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Authors: Estelle Lazer

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Features consistent with HFI in Pompeian wall painting?

A wall painting from the
Casa di Adone Ferito
(VI, vii, 8) depicts a naked hermaphrodite surrounded by three attendants, one of which appears to be a woman sporting a rather luxuriant beard.
158
The interpretation of the bearded individual in this painting is problematic and it could variously be explained as either a male in female garb, or as a woman with a disorder. This painting was described at length in the nineteenth century by Raoul-Rochette.
159
He described the figure in question as being sexually equivocal. He considered that the beard was consistent with a male attribution but the dress and the long curly hairstyle that fell down over the shoulders were indicative of a female. Further, the mirror that was held in the right hand of this figure was interpreted as a feminine accessory. The style of dress worn by this figure, with one shoulder bared and a piece of material covering the top of the head, was claimed to be one that was favoured by women and certain effeminate men. Despite the fact that this figure is barely taller than the female attendant on the far right of the image, Raoul-Rochette cited the height as an additional argument for a male attribution. He concluded that this figure represented a male dressed in female clothing as a reflection of certain Eastern religions where a deity could have both male and female attributes. The figure of the hermaphrodite was used to support this view as Hermaphroditus, the child of a union between Aphrodite and Hermes, has often been identified with Oriental deities with combined sex.
160

A certain degree of caution should be exercised with the use of art for the diagnosis of medical conditions because such interpretations are based on the assumption that art works are literal images of what the artist observed. This is obviously not always the case as attested by the mythical elements that can be observed in this painting, like the hermaphrodite and the Eros in the foreground. This hermaphrodite is generally interpreted as Hermaphroditus, who is commonly encountered in Pompeian wall paintings.
161
Nonetheless, it is possible that elements of such works were informed by the experience of the artist. A good example can be seen in the depiction of pygmies in wall paintings and mosaics across the site. The pygmies in the numerous Nilotic scenes that have been found in Pompeii and other Campanian sites are all achondroplastic dwarfs.
162
It is likely that the artist who set the standard for the depiction of pygmies had never seen a real pygmy but had seen an achondroplastic dwarf. An argument can therefore be mounted that the bearded attendant in the painting from the
Casa di Adone Ferito
could well have been a representation of a person that the artist had actually seen. In view of the number of cases of HFI that have been observed in the Pompeian skeletal sample, it is tempting to consider the possibility that this painting may represent an individual displaying a sign of this syndrome.

Survival prospects of individuals with HFI

The multiple occurrence of HFI in this sample raises the question of the survival prospects of affected individuals trying to escape from the
AD
79 eruption. It is likely that these victims were in the older age range. There is also the possibility that at least some of the cases were associated with obesity. Although HFI has been linked with various disorders, such as noninsulin dependent diabetes, headaches and psychiatric problems, no causal relationship has been established.
163
As a result, it would not be reasonable to assume the existence of these diseases from the skeletal record.

Obesity was certainly known in Campania in this period, as evidenced in the writing of the younger Pliny. In his letters to Tacitus describing the eruption of Mt Vesuvius and the death of his uncle,
164
he mentions that both Pliny the Elder and his mother were somewhat corpulent. His description of his relatives does not suggest that their obesity was at all remarkable for that period. It is possible, but by no means certain, that adiposity was a contributing factor to the respiratory failure that apparently resulted in Pliny the Elder’s death.
165
Pliny the Younger’s account of his flight from Misenum includes a passage where his mother entreats him to leave her behind as she was old and stout and would have possibly threatened his survival by slowing down his escape.
166
In the end, however, she did accompany her son and they both survived.

Although obesity, old age and other possible disorders would certainly not have advantaged individuals in their attempt to flee from Pompeii, there is no compelling evidence that, in the absence of more serious pathology, older, fat people would have been much less likely to escape than the rest of the general population.

If HFI had been a factor, which in fluenced survival prospects, one would have expected to find much higher percentage rates in the sample. Instead, the observed frequency of HFI suggests that the Pompeian skeletal sample reflects a normally distributed population rather than a sample biased by a high incidence of pathology.

Hyperostosis frontalis interna in the archaeological record

Until comparatively recently, few cases of HFI were reported in the archaeological literature and the interpretation of these cases is telling.
167
Armelagos and Chrisman reported a female Nubian skeleton dating to about 300
AD
. Gladykowska-Rzeczycka also recorded a case of HFI in a skeleton that was interpreted as that of an elderly female and was found in an archaeological context in Poland. Anderson identified a case of HFI in an AngloSaxon skeleton from Kent. The authors of these papers conclude that HFI only occurs rarely in archaeological remains, possibly as a result of a shorter lifespan in antiquity. Anderson suggested that the case he described, whom he aged between 30 and 40 years, may be a reflection of the earlier onset of menopause in antiquity, despite the fact that there is no biological justification for this argument.
168

Hyperostosis frontalis interna is not of great clinical signi ficance but it is a good health indicator as an individual has to survive long enough for it to be expressed. It can be difficult to detect in complete skulls and it is possible that scholars did not attempt to look for it because it may have been unexpected due to the often held assumption by physical anthropologists that lifespans were shorter in antiquity. The potential of HFI as a longevity descriptor has been recognized in recent years and it has been more actively investigated in the archaeological record. As a result, the last decade has seen a number of new cases of HFI reported from archaeological contexts, though most of these only involve one or two individuals.
169
Hershkovitz
et al
. surveyed a number of these cases and also concluded that HFI was rare in historic and prehistoric populations. They argued that in the Western world, the ‘industrial revolution’, in the mid-eighteenth century, marked the turning point in the increase in frequency as a reflection of increased longevity in females.
170
The frequency of HFI in the Pompeian skeletal record and the identification of the disorder in 12 out of 37 adults from Pueblo Bonito in New Mexico challenges these claims.
171

Small sample sizes have led to some interesting claims about HFI, including the suggestion that it was more common in males in antiquity.
172
The majority of cases in the multiple findings of HFI in the skeletal record in Pompeii and Pueblo Bonito tend to be female, which indicates that the sex-related nature of this disorder has not changed over time. It is possible that the apparently higher prevalence of males in isolated archaeological cases may be an artefact of small sample size and sex identification based on incomplete skeletal remains.

Few cases of HFI have been reported from Italian sites. These include a female skull from Isola Sacra, dating between the first and third centuries
AD
and two sexually indeterminate individuals from the Early Middle Age necropolis of Vincenne Campochiaro in Molise. These individuals were cautiously interpreted as female.
173

Given the large number of cases identi fied in the Pompeian sample, it is surprising that only one possible case of HFI has been reported from the Herculaneum sample that has been studied. Capasso mentions that two out of 162 individuals he studied presented with hyperostotic changes to the skull, but only one of these conforms to a possible diagnosis of HFI. He noted that there was evidence of hyperostotic change in the skull of an older female that was consistent with a hormonal disturbance that is typical of menopause. He estimated that this individual was about 50 to 55 years of age when she died. Unfortunately, he did not describe the pathology in great detail and did not refer to standard sources for classification, so assessment of his diagnosis is problematic.
174
It is extremely difficult to account for such a significant difference in the finds between these two sites. If this is correct, it suggests that there may be real distinctions between the Pompeian and Herculaneum samples and that they are not interchangeable, even though they are contemporary, geographically very close and all the victims died as a result of the same event. It is possible that Capasso, whose study included radiographic analysis of each skull, may not have observed HFI, especially if it were in the early stages. It has been noted that HFI can be difficult to detect on x-rays.
175
It would certainly be worthwhile to reinvestigate the Herculaneum crania with direct observations on the bone to ascertain whether the frequency of HFI really is so low.

It is probable that the cases of HFI in the present study re flect the incidence of this syndrome in the ancient Pompeian sample. The observed frequency of HFI in the 360 Pompeian skulls that were examined is between 11.1 per cent and 11.9 per cent, which is in the upper end of the range for the incidence cited by the literature of this disorder in modern populations. It should, however, be reiterated that the reported frequency of HFI in modern populations is probably an underestimate as it is generally sub-clinical and is often only incidentally reported. Since the presence of HFI in the Pompeian skeletal record is consistent with its apparent incidence in a modern population, it appears more likely to be a reflection of the frequency of its occurrence in the Pompeian sample than a major contributing factor to the demise of individuals when Mt Vesuvius erupted. This suggests that the total Pompeian skeletal sample is representative of a normally distributed population with no bias towards pathology.

Biochemical analysis for the determination of diet

Trace element analysis was conducted on the essentially complete skeletons retrieved from the House of Julius Polybius (IX, xiii, 1.3) in an attempt to establish the diet of the victims. It would not generally be considered appropriate to attempt biochemical analysis on the compromised and disarticulated Pompeian sample as no evidence of the archaeological context remains and it would be impossible to account for possible diagenesis.

Bisel, Capasso and Petrone
et al
. undertook independent trace element analyses of the Herculaneum material. Bisel pioneered trace element study on skeletal material from the region. Both human and non-human bone was analyzed by atomic absorption spectroscopy for calcium, magnesium, phosphorus, strontium and zinc. Soil samples taken from the same region as the bones were analyzed for calcium, magnesium, strontium and zinc. She considered that strontium would provide more information about diet than the other trace elements. This is because the strontium/calcium ratio in bone is said to indicate the proportion of animal or vegetable protein consumed during life. Calcium and strontium levels in plants are equivalent to those in the soil. As a result of this, herbivores have a higher level of strontium in their bones than carnivores. This scheme is complicated by the fact that sea creatures naturally contain high levels of strontium, which makes it difficult to separate a largely seafood diet from a vegetarian one. She argued that the data she obtained for this seaside town implied that terrestrial animals did not provide the main protein source for the Herculaneum sample and concluded that the Herculaneum population probably relied on vegetables, seafood or a combination of the two. Subsequent studies on skeletons from Pompeii and Herculaneum produced largely comparable results.
176

Unfortunately, more recent research casts doubt on the results of all these studies. While standard techniques were applied, trace element analysis has been superseded by stable isotope analysis, which produces much more reliable results. As yet, there has not been any attempt to establish whether stable isotope analysis would be appropriate for the skeletal remains of the victims of the
AD
79 eruption.
177
Current studies of refuse from the kitchens and latrines of Pompeii and Herculaneum may ultimately provide the best source of information about the ancient Campanian diet.
178

Lead content in the bones

It has been claimed that lead poisoning was the primary cause for the demise of Roman civilization.
179
Though the arguments for this contention are somewhat spurious, it continues to influence popular thought to the extent that scholars embarking on skeletal analysis of Roman remains are compelled to, at least, test the hypothesis that Roman populations suffered from significant lead exposure.
180

Lead is a toxin which can affect all human organs if absorbed in signi ficant quantities. When ingested, it is stored in bone and other tissues. The effects of continued exposure to lead are cumulative. It has been cited as a factor in retarding intellectual development in small children. Large doses can cause anaemia, intestinal spasm, nerve weakness or paralysis, kidney damage, changes of mood, convulsions, coma and death. In theory, the presence of lead in bone should increase with exposure and one would expect to see higher lead content with age. It can be leached out, however, as bone is remodelled. Leaching can also occur with age as a result of decalcification due to osteoporosis, or as a result of starvation or serious illness. A number of scholars, including Gilfillan, have claimed that the ingestion of lead produces sterility, miscarriage, stillbirth and a high level of infant mortality. Laboratory studies on animals indicate that there is a relationship between the presence of lead and decreased gonadal function and hence fertility, but there is no conclusive evidence that this is true for humans.
181

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