTER 6

CLUSTER 1

CLUSTER 3 CLUSTER 5

CLUSTER 4

Table 26: Distribution of Body Position in Burial Clusters at Cemetery 3-J-11. Supine Side Total (n) % (n) % Cluster 1 14 60.9 9 39.1 23 Cluster 2 20 100.0 0 0.0 20 Cluster 3 10 100.0 0 0.0 10 Cluster 4 30 96.8 1 3.2 31 Cluster 5 47 87.0 7 13.0 54 Cluster 6 71 97.3 2 2.7 73 Cluster 7 33 89.2 4 10.8 37 Cluster 8 11 100.0 0 0.0 11

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These spatial and statistical analyses demonstrate that there is an obvious distinction between many of the burial clusters at cemetery 3-J-11. Clusters 1, 2, 5, 6, and 7 tend to have the most variability in the presence of monuments, head coverings, blocking stones, and body orientation, while clusters 3, 4, and 8 tend to maintain very consistent and similar patterns of mortuary style. Since burial groups 3, 4, and 8 also happen to be in peripheral areas of the cemetery, it is likely that the distinction between these groups and the remainder of the graves is not a random occurrence.

Burial cluster 4 is especially interesting because it is so spatially disconnected from the main cemetery, and because most of the burials within the cluster conform to the same burial style. The majority of individuals in cluster 4 have FF03c grave monuments, stone head coverings, are laid supine, and do not have any blocking stones, personal adornment, or grave goods. If each of the burial clusters at cemetery 3-J-11 represent family groups, then it is probable that cluster 4 was a later addition to cemetery 3-J-11, as these mortuary patterns are more consistent with Classic or later Christian burial practices.

Spatial Analyses: Skeletal Indicators of Stress

A review of cemetery 3-J-11 in relation to skeletal indicators of stress, such as maxillary sinusitis, periostitis, and tuberculosis, once again demonstrates that there is no clear distribution of burial according to these infectious diseases. Individuals exhibiting each of these conditions are scattered throughout the cemetery site and there does not appear to have been a special burial space for any of the skeletal indicators. Figures 38, 39, and 40 illustrate the distribution of each of these skeletal indicators of stress.

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Figure 38: Distribution of Maxillary Sinusitis at Cemetery 3-J-11.

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Figure 39: Distribution of Periostitis at Cemetery 3-J-10.

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Figure 40: Distribution of Tuberculosis at Cemetery 3-J-11.

A COMPARISON BETWEEN CEMETERIES 3-J-10 AND 3-J-11

A review of the mortuary results from the previous sections demonstrates that there are key differences between cemeteries 3-J-10 and 3-J-11. Although the cemeteries are located only a short walking distance of approximately 300 meters from one another, they are positioned within two very different landscapes on Mis Island, both in terms of location and natural surroundings. Where cemetery 3-J-10 is placed in a very sheltered and naturally bounded area

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that is bordered by bedrock outcrops, cemetery 3-J-11 is located on an open, unprotected landscape alongside the banks of the Nile River. Since there is plenty of unused area within the earlier cemetery 3-J-11, it is not likely that 3-J-10 was developed in response to a lack of burial space. However, the mortuary results do not indicate why each of these particular disposal areas were chosen, nor why there would be two separate medieval Christian cemeteries within such close proximity at Mis Island.

In addition to the distinctions based on location and natural environment, there are also observable differences in spatial organization and burial patterns between the two sites. A direct statistical comparison of the mortuary patterns reveals that there are many significant differences in burial style at the two sites. A chi-square test at the p <0.05 level was performed to determine the relationships between each cemetery and the burial variables. The following relationships

2 were found to be statistically significant: the presence of blocking stones (x = 13.065, df=1, p=

2 .000, Phi = - .180); the presence of a monument (x = 4.111, df=1, p= .043, Phi = -.103); the

2 presence of head coverings (x = 14.805, df=1, p= .000, Phi = .194); the type of head coverings

2 2 (x = 13.160, df=2, p= .001, Cramer‟s V= .225); body position (x = 32.848, df=3, p= .000,

2 Cramer‟s V= .291); head orientation (x = 13.053, df=3, p= .005, Cramer‟s V= .184); and the

2 presence of personal adornment (x = 9.300, df=1, p= .002, Phi = -.155). Tables 27, 28, 29, 30,

31, 32 and 33 provide side-by-side comparisons of the number and frequency of each of these mortuary variables at cemeteries 3-J-10 and 3-J-11.

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Table 27: Number and Frequency of Blocking Stones at Mis Island. Present Absent (n) % (n) % 3-J-10 0 0.0 126 100.0 3-J-11 27 9.7 252 90.3

Table 28: Number and Frequency of Monuments at Mis Island. Present Absent (n) % (n) % 3-J-10 103 86.6 16 13.4 3-J-11 209 77.7 60 22.3

Table 29: Number and Frequency of Head Coverings at Mis Island. Present Absent (n) % (n) % 3-J-10 65 51.6 61 48.4 3-J-11 190 71.4 76 28.6

Table 30: Number and Frequency of Head Stone Types at Mis Island. Brick Stone Brick/Stone (n) % (n) % (n) % 3-J-10 2 3.0 64 95.5 1 1.5 3-J-11 42 21.9 145 75.5 5 2.6

Table 31: Number and Frequency of Body Orientation at Mis Island. Supine Prone Right Side Left Side (n) % (n) % (n) % (n) % 3-J-10 87 69.0 5 4.0 26 20.6 8 6.3 3-J-11 238 90.8 1 .4 14 5.3 9 3.4

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Table 32: Number and Frequency of Head Orientation at Mis Island. Up Down North South (n) % (n) % (n) % (n) % 3-J-10 53 42.1 3 2.4 27 21.4 43 34.1 3-J-11 151 58.1 1 .4 53 20.4 55 21.2

Table 33: Number and Frequency of Personal Adornment at Mis Island. Present Absent (n) % (n) % 3-J-10 15 11.9 111 88.1 3-J-11 10 3.8 253 96.2

Although both sites tend to share many of the mortuary practices seen at Mis Island, it is evident that there are significant differences in the spatial organization and type of burial patterns between the two sites. Some of these differences are likely related to the chronology of the cemeteries. The presence of blocking stones in the „transitional‟ burials at cemetery 3-J-11 and the lack thereof at cemetery 3-J-10 furthers the argument for some diachronic distinction between the two burial sites. Likewise, the decrease in the frequency of the presence of grave monuments in burials at cemetery 3-J-11 might indicate an earlier chronological date, especially as many of the burials lacking monuments are centrally located and also have blocking stones. It is also possible that the differences in the type of head coverings used are related to diachronic change in burial style, however it remains unclear at this time.

The distinctions between many of the remaining mortuary variables, such as body and head orientation, the presence of head stones, and personal adornment, are possibly caused by different organizational principles of mortuary ritual at cemeteries 3-J-10 and 3-J-11. As discussed earlier, all of the statistically significant variables at cemetery 3-J-10 directly relates to whether an individual was considered a juvenile or an adult at death. The presence of an FF03c

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or FF03a monument, the presence of head coverings or personal adornment, and the orientation of the body are all evidently influenced by this organizing principle. Beyond the age factor, there do not appear to be other overt spatial or statistical relationships at cemetery 3-J-10 that could better explain mortuary patterns at this site.

At cemetery 3-J-11 however, membership within an adult or subadult category is neither the most influential nor the lone organizational standard for burial ritual. Although there is certainly a relationship between age cohort and many variables at 3-J-11, the presence of distinct burial clusters also appears to greatly shape the use of burial space and mortuary patterns. The seemingly diverse and chaotic assortment of these clusters at cemetery 3-J-11 thus initially appear both spatially and statistically very distinct from the more structured organization of burials present at cemetery 3-J-10. However, when the clusters are dissected and analyzed as separate entities, there do appear to be relationships between the form of burial practice and the location of the clusters either in the central burial area or on the periphery. If these clusters represent discrete family disposal areas then it could possibly explain the seemingly chaotic nature of the centrally located clusters that were likely used and expanded over a protracted period of time, as well as the peripherally located clusters that are more consistent in burial form and possibly used for a shorter duration. Likewise it could be explained as contemporary differences in mortuary belief and practice between family groups at Mis Island. While the present mortuary analysis cannot discern the nature of these clusters, future investigations of mitochondrial DNA testing and carbon dating could help clarify these possibilities.

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CHAPTER SEVEN: OSTEOLOGY RESULTS

This chapter presents the results of osteological analyses of age, sex, and skeletal indicators of health among adults at Mis Island. Due to the nature of this dissertation, these results focus solely on the analysis of health and disease in the adult population and do not address the issue of juvenile morbidity and mortality rates. The chapter is divided into four sections. The first section focuses on the demographic profile and osteological analyses of individuals buried at cemetery 3-J-10, while the second section presents the demographic profile and osteological results of individuals from cemetery 3-J-11. The third segment is a direct comparison of paleopathological indicators of health among individuals buried at cemeteries 3-J-

10 and 3-J-11, and the final segment of the chapter compares the results from Mis Island with limited published data on paleopathological analyses from the site of Kulubnarti, located in the

Second Cataract of the Nile River.

The Mis Island osteological sample represents all the adults excavated from cemeteries 3-

J-10 and 3-J-11. The skeletal sample from Mis Island was examined for prevalence rates in a variety of skeletal indicators of health as discussed in Chapter Five: Methods. Cribra orbitalia, porotic hyperostosis, periostitis, osteomyelitis, maxillary sinusitis, linear enamel hypoplasias, and various disease processes were evaluated in the sample of adults. Differences based on sex and adult age cohorts are presented, as they can have an effect on prevalence rates and severity of certain infectious diseases and skeletal indicators of health. Therefore, each section includes a presentation of the demographic profile of each cemetery and a discussion of the effects of age and sex upon prevalence rates of each skeletal indicator of stress.

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The skeletal samples at both 3-J-10 and 3-J-11 were first divided into subadult and adult cohorts to understand the overall age distribution of the skeletal sample. Since this dissertation focuses solely on skeletal indicators of health among adults, the subadult sample was simply divided into standard categories of neonate/infant and juvenile, and more specific age estimations were not conducted on the subadult sample. The adult sample however, was further divided into males and females and age cohorts of young, middle, and old adults. Divisions were based on osteological standards in the field and as presented in other studies to aid in future comparison of the Mis Island sample (Buikstra and Ubelaker 1994). The description of each age cohort is as follows:

Neonate/Infant: Birth – 2 years

Juvenile: 2 years – less than 20 years

Young Adult: 20 years – 35 years

Middle Adult: 35 years – 50 years

Old Adult: 50 + years

These age estimations were based on the overall preservation of particular skeletal elements in each individual and the ability to assess specific sex and age characteristics. In a number of individuals relevant bony characteristics were missing or unobservable and therefore some individuals were simply grouped as adults over the age of twenty. Further, it was occasionally difficult to assess sex and a number of individuals were classified as „indeterminate‟ sex. While these individuals could not be included in a discussion of prevalence rates among specific age or sex cohorts, they are still included in the grouped prevalence rates for each site at

Mis Island.

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Each adult within the Mis Island sample was assessed for all skeletal indicators of stress, as discussed in Chapter Five: Methods. Skeletal indicators were scored as either present, absent, or unscorable. If an individual did not have at least one of the requisite skeletal elements available or observable for analysis then that individual was scored as „unobservable‟ for that particular stress indicator. As such, each skeletal indicator, with the exception of linear enamel hypoplasias, is presented by individual and not by skeletal element. Therefore, all prevalence rates demonstrate the rate of stress and disease among individuals in the sample.

CEMETERY 3-J-10

Demography

A total of 126 individuals were excavated from cemetery 3-J-10. Of the overall sample,

50 individuals are subadults categorized into neonate/infant (n= 7) and juvenile (n= 43) age cohorts. The adults are further divided into categories based on sex and adult age cohorts. The adult sample is relatively evenly distributed with 35 females (46.1%), 38 males (50%), and 3 individuals of indeterminate sex (3.9%). Males and females are also separated into adult age cohorts, with 51.3% of both sexes falling into the middle adult (35-50 years) age cohort. Another

10.5% (n= 8) of the total adult sample could only be assessed as over the age of twenty years and was placed into the nonspecific adult category. Tables 34 and 35 and Figure 41 visually summarize the demographic profile of individuals at cemetery 3-J-10.

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Table 34: Cemetery 3-J-10 Age Demographics. Age Number (n) % Subadult Neonate/Infant 50 7 39.7 5.6 Juvenile 43 34.1 Young 16 12.7 Middle 39 31.0 Adult 76 60.3 Old 13 10.3 Adult (>20) 8 6.3 Total 126 100.0

Table 35: Cemetery 3-J-10 Adult Age and Sex Demographics. Sex Age Number % Young 12 15.8 (n) Middle 23 30.3 Male 38 50 Old 2 2.6 Adult 1 1.3 Young 4 5.3 Middle 15 19.7 Female 35 46.1 Old 11 14.5 Adult 5 6.6 Young 0 0 Middle 1 1.3 Undetermined 3 3.9 Old 0 0 Adult (>20) 2 2.6

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Figure 41: Adult Age Estimations for Males and Females at 3-J-10.

15 Males

10 Females Indeterminate 5

0 Young Middle Old Adult

Table 34 is a summary of the subadult and adult age distributions and demonstrates that the subadult and adult age cohorts are not evenly represented. Only 7 of the sample of 50 subadults are neonates or infants, which would suggest that either they were buried in a separate location or they have not been as well preserved as their juvenile counterparts. Figure 41 also demonstrates that among the adults, most individuals belong to the middle adult age cohort (31% of the total sample). When further broken down into sex and age cohorts, as in Figure 41, many more females are aged as old adults (n= 11), while only a small number of males at cemetery 3-

J-10 are estimated to be old adults (n= 2). Furthermore, there are proportionately more young adult males (15.8% of the male sample) than young adult females (5.3% of the female sample).

These differences are worth further discussion and can hopefully be clarified through an analysis of distinctions in prevalence rates by age and sex cohorts.

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Skeletal Indicators of Stress and Disease

Non-Specific Stress: Cribra Orbitalia

Cribra orbitalia was recorded only for individuals with at least one observable eye orbit.

Thus, out of the sample of 76 adults at cemetery 3-J-10, only 58 individuals (76.3%) were available for analysis. Of these 58 individuals, 26 had evidence for cribra orbitalia (44.8%). Of those with cribra orbitalia, only 1 (3.8%) individual had active cribra orbitalia at the time of death, 2 (7.7%) exhibited a mixed reaction, and the remaining 23 (88.5%) individuals exhibited healed cribra orbitalia. Furthermore, among the 26 individuals with evidence of cribra orbitalia, 4

(15.4%) exhibited scattered fine foramina, 9 (34.6%) exhibited large and small isolated foramina, and 13 (50%) exhibited foramina that had linked into a trabecular structure.

The adult sample was further examined for observable differences in the prevalence of cribra orbitalia between males and females and among adult age cohorts. The Pearson‟s chi- square test at the p <0.05 level demonstrates that there is no significant difference between the

2 prevalence of cribra orbitalia in males and females (x = .121, df=1, p= .728) at cemetery 3-J-10.

In addition, there is no significant difference between adult age cohorts and the prevalence of

2 cribra orbitalia at cemetery 3-J-10 (x = .019, df=2, p= .990). Table 36 shows the frequency and prevalence rates of cribra orbitalia based on sex, and Table 37 shows the frequency and prevalence rates according to adult age cohorts.

Table 36: Frequency of Cribra Orbitalia in Males and Females at Cemetery 3-J-10. Present Absent Number (n) % Prevalence/1000 Adult Male 15 17 58 32 44.8 46.8 448.3 468.7 Females 11 15 26 42.3 423.0

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Table 37: Frequency of Cribra Orbitalia in Adults at Cemetery 3-J-10. Present Absent Number (n) % Prevalence/1000 Adult Young 6 8 58 14 44.8 42.8 448.3 428.5 Middle 13 17 30 43.3 433.3 Old 5 6 11 45.4 454.4

Non-Specific Stress: Porotic Hyperostosis

Porotic hyperostosis was recorded for presence or absence on the bones of the cranial vault, including the parietals, the frontal, and the occipital. If an individual did not have at least a portion of a parietal, frontal, or occipital available for analysis then that individual was given a rank of “unscorable”. A total of 72 (94.7%) out of 76 adults in cemetery 3-J-10 had well- preserved crania and could be assessed for porotic hyperostosis. A large percentage of individuals (n= 49, 68.1%) at cemetery 3-J-10 exhibited some degree of porotic hyperostosis. All of these 49 individuals exhibited healed porotic hyperostosis, and were scored as either barely discernible with scattered fine foramina (n= 30, 61.2%) or somewhat discernible with large and small isolated foramina (n= 19, 38.8%).

The adult sample was further examined for observable differences in the prevalence of porotic hyperostosis between males and females and among adult age cohorts. The Pearson‟s chi-square test at the p <0.05 level demonstrates that there is no significant difference between

2 the prevalence rates of porotic hyperostosis in males and females (x = 1.603, df=1, p= .205) at cemetery 3-J-10. Similarly, there is not a significant difference between adult age cohorts and the

2 prevalence of porotic hyperostosis at cemetery 3-J-10 (x = 1.465, df=2, p= .481) however, the young adult and old adult age cohorts display the largest percentage with 75% and 84.6% respectively exhibiting porotic hyperostosis. Table 38 shows the frequency and prevalence rates

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of porotic hyperostosis based on sex, and Table 39 shows the frequency and prevalence rates according to adult age cohorts.

Table 38: Frequency of Porotic Hyperostosis in Males and Females at Cemetery 3-J-10. Present Absent Number (n) % Prevalence/1000 Adult Male 28 9 71 37 69.0 75.7 690.0 756.7 Female 21 13 34 61.8 617.6

Table 39: Frequency of Porotic Hyperostosis in Adults at Cemetery 3-J-10. Present Absent Number (n) % Prevalence/1000 Adult Young 12 4 72 16 68.1 75.0 681.0 750.0 Middle 25 12 37 67.6 675.6 Old 11 2 13 84.6 846.2

Non-Specific Stress: Linear Enamel Hypoplasias (LEH)

LEH were recorded for the right maxillary and mandibular anterior teeth, including the canines, lateral incisors, and central incisors. If the right side was unavailable for analysis, then the left side was substituted. The prevalence rates are presented here according to each tooth, as many individuals did not have available teeth for analysis. There was a lot of extreme tooth wear and postmortem destruction and therefore, only 40-50 individuals within the cemetery 3-J-10 sample had a number of anterior teeth available for analysis.

The frequency of LEH varies according to tooth, with the maxillary and mandibular canines the most likely to have a hypoplasia with 54.3% and 63.3% of the sample affected, respectively. On the other hand, the maxillary lateral incisor (304.3/1000) and mandibular central incisor (156.2/1000) have much lower calculated prevalence rates. There does not appear to be a substantial difference in the frequency of LEH between the maxillary and mandibular teeth.

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Table 40 presents the number of anterior maxillary and mandibular teeth with an observable

LEH out of the total number of adult teeth that could be analyzed.

Table 40: Frequency of LEH in Adults at Cemetery 3-J-10. Present Absent Number % Prevalence/ (n) 1000 Maxillary Canine 25 21 46 54.3 543.4 Maxillary Lateral Incisor 14 36 50 28.0 280.0

Maxillary Central Incisor 14 32 46 30.4 304.3 MaxMandibular Canine Canine 31 18 49 63.3 632.6 Mandibular Lateral Incisor 15 30 45 33.3 333.3 Mandibular Central Incisor 5 27 32 15.6 156.2

When the prevalence rates of LEH are compared according to adult age and sex cohorts there are no statistically significant differences. However, males appear to have slightly higher prevalence rates than females, with 71.4% of the mandibular canine in the male sample affected

(Table 41), and only 52.4% of the mandibular canine in the female sample affected (Table 42).

When Table 41 and Table 42 are directly compared, the males do in fact have higher prevalence rates for many teeth, including the maxillary and mandibular canines, and the maxillary and mandibular lateral incisors. Females, on the other hand, have slightly higher frequencies for the maxillary and mandibular central incisors and the mandibular lateral incisor. However, when a chi-square test at the p <0.05 level is conducted there is no statistically significant difference between the male and female samples for any of the observable teeth.

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Table 41: Frequency of LEH in Males at Cemetery 3-J-10. Present Absent Number % Prevalence/ (n) 1000 Maxillary Canine 17 10 27 63.0 629.6 Maxillary Lateral Incisor 9 19 28 32.1 321.4 28 Maxillary Central Incisor 7 18 25 28.0 280.0 MaxMandibular Canine Canine 20 8 2528 71.4 714.2 Mandibular Lateral Incisor 10 16 26 38.5 384.6 Mandibular Central Incisor 3 17 20 15.0 150.0

Table 42: Frequency of LEH in Females at Cemetery 3-J-10. Present Absent Number % Prevalence/ (n) 1000 Maxillary Canine 8 10 18 44.4 444.4 Maxillary Lateral Incisor 5 16 21 23.8 238.1

Maxillary Central Incisor 7 13 20 35.0 350.0 MaxMandibular Canine Canine 11 10 21 52.4 523.8 Mandibular Lateral Incisor 5 13 18 27.8 277.7 Mandibular Central Incisor 2 10 12 16.7 166.6

Table 43 illustrates LEH frequencies according to the young, middle, and old adult age cohorts at cemetery 3-J-10. When divided this way, the sample sizes for the young and old adults are rather small, but it is still possible to see that there are some different trends in prevalence based on age cohort. For the young and middle adults the maxillary and mandibular canines are the most likely to have an LEH, while the older adults are more likely to have an LEH on the maxillary lateral and central incisors. However, in total, the prevalence rates seem to be rather evenly distributed between the age groups. A chi-square comparison of the prevalence of LEH in each of the teeth between the age cohorts demonstrates that there are no statistically significant

2 differences for a majority of the teeth, except for the mandibular canine (x = 7.482, df=2, p=

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.024, Cramer‟s V= .403). In this tooth middle adults are much more affected, with 80.0% of the sample exhibiting an LEH, while the young and old adults have much lower prevalence rates at

56.3% and 20.0%, respectively.

Table 43: Frequency of LEH among Adult Age Cohorts at Cemetery 3-J-10. Young Adult Middle Adult Old Adult (n) % (n) % (n) % Maxillary Canine 13 69.2 26 50.0 6 33.3 Maxillary Lateral Incisor 14 21.4 30 26.7 5 40.0 Maxillary Central Incisor 11 18.2 29 27.6 5 60.0 Mandibular Canine 16 56.3 25 80.0 5 20.0 Mandibular Lateral Incisor 12 41.7 26 34.6 5 0.0 Mandibular Central lncisor 9 11.1 20 15.0 3 33.3

Nonspecific Infection: Periostitis and Osteomyelitis

Periostitis was recorded for the femur, tibia, and fibula. Thus, only individuals with observable cortical surfaces on the lower limb bones were included in this analysis. Due to the excellent state of preservation in cemetery 3-J-10, each individual had at least a portion of all lower limb bones present for analysis, however, not all cortical surfaces were sound enough to determine if periostitis was present or absent. Those individuals without sound cortical surfaces of the tibia, femur, or fibula were determined to be „unscorable.‟ Individuals with lower limb bone shafts were also scored for the presence or absence of osteomyelitis, however there are no individuals at cemetery 3-J-10 with osteomyelitis.

A total of 70 out of 76 adults (92.1%) at cemetery 3-J-10 had observable cortical surfaces of the lower limb bones. The frequency of periostitis among the adults available for analysis is

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70% (n= 49). Only three of these individuals (6.1%) exhibited active periostitis at the time of death, while a majority of individuals had healed periostitis (n= 32, 65.3%), and a smaller number a mixed reaction (n= 14, 28.6%). Furthermore, the severity of periostitis was most often either barely discernible (n= 24, 49.0%) or moderately expressed (n= 24, 49.0%). Only one adult at cemetery 3-J-10 exhibited a severe expression of periostitis. In addition, 46.9% (n= 23) of individuals exhibited periostitis on more than one lower limb, with the tibia (n= 40, 81.6%) as the most commonly affected, followed by the fibula (n= 36, 73.4%) and the femur (n= 16,

32.6%).

There is no significant difference at the p <0.05 level between the prevalence of

2 periostitis in males and females (x = 2.398, df=1, p= .121) at cemetery 3-J-10. In addition, there

2 is no significant difference between adult age cohorts and the prevalence of periostitis (x =

2.727, df=2, p= .256). Table 44 shows the frequency and prevalence rates of periostitis based on sex, and Table 45 summarizes the frequency and prevalence rates according to adult age cohorts.

Table 44: Frequency of Periostitis in Males and Females at 3-J-10. Present Absent Number (n) % Prevalence/1000 Adult Males 28 8 69 36 69.6 77.8 695.6 777.7 Females 20 13 33 60.6 606.0

Table 45: Frequency of Periostitis in Adults at Cemetery 3-J-10. Present Absent Number (n) % Prevalence/1000 Adult Young 11 4 70 15 70.0 73.3 700.0 733.3 Middle 28 8 36 77.8 777.7 Old 7 6 13 53.8 538.4

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Nonspecific Infection: Maxillary Sinusitis

Maxillary sinusitis was scored on all individuals who had an observable maxillary sinus.

Only those individuals with a broken cranial vault could be scored as no scopes were used in this study to visualize unobservable sinuses. Therefore, only 35 out of 76 adults could be scored for maxillary sinusitis at cemetery 3-J-10. A total of 15 individuals (42.9%) exhibited the condition.

Of those with maxillary sinusitis, 5 (33.3%) exhibited a healed reaction, 9 (60.0%) exhibited an active reaction, and 1 individual exhibited a mixed reaction.

The sample was also examined for observable differences in the prevalence of maxillary sinusitis between males and females and among adult age cohorts. There is no significant difference at the p <0.05 level between the presence of maxillary sinusitis in males and females

2 (x = .614, df=1, p= .433) at cemetery 3-J-10. In addition, there is no significant difference

2 between adult age cohorts and the prevalence of maxillary sinusitis (x = 1.16, df=2, p= .572).

Table 46 shows the frequency and prevalence rates of maxillary sinusitis based on sex, and Table

47 summarizes the frequency and prevalence rates according to adult age cohorts.

Table 46: Frequency of Maxillary Sinusitis in Males and Females at Cemetery 3-J-10. Present Absent Number (n) % Prevalence/1000 Adult Male 7 12 35 19 42.9 36.8 428.5 368.4 Female 8 8 16 50.0 500.0

Table 47: Frequency of Maxillary Sinusitis in Adults at Cemetery 3-J-10. Present Absent Number (n) % Prevalence/1000 Adult Young 2 6 35 8 42.9 25.0 428.5 250.0 Middle 8 9 17 47.1 470.5 Old 3 4 7 42.9 428.5

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Specific Infection: Tuberculosis

As discussed in Chapter Five: Methods, an additional focus of this research is on the incidence and prevalence of specific infections within the adult samples at Mis Island. A detailed paleopathological analysis of the human remains from cemetery 3-J-10 revealed that the only specific infectious disease that could be identified within the sample was probable tuberculosis.

Tuberculosis has been identified through both paleopathological analyses and molecular DNA at numerous sites throughout Egypt and Nubia, and thus the infectious lesions visible on the vertebrae and ribs in the Mis Island sample are not a surprising discovery (Strouhal 1991, 1995;

Waldron 2000; Spiegelman et al. 2005; Zink et al. 2001, 2005). Out of the 73 adults available for analysis at cemetery 3-J-10, at least 3 males in the sample exhibit bony lesions indicative of possible tuberculosis. Only two individuals have clear vertebral involvement of the condition and another individual has isolated involvement of the ribs. Despite the fact that only males are affected there is no statistically significant difference between males and females and prevalence

2 of tuberculosis (x = 2.882, df=1, p= .090). Table 48 summarizes the frequency and prevalence of possible tuberculosis in the 3-J-10 sample.

Table 48: Frequency of Possible Tuberculosis in Males and Females at Cemetery 3-J-10. Present Absent Number (n) % Prevalence/1000 Adult Male 3 35 73 38 4.1 7.9 41.0 78.9 Female 0 35 35 0.0 00.0

Skeleton 5040 is estimated as a middle adult male, aged thirty-five to fifty years. The skeletal inventory for this individual includes a nearly complete cranium, fragmentary cervical, thoracic and lumbar vertebrae, portions of the sacrum and os coxae, fragments of twenty-four

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ribs, and portions of the long bones. Evidence for tuberculosis on this individual includes the presence of multifocal lytic lesions on the anterior and posterior bodies of multiple lower thoracic and lumbar vertebrae. It is impossible to determine how many lumbar vertebrae are affected due to postmortem damage. At least one thoracic body has been nearly destroyed by lytic destruction, which most likely caused vertebral collapse and Pott‟s disease. As a result of this collapse, two thoracic neural arches are fused together, most likely to lend more stability to the vertebral column. The ribs are unaffected.

Skeleton 1013 is estimated as a young adult male, most likely between twenty and thirty years old. The skeletal remains for this individual are extremely well preserved and complete.

The evidence for tuberculosis on Skeleton 1013 is extensive and the vertebral bodies of C3-T11 are all affected by varying degrees of lytic destruction. The anterior bodies of C3-C5 have an early stage of focalized lytic destruction, with small areas of woven bone just adjacent to the lesions. The anterior bodies of C7-T3 are extensively affected and exhibit large cavitating lesions with rounded edges. The body of T1 has been entirely destroyed and only the neural arch remains. The bodies of T2 and T3 are nearly destroyed, and there is resulting vertebral collapse and anterior kyphosis (Pott‟s Disease) of the vertebrae from C7 to T2. The remaining portions of the bodies of C7-T2 and the neural arches, including the vertebral joints and laminae have fused with extensive remodeling. In addition, T4 through T11 have a number of multifocal cavitating lesions on the anterior bodies, without any resulting vertebral destruction or periosteal buildup.

The superior aspect of the sacrum is also affected with circular areas of lytic destruction that mimic the lesions found in the vertebrae. Finally, many of the right and left ribs have extensive reactive woven bone formation along the visceral surface of the rib heads and necks. In addition to this periosteal bone deposition, the most superior right and left ribs (#‟s 1-6) also have large

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focalized lytic lesions on the superior surface of the rib heads. The widespread involvement of multiple vertebrae and ribs and the resulting kyphosis and fusion of the vertebral bodies indicate that the infection was sustained for a long period of time, with extensive healing and remodeling.

Skeleton 5106 is estimated as a middle adult male most likely between the age of forty and fifty years old. The skeleton of this individual is very well preserved and nearly complete with most of the bony elements, including all of the vertebrae except for the body of T2 and all of T3, as well as the complete sacrum, partial os coxae, and the complete series of ribs from the right and left sides. At least eight left ribs (#‟s 3-10) and six right ribs (#‟s 4-9) have active woven bone formation along the visceral surfaces, most concentrated near the rib heads, necks, and rib angles. The proliferative bony reaction is more concentrated on the left side, with a thickened layer of periostitis along the visceral surface of most of the affected ribs. Although there are no subsequent lesions on the vertebral bodies, it is quite possible that these lesions are indicative of a pulmonary form of tuberculosis that never affected the vertebrae (Ortner 2003).

Since pulmonary tuberculosis is a condition well recorded in archaeological remains and a common periosteal reaction is seen on other ribs of affected individuals in the Mis Island sample, this individual will be included in the analysis of tuberculosis at cemetery 3-J-10.

CEMETERY 3-J-11

For the purposes of accurately reflecting paleopathology frequencies, cemetery 3-J-11 has been further divided into two analytical samples based on the mortuary findings presented in

Chapter Six: Mortuary Results. The first sample will consist of the possible transitional Christian burials with blocking stones and grave goods (n= 30). Simple demographic profiles and frequencies for each of the pathological conditions will be reported for these burials, however an

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analysis of statistically significant differences in age and sex cohorts cannot be performed because of the small number of adults within this group. The second sample will consist of the fully Christianized burials at cemetery 3-J-11, without blocking stones or grave goods (n= 249).

Since the sample of adults from this group of burials is larger, a full analysis of pathological conditions by age and sex cohorts will also be presented.

Transitional Christian Burials: Demography

There are 30 graves that were identified as possible transitional Christian burials at cemetery 3-J-11. A majority of the sample is made up of adults (n= 21, 70%) and a much smaller proportion is subadult (n= 9, 30.0%). The adults are further divided into categories based on sex and adult age cohorts. The adult sample is relatively evenly distributed with 7 females (31.8%),

10 males (45.5%), and 4 individuals of indeterminate sex (19.0%). Males and females are also separated into adult age cohorts, with the majority of both sexes falling into the middle adult (35-

50 years) age cohort, at 38.1% of the adult sample. A large proportion of the adult sample could only be assessed as over the age of twenty years (19.0%) due to post-depositional disturbance and taphonomic damage. These individuals were placed into the nonspecific adult age category.

Tables 49 and 50 summarize the demographic profile of the transitional burials at cemetery 3-J-

11.

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Table 49: Cemetery 3-J-11 Age Demographics: Transitional Burials. Age Number (n) % Subadult Neonate/Infant 9 0 30.0 0.0 Juvenile 9 30.0 Adult Young 4 13.3 Middle 8 26.7 21 70.0 Old 5 16.7 Adult (>20) 4 13.3 Total 30 100.0

Table 50: Cemetery 3-J-11 Adult Age and Sex Demographics: Transitional Burials.

Sex Age Number (n) % Young 3 14.3 Middle 7 33.3 Male 10 47.6 Old 0 0.0 Adult 0 0.0

Young 1 4.8 Middle 1 4.8 Female 7 33.4 Old 5 23.8

Adult 0 0.0 Young 0 0.0 Middle 4 19.0 Undetermined 4 19.0 Old 0 0.0 Adult 0 0.0

Transitional Christian Burials: Skeletal Indicators of Stress and Disease

Cribra Orbitalia

Of the 13 adults who had at least one eye orbit scorable for the presence of cribra orbitalia in the transitional burial sample at cemetery 3-J-11, 46.2% (n= 6) show evidence of cribra orbitalia with a calculated prevalence rate of 461.5 out of 1000 individuals (Table 51).

Three females, two males, and one individual of undetermined sex are affected, showing a rather

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even distribution by sex cohort. Of the six individuals affected, all exhibit healed lesions, 33.3% of which are large and small isolated foramina and 66.7% a more moderate expression of foramina that have linked into a trabecular structure.

Table 51: Frequency of Cribra Orbitalia in Adults: 3-J-11 Transitional Burials. Present Absent Number % Prevalence/ (n) 1000 Adult Male 2 3 13 5 46.1 66.7 461.5 666.7 Female 3 4 7 75.0 750.1 7 Undetermined 1 0 1 100 1000 1

Porotic Hyperostosis

Out of the sample of 21 adults only 16 individuals had at least one cranial vault fragment that could be scored. The frequency of porotic hyperostosis is 56.3% with a calculated prevalence rate of 562.5 per 1000 individuals (Table 52). An equal number of males and females are affected. A large majority (88.9%) had more than one cranial bone affected, with the parietal bone most commonly involved (100%), followed by the occipital (77.8%) and frontal (22.2%).

All nine affected individuals exhibited barely discernible healed lesions, with 77.8% exhibiting scattered fine foramina and another 22.2% expressing large and small isolated foramina.

Table 52: Frequency of Porotic Hyperostosis in Adults: 3-J-11 Transitional Burials. Present Absent Number % Prevalence/ (n) 1000 Adult Male 5 3 16 8 56.3 62.5 562.5 625.0 4 3 7 57.1 571.4 Female 7 Undetermined 0 1 1 0.0 000.0 1

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Linear Enamel Hypoplasias (LEH)

Very few individuals in the transitional burial sample had intact and observable anterior teeth, and at most only nine individuals could be analyzed for each tooth type. Table 53 presents the number of observable teeth and the prevalence rates for each anterior tooth in the sample. As in the 3-J-10 sample, the mandibular canines are most affected, with 77.8% (n= 7) of the sample exhibiting an LEH. However, the prevalence of LEH in this sample is remarkably low, with most of the teeth exhibiting a frequency below 35%. A further breakdown of the prevalence rates according to adult age and sex cohorts is difficult as this would reduce the sample to one or two individuals and would not provide accurate statistical analyses. Consequently, differences according to age and sex are not provided for the transitional burials.

Table 53: Frequency of LEH in Adults: 3-J-11 Transitional Burials. Present Absent Number % Prevalence/ (n) 1000 Maxillary Canine 2 7 9 22.2 222.2 Maxillary Lateral Incisor 2 7 9 22.2 222.2

Maxillary Central Incisor 3 6 9 33.3 333.3 MaxMandibular Canine Canine 7 2 9 77.8 777.7 Mandibular Lateral Incisor 2 4 6 33.3 333.3 Mandibular Central Incisor 1 5 6 16.7 166.6

Non-specific Infection: Periostitis and Osteomyelitis

Of the 13 adults who could be assessed for the presence of periostitis on the lower limb bones, 5 were affected with a frequency of 38.5% and a calculated prevalence rate of 384.6 per

1000 individuals (Table 54). Once again males and females appear to be evenly represented, with two individuals from each sex cohort exhibiting the lesion. The severity of lesions is rather minor with 80% of individuals exhibiting healed and barely discernible periostitis. Furthermore, only

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one individual has periostitis to more than one lower limb, and the majority exhibit lesions only on the tibia (60%) or the fibula (20%).

Table 54: Frequency of Periostitis in Males and Females: 3-J-11 Transitional Burials. Present Absent Number % Prevalence/ (n) 1000 Adult Male 2 4 14 6 35.7 33.3 357.1 357.1 2 5 7 28.6 285.7 Female 7 Undetermined 1 0 1 100 1000 1

Osteomyelitis is a more rare condition in the transitional sample and only 1 individual out of the 17 that could be assessed exhibits the infection. Skeleton 3386, a middle adult male, exhibits a severe infection with a distinct narrowing of the medullary cavity of the left fibula

(Appendix B). Unfortunately, the remains of this individual were rather fragmentary and the fibula had been broken postmortem in multiple regions, making it difficult to ascertain the extent of the infection. Regardless, it appears that the infection was rather severe and active and thus, could have contributed to his death.

Non-specific Infection: Maxillary Sinusitis

A total of 9 out of 21 adults could be assessed for the presence of maxillary sinusitis

(Table 55). Since only three individuals (15.0%) exhibited any maxillary sinusitis, the small sample size precluded any statistical tests regarding differences in age or sex cohorts. However, it appears that both males and females and individuals in the middle older adult age cohorts are affected. One middle adult male and one old adult female exhibited healed maxillary sinusitis and another old adult female had a mixed reaction.

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Table 55: Frequency of Maxillary Sinusitis: 3-J-11 Transitional Burials. Present Absent Number % Prevalence/ (n) 1000 Adult Male 1 4 9 5 33.3 20.0 200.0 2 1 3 66.7 666.6 Female 7 Undetermined 0 1 1 0.0 000.0 1

Specific Infection: Tuberculosis

There are no individuals in the transitional burial sample with evidence for tuberculosis.

Non-Transitional Christian Burials: Demography

A total of 249 individuals were excavated from the non-transitional Christian burials at cemetery 3-J-11. Of the overall sample, 127 individuals are subadults and have been categorized into neonate/infant (n= 15) and juvenile (n= 112) age cohorts. The adults are further divided into categories based on sex and adult age cohorts. The adult sample is relatively evenly distributed with 62 females (50.8%), 52 males (42.6%), and 8 individuals of indeterminate sex (6.6%).

Males and females are also separated into adult age cohorts, with 42.6% of the total adult sample falling into the middle adult (35-50 years) age cohort. Another 6.5% (n= 8) of the adult sample could only be assessed as over the age of twenty years and was placed into the nonspecific adult category. Tables 56 and 57 and Figure 42 illustrate the demographic profile of individuals at cemetery 3-J-11.

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Table 56: Cemetery 3-J-11 Age Demographics: Christian Burials. Age Number (n) % Subadult Neonate/Infant 127 15 51 6.0 Juvenile 112 45.0 Adult Young 33 13.3 Middle 53 21.3 122 49 Old 28 11.2 Adult (>20) 8 3.2 Total 249 100.0

Table 57: Cemetery 3-J-11 Adult Age and Sex Demographics: Christian Burials. Sex Age Number (n) % Young 12 9.8 Middle 26 21.3 Male 52 42.6 Old 12 9.8 Adult 2 1.7 Young 18 14.8 Middle 26 21.3 Female 62 50.8 Old 16 13.1 Adult 2 1.6 Young 3 2.5 Middle 1 .8 Undetermined 8 6.6 Old 0 0.0 Adult 4 3.3

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Figure 42: Age Estimations by Sex in non-transitional Christian burials at 3-J-11.

25 20 Males 15 Females 10 Indeterminate 5 0 Young Middle Old Adult

Non-Transitional Christian Burials:

Skeletal Indicators of Stress and Disease

Cribra Orbitalia

Out of the 122 adults from the Christian sample at cemetery 3-J-11, a total of 109 had at least one observable eye orbit and could be scored for cribra orbitalia. Just under half of these

(n= 52, 47.7%) had evidence of cribra orbitalia. As would be expected of an adult sample, 44

(84.6%) of these individuals exhibited healed cribra orbitalia at the time of death and another 5

(9.6%) exhibited a mixed reaction. Only two young adults and one middle adult (n= 3, 2.8%) exhibited active cribra orbitalia at the time of death. The severity of those with cribra orbitalia ranged from those with barely discernible small, scattered fine foramina (n= 14, 26.9%) to extremely expressed outgrowth in trabecular form from the outer table surface (n= 4, 7.7%). The

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largest majority of individuals with cribra orbitalia had a moderate expression where the foramina had linked into a trabecular structure. It is clear that although the evidence of cribra orbitalia was healed in this sample of adults, a large majority of them had at one time exhibited at least a moderately severe stage of the lesion.

In addition, the Pearson‟s chi-square test at the p <0.05 level demonstrates that there is no

2 significant difference between the prevalence of cribra orbitalia in males and females (x = 1.256, df=1, p= .328). Similarly, there is not a statistically significant difference in prevalence rates

2 between the adult age cohorts (x = 2.696, df=2, p= .260). Table 58 shows the frequency and prevalence rates of cribra orbitalia based on sex, and Table 59 shows the frequency and prevalence rates according to adult age cohorts.

Table 58: Frequency of Cribra Orbitalia in Males and Females: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Male 20 30 105 50 45.7 40.0 457.1 400.0 Female 28 27 55 50.9 509.0

Table 59: Frequency of Cribra Orbitalia in Adults: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Young 19 13 107 32 48.6 59.4 485.9 593.7 Middle 20 29 49 40.8 408.1 Old 13 13 26 50.0 500.0

Porotic Hyperostosis

Among the Christian sample at cemetery 3-J-11, 112 adults had at least one cranial vault fragment that could be scored for porotic hyperostosis. Just over half of this sample (n= 61,

54.5%) exhibited evidence of the lesion on at least one of the cranial bones. In the majority of

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cases more than two cranial bones, most frequently the parietal and the occipital, were affected

(n= 53, 86.9%). Only one individual showed evidence of a mixed reaction, yet characteristically, only 98.4% of the sample exhibited healed porotic hyperostosis at the time of death. In addition, an overwhelming majority of the adults with porotic hyperostosis exhibited barely discernible lesions of small, scattered fine foramina (n= 54, 90.0%), and only six individuals had somewhat more advanced expressions of the lesion. Either the porotic hyperostosis was never very severe in the first place or the process of healing in these individuals was in such an advanced state as to nearly erase any evidence of the lesion‟s existence.

Once again, an analysis of differences in the prevalence of porotic hyperostosis between

2 adult groups reveals that there is no significant difference in males or females (x = 1.651, df=1, p= .199). Similarly, there is not a statistically significant difference in prevalence rates between

2 adult age cohorts (x = 3.568, df=2, p= .168), or in the activity or severity of the lesions. Table 60 shows the frequency and prevalence rates of cribra orbitalia based on sex, and Table 61 shows the frequency and prevalence rates according to adult age cohorts.

Table 60: Frequency of Porotic Hyperostosis in Males and Females: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Male 24 26 100 50 54.5 48.0 545.4 480.0 Female 36 24 60 60.0 600.0

Table 61: Frequency of Porotic Hyperostosis in Adults: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Young 18 15 110 33 55.5 54.5 554.5 545.4 Middle 24 26 50 48.0 480.0 Old 19 8 27 70.4 703.7

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Linear Enamel Hypoplasias (LEH)

Approximately half of the 122 adults from non-transitional Christian burials at cemetery

3-J-11 had intact and observable anterior teeth. On average only 40-60 teeth were available for observation in any tooth class and therefore, the LEH frequencies can only be considered an estimation of their overall prevalence within the adult population. The maxillary and mandibular canines are once again the most affected teeth, with 59.7% and 67.2% of individuals exhibiting an LEH. The maxillary and mandibular central incisors are the least affected with only 37.7% and 26.8% of individuals exhibiting an LEH on these particular teeth. Table 62 summarizes the frequency and prevalence of LEH for the entire adult sample.

Table 62: Frequency of LEH in Adults: 3-J-11 Christian Burials. Present Absent Number % Prevalence/ (n) 1000 Maxillary Canine 37 25 62 59.7 596.7 Maxillary Lateral Incisor 21 32 53 39.6 396.2

Maxillary Central Incisor 20 33 53 37.7 377.3 MaxMandibular Canine Canine 43 21 64 67.2 671.8 Mandibular Lateral Incisor 17 30 47 36.2 361.7 Mandibular Central Incisor 11 30 41 26.8 268.2

When the frequencies of LEH are separated according to sex, there do not appear to be any overwhelming differences in prevalence rate according to tooth. Males and females tend to follow the same pattern of prevalence, with the maxillary and mandibular canines the most affected and the central incisors the least affected. Only one tooth, the maxillary central incisor,

2 is statistically significant at the p <0.05 level between males and females (x = 4.680, df=1, p=

.031, Phi= - .300). Females have substantially more hypoplasias on this tooth, with 50% of the

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sample affected, while only 20% of the male sample exhibits an LEH on the maxillary central incisor. It is unclear why there would be a difference in this particular tooth, but it is possibly a product of small sample sizes, especially since none of the other teeth demonstrate a statistically significant difference. Tables 63 and 64 summarize the frequency and prevalence of hypoplasias in males and females.

Table 63: Frequency of LEH in Males: 3-J-11 Christian Burials. Present Absent Number % Prevalence/ (n) 1000 Maxillary Canine 15 8 23 65.2 652.1 Maxillary Lateral Incisor 6 13 19 31.6 315.7

Maxillary Central Incisor 4 16 20 20.0 200.0 MaxMandibular Canine Canine 11 7 18 61.1 611.1 Mandibular Lateral Incisor 5 10 15 33.3 333.3 Mandibular Central Incisor 5 10 15 33.3 333.3

Table 64: Frequency of LEH in Females: 3-J-11 Christian Burials. Present Absent Number % Prevalence/ (n) 1000 Maxillary Canine 21 16 37 56.8 567.5 Maxillary Lateral Incisor 15 18 33 45.4 454.5

Maxillary Central Incisor 16 16 32 50.0 500.0 MaxMandibular Canine Canine 32 12 44 72.7 727.2 Mandibular Lateral Incisor 12 18 30 40.0 400.0 Mandibular Central Incisor 6 18 24 25.0 250.0

Unfortunately, when the frequency and prevalence of hypoplasias are divided according to adult age cohorts, the sample sizes reduce even more (Table 65). There are very few old adults with observable anterior teeth, most likely due to the extreme tooth wear that individuals in this population experience. By the time an individual in this population reaches old age, most of the

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tooth enamel has been worn down to the dentine and it is impossible to determine if the individual ever had an LEH in life. As such, the sample sizes of old adults range from two to ten individuals and with so few individuals, it is difficult to determine the true prevalence rate for this age cohort. While it appears that the old adult cohort exhibits a much higher rate of LEH for most of the teeth, with 80% of individuals affected, it is probable that this difference stems from the small samples and not from a true difference in LEH prevalence. In addition, a chi-square test at the p <0.05 level demonstrates that the only statistically significant differences between the

2 age cohorts are in the mandibular lateral incisor (x = .189, df=1, p=047, Cramer‟s V= .361) and

2 the mandibular central incisor (x = 6.737, df=2, p= .034, Cramer‟s V=.405). However, there are as few as two individuals representing the old adult age cohort for the mandibular central incisor, producing a result of 100% frequency and thus, likely skewing the statistical significance. In addition, considering there is no statistical difference between the maxillary and mandibular canines, which are the most likely to be affected, it is probable that any differences seen in the other teeth are due to an inadequate sample size.

Table 65: Frequency of LEH among Adult Age Cohorts: 3-J-11 Christian Burials. Young Adult Middle Adult Old Adult (n) % (n) % (n) % Maxillary Canine 26 61.5 29 51.7 7 85.7 Maxillary Lateral Incisor 23 30.4 25 40.0 5 80.0 Maxillary Central Incisor 23 43.5 25 32.0 5 40.0 Mandibular Canine 27 66.7 27 63.0 10 80.0 Mandibular Lateral Incisor 23 39.1 19 21.1 5 80.0 Mandibular Central lncisor 19 15.8 20 30.0 2 100.0

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Nonspecific Infection: Periostitis and Osteomyelitis

Only 106 of the 122 adults (8.9%) in the Christian burial sample at cemetery 3-J-11 had observable cortical surfaces of the lower limb bones. The frequency of periostitis among the adults available for analysis is 55.7% (n= 59). Only four of these individuals (3.8%) exhibited active periostitis at the time of death, while a majority of individuals had healed periostitis (n=

47, 79.7%), and a smaller number a mixed reaction (n= 8, 7.5%). Furthermore, the severity of periostitis was most often either barely discernible (n= 27, 45.8%) or moderately expressed (n=

30, 50.8%). Only two adults exhibited a severe expression of periostitis. In addition, 46.9% (n=

23) of individuals exhibited periostitis on more than one lower limb, with the fibula (n= 56,

94.9%) the most commonly affected, followed by the tibia (n= 37, 62.7%) and the femur (n= 27,

45.7%). In addition, at least 57.6% (n= 34) had more than one affected limb.

Further, the adult sample showed no significant difference at the p <0.05 level between

2 the prevalence of periostitis in males and females (x = .100, df=1, p= .752). In addition, there is

2 no significant difference between adult age cohorts and the prevalence of periostitis (x = 1.562, df=2, p= .458), despite the fact that the majority of affected individuals fall within the middle adult cohort. Table 66 shows the frequency and prevalence rates of periostitis based on sex, and

Table 67 summarizes the frequency and prevalence rates according to adult age cohorts.

Table 66: Frequency of Periostitis in Males and Females: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Male 27 22 106 49 56.1 55.1 566.0 551.0 Female 32 23 55 58.2 581.8

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Table 67: Frequency of Periostitis in Adults: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Young 17 12 105 29 56.2 58.6 561.9 586.2 Middle 24 24 48 50.0 500.0 Old 18 10 28 64.3 642.8

In contrast to the prevalence of periostitis, only one adult out of the 122 Christian burials at cemetery 3-J-11 has evidence for osteomyelitis active at the time of death. Skeleton 1146 is estimated as a young adult female, most likely over the age of thirty. This individual has a large lytic lesion covering almost the entire anterior diaphysis of the left tibia, measuring approximately 77.39 millimeters long, by 33.37 millimeters at its widest (Appendix B). The floor of the lesion appears coarse with reactive bony spicule formation. Along the inferior wall of the lesions there is a small circular perforation, most likely a cloaca for pus drainage. The remaining tibial diaphysis is covered with a mixture of lamellar and woven bone formation that more or less encapsulates the original cortical bone surface. The osteomyelitic infection is extensive and active and it is clear that this individual survived for a period of time with this infection, which might have ultimately led to her death.

Nonspecific Infection: Maxillary Sinusitis

Because maxillary sinusitis was scored only on individuals with a broken cranial vault, only a very small sample of 27 individuals could be analyzed. Of the 27 adults available for analysis, only 10 individuals (37.0%) exhibited the condition. Only two individuals exhibited active sinusitis at the time of death, another five exhibited a healed reaction, and the remaining three had a mixed reaction.

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There is no significant difference at the p <0.05 level between the presence or activity of

2 maxillary sinusitis in males and females (x = .014, df=1, p= .907). In addition, there is no

2 significant difference between adult age cohorts and maxillary sinus prevalence rates (x = .429, df=2, p= .807). Table 68 shows the frequency and prevalence rates of maxillary sinusitis based on sex, and Table 69 summarizes the frequency and prevalence rates according to adult age cohorts.

Table 68: Frequency of Maxillary Sinusitis in Males and Females: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Male 5 11 28 16 32.1 31.3 321.4 312.5 Female 4 8 12 33.3 333.3

Table 69: Frequency of Maxillary Sinusitis in Adults: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Young 2 5 27 7 37.0 28.6 370.3 285.7 Middle 4 7 11 36.4 363.6 Old 4 5 9 44.4 444.4

Specific Infection: Tuberculosis

There are five individuals in the Christian burial sample that exhibit indications of tuberculosis affecting either the vertebrae or ribs. Both males and females, and adults from all age cohorts are included as individuals with probable tuberculosis (Tables 70 and 71). Four of these individuals are estimated to be females, one young adult, two middle adults, and one old adult. The fifth individual is estimated to be a young adult male. Although only two of these individuals have resulting vertebral collapse and kyphosis the remainder have very strong indications for possible tuberculosis and as such, have been included in the sample. A detailed

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description of the bony changes in each infected individual is described in more detail below.

See Appendix B for photographic documentation of the lesions.

Table 70: Frequency of Probable Tuberculosis in Males and Females: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Male 1 50 111 51 4.5 2.0 45.0 19.6 Female 4 56 60 6.7 66.7

Table 71: Frequency of Probable Tuberculosis in Adults: 3-J-11 Christian Burials. Present Absent Number (n) % Prevalence/1000 Adult Young 1 32 113 33 4.4 3.0 44.2 30.3 Middle 3 49 52 5.8 57.6 Old 1 27 28 3.6 35.7

Skeleton 1131 is estimated as a young adult female, most likely between twenty and twenty-five years old. The skeletal remains for this individual are extremely well preserved and the skeleton is almost entirely complete, but missing a few small bony elements. Evidence for tuberculosis in this individual includes large lytic lesions cavitating into the right and left aspects of the vertebral centra of T6-T8 and L1. The body of T10 has been essentially destroyed by a pathological process, with just the neural arch remaining, the bodies of T11 and T12 have collapsed to such a degree that only half of the original body height remains. The result is vertebral collapse and acute kyphosis of vertebrae T9 through T11, with fusion and remodeling of the bodies and zygapophyseal joints. In addition, the right and left lower ribs (#‟s 10-12) have similar large lytic lesions on the superior surface of the rib heads, surrounded by small areas of woven bone deposition. It is likely this individual lived with the infection for a long period of time, as the degree of vertebral collapse, fusion, and remodeling of the bodies is extensive.

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Skeleton 1074 is estimated as a middle adult female, most likely between the age of forty and fifty years. The skeletal inventory for this individual is relatively complete and represented by the cranium, all of the vertebrae, the sacrum and os coxae, all 24 ribs, and the long bones.

Indications of tuberculosis include focal lytic lesions concentrated on the first and second lumbar vertebrae, with subsequent destruction of the vertebral bodies. The lytic destruction of L1 is focalized on the right anterior lateral surface, with destruction of the inferior body. This lytic lesion on L1 directly communicates with a similar circular lesion located on the superior body of

L2. A large bony formation between the inferior body of L1 and the superior body of L2 has effectively fused the two vertebrae, while still maintaining the vertebral disc space. There is no subsequent vertebral collapse or associated kyphosis. In addition, the anterior and lateral bodies of T11, T12, and L3 have minor active proliferative bony buildup. There is also involvement of the right and left lower ribs, specifically numbers 10-12. On the visceral surface there is some minor periosteal bone deposition running along the entire body of the rib. The ventral surfaces of all of the ribs, but especially the right twelfth rib, have thick lamellar bone apposition, with associated bony spicules, running along the entire body of the ribs but most concentrate near the rib heads.

Skeleton 1077 is estimated as a middle adult male between thirty-five and fifty years old.

The skeletal inventory for this individual is nearly complete and represented by the cranium, all of the vertebrae, the sacrum and os coxae, all 24 ribs, and portions of the long bones. Evidence for possible tuberculosis is exhibited on the anterior aspect of the vertebral bodies of T9 through

L4. There are large focalized lytic lesions cavitating into the anterior bodies. The walls and floor of the lytic lesions are poorly defined and spiculed with reactive bone, creating a roughened appearance. There is no subsequent vertebral collapse or kyphosis. Along the lateral bodies and

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neural arches of L1 and L2 there is ligamentous ossification, causing substantial fusion of the bodies. There is additional ossification of the lateral ligaments of T11 through L1, all of which maintain the intervertebral spaces. It is unclear if this is the result of the tubercular infection, or a separate and unrelated disorder. In addition, the right and left lower ribs (#‟s 7-12) exhibit mild periostitis along the visceral surfaces, which is most visible near the rib heads. The right twelfth rib also exhibits a large circular area of lytic destruction on the superior surface of the rib head.

Skeleton 1288 is estimated as an old adult female, most likely over the age of fifty years old. The skeletal remains of this individual are also nearly complete, represented by an intact cranium, all of the vertebrae, portions of the sacrum and os coxae, 23 ribs, and portions of the limb bones. The evidence for tuberculosis in this individual is extensive. There is advanced lytic destruction of the anterior bodies of T12 through L5, with nearly complete destruction of many of the bodies. Only fragments of the bodies and neural arches for these vertebrae remain. Two unidentified lumbar vertebrae have large circular mutifocal lesions tunneling into the anterior and posterior aspects of the bodies. The edges of the larger lesions appear smooth and somewhat remodeled, while the smaller lesions have more sharp exterior borders. Although most of the bodies are destroyed and the vertebral column cannot be reconstructed it is clear that there would have been vertebral collapse and resulting kyphosis in this individual. The right and left ribs are also affected. Right rib number twelve has a large destructive lesion on the superior aspect of the rib head, with woven bone periostitis present just lateral. Left ribs 9 through 12 have small areas of active periostitis on the visceral aspects of the rib heads.

Skeleton 1466 is estimated as a middle adult female, most likely between thirty and forty years of age. The skeletal remains for this individual are extremely well preserved and most of the bony elements are complete and intact. Skeleton 1466 exhibits a probable case of pulmonary

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tuberculosis, concentrated on the right side. Right ribs 1-11 have thick deposits of woven bone periostitis along the entire length of the ribs, from the head to the sternal ends. A cross sectional view demonstrates that the bony deposits are quite extensive and can measure up to 3.52 millimeters from the original cortical surface on many of the ribs. In addition, on the visceral surfaces of some of the ribs, there are large, focalized lytic lesions cavitating into the surface of the thickened areas of periostitis. Despite the extensive bony proliferation and simultaneous focalized destruction on the right side, the left ribs and the vertebrae are entirely unaffected.

Infectious Disease: Leprosy

There is a possible case of leprosy within the sample of non-early burials at cemetery 3-J-

11. Skeleton 3265 is estimated as an adult male, and the skeletal inventory indicates that the remains from this individual are extremely well preserved with over 95% of the total bony elements present and intact. Indications of possible leprosy include destructive infectious changes to the distal pedal and hand phalanges. There is extensive resorption of the metacarpals of the hand, as well as the metatarsals and phalanges of the feet, and new woven bone formation along the lower limb bones. Unfortunately, the poor preservation and fragility of the skeletal remains of this individual precluded shipment to Michigan State University. Therefore, the present author was unable to collect further data on this individual and any information regarding the bony changes in this individual are reliant upon the inventory work of Dr. Rebecca Redfern at the British Museum. As such, it is unclear what other bony changes might be present in this individual, however, according to the skeletal inventory provided by the British Museum, the visible changes were enough to make a differential diagnosis of possible leprosy. Appendix B provides photographic documentation of the bony changes in this individual.

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A Comparison of Transitional and Non-Transitional Christian Burials at Cemetery 3-J-11

To better understand the health of adults within cemetery 3-J-11 this section aims to determine whether there are any differences in skeletal indicators of stress between the identified transitional and fully Christianized burials. Although it is unclear what the diachronic distinctions are at cemetery 3-J-11, a direct comparison of skeletal indicators of stress can help determine whether the two burial samples can be grouped for the purpose of comparison with other contemporaneous sites in the region. Since the sample sizes for the early burial group are so small and there are no statistically significant differences between adult age or sex in either burial group, males and females of all adult age cohorts will be combined for comparison.

Skeletal Indicators of Stress and Disease

A comparison of the frequency and prevalence rates of skeletal indicators of stress at cemetery 3-J-11 demonstrates that there are no real statistical differences between the two samples. A chi-square test of each of the skeletal indicators demonstrates that only the presence of linear enamel hypoplasias on the maxillary canines is statistically significant at p <0.05 level

2 (x = 4.454, df=1, p= .035, Phi= -.250). However, Tables 74 and 75 demonstrates that the total sample of observable teeth in the „transitional‟ burial group is made up of only nine individuals, which calls the statistical significance into question. In addition, there is not a statistically significant difference between the frequency of linear enamel hypoplasias on the mandibular

2 canines (x = .406, df=1, p= .522), and it is difficult to determine why the prevalence of LEH on canines within the same sample would be so considerably different. Only the linear enamel hypoplasia prevalence rates for the maxillary and mandibular canines are directly compared, as they were the most frequently affected in all burial samples. Furthermore, a chi-square test of the

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remaining indicators of stress demonstrates that there are no other statistically significant

2 differences between the two samples: cribra orbitalia (x = .011, df=1, p= .916); porotic

2 2 hyperostosis (x = .018, df=1, p= .893); maxillary sinusitis (x = .004, df=1, p= .949); and

2 tuberculosis (x = .768, df=1, p= .381). Tables 73, 74, 75, 76, 77 and 78, and Figure 43 summarize the frequency and prevalence rates in health indicators at cemetery 3-J-11.

Table 72: Frequency of Cribra Orbitalia at Cemetery 3-J-11. Present Absent Number (n) % Prevalence/1000 Transitional 6 7 13 46.2 461.5 Christian 52 57 109 47.7 477.0

Table 73: Frequency of Porotic Hyperostosis at Cemetery 3-J-11. Present Absent Number (n) % Prevalence/1000 Transitional 61 51 112 54.5 544.6 Christian 9 7 16 56.3 562.5

Table 74: Frequency of LEH on Maxillary Canines at Cemetery 3-J-11. Present Absent Number (n) % Prevalence/1000 Transitional 2 7 9 22.2 222.2 Christian 37 25 62 59.7 596.7

Table 75: Frequency of LEH on Mandibular Canines at Cemetery 3-J-11. Present Absent Number (n) % Prevalence/1000 Transitional 7 2 9 77.8 777.7 Christian 43 21 64 67.2 671.8

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Table 76: Frequency of Periostitis at Cemetery 3-J-11. Present Absent Number (n) % Prevalence/1000 Transitional 5 9 14 35.7 357.1 Christian 59 47 106 55.7 528.3

Table 77: Frequency of Maxillary Sinusitis at Cemetery 3-J-11. Present Absent Number (n) % Prevalence/1000 Transitional 3 6 9 33.3 333.3 Christian 10 19 29 34.5 344.8

Table 78: Frequency of Probable Tuberculosis at Cemetery 3-J-11. Present Absent Number (n) % Prevalence/1000 Transitional 0 17 17 0.0 000.0 Christian 5 110 115 4.3 43.4

Figure 43: Frequency of Health Indicators1 at Cemetery 3-J-11.

100 CO 80 PH 60 LEH Max 40 LEH Man Peri 20 Max Sin 0 TB Early Non-Early

Cribra orbitalia (CO), Porotic hyperostosis (PH), Linear enamel hypoplasias of maxillary canines (LEH Max), Linear enamel hypoplasias of mandibular canines (LEH Man), Periostitis (Peri), Maxillary sinusitis (Max Sin), and Tuberculosis (TB)

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A Comparison of Burial Clusters at Cemetery 3-J-11

The final examination of cemetery 3-J-11 focuses on the differences in skeletal indicators of stress between the burial clusters as outlined in Chapter Six: Mortuary Results. Tables 79 and

80 are a review of the demographic profiles of the burial clusters by age and sex cohort. As the tables demonstrate, a subdivision of adults into age and sex cohorts within each burial cluster creates excessively small sample sizes, making accurate statistical analyses untenable. Therefore, all of the adults in each burial cluster will be grouped into a single comparative sample.

Furthermore, the previous sections of this chapter have demonstrated that there are no overwhelming differences between males and females or age categories in any of the burial groups, and therefore, there should be no detriment to grouping all adults into a single comparative sample.

Table 81 summarizes the number and frequency of the skeletal indicators of stress in each of the burial clusters. Even when all adults are grouped, the sample sizes in many of the burial clusters are still relatively small, and thus the statistical results for this analysis can only offer tentative suggestions as to the true relationships between burial clusters. A chi-square test at the p <0.05 level with a proportion of error test was conducted to determine the statistical relationships between each skeletal indicator and membership within a burial cluster. The results indicate that there are no statistically significant differences between the eight clusters and the prevalence of any of the indicators of stress. The following chi-square statistics were obtained:

2 2 cribra orbitalia (x = 9.644, df=7, p= .210); porotic hyperostosis (x = 4.742, df=7, p= .691); LEH

2 2 maxillary canines (x = 4.835, df=7, p= .680); LEH mandibular canines (x = 6.938, df=7, p=

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2 2 .435); periostitis (x = 6.017, df=7, p= .538); maxillary sinusitis (x = 7.494, df= 6, p= .278); and

2 tuberculosis (x = 3.265, df= 7, p= .859).

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Table 79: Demographic Profiles of Cemetery 3-J-11 Burial Clusters. Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 6 Cluster 7 Cluster 8 (n) % (n) % (n) % (n) % (n) % (n) % (n) % (n) % Subadult 16 69.6 16 72.8 4 40.0 9 29.0 21 35.0 39 47.6 23 59.0 9 81.8 Young Adult 5 21.7 2 9.1 3 30.0 6 19.4 10 16.7 9 10.9 2 5.1 0 0.0

Middle Adult 0 0.0 1 4.5 2 20.0 9 29.0 16 26.7 23 28.0 8 20.5 1 9.1

Old Adult 2 8.7 3 13.6 0 0.0 7 22.6 6 10.0 8 9.8 5 12.8 1 9.1 Adult >20 0 0.0 0 0.0 1 10.0 0 0.0 7 11.6 3 3.7 1 2.6 0 0.0

Total 23 100.0 22 100.0 10 100.0 31 100.0 60 100.0 82 100.0 39 100.0 11 100.0

Table 80: Demographic Profiles of Cemetery 3-J-11 Burial Clusters. Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 6 Cluster 7 Cluster 8 (n) % (n) % (n) % (n) % (n) % (n) % (n) % (n) % Male 3 37.5 2 33.3 2 33.3 12 54.5 16 40.0 17 39.5 9 56.3 1 50.0 Female 4 50.0 3 50.0 2 33.3 10 45.5 16 40.0 25 58.1 6 37.5 1 50.0 Undetermined 1 12.5 1 16.7 2 33.3 0 0.0 8 20.0 1 2.3 1 6.2 0 0.0 Total 8 100.0 6 100.0 6 100.0 22 100.0 40 100.0 43 100.0 16 100.0 2 100.0

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Table 81: Skeletal Indicators of Stress in Cemetery 3-J-11 Burial Clusters. Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 6 Cluster 7 Cluster 8 (n) % (n) % (n) % (n) % (n) % (n) % (n) % (n) % Cribra Orbitalia 7 57.1 6 83.3 5 60.0 21 42.9 27 51.9 36 44.4 16 25.0 2 100

Porotic 7 85.7 6 50.0 5 40.0 22 59.1 29 58.6 39 46.2 16 56.3 2 50.0 Hyperostosis

222 LEH Max 7 71.4 3 66.7 4 50.0 9 77.8 16 43.8 22 45.5 6 66.7 2 50.0 Canine LEH Mand 6 50.0 4 75.0 3 66.7 11 72.7 18 55.6 20 80.0 6 100 2 50.0 Canine Periostitis 7 71.4 5 80.0 5 20.0 22 45.5 23 47.8 38 55.3 16 62.5 2 100

Maxillary 2 50.0 1 100 2 50.0 7 57.1 7 42.9 16 18.8 3 0.0 0 0.0 Sinusitis Tuberculosis 7 0.0 6 0.0 5 0.0 22 9.1 32 3.1 40 5.0 16 0.0 2 0.0

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A COMPARISON OF CEMETERIES 3-J-10 AND 3-J-11

The following section is a direct comparison of the paleopathological results between cemeteries 3-J-10 and 3-J-11, both located at Mis Island. For the purposes of a direct comparison and to account for differences between burial samples based on relative time period, only the non-early Christian adults from cemetery 3-J-11 are included in the comparison with cemetery 3-

J-10. Skeletal indicators of stress from the previous sections, such as cribra orbitalia, porotic hyperostosis, linear enamel hypoplasias, periostitis, maxillary sinusitis, and tuberculosis are evaluated. Osteomyelitis is not included, as only one individual from each site was affected and a direct comparison is untenable for such a small sample. In addition, only the linear enamel hypoplasia prevalence rates for the maxillary and mandibular canines are directly compared, as these teeth were the most frequently affected at both sites. Pearson‟s chi-square and

Fisher‟s exact statistics were used to test for significance at the p <0.05 levels.

Demography

A comparison of age and sex distributions demonstrates that there are only slight demographic differences between cemeteries 3-J-10 and 3-J-11. The biggest difference is in the ratio of subadults to adults. Cemetery 3-J-10 has a much smaller subadult group accounting for only 39.7% of the total sample, while subadults at cemetery 3-J-11 account for just over half

2 (51%) of the total sample. This difference is statistically significant at the p <0.05 level (x =

.739, df=1, p= .390). Aside from this disparity though, there do not appear to be any considerable

2 2 differences in the distribution of adult age (x = 2.019, df=2, p= .364) or sex cohorts (x = .739, df=1, p= .390). The distribution of males and females is fairly constant, with a nearly equal divide between the sex cohorts at both cemeteries 3-J-10 and 3-J-11. In addition, the dispersal of

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young, middle, and old adults are roughly equal between the sites, and at both, middle adults represent the largest adult cohort, with 57.4% and 46.5% of adults at cemeteries 3-J-10 and 3-J-

11, respectively. Young and old adults each characterize a smaller portion of the sample, accounting for 20-25% of the adults at each site.

Table 82: A Comparison of Age and Sex Cohorts at Mis Island. 3-J-10 % 3-J-11 % Subadults 50 39.7 127 51.0 Young Males 12 9.5 12 4.8 Middle Males 23 18.3 26 10.4 38 30.2 52 20.8 Old Males 2 1.6 12 4.8 Unknown Males 1 .8 2 .8 Young Females 4 3.2 18 7.2 Middle Females 15 11.9 26 10.4 35 27.7 62 24.8 Old Females 11 8.7 16 6.4 Unknown Females 5 3.9 2 .8 Young Unknown 0 0.0 3 1.2 Middle Unknown 1 .8 1 .4 1 .8 4 1.6 Old Unknown 0 0.0 0 0.0 Unknown Adult 2 1.6 4 1.6 Total 126 100.0 249 100.0

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Figure 44: A Comparison of Demographic Profiles at Mis Island.

100

60 Males Females 40 Subadults 20

0 3-J-10 3-J-11

Table 82 and Figure 44 demonstrate a side-by-side comparison of the demographic profiles at cemeteries 3-J-10 and 3-J-11 at Mis Island. The relatively equally distributed subadult and adult age and sex cohorts indicate that both cemeteries 3-J-10 and 3-J-11 are likely mixed use burial grounds utilized for the internment of individuals of every demographic group.

Furthermore, since the adult age and sex cohorts are not significantly different between the two sites at Mis Island, it is possible to make a direct comparison of skeletal indicators of health using Pearson‟s chi-square and Fisher exact tests for smaller samples.

Skeletal Indicators of Stress and Disease

A comparison of the skeletal indicators of stress and disease among all adults at cemeteries 3-J-10 and 3-J-11 demonstrates that there are slightly higher prevalence rates for most indicators at cemetery 3-J-10. Table 83 and Figure 45 summarize the overall frequency and prevalence rates for all adults at Mis Island. There is a slightly higher frequency for porotic

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hyperostosis, periostitis, maxillary sinusitis, and tuberculosis at cemetery 3-J-10. On the other hand, cribra orbitalia and linear enamel hypoplasias on both the maxillary and mandibular canines have slightly higher prevalence rates among adults at cemetery 3-J-11. Pearson‟s chi- square tests were performed to determine whether any of these differences were significant at the

2 p <0.05 level. The following chi-square tests were established: cribra orbitalia (x = .126, df=1,

2 p= .723); porotic hyperostosis (x = 3.367, df=1, p= .067); LEH maxillary canine (x2= .307, df=1,

2 2 p= .580); LEH mandibular canine (x = .189, df=1, p= .664); periostitis (x = 3.656, df=1, p=

2 2 .056); maxillary sinusitis (x = .467, df=1, p= .494); and tuberculosis (x = .009, df=1, p= .924).

These chi-square tests demonstrate that although there might be some trends in the prevalence rates of specific indicators, none of the disparities are statistically significant and indicate that any differences between the two groups are more likely due to chance.

Table 83: Frequency and Prevalence Rates at Mis Island. 3-J-10 3-J-11 (n) % Prevalence/ (n) % Prevalence/ 1000 1000 Cribra Orbitalia 58 44.8 448.2 109 47.7 477.0 Porotic Hyperostosis 72 68.1 680.5 112 54.5 544.6 LEH Maxillary Canine 46 54.3 543.4 62 59.7 596.7 LEH Mandibular Canine 49 63.3 632.6 64 67.2 671.8 Periostitis 70 70.0 700.0 106 55.7 556.6 Maxillary Sinusitis 35 42.9 428.5 29 34.5 344.8 Tuberculosis 74 4.1 45.4 115 4.3 43.4

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Figure 45: Frequency of Each Indicator of Health1 in Adults at Mis Island.

100 CO 80 PH 60 LEH Max LEH Man 40 Peri 20 Max Sin TB 0 3-J-10 3-J-11

To further test the differences in frequency and prevalence of skeletal indicators of health at Mis Island, the adult samples were also divided into male and female cohorts and specific age groups for additional comparisons. The first comparison was between sex cohorts at both sites.

Table 84 and Figure 46 summarize the frequency of skeletal indicators of health among males at cemeteries 3-J-10 and 3-J-11. Once again there appears to be a higher frequency for most indicators of stress at cemetery 3-J-10, with higher prevalence rates of cribra orbitalia, porotic hyperostosis, periostitis, hypoplasias on the mandibular canines, maxillary sinusitis, and the presence of tuberculosis. Chi-square tests reveal that some of these differences are in fact

2 statistically significant, particularly for the presence of porotic hyperostosis (x = 6.774, df=1, p=

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2 .009, Phi= -.279) and periostitis (x = 4.673, df=1, p= .031, Phi= - .234). Tests for the significance of the remaining indicators of stress reveal that there are no further statistically

2 significant differences, and are as follows: cribra orbitalia (x = .377, df= 1, p= .539); LEH

2 2 maxillary canines (x = .027, df= 1, p= .869); LEH mandibular canines (x = .531, df=1, p= .466);

2 2 maxillary sinusitis (x = .121, df= 1, p= .728); and tuberculosis (x = .786, df=1, p= .181).

Therefore, it appears that while males at cemetery 3-J-10 are more likely to exhibit porotic hyperostosis and periostitis, they are not any more affected by the remaining indicators of stress than males at cemetery 3-J-11.

Table 84: Frequency and Prevalence Rates for Males at Mis Island. 3-J-10 3-J-11 (n) % Prevalence/ (n) % Prevalence/ 1000 1000 Cribra Orbitalia 32 46.8 468.7 50 40.0 400.0 Porotic Hyperostosis 37 75.7 756.7 50 48.0 480.0 Periostitis 36 77.8 777.7 49 55.1 551.0 LEH Maxillary Canine 27 63.0 629.6 23 65.2 652.1 LEH Mandibular Canine 28 71.4 714.2 18 61.1 611.1 Maxillary Sinusitis 19 36.8 368.4 16 31.1 312.5 Tuberculosis 38 7.9 78.9 51 2.0 19.6

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Figure 46: Frequency of Each Indicator of Health1 in Males at Mis Island. Cribra orbitalia (CO), Porotic hyperostosis (PH), Linear enamel hypoplasias of maxillary canines

100 CO 80 PH 60 LEH Max LEH Man 40 Peri 20 Max Sin TB 0 3-J-10 3-J-11

(LEH Max), Linear enamel hypoplasias of mandibular canines (LEH Man), Periostitis (Peri), Maxillary sinusitis (Max Sin), and Tuberculosis (TB)

A comparison of indicators of stress among females demonstrates that there is a relatively equal division between which site exhibits the highest frequency of each indicator. For example, females at cemetery 3-J-10 exhibit slightly higher prevalence rates for the presence of porotic hyperostosis, periostitis, and maxillary sinusitis, while females at cemetery 3-J-11 exhibit higher prevalence rates for the remainder of skeletal indicators, including cribra orbitalia, hypoplasias on both the maxillary and mandibular canines, as well as the incidence of tuberculosis (Table

85). A review of Figure 47 demonstrates that despite these small differences in prevalence rates, the actual frequency of skeletal indicators between the two sites appears rather equal, and most frequencies average about or just below 60%, with the exception of hypoplasias on the mandibular canines at cemetery 3-J-11. Chi-square tests confirm that none of the minor differences in female prevalence rates between the cemeteries are statistically significant. The

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2 2 results are as follows: cribra orbitalia (x = .523, df=1, p= .469); porotic hyperostosis (x = .018,

2 2 df= 1, p= .893); LEH maxillary canines (x = .736, df=1, p= .391): LEH mandibular canines (x =

2 2 2.628, df=1, p= .105); periostitis (x = .050, df=1, p= .823); maxillary sinusitis (x = .778, df=1,

2 p= .378); and tuberculosis (x = 2.436, df=1, p= .119). Therefore, although there appear to be minor differences in the frequency of specific skeletal indicators, there are no real distinctions in the health of females at Mis Island.

Table 85: Frequency and Prevalence Rates for Females at Mis Island. 3-J-10 3-J-11 (n) % Prevalence/ (n) % Prevalence/ 1000 1000 Cribra Orbitalia 26 42.3 423.0 55 50.9 509.0 Porotic Hyperostosis 34 61.8 617.6 60 60.0 600.0 . LEH Maxillary Canine 18 44.4 444.4 37 56.8 567.5 LEH Mandibular Canine 21 52.4 523.8 44 72.7 727.2 Periostitis 33 60.6 606.0 55 58.2 581.8 Maxillary Sinusitis 16 50.0 500.0 12 33.3 333.3 Tuberculosis 35 0.0 000.0 60 6.7 666.6

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Figure 47: Frequency of Each Indicator of Health1 in Females at Mis Island.

100 CO 80 PH

60 LEH Max LEH Man 40 Peri 20 Max Sin TB 0 3-J-10 3-J-11

The next focus of analysis at Mis Island was an evaluation of the differences between prevalence rates in the young, middle, and old adult age cohorts. As demonstrated with the males and females there is very little difference between the frequencies of most indicators of stress in all of the adult age cohorts. Table 86 and Figure 48 summarize the frequency and prevalence rates of young adults at cemeteries 3-J-10 and 3-J-11. The prevalence rates for porotic hyperostosis and periostitis are much higher in the young adults at cemetery 3-J-10, with more than 70% of individuals exhibiting both, while only a little more than 50% of individuals exhibit these indicators at cemetery 3-J-11. Despite these seemingly large distinctions, chi-square tests

2 for both indicators reveal that neither are statistically significant (porotic hyperostosis x = 1.899,

2 df=1, p= .168; periostitis x = .925, df=1, p= .336). In addition, none of the remaining indicators

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of stress are significantly different between the two samples, and are reported as follows: cribra

2 2 orbitalia (x = 1.071, df=1, p= .301); LEH maxillary canine (x = .223, df= 1, p= .637); LEH

2 2 mandibular canine (x = .467, df=1, p= .495); maxillary sinusitis (x = .024, df=1, p= .876); and

2 tuberculosis (x = .285, df=1, p= .593). As such, skeletal indicators of stress appear relatively constant and indicate that young adults at both cemeteries were likely exposed to the same levels of stressors and infectious disease at Mis Island.

Table 86: Frequency and Prevalence Rates for Young Adults at Mis Island. 3-J-10 3-J-11 (n) % Prevalence/ (n) % Prevalence/ 1000 1000 Cribra Orbitalia 14 42.8 428.5 32 59.4 593.7 Porotic Hyperostosis 16 75.0 750.0 33 54.5 545.5 LEH Maxillary Canine 13 69.2 692.3 26 61.5 615.2 LEH Mandibular Canine 16 56.3 562.5 27 66.7 666.6 Periostitis 15 73.3 733.3 29 58.6 586.2 Maxillary Sinusitis 8 25.0 250.0 7 28.6 285.7 Tuberculosis 16 6.3 62.5 33 3.0 30.3

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Figure 48: Frequency of Each Indicator of Health1 in Young Adults at Mis Island.

100 CO 80 PH 60 LEH Max LEH Man 40 Peri 20 Max Sin TB 0 3-J-10 3-J-11

An analysis of skeletal indicators of stress among the middle adults at Mis Island conveys the same results. Once again there are some slight differences in the frequencies of specific skeletal indicators between the two cemeteries, but for the most part, the prevalence rates for the most part, are not significantly different. Chi-square tests demonstrate that the middle adults are

2 comparable in the frequency of cribra orbitalia (x = .048, df=1, p= .826), porotic hyperostosis

2 2 (x = 3.310, df=1, p= .069), linear enamel hypoplasias on the maxillary (x = .016, df=1, p= .898)

2 2 and mandibular canines (x = 1.836, df=1, p= .175), maxillary sinusitis (x = .312, df=1, p= .576),

2 and tuberculosis (x = .018, df=1, p= .894). The frequency of periostitis is the only statistically significant difference in the middle adult cohort, with a much larger percentage of individuals at

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2 3-J-10 exhibiting periostitis of the lower limb bones (x = 6.731, df=1, p= .009). However, the statistical association is rather low (Phi= - .283). Table 87 and Figure 49 illustrate a side-by-side comparison of the frequency and prevalence rates of middle adults at cemeteries 3-J-10 and 3-J-

11.

Table 87: Frequency and Prevalence Rates for Middle Adults at Mis Island. 3-J-10 3-J-11 (n) % Prevalence/ (n) % Prevalence/ 1000 1000 Cribra Orbitalia 30 43.3 433.3 49 40.8 408.1 Porotic Hyperostosis 37 67.6 675.6 50 48.9 480.0 LEH Maxillary Canine 26 50.0 500.0 29 51.7 517.2 0 LEH Mandibular Canine 25 80.0 800.0 27 63.0 629.6 Periostitis 36 77.8 777.7 48 50.0 500.0 Maxillary Sinusitis 17 47.1 470.5 11 36.4 363.6 Tuberculosis 39 5.1 51.2 3 5.8 57.6

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Figure 49: Frequency of Each Indicator of Health1 in Middle Adults at Mis Island.

100 CO 80 PH 60 LEH Max LEH Man 40 Peri 20 Max Sin TB 0 3-J-10 3-J-11

A comparison of the old adult cohort at Mis Island demonstrates the same pattern as with the young and middle adults. Once again the skeletal indicators of stress for both samples are very similar and most of the prevalence rates are closely matched. There appear to be a couple skeletal indicators, such as linear enamel hypoplasias and tuberculosis, that are considerably different between the samples, but the old adult sample sizes are relatively small, so minor differences in frequency appear much larger than they actually are. In fact, there is only one skeletal indicator, linear enamel hypoplasias of the mandibular canine, which reveals a

2 statistically significant difference between the two samples (x = 5.000, df=1, p= .025, Phi=

.577). Chi-square tests reveal that there are no other statistically significant disparities among the

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2 remaining skeletal indicators. The results are as follows: cribra orbitalia (x = .064, df=1, p=

2 2 .800); porotic hyperostosis (x = .950, df=1, p= .330); LEH maxillary canine (x = 3.745, df=1, p=

2 2 .053); periostitis (x = .407, df=1, p= .524); maxillary sinusitis (x = .004, df=1, p= .949);

2 tuberculosis (x = .476, df=1, p= .490). Table 88 and Figure 50 summarize the frequency and prevalence rates for old adults at Mis Island.

Table 88: Frequency and Prevalence Rates for Old Adults at Mis Island. 3-J-10 3-J-11 (n) % Prevalence/ (n) % Prevalence/ 1000 1000 Cribra Orbitalia 11 45.4 454.4 26 50.0 500.0 Porotic Hyperostosis 13 84.6 846.2 27 70.4 703.7 LEH Maxillary Canine 6 33.3 333.3 7 85.7 857.1 LEH Mandibular Canine 5 20.0 200.0 10 80.0 800.0 Periostitis 13 53.3 538.4 28 64.3 642.8 Maxillary Sinusitis 7 42.9 428.5 9 44.4 444.4 Tuberculosis 13 0.0 000.0 28 3.6 35.7

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Figure 50: Frequency of Each Indicator of Health1 in Old Adults at Mis Island.

100 CO 80 PH 60 LEH Max LEH Man 40 Peri 20 Max Sin TB 0 3-J-10 3-J-11

PLACING MIS ISLAND WITHIN A REGIONAL CONTEXT:

A COMPARISON TO KULUBNARTI

As discussed in Chapter Four, one of the goals of this dissertation was to conduct a regional analysis and compare the paleopathological results from Mis Island with the extensively researched site of Kulubnarti. Unfortunately, the raw osteological data from Kulubnarti are not available for a comparative analysis and as such, all comparisons in this study were made using published site reports and research articles. The use of published data limits the scope of a comparison, as the frequency of only a few skeletal indicators of stress in adults have been sufficiently reported in the literature. As a result, a direct comparison between Mis Island and

Kulubnarti could only be conducted on three health indicators: cribra orbitalia, linear enamel

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hypoplasias, and maxillary sinusitis. Since the results presented in this chapter indicate that there is not a substantially significant difference between the early and non-early burials, nor between cemeteries 3-J-10 and 3-J-11, all the burials at Mis Island will be grouped together for further regional comparison. Tables 89 and 90 summarize the samples of adults at Mis Island and

Kulubnarti used in the current comparison.

Table 89: Number and Frequency of Individuals in Adult Sex Cohorts. Mis Island Kulubnarti 21-S-46 21-R-2 (n) % (n) % (n) % Male 100 45.7 17 31.5 41 45.1 Female 104 47.5 25 46.3 49 53.8 Undetermined 15 6.8 12 22.2 1 1.1 Total Adults 219 100.0 54 100.0 91 100.0

Table 90: Number and Frequency of Individuals in Adult Age Cohorts. Mis Island Kulubnarti 21-S-46 21-R-2 (n) % (n) % (n) % 20-30 46 21.0 9 16.7 19 20.9 31-40 60 27.4 15 27.7 36 39.6 41-50 47 21.5 21 38.9 28 30.7 50+ 46 21.0 9 16.7 8 8.8 Adult (>20) 20 9.1 Total Adults 219 100.0 54 100.0 91 100.0

Cribra Orbitalia

At Kulubnarti located just south of Wadi Halfa in the Second Cataract of the Nile, the combined frequency for adults with cribra orbitalia is roughly 30% (Mittler and van Gerven

1994; Adams et al. 1999). When the adult groups are broken down into age cohorts and

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according to cemetery, the prevalence rates range from 20-40%, but never quite reach the elevated levels present in the combined adult sample at Mis Island (Table 91 and Figure 46).

When a chi-square test is conducted on each age cohort between Mis Island and cemeteries 21-S-

46 and 21-R-2, there are very few statistically significant differences among age categories at the p <0.05 level (highlighted in gray in Table 92). On the other hand, when the age groups are combined into a complete adult sample at each site there is a statistically significant difference between Mis Island and both cemeteries at Kulubnarti (highlighted in gray in Table 92). The chi- square tests demonstrate that the statistical difference between the two sites is much larger for

2 2 cemetery 21-R-2 (x = 8.838, df=1, p= .003) than for cemetery 21-S-46 (x = 3.930, df=1, p=

.047). Common odds ratios were also computed for a comparison between the two sites and demonstrate that it is more likely for adults at Mis Island to exhibit healed cribra orbitalia than at either cemetery 21-S-46 (.500; CI: .250-1.000) or cemetery 21-R-2 (.431; CI: .246-.756) at

Kulubnarti. Once again the divergence between Mis Island and 21-R-2 is slightly smaller than for cemetery 21-S-46. This is not surprising, as multiple publications have demonstrated that health for individuals at cemetery 21-S-46 was much worse than for those buried at cemetery 21-

R-2 (Hummert and van Gerven 1980; Moore et al. 1986; van Gerven et al. 1990; Mittler and van

Gerven 1994; van Gerven et al. 1994; Adams et al. 1999; Sandberg 2006; DeLeon 2007). Thus, the prevalence of cribra orbitalia in adults at Mis Island is significantly higher than even the unhealthiest group of individuals at Kulubnarti.

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Table 91: Frequency of Cribra Orbitalia in Adults at Mis Island and Kulubnarti. Mis Island Kulubnarti 21-S-46 21-R-2 (n) % (n) % (n) % 20-30 42 57.1 8 37.5 17 23.5 30-40 49 38.8 13 38.5 33 36.4 40-50 41 41.5 16 25.0 26 23.1 50+ 42 50.0 9 22.2 8 12.5 Total 174 46.6 46 30.4 84 27.4

Figure 51: Frequency of Cribra Orbitalia in Adult Age Cohort.

100

80 20-30 60 30-40 40 40-50 50+ 20

0 Mis Island 21-S-46 21-R-2

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Table 92: Statistical Relationship for Prevalence Rates of Cribra Orbitalia at Mis Island and Kulubnarti.

21-S-46 21-R-2

2 2 Age x df p x df p Group 20-30 1.044 1 .307 5.483 1 .019

30-40 .000 1 .984 .049 1 .825

40-50 1.341 1 .247 2.386 1 .122

50+ 2.310 1 .129 3.835 1 .050

TOTAL 3.930 1 .047 8.838 1 .003

Linear Enamel Hypoplasias (LEH)

Interestingly, a comparison of the prevalence of linear enamel hypoplasias at Kulubnarti and Mis Island reveals a different pattern entirely. Van Gerven et al. (1990) analyzed the mandibular canines of a combined sample of 31 adults and subadults from cemetery 21-S-46, and a combined sample of 56 subadults and adults from cemetery 21-R-2. They found a 100% prevalence rate of LEH for individuals in both cemetery samples. In addition, at cemetery 21-S-

46 each individual had a mean frequency of 4.2 LEH per mandibular canine, while the mean frequency at cemetery 21-R-2 was 3.7 per mandibular canine. These mean frequencies and overall prevalence rates are in stark contrast to what is being reported in the current study. As discussed earlier, the overall frequency of LEH at Mis Island is 66.7% of the adult sample. The number of LEH per mandibular canine is also substantially lower at Mis Island, with 79%

(64/81) of individuals exhibiting only one LEH, 11% (9/81) exhibiting two, 8.6% (7/81) exhibiting three, and 1.2% (1/81) exhibiting four LEH. There are no individuals exhibiting more than four LEH on any of the observable teeth. Unfortunately, the exact sample of males, females,

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and subadults in each cemetery group were not clearly reported and a direct comparison according to sex or age groups is not possible in this comparison. Regardless, it is clear that the reported prevalence rates of LEH at Kulubnarti are significantly higher than at Mis Island.

Maxillary Sinusitis

An examination of maxillary sinusitis at the two sites reveals a rather elevated frequency at Mis Island in contrast to Kulubnarti. Table 93 is a comparison of prevalence rates in males and females from the combined cemetery samples at Kulubnarti and Mis Island. Roberts (2007) reports that only 21.8% of the 101 crania selected for analysis show any indication of maxillary sinusitis at Kulubnarti, which is considerably lower than the other rural agricultural populations in the study sample. In contrast, Mis Island demonstrates a much higher frequency with 38% of individuals exhibiting the maxillary sinus lesion, which is much closer to the average of 45% frequency reported for the other rural agricultural populations in Roberts‟ 2007 study. At both

Kulubnarti and Mis Island, females exhibit higher frequency and prevalence rates than males, however a statistical evaluation of the differences reveals that they are not in fact significant at either site. As such, it appears that males and females at both sites are experiencing approximately the same levels of maxillary sinusitis, however at a relatively higher overall prevalence rate at Mis Island.

Chi-square tests at the p <0.05 level demonstrate that a direct comparison between males

2 at Kulubnarti and at Mis Island is not statistically significant (x = 2.467, df=1, p= .116).

Likewise, a comparison between female cohorts at the two sites does not show statistical

2 significance (x = 3.716, df=1, p= .054). However, when males and females are combined and compared between the two sites, there is a significant difference between the prevalence of

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2 maxillary sinusitis at Mis Island and Kulubnarti (x = 5.684, df=1, p= .017), however with a low level of association (Phi= -.181). A common odds ratio was also conducted and confirms that there are slightly lower odds for the inhabitants on Kulubnarti to have maxillary sinusitis (.448;

CI: .230-.873).

Table 93: Frequency and Prevalence of Maxillary Sinusitis at Mis Island and Kulubnarti. Mis Island Kulubnarti (n) % Prevalence/ (n) % Prevalence/ 1000 1000 Male 40 32.5 325.0 45 17.7 177.7 Female 31 45.2 451.6 56 25.0 250.0 Total 71 38.0 380.2 101 21.8 217.8

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CHAPTER 8: DISCUSSION

The purpose of this study is to use an integrated approach that combines skeletal biology and mortuary archaeology, as well as a historical and regional context to understand the life experience of a medieval Nubian community living in the Fourth Cataract of the Nile River.

Given the fact that studies of medieval Nubia have traditionally focused on populations living in the northern Nile Cataracts, this study provides a unique opportunity to learn about a community living in a lesser known region of the river. Spatial and statistical results of the mortuary archaeology and skeletal analyses have been provided in Chapter Six and Chapter Seven. The goal of this chapter, therefore, is to integrate and discuss these results to provide an interpretation of life and death for the community at Mis Island during the medieval Christian period.

A DISCUSSION OF THE MORTUARY RESULTS

The mortuary results from cemeteries 3-J-10 and 3-J-11 indicate that there is an overarching structural system responsible for the organization of burials at Mis Island.

Nonetheless, although both sites tend to share many of the same mortuary practices, it is evident that there are significant differences in the spatial organization and distribution of burial treatment among the cemeteries. Briefly, the mortuary patterns at cemetery 3-J-10 appear to be community-based and there are not any detectable burial clusters or mortuary variables that would imply distinct burial groups within the site. Cemetery 3-J-11, on the other hand, does not have community-wide organization of graves and there appear to be smaller burial clusters, possibly related to corporate or family-based burial areas and varied access to exclusive space within the larger site. Despite the differences in mortuary patterns between cemeteries 3-J-10 and

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3-J-11, however, there are no community-specific differences in the prevalence of skeletal indicators of stress or disease among the two communities. Males and females of all age groups at each of the sites exhibit the same elevated levels of skeletal indicators of stress, regardless of their burial chronology, mortuary patterns, or burial location.

The Concept of Community Identity and Age at Cemetery 3-J-10

As demonstrated in Chapter Six, there is visible spatial order to the graves at cemetery 3-

J-10 that is rather consistent across the site. A majority of burials appear to conform to a community-specific mortuary pattern and most interments are fairly homogenous. Interestingly, the key influence for the placement of these burials and the mortuary treatment of individuals at cemetery 3-J-10 appears to be membership within a specific age cohort. There is an unmistakable distinction between subadults and adults, both in the location of the burial within the cemetery space and the type of mortuary custom associated with the individual. For example, subadults in cemetery 3-J-10 cluster within the eastern portion of the site or are scattered along the outer periphery of the cemetery borders. Furthermore, while infants and young children are included in the mortuary rites and burial within the cemetery, they are restricted to placement within the eastern portion of the cemetery. Conversely, the interior of the cemetery appears to remain almost exclusive to the interment of adults, with the exception of a small number of burials of adolescent individuals.

Ethnographic and archaeological literature indicates that the mortuary practice of burial differentiation between adults and children is a common phenomenon, and often reflects the local beliefs of social identity on age and childhood (Kamp 2001). At many sites, the integration of children within a cemetery has been used to interpret issues of identity and adulthood and the

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concept of attained membership within a community. For example, at Kellis II scholars have argued that the presence of fetal and infant burials within the main disposal area indicates that the emerging concept of the Christian soul and afterlife was being applied to all members of society regardless of age or identity (Tocheri et al. 2005). In contrast, many anthropologists have argued that the placement of fetal and infant burials outside of the general burial population might indicate a different social or symbolic status of children within the community (Scott

1991, 1993; Skeates 1991). Similarly, in Egypt and medieval Nubia burying an un-baptised fetus or infant in a pot burial under the floor of a home could also be interpreted as a symbolic indication of the non-identity of these newborns and infants within some Coptic communities

(Żurawski 1987).

Interestingly, there appears to be a combination of those two factors at work in cemetery

3-J-10. Although fetuses, neonates, infants, and children are included in the same general disposal area as adolescents and adults, the discrete spatial differentiation of these burials indicates a culturally symbolic distinction between the two age groups. Thus, while it appears that all individuals at cemetery 3-J-10 are afforded the same access to a Christian burial and the pursuit of an afterlife, differences in the placement and the way subadults and adults are buried indicates that there is a specific social identity associated with membership in each of the age groups.

In addition to this spatial distinction, there is further variation in the burial treatment of individuals within specific age groups. As such, all mortuary variables regarding grave superstructure and substructure, personal adornment, as well as body, head, and leg position tested as significantly different between the two age groups. For instance, adults are almost exclusively buried with FF03c grave monuments and head coverings, without items of personal

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adornment, and are most often positioned supine with legs extended and heads centered.

Subadults, on the other hand, are more typically buried with items of personal adornment, FF03a grave monuments, without head coverings, and in more variable body positions, such as either supine, on their sides, and with legs in a variety of positions and their heads facing multiple directions. Furthermore, a small number of subadults were buried with their heads to the west or in prone positions. As such, adults tend to have a more homogenous and standardized burial ritual, while subadults are much more variable in relation to the inclusion of personal adornment and the position of their bodies.

It has been argued that the differences with respect to grave superstructures in medieval

Nubia concern the fact that children are smaller and thus do not need as elaborate or large a grave monument as the adults (Adams 1998; Ginns 2010 a, b). However, when they are seen in combination with other differences in burial treatment, such as body position, head coverings and personal adornment, these superstructures take on a deeper social significance. In fact, similar examples of a distinction in grave monuments between adults and subadults have also been noted at other sites in medieval Nubia. At Meinarti, Adams (2001) notes that there is a significant difference in the use of grave monuments and that the majority of subadults and especially infants were not buried beneath a grave superstructure. Furthermore, the older the individuals the more likely they were to have a grave superstructure. Although these patterns are slightly different than at Mis Island, as children in the present sample are buried with grave monuments, it does indicate that inclusion in a subadult or adult age cohort was also an important distinguishing factor for burial at medieval Meinarti.

In addition, the presence of personal adornment almost exclusively within subadult burials indicates that there was an age-based social rule governing who received specific burial

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inclusions. At cemetery 3-J-10, 12 out of 15 individuals (80%) buried with an item of personal adornment were subadult. Furthermore, even with the small sample of adults buried with personal adornment (20%, 3/15), there was no overlap in the type of personal adornment associated with the juveniles and those associated with the adults. Juveniles were typically buried with disc, cylindrical and ostrich eggshell beads, while the three adults were only buried with faience beads, tubular bone beads, and spherical beads. As such, if grave inclusions were considered symbols of personal identity and juveniles and adults had different social identities, then one would expect these age groups to include diverse grave goods.

Items of personal adornment, such as shells, beads, and metal crosses were also found primarily with subadults at other medieval Nubian sites, such as Meinarti and Kulubnarti (Adams et al. 1999; Adams 2003). Adams et al. (1999) believes that they were likely everyday items of personal jewelry that were left on individuals when they were interred. However, if subadults were more likely to wear these items in life and by Adams‟ account more likely to be buried with them, this still stands as evidence of social distinction for these age groups through the mortuary ritual. Furthermore, the inclusion of these items more frequently in subadult burials and the lack thereof in almost all adult burials could indicate a more relaxed social rule governing the burial of children with personal adornment.

This differentiation between subadult and adult burials at medieval Mis Island signifies a clear social distinction between the two age groups, at least in relation to mortuary ritual. The differences in burial location and treatment, as well as the strict standardization of burial practice for the adults, and the lack thereof for subadults, demonstrates that there was an official mortuary program that was not yet available to the children. Although children were included in the community burial ground, their location within a tangential space indicates that they were not an

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official part of the Mis Island society. Furthermore, the flexibility of the mortuary program for children also demonstrates that the rules governing adult Christian burials was not as fixed for children. As such, a biological or social age threshold was likely directing mortuary ritual and perhaps even social treatment of individuals within the Late Medieval Christian Mis Island community.

The distinctive way children were portrayed in the mortuary ritual was likely tied to a number of things, including their membership or lack thereof within the local community. For example, in communities with high infant mortality rates, it is quite possible that young children were not yet considered full members of society due to their vulnerability. Full status may not have been given to children below a certain age because they were not entirely expected to survive, and, consequently, they would not get the complete treatment of personhood until their survival became imminent. In addition to this, caregivers might have focused more energy and resources towards older children that were more likely to survive, as opposed to wasting valuable resources on young infants that were not able to contribute to the subsistence of the family

(Scrimshaw 1978). At Mis Island, the high prevalence of childhood stress indicators in adults indicate that childhood was likely a difficult and dangerous period for the individual, and thus the survival of the younger age cohorts might not have been an expected phenomenon.

For those children that had reached the age of increased survival it is clear that they still were not considered to be of an appropriate age or developmental stage to be afforded an adult burial. The attainment of puberty and a specific biological age, or the integration of a young individual into household, farming, or specialized tasks might have been an important social factor governing the mortuary treatment of an individual as either a child or an adult. This clear division between adult and subadult mortuary treatment is confirmed when the burials of

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adolescents are taken into consideration. Although a thorough osteological analysis of individuals below the biological age of twenty was not conducted in the present study, scholars in the field identified a number of probable adolescents at the time of excavation (Ginns 2010 a, b). When the burial patterns of these adolescents are compared to the subadult and adult patterns, it becomes clear that adolescents were considered a part of the adult age group. To a large degree, adolescents at both cemeteries 3-J-10 and 3-J-11 were treated similarly to adults in the use of FF03c monument types, the presence of head coverings, the absence of personal adornment, and the positioning of the body and head. As such, it is clear that the biologically determined subadult group of adolescents had crossed the cultural threshold of adulthood in the

Mis Island community and its members were considered adults with respect to mortuary treatment.

Nevertheless, it is uncertain what age threshold or rite of passage was necessary to become an adult at medieval Mis Island. The attainment of adulthood is a socially constructed phenomenon determined through local cultural and religious belief systems and thus has no direct relationship to the scientifically constructed categories of subadult or adult in skeletal biology (Perry 2006). Each culture or population group has different initiation rites and/or age thresholds that must be surpassed in order to be considered an adult, and mortuary studies have identified the attainment of adulthood in a variety of subadult age groups. For example, in

Bronze Age Ireland adolescents were treated as adults after the age of fourteen years

(O‟Donnabhain and Brindley 1989), while in Early Anglo-Saxon England this coming of age occurred as early as ten years old (Stoodley 2000). In fact, transitions to adulthood are often marked by significant changes in social roles, such as marriage, full membership within a society, and economic autonomy (La Fontaine 1985). In the Byzantine Near East, the attainment

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of adulthood was not specific to a precise age, but rather to attainment of a particular social status either through a toga-donning ceremony, through service in the Roman military, or through marriage (Wiedemann 1989), and thus the attainment of adulthood occurred for a range of ages, typically between thirteen and fifteen years old (Perry 2006). Interestingly, Perry (2006) found that the cultural transition to adulthood in this group was marked by greater disease and higher mortality rates, as becoming an adult also meant increased self-reliance and labor responsibilities. Thus, the transition to adulthood is an important social phenomenon in many cultures, as it can be marked by a shift in personal or cultural identity, and social roles within the community (Sofaer 2009).

Interestingly, researchers at medieval Kulubnarti, located in Nubia near the Second

Cataract of the Nile River, found an unusual distinction between adults and subadults in regards to isotopic indicators of diet (Turner et al. 2007). Turner and colleagues found that there was a threshold for nutritional intake among three age groups: subadult ages 0-3; subadult ages 4-17; and adult ages 17+. Most interesting was the division in dietary intake between subadults that had been weaned (ages 4-17) and adults (17+). The results demonstrate that weaned subadults were consuming less carbon and nitrogen rich foods than adults, indicating they consistently had diets disproportionately lower in animal and legume-based proteins. Turner et al. (2007) hypothesize that this indicates distinct subsistence strategies between the age groups, with a

„child‟-specific diet and an „adult‟-specific diet, which was significantly higher in protein. Of further interest to the present discussion is the subadult age threshold of seventeen years, when individuals at Kulubnarti began to consistently consume a more „adult‟ diet. Consequently, individuals around the age of seventeen had adopted a different social persona or identity at

Kulubnarti that at least allowed them to consume more animal and/or legume-based proteins. It

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is possible this had something to do with increased labor or farming responsibilities that predicated higher dietary consumption for energy; however there is no archaeological or ethnographic data to confirm this theory. Regardless, the dietary findings at Kulubnarti indicate that the differential concept of childhood and the presence of a cultural transition to adulthood was recognized at regional medieval Nubian sites other than Mis Island.

A further osteological analysis of the subadult age ranges within the Mis Island burial sample can truly expand our understanding of childhood identity and when the shift into adulthood occurred with regards to mortuary treatment in the present sample. A refinement of the age of transition to an adult burial pattern can also further clarify what kinds of social rites of passage might have made an individual an „adult‟, such as puberty, marriage, economic contribution through work in the fields, or through a religious rite of passage, such as baptism or confirmation. Additionally, future studies regarding health, diet, skeletal muscle markings, and traumatic lesions in both the adult and subadult remains can help determine how the transition to adulthood might have affected social identity and the treatment of individuals at Mis Island throughout the medieval period.

The Concept of Family or Clan Identity at Cemetery 3-J-11

Mortuary results from the present study indicate that cemetery 3-J-11 does not appear to have the same community-based spatial organization as that seen in cemetery 3-J-10. Burials of individuals from the pre-Christian and the medieval Christian periods, as well as multiple demographic age and sex groups are buried side-by-side in ostensibly equal likelihood throughout the cemetery space. Above all, there is no obvious spatial preference for the placement of subadults and adults, as there is at cemetery 3-J-10. Furthermore, the mortuary

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patterns at cemetery 3-J-11 are more diverse than at 3-J-10, and both subadults and adults are buried with a larger assortment of grave monuments, blocking stones, head coverings, grave goods, and varied body, leg, and head positions.

There is some distinction between specific mortuary treatment and membership within a subadult or adult age cohort; however, at cemetery 3-J-11 there is substantially more variation in mortuary patterns within each of the age cohorts. Furthermore, only a small subset of mortuary variables tested as significantly different between adults and subadults at this site. For example, when the „transitional‟ burials with blocking stones and grave goods were tested, only two variables were significantly different: the presence of a monument and the presence of grave goods. Unfortunately the samples of juveniles (n= 9) and adults (n= 18), in the „transitional‟ burial group are rather undersized, and it is difficult to determine whether the statistical relationship in the presence of a monument is actually a product of a small sample size.

Furthermore, many of the „transitional‟ Christian burials are disturbed and it is possible that a grave monument was in place at some point, but was somehow destroyed prior to excavation. As a result, it is difficult to determine whether the relationship among age and the presence of a monument is an accurate depiction of intentional mortuary practices in the „transitional‟

Christian burials. Nonetheless, differences in the presence of grave goods among the

„transitional‟ burials appears to have been of importance, as all 12 individuals with grave goods at cemetery 3-J-11 are adults. Obviously, only adults were considered viable recipients of grave goods, which was possibly associated with the achievement of a specific adult status in the community. Males and females were equally represented and had relatively similar grave goods, and therefore, it appears that membership in a specific adult cohort regardless of sex was the most important factor.

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When the later Christian burials without blocking stones or grave goods were analyzed, four different variables tested as statistically significant between adults and subadults: monument type, the presence of head coverings, and hand and leg position. In terms of monument type, an

FF03a grave monument was more likely to mark the burial of a subadult, while an FF03c monument was more likely to mark the grave of an adult. Despite this distinction however, there were 70 subadults buried with FF03c monuments and 2 adults buried with FF03a monuments, implying that the use of a specific grave monument for each age group was not as definitive as at cemetery 3-J-10. The same appears to be true for the use of head coverings, as well. Although adults are statistically more likely to be buried with head coverings, at least 70.7% of subadults also have head coverings, indicating once again that there is no absolute distinction between the age cohorts. Furthermore, the distribution of hand and leg positions was also variable among both adults and subadults and since it is difficult to determine if these positions were intentional, it is quite possible that any differences might simply be due to chance.

Most importantly, these results indicate that there is significant variability in mortuary patterns among all age groups at cemetery 3-J-11. This inconsistency might best be explained by diachronic transformations in burial style over time. As the use of cemetery 3-J-11 continued later into the Classic Medieval Phase, and Christianity was further integrated into the local community it is possible that there was a transition in the mortuary treatment of subadults and adults from a more individualized burial ritual into a more homogenized and Christian-based burial ritual. In fact, Ginns (2010b) argues that cemetery 3-J-11 was in use for a prolonged period of time from the Kushite and Meroitic phases, through the medieval periods and possibly into the Classic and Later Medieval Phases. If this is indeed the case, then one would expect substantial change in burial patterns over time. While the medieval Christian mortuary patterns at

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cemetery 3-J-11 are rather subtle and difficult to differentiate, the high variability in burial treatment does support the diachronic hypothesis, especially in comparison to the Late to

Terminal Christian cemetery 3-J-10. This hypothesis will be further explored in reference to the substantial differences between cemeteries 3-J-10 and 3-J-11 in more detail below. Additionally, future carbon dating of a number of the burials at cemetery 3-J-11 can further refine the argument for social or cultural change over time in relation to the mortuary treatment of the age groups.

Despite some overlap with regards to age-related mortuary patterns at Mis Island, the overall spatial organization of burials at cemetery 3-J-11 is dramatically different in comparison to cemetery 3-J-10. As previously mentioned, there are no obvious community-wide burial programs representing separate disposal areas for particular segments of the population. Instead, the results from Chapter Six demonstrate that there are a number of discrete burial clusters, each with a mixed demographic profile of males, females, and subadults. Furthermore, the dispersion of pre-Christian burials, „transitional‟ burials with blocking stones and/or grave goods, and more

„Christianized‟ homogenous burial forms within several of the burial clusters indicates that the cemetery plausibly grew from a number of discrete burial plots, instead of from one specific region of the site. As such, the cemetery does not appear to have a specific trajectory of horizontal or vertical growth based on burial chronology, nor demographic or status group. As a result, it is likely that there is an alternative and more significant social principle driving the distribution of mortuary patterns at cemetery 3-J-11.

One possible rationale for multiple disposal areas developing simultaneously across the cemetery could be the use of such areas by family or clan groups. This is not entirely unreasonable, considering that family and clan-based burial plots have been identified at multiple

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Early Christian cemeteries throughout the Roman and Byzantine world (Montserrat and Meskell

1997; Bowen 2003; Yasin 2005; Tulloch 2011). In fact, the continued respect and re-use of pre-

Christian burial sites was not uncommon in the early medieval period in Nubia (Welsby 2002).

Nubian sites such as Sesibi, Gabbati, and Jebbel Adar North exhibit a mix of pre-Christian and

Christian burials within the same cemetery space, indicating the syncretism of pagan and

Christian burial rites (Edwards 1994, 1998, 2001; Żurawski and Mahmoud el-Tayeb 1994;

Mahmoud el-Tayeb 2010). Moreover, at the site of Sesibi, archaeologists hypothesize that the close spatial relationship between X-Group tumulus burials and typical East-West Christian graves with mastabas likely represents the familial relationship between those individuals with more traditional burial styles and those individuals with the new Christian tomb monuments

(Edwards 1994; Welsby 2002). Furthermore, during the earliest stages of Christian conversion it is very reasonable to believe that newly converted Christian Nubians would still identify with their direct non-Christian ancestors. Therefore, the continued use of family burial plots within previously established pre-Christian cemeteries would be expected.

As such, it is probable that cemetery 3-J-11 also originated from family burial plots, where extended relatives shared a specific disposal area within the cemetery site. In fact the presence of distinct burial clusters with mixed mortuary practices at cemetery 3-J-10 likely reflects this family or clan-based development across the site. For example, these family burial plots could have been used over extended periods of time, as related descendents were buried next to their long-deceased ancestors. During the initial transition to Christianity in the mid-fifth century AD many of the early Christians were likely buried near to their pagan ancestors, accounting for the mix of pre-Christian and „transitional‟ Christian burials situated side-by-side.

As a result one would expect to see a mixture of mortuary patterns within some of the oldest

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burial clusters. The oldest clusters would have evidence of diachronic change as the family or clan plot was used over the course of many generations. In addition, as the cemetery expanded, new clan or family plots might have been added as immigrants arrived to the area or new factions of local families selected unmarked disposal areas within the site. These more recent clusters developed by new or extended and fully „Christianized‟ family groups would reflect more homogenized burial practices and would not have the same extent of diachronic change in burial style as the oldest family clusters.

A Transition from Family to Community Identity at Medieval Mis Island

As a result, it is entirely possible that a majority of the differences in mortuary patterns between cemeteries 3-J-10 and 3-J-11 on Mis Island are also due to this diachronic change and the fact that the two sites were primarily used during different phases of the medieval Christian period. As presented in the current discussion, cemetery 3-J-11 was likely in use at minimum through the Transitional, Early, and possibly into the Classic medieval periods, as evidenced through the presence of pre-Christian burials throughout the site, as well as a number of

„transitional‟ and „fully‟ Christianitized burial forms. The presence of blocking stones in the early Christian burials and the lack of grave monuments for many burials at cemetery 3-J-11 indicate its use in the Transitional or Early Phases, especially as many of the burials lacking monuments are centrally located within the site and also have blocking stones. The stone or mud pavement grave monuments typical of sites in medieval Nubia, and present within both cemeteries 3-J-10 and 3-J-11 at Mis Island, represent a clear Christian tradition and a distinct break from previous Nubian practice (Adams 2003). Thus the lack of these grave monuments over many of the central burials at cemetery 3-J-11, and especially in conjunction with blocking

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stones, would likely signify a transitional medieval mortuary tradition. In addition, blocking stones are often considered typical of „transitional‟ or early burial forms, since they are closely identified with pre-Christian X-Group mortuary features and they tend to be replaced by head coverings in many medieval Christian Nubian sites in the later Early and Classic medieval periods (Adams et al. 1999; Adams 2003; Żurawski 1986, 1987). Finally, the increased frequency of grave goods at cemetery 3-J-11 corroborates an earlier medieval chronology, as grave goods became increasingly rare with the localized adoption of Christianity (Adams et al.

1999; Edwards 2001).

Cemetery 3-J-10, on the other hand, does not share any of these transitional or early

Christian burial features. Almost all burials at cemetery 3-J-10 have Christian stone or mud brick pavement monuments, with a few exceptions of graves located along the edges of the cemetery that were disturbed by natural or human postdepositional processes. The burials of adults at cemetery 3-J-10 are also rather uniform, with stone or mud brick head coverings and the largest majority of individuals buried in a supine position with legs extended, the head facing east, and the hands at the hips or sides. Furthermore, there are not any blocking stones or other burial features identified as typical of transitional mortuary patterns at cemetery 3-J-10. Only one individual was found with a grave good in situ, and while it is unclear what the context of this burial might imply, it does not make the argument for an Early Christian chronology for cemetery 3-J-10. In addition, the clear delineation between Christian and Muslim burials along the eastern edge of cemetery 3-J-10 demonstrates the continuation of the cemetery from the Late or Terminal Medieval Periods through to the Muslim occupation and conversion.

As such, differences in the spatial organization and mortuary treatment of individuals buried in cemeteries 3-J-10 and 3-J-11 are to be expected. Several literary and mortuary studies

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focusing on the conversion and expansion of early Christianity have identified very similar transitions in burial treatment (Effros 1997; Bowen 2004; Yasin 2005; Osiek 2011). In a discussion of early Christian Merovingian funerary ritual, Effros (1997) uses literary and archaeological sources to demonstrate that burial and funerary commemoration of the dead in the pre-Christian and early Christian periods was the sole responsibility of individual families.

During the early years of Christianity the church had little, if any, influence on funerary ritual however, past the sixth and seventh centuries AD, as communities became increasingly

Christian, the Church began to play a substantially larger role in commemoration of the dead.

Consequently, by the eighth century AD, clerics of the Christian Church had claimed their roles as spiritual advisors of the dead and essentially taken control of Christian burial grounds.

This same adoption by the Church of commemoration of the dead occurred within many early Christian societies throughout the Roman and Byzantine world and cemeteries began to increasingly adopt the homogenized mortuary patterns so typical of the Christian period (Osiek

2008; Bowen 2004; Yasin 2005). Membership within the Christian Church and the sense of a religious community became increasingly more important than the concept of the individual or the family. As such, the Christian burial grounds began to adopt a more communal mortuary tradition to express their collective identity as part of a larger religious community (Yasin 2005).

Furthermore, the adoption of new burial grounds near churches and basilicas became more widespread as the mortuary ritual was primarily organized around membership within the greater religious community, as opposed to the family or clan group (Yasin 2005). Consequently, the increasingly Christian collective identity was reinforced through the funerary ritual and burial of loved ones. As such, all good believers were equalized in death and their pursuit of an afterlife

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through membership within the Christian collective identity and burial within the sacred

Christian burial ground.

However, while it is clear that cemetery 3-J-11 was heavily used during the Post-

Meroitic, Transitional, Early and possibly Classic medieval periods and cemetery 3-J-10 was used during the Late and Terminal medieval periods it is hard to determine when the community at Mis Island ceased using cemetery 3-J-11 and began using cemetery 3-J-10. As discussed earlier, it is difficult to resolve the chronology of Christian burials in medieval Nubia. Once

Christianity was firmly established all burials took on a specific uniformity with little change until the conversion to Islam in the fifteenth century AD (Edwards 2001; Welsby 2002). Burials from the Classic period might look identical to burials of the Late and Terminal periods and it is impossible to definitively determine chronology. Plans are in place to conduct carbon dating on a number of the burials at both cemeteries 3-J-11 and 3-J-10 to further distinguish burial forms, as well relative dates for the termination of cemetery 3-J-11 and the establishment of cemetery 3-J-

10.

In addition to differences in chronology between the two sites, there are other possible explanations for the use of cemeteries 3-J-10 and 3-J-11, especially if it is determined that there is substantial overlap in the chronology of the sites. As an example, the burial space at cemetery

3-J-10 could have been adopted by a separate indigenous community that was considered either socially, politically, religiously, or economically distinct from those buried at cemetery 3-J-11.

Unfortunately, a mortuary analysis based on rank, economic, and political disparities is difficult at this site, because as is the case in most Christian communities, there are no obvious rank or status disparities in mortuary practice between cemeteries 3-J-10 and 3-J-11. Furthermore, there are no items identifying individuals as political or religious leaders, no burial patterns that are

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particularly distinguishing and both cemeteries have burials with some items of personal adornment or grave goods. Therefore, it is just as possible that the cemeteries represent two separate yet equal communities that have different social organizing principles influencing the preference for a particular disposal area and/or type of burial ritual. At this time there is no further information on settlement patterns of this population that might identify whether there are different social, political, or religious groups living at the site, but the examination of a third burial ground, cemetery 3-J-18, might enhance our understanding of why there are multiple, and perhaps contemporaneous, burial grounds located at Mis Island. In this regard it is worth noting that cemetery 3-J-18, which could not be included in this analysis because the data has not yet been analyzed and published, was located adjacent to a Christian church, which is very distinctive from both cemeteries 3-J-10 and 3-J-11.

A final possibility for the differences between cemeteries 3-J-10 and 3-J-11 could be that an outside immigrant population settled on Mis Island sometime later during the medieval period, establishing a new Christian burial ground at cemetery 3-J-10. Historical and archeological literature reference an influx of immigrant populations settling in central Sudan during the Late and Terminal phases to escape warfare and political instability in the north

(Osman 1973; Vantini 1975; Welsby 2006). It is possible that Mis Island, located further south and in a protected area of the Nile River, could have provided a refuge for outside Nubian populations. An investigation of the personal adornment and grave goods within cemetery 3-J-10 might elucidate whether these items were locally produced or brought in from distant regions.

Furthermore, osteological analyses of population specific traits, such as cranial morphometrics, dental and non-metric traits, isotopic analyses, and mitochondrial DNA studies could also make a significant contribution to this inquiry.

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Needless to say, there are many implications for the differences in mortuary practice at cemetery 3-J-10 and 3-J-11. Regardless of these differences however, there are no large distinctions in the prevalence of skeletal indicators of stress and disease between the two burial groups. While there is a slightly higher prevalence of periostitis and porotic hyperostosis for males at cemetery 3-J-10, there are no disparities in any other indicators of stress or among the various demographic groupings. Therefore, whatever the social organizing principles influencing the disparate burial patterns at the two sites, whether it could be chronology, differences in religious adherence, or different burial populations, these social phenomena are not reflected in the osteological data. This indicates that there is no direct correlation between mortuary treatment and the experience of health at Mis Island. This could imply a couple of things, including that there were no rank differentiations among individuals at cemeteries 3-J-10 and 3-

J-11, or that any differences in status were negated by an equivalent struggle against the harsh environment at Mis Island. For a small farming community living along the Nile River in the medieval period, it is likely that there were not any large-scale status differences and that most individuals at Mis Island were equal in their pursuit of a relatively difficult existence.

A DISCUSSION OF THE OSTEOLOGY RESULTS

As discussed in Chapter Two, a variety of factors can result in the formation of non- specific skeletal indicators of stress, such as linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis, and periostitis. Chronic and episodic stress in the form of environmental or cultural pressures can negatively impact the individual and become expressed in the skeleton (Goodman et al. 1988; Goodman and Armelagos 1988; Martin et al. 1991). Environmental constraints to human adaptation and an inability to gain access to basic resources, such as water, food, and

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shelter are causative factors leading to systemic stress in the individual, and ultimately the community (Goodman and Martin 2002). Certain environmental constraints like an insufficient diet, climatic extremes, parasitic infections, and high pathogen loads may impact the skeleton directly. Furthermore, social stressors including one‟s occupation, low socioeconomic or gender status, political and social disruptions, or cultural stigma can all affect a person‟s access to food and further exposure to a multitude of biological stressors. A prolonged inability to access necessary resources and a chronic exposure to both environmental and social stressors can eventually overburden the system and lead to physiological perturbations, many of which can leave a permanent mark on the skeleton (Goodman and Martin 2002). Furthermore, the severity of the skeletal response can imply the degree to which the social and environmental stressors were affecting the populace, and the sufficiency of the community wide cultural adaptations to these stressors (Goodman and Martin 2002).

Factors resulting from any of these stressors might include a poor diet and inadequate micronutrient intake of folic acid and vitamins C and B12, as well as chronic fevers and diarrhea, and bacterial, viral and parasitic infections. Most of these can also impede normal growth and development trajectories and lead to lifelong defects, such as stunted height, harris lines, and linear enamel hypoplasias. Furthermore, many of these factors, when endemic and chronic to a region, can produce malabsorption of vital micronutrients, such as Vitamin B12, folate, and

Vitamin C, thus further contributing to the formation of megaloblastic or hemolytic anemia and scurvy, and in chronic cases the formation of porotic hyperostosis and cribra orbitalia. Therefore, the high prevalence of many of these non-specific skeletal indicators in the adult sample at Mis

Island likely indicates the presence of a number of these stressors in the local natural and cultural environment. In addition, the presence of tuberculosis and leprosy within the small skeletal

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sample demonstrates that they were an important factor contributing to morbidity and possibly even mortality rates at Mis Island.

An analysis of each of the adult samples separately demonstrates that these elevated levels of skeletal stress are equally distributed among males and females of all age groups. Only a few of the age or sex cohorts are significantly different among any of the burial samples at Mis

Island. Males and females at both cemeteries 3-J-10 and 3-J-11 have equivalent prevalence rates for all childhood-specific skeletal indicators, such as cribra orbitalia, porotic hyperostosis, and linear enamel hypoplasias. Similarly, both sexes have comparable frequencies of periostitis, maxillary sinusitis, and tuberculosis. Therefore, even if there were sex-based differences in access to resources or social, political, and economic status, these did not affect the overall experience of skeletal health and wellbeing in this population. Two chi-square analyses at the p

<0.05 level are significant for differences among specific adult age cohorts and the prevalence of linear enamel hypoplasias at cemeteries 3-J-10 and 3-J-11. However, sample sizes for these groups are extremely small and it is unclear whether larger samples would produce the same results. Overall, there do not appear to be any large-scale systemic differences between adult age and sex cohorts in each of the cemetery burial samples.

These osteological results align well with further comparison of mortuary treatment among adults at both cemeteries at Mis Island. As demonstrated in Chapter Six, young, middle, and old adults appear to have been buried in the same way at both sites. Furthermore, there are no significant differences in the location or the manner of burial for males and females at either cemetery 3-J-10 or 3-J-11. If mortuary ritual is indeed a reflection of the social organizing principles within a community, then these burial similarities between adult age and sex groups, as well as the lack of difference in the prevalence of skeletal indicators of stress, likely

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demonstrate that the demographic age and sex groups had equal access to the same resources and were exposed to similar environmental stressors in life.

A direct comparison between cemeteries 3-J-10 and 3-J-11 reveals only slight differences in health among the skeletal samples in specific age and sex groups. For example, chi-square tests reveal that males at cemetery 3-J-10 are more likely to exhibit porotic hyperostosis and periostitis than males at cemetery 3-J-11. However, a proportion of error test for each of these significant differences demonstrated very low levels of association between the variables, thus suggesting that there is not a strong relationship for higher indicators of stress in males at cemetery 3-J-10. The same argument can be made for the statistical relationship between an increased frequency of periostitis in middle adults from cemetery 3-J-10 in comparison to middle adults from cemetery 3-J-11. Once again the proportion of error test demonstrates a low level of association between the variables, indicating a rather weak relationship of increased periostitis prevalence at cemetery 3-J-10. Only a comparison of the prevalence of linear enamel hypoplasias in the mandibular canines of old adults exhibit a high level of association between the variables

(Phi = .577), however, each of the chi-square cell sizes is below 5, thus reducing the power of the

Pearson‟s chi-square and Phi tests. In addition, there are no statistical differences in other indicator of stress among the age or sex groups at Mis Island. Consequently, these results indicate that there do not appear to be any substantial community-wide distinctions in the prevalence of skeletal indicators of stress at cemeteries 3-J-10 and 3-J-11, and thus, there are no appreciable differences in health among the adults at Mis Island.

As such, the overall osteological results demonstrate that there are relatively high frequency and prevalence rates for many non-specific indicators of stress, but especially for porotic hyperostosis, cribra orbitalia, linear enamel hypoplasias, and periostitis. When all of the

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age, sex, and cemetery samples are combined it is evident that the population at Mis Island was experiencing relatively high levels of childhood stress. Table 94 is a summary of the frequency and prevalence of each of the skeletal indicators of health in the combined Mis Island sample.

The average frequency for non-specific indicators of stress, including cribra orbitalia, porotic hyperostosis, linear enamel hypoplasias, and periostitis is approximately 50-60% of the adult population. The incidence of osteomyelitis and tuberculosis is appreciably lower at only .9% and

3.9% of the total sample, respectively, however, their presence in the sample indicate that these infectious diseases were still a genuine concern for the local community.

Table 94: Overall Frequency and Prevalence of Indicators of Health at Mis Island. Present Absent (n) % Prevalence/ 10000 Cribra Orbitalia 84 96 180 46.7 466.7 Porotic Hyperostosis 119 81 200 59.5 595.0 LEH Max Canine 64 52 116 55.2 551.7 LEH Mand Canine 81 40 121 66.9 669.4 Periostitis 113 77 190 59.5 594.7 Osteomyelitis 2 205 207 .9 9.6 Maxillary Sinusitis 28 45 73 38.4 383.5 Tuberculosis 8 198 206 3.9 38.8

In general, the skeletal evidence suggests that life might have been somewhat difficult for the population at Mis Island, especially for the subadult cohort. The relatively high prevalence rates of non-specific indicators of childhood stress indicate that at least half of the adult sample exhibits evidence of surviving a chronic nutritional deficiency during childhood. The number of total affected individuals was likely much higher however, as the bony evidence of such nutritional disorders disappear as the inflammation fades and bone remodels with age.

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In addition to these child-specific indicators, however, other non-specific skeletal indicators of stress experienced throughout the life cycle are reasonably high. Approximately 38% of adults exhibit either active or healed maxillary sinusitis, while another 60% of the total sample exhibit periosteal reactions evident of a chronic nutritional deficiency or systemic infection.

A regional evaluation of health in medieval Nubia reveals that the prevalence of many of these skeletal indicators of stress in adults at Mis Island are fairly elevated in comparison to other sites. For example, at Wadi Halfa, a Nubian village located near the Second Cataract in Northern

Nubia, Carlson (1984) reports that only 20% of the sample of adults from Meroitic, X-Group, and medieval Christian periods have cribra orbitalia, and just a slightly higher percentage (30%) of the subadult sample exhibit the orbital lesions. The incidence of porotic hyperostosis in the

Wadi Halfa area is even less prevalent with fewer than 5% of the subadult and adult population exhibiting porotic lesions.

These frequencies for both porotic hyperostosis and cribra orbitalia are substantially lower than those reported for both Mis Island and Kulubnarti. At Kulubnarti located just south of

Wadi Halfa in the Second Cataract of the Nile, the combined frequency for adults with cribra orbitalia is roughly 30% (Mittler and van Gerven 1994; Adams et al. 1999). When the adult groups are broken down into age cohorts and according to cemetery, the prevalence rates range from 20-40%, but never quite reach the elevated levels present in the combined adult sample at

Mis Island. For most adult age groups the prevalence rates at Mis Island are well above the highest frequencies for adults at Kulubnarti, especially for the youngest and oldest adults.

Interestingly, a review of the reported frequencies for orbital lesions in subadults at

Kulubnarti demonstrates that nearly 78% of children aged four to six years and 70% of subadults up to the age of thirteen exhibit cribra orbitalia. Although the current study cannot make a direct

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comparison to the subadult samples, it is clear that the occurrence of cribra orbitalia in the subadult population at Kulubnarti is extremely high, and more analogous to what is being reported for adults at Mis Island. Since cribra orbitalia is a childhood disorder it is likely that the life experience for children at both Mis Island and Kulubnarti was rather harsh, however the prevalence of chronic cribra orbitalia in the Mis Island adult population appears to be somewhat elevated. These results could indicate higher rates of parasitic infection and substantially more nutritional stress in the Mis Island adult population. Conversely, it could also indicate that the subadults at Mis Island were better able to adapt to and heal from a variety of chronic nutritional disorders and survive into advanced adulthood. As the “osteological paradox” argues, the lower incidence of these indicators in adults at Kulubnarti could indicate that the subadult populations were so ill that they were dying before they reached adulthood and/or exhibited the characteristic lesions of illness. The prevalence of porotic hyperostosis at Kulubnarti is not reported in the literature and thus cannot further contribute to the current discussion, however an investigation of the prevalence of linear enamel hypoplasias (LEH), another childhood stress indicator, might help clarify this discussion.

A direct comparison between Kulubnarti and Mis Island reveals that the prevalence of

LEH at Kulubnarti is significantly higher than at Mis Island. All individuals tested for LEH at

Kulubnarti exhibited at least one LEH, with a mean frequency of four LEH per individual. At

Mis Island only 66% of adults exhibited an LEH, with the mean frequency only one LEH per individual. The significantly elevated LEH frequencies at Kulubnarti are especially interesting, because of the reported higher frequency of cribra orbitalia at Mis Island. There are a number of possible explanations for these differences. First, it could be a disparity in the definition and identification of a linear enamel hypoplasia among researchers. As discussed in Chapter Five, the

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present study uses a rather conservative definition of an LEH, which is a horizontal growth disturbance in the tooth enamel that is seen macroscopically and can be felt with a fingernail.

This definition of an LEH is a rather recent development in the field of paleopathology, and was presented in an attempt to prevent the over-identification of the stress indicator in archaeological samples (Steckel et al. 2006). Consequently, there were a number of teeth in this study that had horizontally oriented lines along the tooth enamel, however an indentation could not be felt with the fingernail and thus they were not included in this study as an LEH. Although van Gerven et al. (1990) do not clarify their definition of a linear enamel hypoplasia, it is possible that it was not as conservative as in the present study, and this may account for some differences in the overall prevalence rate and mean frequencies of LEH between the two samples.

Nevertheless, it is likely this is not a definitive explanation for the overall difference in the frequency of LEH between the two sites. The higher prevalence of cribra orbitalia in Mis

Island could indicate an increased likelihood for chronic childhood nutritional disorders, while the elevated LEH frequency at Kulubnarti could indicate higher levels of severe childhood episodic stressors. As presented in Chapter Two, the etiology and timing of linear enamel hypoplasias and cribra orbitalia are quite distinctive and point towards different childhood illnesses or health indicators. Linear enamel hypoplasias can be suggestive of a number of episodic stressors, including severe starvation, high fever resulting from acute parasitic, bacterial or viral infections, infectious diseases, or any combination of these factors. As such, an LEH is typically formed after an acute and often severe experience of stress, and many scholars have attributed LEH to episodes of infant diarrhea, weaning practices and changes in the diets of young children (Cook 1979; Moggi-Cecchi et al. 1994; Goodman et al. 1984; Alcorn and

Goodman 1985; Goodman et al. 1987).

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This could be one such hypothesis for the high prevalence of LEH at Kulubnarti. To support this, Turner et al. (2007) conducted an analysis of dietary composition of the population at Kulubnarti and found that there was a distinct break in isotopic indicators between young subadults from birth to three years and older subadults between four and seventeen years of age.

Specifically, the four to seventeen year-old subadult cohort was found to have substantially lower protein consumption in comparison to the younger subadult and adult age cohorts.

Interestingly, this change to a lower protein consumption around four years of age also overlaps with the average age of LEH, which is between the ages of one and a half to four years, with the highest rate of incidence around the age of four years-old (van Gerven et al. 1990). It is quite possible there is a direct correlation between the incidence of LEH, the distinct break in isotopic indicators in the young subadult group, and the timing of weaning in the subadult population.

The prevalence of LEH at Mis Island appears to be at a much lower rate than at

Kulubnarti, however it remains unclear when and why LEH occur in the Mis Island sample. It is possible that the weaning and/or dietary practices of the Mis Island population are not as traumatic, and thus are not causing the same levels of childhood acute stress. Based on the prevalence of cribra orbitalia and LEH at Mis Island and Kulubnarti it is also possible that the types and levels of stressors are distinctive and thus could cause varying frequencies of non- specific skeletal indicators. The higher prevalence of cribra orbitalia at Mis Island could simply indicate chronic low-level nutritional deficiency, while the higher prevalence of LEH at

Kulubnarti could indicate an acute or perhaps more detrimental stressor affecting the Kulubnarti population. Further research into dietary isotopes and ancient DNA in the current sample can better discern the exact etiology of these skeletal indicators at Mis Island and hopefully

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biologically clarify why there would be differences in these skeletal indicators of stress in comparison to Kulubnarti.

In terms of other non-specific indicators of stress there is also a distinct difference in the prevalence of maxillary sinusitis between adults at Mis Island and adults at Kulubnarti. A comparison of the two sites reveals a rather elevated frequency at Mis Island in contrast to

Kulubnarti. Roberts (2007) reports that only 21.8% of the 101 crania selected for analysis show any indication of maxillary sinusitis at Kulubnarti, which is considerably lower than the other rural agricultural populations in the study sample. In contrast, Mis Island demonstrates a much higher frequency with 38% of individuals exhibiting the maxillary sinus lesion, which is much closer to the average of 45% frequency reported for the other rural agricultural populations in

Roberts‟ 2007 study. At both Kulubnarti and Mis Island, females exhibit higher prevalence rates than males, however a statistical evaluation of the differences reveals that they are not in fact significantly different at either site. As such, it appears that males and females at both Kulubnarti and Mis Island are experiencing approximately the same levels of maxillary sinusitis, however at a relatively higher overall prevalence rate at Mis Island.

It is not clear what would cause an increased prevalence of maxillary sinusitis at Mis

Island in comparison to Kulubnarti. As discussed in Chapter Two, maxillary sinusitis is often caused by exposure to poor indoor and outdoor air quality as a result of cultural and natural factors. “Indoor” factors include poor air ventilation and exposure to dust, mites, and mold, as well as exposure to smoke from indoor cooking fires and smoke-producing occupations (Roberts

2007; Jones 1999; Mercer 2003; Rinne et al. 2006). “Outdoor” factors include climate, weather, pollen, pollution, and dust exposure (Roberts 2007; Mercer 2003, Haines et al. 2006; McCurdy et al. 1996). Direct infections via dental abscesses into the sinus can also cause maxillary

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sinusitis; however there did not appear to be a high correlation between abscesses at Kulubnarti or Mis Island. Thus these are not likely to be the compelling cause of maxillary sinusitis at either site.

Archaeological evidence at Kulubnarti demonstrates very little likelihood for exposure to

“indoor factors” as there is no indication for cooking fires or smoke producing activities within the settlements (Adams 1994; Adams and Adams 1998). Furthermore, Roberts (2007) did not see a high prevalence for direct maxillary infection through dental abscesses. Therefore, she argues that the occurrence of maxillary sinusitis at Kulubnarti it is most likely due to “outdoor” factors, such as climate, weather, pollution from agricultural production, and the presence of smoke producing occupations, such as metalworking and pottery production. Due to the similarity in desert environment among the two sites, is quite probable that the population at Mis Island was exposed to the same “outdoor” factors as at Kulubnarti. It is expected that these factors also account for much of the occurrence of maxillary sinusitis at Mis Island; however it remains to be seen whether there are any substantial differences in causative environmental factors between the two sites, such as increased exposure to agricultural dust or smoke-producing activities between the two sites. What is also unknown about Mis Island is the rate of exposure to indoor factors, such as cooking fires or smoke-producing occupations within confined spaces. The archaeological settlement data is currently unavailable, but should it someday indicate a higher incidence of “indoor” factors then it could account for the increased prevalence at Mis Island.

Although the prevalence rate of skeletal indicators of stress in the present sample are relatively elevated and in some cases higher than at Kulubnarti, a further examination demonstrates that nearly all affected adults at Mis Island exhibit healed lesions with minimal to moderate expressions for most non-specific skeletal indicators. For example, 77.1% (91/118) of

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all adults with porotic hyperostosis in the Mis Island sample exhibit scattered fine foramina and only 2.5% (3/118) of the sample exhibit the moderate expression of porotic hyperostosis in which the foramina have linked into a trabecular structure. Likewise, only 4.8% (4/84) of adults with cribra orbitalia exhibit an extreme expression where there is outgrowth in trabecular form from the outer table surface. In addition, among those who have periostitis, only 2.7% (3/113) of individuals exhibit a severe form of the lesion, while the remaining exhibit barely discernible

(48.7%) and moderate expressions of the lesion (48.7%). Therefore, although there are high prevalence rates for non-specific skeletal indicators of stress at Mis Island, the actual severity of lesions reveal an ability for most adults to adapt to and recover from a majority of the non- specific stressors affecting the skeleton. Tables 95 and 96 summarize the severity of lesions for cribra orbitalia, porotic hyperostosis, and periostitis in the Mis Island adult sample.

Table 95: Severity of Cranial Lesions in the Mis Island Combined Sample. Cribra Orbitalia Porotic Hyperostosis Number % Number % (n) (n) Scattered fine foramina 18 21.4 91 77.1 Large and small 17 20.2 24 20.3 isolated foramina Foramina linked into a 45 53.6 3 2.5 trabecular structure Outgrowth in 4 4.8 0 0.0 trabecular form Total Sample 84 100.0 118 100.0

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Table 96: Severity of Periosteal Lesions in the Mis Island Combined Sample. Number % (n) Barely Discernible 55 48.7 Moderate Expression 55 48.7 Extreme Expression 3 2.7 Total Sample 113 100.0

In addition, an overwhelming majority of adults at Mis Island exhibit well-healed lesions.

Among those with cribra orbitalia, only 4.0 % (4/84) exhibit an active lesion, another 8.3%

(7/84) a mixed reaction, and the largest number of individuals (86.9%, 73/84) exhibit healed lesions. Even more striking, for individuals with porotic hyperostosis, only 1 individual out of a total sample of 119 adults has a mixed reaction, while the remaining exhibit healed lesions. The healed nature of these cranial lesions is not a surprising find, however. As discussed in Chapter

Two, cribra orbitalia and porotic hyperostosis are indicative of a childhood disorder, and lesions present in adults are most likely signs of chronic childhood stress that has not undergone complete bony remodeling (Stuart-Macadam 1995). Nevertheless, the presence of these healed lesions in the Mis Island sample reveals a prolonged adaptive ability in which the individual has adequately healed and reached adulthood (Ortner 1998).

Interestingly, the distribution of healed periosteal lesions in the adult sample also indicates an increased adaptive stress response. Periostitis is not a subadult-specific stress indicator, and therefore, it is common for adults to exhibit a range of active, healed, and mixed bony reactions. At Mis Island however, 68.1% (77/113) of individuals exhibit a healed lesion,

26.5% (30/113) exhibit a mixture of active and healed lesions, and only 5.3% of the total sample

(6/113) exhibit an active response. Therefore, while 60.9% of adults at Mis Island have periostitis to the one or more of the lower limbs, an overwhelming majority of affected

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individuals demonstrate an adaptive ability to recover from whatever systemic infection or nutritional deficiency ailed them. Although it is evident that there are a number of environmental stressors negatively affecting health, it is possible that either biological or cultural adaptations at

Mis Island were affording a sense of protection and increased survivability for the population.

Table 97 summarizes the stage of activity for lesions in each of the skeletal indicators of stress.

Table 97: Stages of Lesion Activity in Non-Specific Indicators of Stress at Mis Island. Cribra Orbitalia Porotic Hyperostosis Periostitis Number % Number % Number % (n) (n) (n) Active 4 4.8 0 0.0 6 5.3 Mixed 7 8.3 1 .8 30 26.5 Healed 73 86.9 118 99.2 77 68.1 Reaction Total 84 100.0 119 100.0 113 100.0

Although information regarding the severity and activity of lesions are not available for a comparison to the sample from Kulubnarti, the implications for these health disorders at Mis

Island are incredibly telling, especially in relation to the non-specific skeletal indicators of stress.

The high prevalence of cribra orbitalia, porotic hyperostosis, LEH, periostitis, and maxillary sinusitis in comparison to other sites in medieval Nubia would indicate that health was rather poor for the population at Mis Island. As such, Chapter Three outlined many of the detriments of the local environment in the Fourth Cataract, including high parasite loads from proximity to the

Nile River and the use of specific farming activities, which contribute to the higher prevalence of a variety of parasite carrying vectors. In addition, overreliance on the variable Nile River levels and seasonal production of the primary and secondary grain staples, as well as a general lack of animal protein consumption, almost certainly contributed to poor dietary intake and the high

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likelihood for multiple nutritional deficiencies. As such, it is not surprising that there are demonstrably high levels of non-specific indicators of stress and disease in the skeletons of adults buried at Mis Island. However, the reduced severity and healed nature of the lesions in the adult sample at Mis Island demonstrates that while the local environment might have been harsh, the community was rather well adapted and many individuals survived and maintained relatively good skeletal health into advanced adulthood.

SUMMARY

In summary, this research demonstrates that there were no differences in the health experience of individuals buried at cemeteries 3-J-10 and 3-J-11 regardless of the visible differences in mortuary organization between the two cemeteries. As established here, the differences in mortuary patterns at Mis Island most likely indicate two diachronic phases of

Christian burial on the island, with cemetery 3-J-11 representing an earlier phase of burial and cemetery 3-J-10 representing a later phase of burial. Although it is true that diachronic change in mortuary practice was the largest factor dictating differences in burial styles at the two sites, it is still possible that there are some differences in social, political, or economic status between cemeteries 3-J-10 and 3-J-11 that might account for some of these distinctions. Regardless of the reasons for these mortuary differences, however, it is clear that the environment in medieval

Nubia and the Fourth Cataract of the Nile appear to have played a more important role in health of the local community at Mis Island than any factors relating to diachronic change or differences in age, sex, population, or status groups. The particularly harsh environmental conditions likely led to exposure to a number of health related issues such as a seasonally deficient diet, a minimal consumption of animal proteins and vitamin B12, numerous parasitic

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infections, such as malaria, schistosomiasias, leishmaniasis and hookworm, and the bacterial infections of tuberculosis and leprosy. An endemic exposure to each of these conditions independently would be enough of a public health crisis to contribute to the high prevalence of skeletal indicators of stress such as cribra orbitalia, porotic hyperostosis, linear enamel hypoplasias, periostitis, tuberculosis, and maxillary sinusitis at Mis Island. As evidenced in this discussion, it is likely that there were a number of endemic problems present in medieval Mis

Island that created a particularly difficult living environment, especially in childhood. The lack of a developed immune system would have left many of the younger cohorts increasingly vulnerable to these environmental factors. However, the fact that most adults in this study exhibit healed and barely discernible lesions, demonstrates the adaptive potential of the community at

Mis Island and the probability that most individuals who lived past childhood developed some sort of immunity to the various infections. Therefore, it appears that while childhood was undeniably a difficult and rather dangerous period of the life cycle at Mis Island, individuals who lived past this phase of their lives were rather well adapted and healthy in comparison to their younger counterparts. Furthermore, the existence of such healed lesions in adults, the low levels of sustained infection, and the large number of individuals that surpassed fifty years of age, indicate that once individuals reached a certain threshold they were likely able to adapt to the hardships and survive.

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CHAPTER 9: CONCLUSIONS

This research has sought to answer a number of research questions regarding the life and death of a medieval Nubian community. Both osteological and archaeological data were included in this study and assessed using multiple lines of evidence including spatial analyses and multivariate statistics to best interpret the life history of a Fourth Cataract population.

Furthermore, a contextualized interpretation of the results using both modern and historical information has aided in a multivariate analysis and worked to create a deeper understanding of what life might have been like for the medieval community at Mis Island. A brief review of the proposed research questions and the results presented in this dissertation provide the following conclusions:

Question 1: Do skeletal indicators of health and mortuary patterns indicate that males and females were treated differently at Mis Island?

There are no clear distinctions in skeletal indicators of health or mortuary treatment between males and females at either cemetery 3-J-10 or 3-J-11. At both sites males and females are buried with the same type of grave monuments, head coverings, body and head positioning, and have an equal likelihood to be buried with grave inclusions. Although it appears that males received more grave goods than females in some of the early burials at cemetery 3-J-11, the small sample size and disturbed nature of many of the graves precludes a definitive conclusion of gendered differences among the earlier Christian sample. Furthermore, there are no statistical differences in the prevalence of skeletal indicators of stress or disease in any of the burial samples at cemetery 3-J-10 and 3-J-11. While these results cannot identify gendered differences

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in social, economic, or political roles at Mis Island, they do indicate that if there were any differences in the position or status of males and females they were not perpetuated in the mortuary treatment of individuals. Furthermore, any differences in these roles did not affect access to food resources or exposure to environmental and cultural stressors, as reflected through the equal prevalence of skeletal indicators of stress in both sexes.

Question 2: Will burial patterns at cemetery 3-J-11 reflect diachronic change in mortuary practice that is indicative of transformations in social, political or religious organization at Mis

Island? If these patterns exist, will there be a correlation with different prevalence rates of skeletal indicators of stress?

Mortuary patterns at cemetery 3-J-11 demonstrate diachronic change in burial style, likely indicative of a transformation from pre-Christian “transitional” burials to increasingly

“Christianized” burial forms. Burials with blocking stones, grave goods and without superstructures most closely resemble X-Group burial practice, and likely represent the earliest

“transitional” burial style. Subsequently, those burials with blocking stones, grave goods and the adoption of stone box monuments likely represent a further transition to the Christian mortuary practice. Other than a distinction between the early or “transitional” burials, there are no further indications of religious change in mortuary practice. The remainder of graves at cemetery 3-J-11 are most typical of medieval Nubian Christian burial practice, with similar stone box monuments, head coverings, and a supine and extended body position. Furthermore, the consistent patterning of these burials indicates that there are no overt social or political distinctions reflected in the mortuary remains at cemetery 3-J-11. This is unsurprising for a

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typical Christian burial program that would perpetuate the concept of equality of all individuals in death.

A comparison of skeletal indicators of stress demonstrates that despite this diachronic change in mortuary style there are no statistical differences in the overall health experience of these burial groups. It is apparent that although cemetery 3-J-11 was in use primarily during the

Early to Classic Christian period, and to some extent over a protracted period of time that included a number of religious, social, political, and economic transitions, the overall health experience at Mis Island did not reflect any of these changes. There could be a number of explanations for this: 1) the earlier burial sample could be too small to exhibit a statistical difference between groups; 2) the larger political, economic, and social changes happening within the Nubian kingdom were not locally experienced within the remote farming community at Mis Island; or 3) the environmental factors for health, such as diet and exposure to parasites and infectious disease was more relevant to skeletal health, even if the larger political, social, and economic changes were directly experienced within the Mis Island community.

Question 3: Cemetery 3-J-10 and cemetery 3-J-11 are spatially distinct (about 91 meters apart) cemeteries on Mis Island. Will the mortuary analysis and skeletal indicators of health denote that the spatial differentiation between the two sites correlates with different time periods, populations, or distinct social groups of the same population?

The mortuary results from cemeteries 3-J-10 and 3-J-11 indicate that there is an unambigiously Christianized mortuary system responsible for the organization of medieval burials at Mis Island. The majority of burials at both sites tend to follow the typical Christianized burial form and individuals are laid east-west with their heads facing the east, their graves

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marked by stone box monuments, and individuals laid extended and supine with few or no grave inclusions. Nonetheless, although both sites tend to share many of these same mortuary practices, it is evident that there are significant differences in the spatial organization and distribution of specific burial treatments among the cemeteries. The mortuary organization at cemetery 3-J-11 appears to have been organized around discrete burial clusters, possibly related to corporate or family-based burial areas with varied access to exclusive space within the larger site. Depending on their location within the cemetery each cluster had a wide range of mortuary programs with a mixture of transitional, early, and fully Christianized burials. It is most likely that specific family or corporate based burial spaces established in the pre-Christian or transitional period were continuously used even as the community began to more firmly adopt Christian burial practice.

Cemetery 3-J-10, on the other hand, is overtly homogenized and community-based with a lack of any detectable burial clusters or mortuary patterns that would imply distinct burial groups within the site. The only distinctions in burial practice among individuals at cemetery 3-J-10 were entirely reliant upon membership within the adult or subadult age cohorts. Subadults were spatially segregated to the edges of the cemetery, tended to have more variable burial patterns, and were more likely to be buried with items of personal adornment. Adults, on the other hand, were buried within the central core area of the cemetery, and were extensively buried extended, supine, and without grave inclusions of any kind. As such, a community-based burial program established how either adults or subadults were buried at cemetery 3-J-10, regardless of an individual‟s membership within a specific family, clan, or status group.

Although it is entirely possible that some of these differences are the result of a discrete social, political, religious, or immigrant group establishing a new burial ground at cemetery 3-J-

10, the easiest explanation for these differences is a diachronic change in the local mortuary

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program over time. It is clear that cemetery 3-J-11 was in use during the Pre-Christian,

Transitional, and Early Medieval Periods, however it is not entirely evident when the cemetery ceased to be used. Conversely, cemetery 3-J-10 was definitively used during the Late Medieval

Period, continuing through the Muslim conversion, and into the modern era. Therefore, as the local Mis Islanders more effusively adopted the Christian religion, it is likely that the new burial ground at cemetery 3-J-10 was established to demonstrate a fully Christianized community at

Mis Island. As the homogenized mortuary patterns at cemetery 3-J-10 demonstrate, membership within the larger Christian community became more important than membership within a specific family, clan, or status group on Mis Island.

Despite the diachronic change in mortuary patterns at Mis Island, however, there are no cemetery-specific differences in the prevalence of skeletal indicators of stress or disease among the two samples. Males and females of all age groups at both cemeteries 3-J-10 and 3-J-11 exhibit the same elevated levels of skeletal indicators of stress, regardless of their burial chronology, mortuary patterns, or burial location. As such, all of the adults at Mis Island appear to display the same elevated levels of non-specific indicators of stress and disease, indicating that the local environment likely played a larger role in the health of the community than any changes in the religious, political, or social atmosphere.

Question 4: How does health and disease at Mis Island compare to the experience of health at the Second Cataract site of Kulubnarti?

An evaluation of cribra orbitalia, linear enamel hypoplasias, and maxillary sinusitis at

Mis Island and Kulubnarti demonstrates that health was rather poor for both of these medieval

Nile Valley communities. A direct comparison of the prevalence rates of cribra orbitalia and

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maxillary sinusitis demonstrate that these indicators of stress are statistically higher in the Mis

Island population. In contrast, the frequency and average number of LEH per tooth in individuals at Kulubnarti are remarkably higher. Although these findings would appear to be rather contradictory, there are a number of possible explanations for the health disparities between these two populations.

The difference in the prevalence of maxillary sinusitis between the two sites could indicate that there were higher rates of respiratory illness in the adult population at Mis Island.

While it is likely that many of the outdoor factors contributing to maxillary sinusitis at both

Kulubnarti and Mis Island were similar, it is unclear what differences in indoor factors might have influenced the prevalence of maxillary sinusitis at Mis Island. While the present community at Mis Island cooks indoors over small fires, it remains unclear whether this was also practiced during the medieval period. There is no definitive archaeological information regarding cooking or other smoke-producing cultural practices in the medieval population at Mis Island and therefore, it is difficult to determine what would account for the significant difference between the two sites. Further archaeological and ethnographic research at Mis Island will hopefully further contribute to this discussion.

Although distinctions in the prevalence of maxillary sinusitis between Mis Island and

Kulubnarti appears rather clear, differences in the frequency of cribra orbitalia and LEH are more complicated. At first glance, the increased prevalence of cribra orbitalia at Mis Island and the increased frequency of LEH at Kulubnarti could indicate conflicting arguments for health among the two populations. For example, the higher prevalence of cribra orbitalia at Mis Island might be explained by a number of factors, such as 1) differences in dietary intake between the two sites and the possibility for a chronic depleted consumption of Vitamin C, folate, or B12 rich

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foods at Mis Island; or 2) differences in agricultural practices between the two sites and an increase in parasite activity at Mis Island. Saqia and irrigation farming likely practiced at Mis

Island are known to produce higher parasite and pathogen loads than the seluka or flood plain farming practiced at Kulubnarti. The constant presence of standing water in irrigation canals are prime breeding grounds for a number of harmful parasitic diseases, including schistosomiasis, leishmaniasis, and malaria. The presence of these kinds of parasitic diseases within a local community have been demonstrated to produce a variety of anemic conditions, including megaloblastic and hemolytic anemias, which could directly contribute to the increased formation of cribra orbitalia and porotic hyperostosis at Mis Island.

On the other hand, the higher prevalence of linear enamel hypoplasias at Kulubnarti could be due to a number of other health-related factors. The higher frequency of LEH at

Kulubnarti likely indicates that more acute or injurious childhood stressors, such as weaning, were increasingly prevalent and detrimental for young children at Kulubnarti. Differences in childhood experience, the timing of weaning, and dietary intake of weanling children at Mis

Island is poorly understood however, and a definitive conclusion about further differences in the frequency of linear enamel hypoplasias related to weaning is difficult to determine until further research is conducted.

The higher frequency of LEH and the lower prevalence of cribra orbitalia at Kulubnarti in comparison to Mis Island could have another possible explanation, however. It is entirely possible that the contrast in these health indicators between the two sites could actually make an argument for a better health experience at Mis Island than at Kulubnarti. The „osteological paradox‟ argues that individuals exhibiting skeletal indicators of stress such as cribra orbitalia, porotic hyperostosis, and periostitis are actually healthier than their counterparts who do not

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exhibit these non-specific indicators (Wood et al. 1992). The argument is that the unhealthiest cohort of individuals will die before their skeletons have time to adapt and produce the skeletal manifestations of poor health. As such, the high prevalence of adults at Mis Island exhibiting cribra orbitalia, porotic hyperostosis, and periostitis are actually examples of individuals who have healed from and survived prior health insults. Furthermore, the higher number of old adults within the Mis Island sample could demonstrate that the average life span of inhabitants at Mis

Island is longer than that at Kulubnarti. Bioarchaeological research at Kulubnarti paints a dismal picture for health of the local inhabitants, with high infant mortality rates, low birth rates, low growth trajectories, and particularly high prevalence rates of LEH (Hummert 1983; Hummert and van Gerven 1983; van Gerven et al. 1981, 1990, 1995). Although there are relatively high frequencies of many non-specific childhood indicators of stress within the Mis Island sample, the low severity levels and healed nature of the lesions indicate that the adults at Mis Island were healthy enough to fight infection for a sustained period of time and ultimately survive the original insult. Therefore, it is clear that childhood health was poor at Mis Island, possibly as poor as at Kulubnarti, however, the healed nature of these lesions in adults that lived well into old adulthood demonstrates that adult health at Mis Island was possibly not as bad as at

Kulubnarti. Further research regarding the health of subadults in the sample, infant mortality rates, and investigations into the isotopic indicators of diet can help further clarify the differences between Kulubnarti and Mis Island and how much the “osteological paradox” has a place in the current health comparison.

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FUTURE RESEARCH

As the first research endeavor using the mortuary and skeletal data from Mis Island, this study has provided a new perspective on the life and death of medieval Nubians living in the

Fourth Cataract of the Nile River. In addition to a basic understanding of mortuary ritual and skeletal health of individuals at Mis Island, this study has also provided a baseline of knowledge for the formation of a number of research questions and hypotheses. There are infinite possibilities for future investigations on the present mortuary and skeletal collection and this section aims to highlight the most pressing questions that might further clarify the findings in the current study. Research that can further contribute to this study spans a number of different enquiries, including the following:

A clarification of the overall health of the medieval Christian sample from Mis Island:

o Investigations into subadult health and the prevalence of non-specific indicators

of stress and disease, the hypothesized age of weaning in relation to LEH

formation, and infant mortality rates;

o Isotopic enquiries into the overall diet of the medieval Mis Islanders, focusing on

the consumption of animal proteins, vitamin B12, vitamin C, and folate rich food

resources;

o Isotopic enquiries into the seasonality of food consumption at Mis Island and

whether it relates to the prevalence of cribra orbitalia and porotic hyperostosis

within certain areas of the cemeteries;

o DNA identification of specific disease processes within the Mis Island sample for

further clarification of probable tuberculosis and leprosy found in the current

study;

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Further research into understanding the mortuary differences between cemeteries 3-J-10 and 3-J-11:

o Carbon dating on a number of transitional burials within cemetery 3-J-11, as well

as a number of fully Christianized burials at both cemeteries 3-J-10 and 3-J-11 to

further clarify the chronology of medieval burials at Mis Island;

o A comparison of craniomorphometric, non-metric traits, and mitochondrial DNA

profiles to determine whether there are any population differences between

cemeteries 3-J-10 and 3-J-11;

o A comparison of traumatic injuries and musculoskeletal activity markers among

individuals at cemeteries 3-J-10 and 3-J-11 to determine if there are any

diachronic changes in injury, interpersonal violence, or hard labor at Mis Island.

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APPENDIX A

Mortuary Photographs

This appendix includes a selection of photographs to illustrate the types of mortuary variables discussed in the current study. These photographs are intended to provide examples of many of the burial patterns found at Mis Island, including a selection of grave monuments, head coverings, blocking stones, grave inclusions, and body positions of individuals from both cemeteries 3-J-10 and 3-J-11. All photographs in this appendix were taken by archaeologists and bioarchaeologists during the excavation and are kindly provided by Andrew Ginns, Catherine

Bird, Lindsey Jenny, Tracey Tichnell, and Andrea Clowes.

Figure 52: Overview of Cemetery 3-J-10.

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Figure 53: Overview of Cemetery 3-J-11.

Figure 54: Examples of Christian Stone and Mudbrick Box Monuments at Mis Island, Cemetery 3-J-18B.

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Figure 55: Cemetery 3-J-11 Grave 3266 Skeleton 3265, Blocking Stones.

Figure 56: Cemetery 3-J-11, Example of Burial with Head Covering and Grave Goods.

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Figure 57: Cemetery 3-J-10 Grave 5236 Skeleton 5235, Head Coverings.

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Figure 58: Cemetery 3-J-11 Grave 1420 Skeleton 1422, Child Laid on Right Side with no Structural Elaboration.

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Figure 59: Cemetery 3-J-10 Grave 5074 Skeleton 5070, Adult Laid Supine with no Structural Elaboration.

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APPENDIX B

Paleopathology Photographs

This appendix includes a selection of photographs to illustrate the indicators of health and disease discussed in the present study. Photographs of non-specific indicators of stress, such as linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis, and maxillary sinusitis are intended to provide examples of the type of pathological conditions, as opposed to detailed photographs of each selected case. Photographs of more specific disease processes, such as tuberculosis and leprosy, are intended to provide documentation of how each of these pathological conditions were diagnosed on all affected individuals within the sample. All of the

photographs presented here were taken by the author at the time of study. Each photograph is labeled with the skeleton number, the anatomical orientation of the remains being photographed, and the pathological condition being illustrated. Arrows may be provided to point to more specific areas of the skeletal remains. The photographs appear in the following order:

Linear Enamel Hypoplasias (LEH)

Porotic Hyperostosis

Cribra Orbitalia

Maxillary Sinusitis

Osteomyelitis

Tuberculosis

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Figure 60: Cemetery 3-J-11 Skeleton 1158, LEH, Left Mandibular Canine, Labial View.

Figure 61: Cemetery 3-J-11 Skeleton 1158, LEH, Left Mandibular Canine, Distal View.

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Figure 62: Cemetery 3-J-11 Skeleton 1077, Healed Porotic Hyperostosis, Posterior View of Cranium Surrounding Lambda.

Figure 63: Cemetery 3-J-11 Skeleton 1041, Healed Cribra Orbitalia.

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Figure 64: Cemetery 3-J-11 Skeleton 1086, Active Maxillary Sinusitis with Spicule Formation, Left Maxillary Sinus.

Figure 65: Cemetery3-J-11 Skeleton 1086, Active Maxillary Sinusitis with Spicule Formation, Right Maxillary Sinus.

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Figure 66: Cemetery 3-J-11 Skeleton 1146, Osteomyelitis, Left Tibia Overview.

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Figure 67: Cemetery 3-J-11 Skeleton 1146, Osteomyelitis, Left Tibia, Anterior View of Cloaca.

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Figure 68: Cemetery 3-J-11 Skeleton 1146, Osteomyelitis, Left Tibia, Lateral View of Cloaca with Bone Formation.

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Figure 69: Cemetery 3-J-11 Skeleton 1074, Lytic Lesion, Tuberculosis, Anterior Bodies T11-L3.

Figure 70: Cemetery 3-J-11 Skeleton 1074, Lytic Lesion, Tuberculosis, Lateral Bodies T11-L3.

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Figure 71: Cemetery 3-J-11 Skeleton 1074, Periostitis, Tuberculosis, Left Ribs 10-12 and Right Ribs 11-12.

Figure 72: Cemetery 3-J-11 Skeleton 1077, Lytic Lesions, Tuberculosis, Anterior Bodies T12-L4.

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Figure 73: Cemetery 3-J-11 Skeleton 1131, Pott‟s Disease with Vertebral Destruction and Collapse, Tuberculosis, Lateral Bodies T6-L1.

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Figure 74: Cemetery 3-J-11 Skeleton 1288, Lytic Lesion, Tuberculosis, Anterior Body L2.

Figure 75: Cemetery 3-J-11 Skeleton 1288, Lytic Lesions, Tuberculosis, Posterior Body L2.

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Figure 76: Cemetery 3-J-11 Skeleton 1466, Periostitis and Lytic Lesions, Possible Tuberculosis, Visceral Surface Right Rib Fragments.

Figure 77: Cemetery 3-J-11 Skeleton 3265, Lytic Destruction of Tarsals and Foot Phalanges, Possible Leprosy. Photograph Provided by Rebecca Redfern.

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Figure 78: Cemetery 3-J-11 Skeleton 3265, Lytic Destruction of Foot Phalanges, Possible Leprosy. Photograph Provided by Rebecca Redfern.

Figure 79: Cemetery 3-J-11 Skeleton 3265, Lytic Destruction of Metacarpal and Hand Phalanges, Possible Leprosy. Photograph Provided by Rebecca Redfern.

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