A 900-year-old skeleton of a young child, unearthed from a Byzantine-era cemetery, is offering researchers a rare glimpse into the history of a painful childhood disease. An analysis of the remains suggests the child suffered from infantile cortical hyperostosis, a condition seldom seen in the archaeological record, providing new evidence of the health challenges faced by children in the Middle Byzantine period.
The study, led by bioarchaeologist Duru Yağmur Başaran and published in the journal Childhood in the Past, details the skeletal abnormalities found on a child who was between 2.5 and 3.5 years old at the time of death. The bones, excavated in the ancient city of Aphrodisias in modern-day Türkiye, display significant swelling and inflammation. This finding points to a probable diagnosis of what is now known as Caffey disease, a rare and often painful inflammatory bone disorder that affects infants.
An Unexpected Discovery in an Ancient City
The discovery was made in a Middle Byzantine cemetery at Aphrodisias, a once-thriving metropolis in southwestern Türkiye known for its extensive marble quarries and structures. During the excavation of a burial site designated Tomb 73A, archaeologists found the remains of two children buried together. One of these individuals, labeled S-TET-II-85-73A, immediately stood out to researchers due to the unusual condition of its bones.
The child was buried with grave goods, including a piece of a glass vessel and an earring, which was a common practice for non-adult burials in this period at Aphrodisias. While the presence of burial offerings provided cultural context, it was the skeleton itself that held the most compelling story. Başaran, a Ph.D. candidate at University College London’s Institute of Archaeology, undertook a detailed examination of the pathological changes to understand the child’s quality of life and cause of suffering.
Signs of Suffering Etched in Bone
A close osteological analysis revealed that several of the child’s bones were pathologically altered. The jawbone, the ulna (one of the forearm bones), and the shoulder blade all exhibited signs of significant thickening and inflammation. The changes were notably asymmetrical, affecting one side of the body more than the other. This pattern of uneven bone growth is a key indicator that separates certain systemic diseases from localized infections or injuries.
According to Dr. Eleni Fotopoulou, a paleopathologist at the University of Thessaloniki who commented on the findings, such asymmetry is highly unusual in ancient skeletal remains. It suggests a systemic condition that profoundly affected the child’s development during its short life. The inflammation would have likely caused chronic, severe pain, irritability, and fever, symptoms consistent with the modern clinical presentation of Caffey disease. The skeletal evidence paints a picture of a child who endured a difficult and painful illness.
The Diagnostic Challenge of Ancient Diseases
Eliminating Other Possibilities
Diagnosing a specific disease from bones that are centuries old is a complex process of elimination. The research team had to consider several other conditions that can leave similar marks on a developing skeleton. Among the possibilities were metabolic diseases like scurvy (vitamin C deficiency) and rickets (vitamin D deficiency), infections such as tuberculosis, and even non-accidental injury or child abuse.
However, each of these conditions has a distinct signature. Scurvy and rickets typically cause more widespread and symmetrical skeletal changes. Tuberculosis often affects the spine and joints in specific ways not seen in this individual. Trauma would likely present as fractures, which were absent. After carefully comparing the evidence against the diagnostic criteria for various paleopathologies, the researchers concluded that infantile cortical hyperostosis was the most plausible explanation.
A Probable Case of Caffey Disease
Infantile cortical hyperostosis, or Caffey disease, is a self-limiting inflammatory disorder of infancy characterized by the triad of fever, irritability, and tender soft-tissue swelling that is quickly followed by cortical thickening of the underlying bones. While the exact cause is still debated, a genetic component is strongly suspected. The disease typically manifests in the first few months of life and resolves on its own, although the bone deformities can persist.
The pattern of swelling in the jawbone and the asymmetrical involvement of long bones in the Aphrodisias child strongly matched the clinical profile of ICH. While a definitive diagnosis is impossible without soft tissue or DNA evidence, the skeletal manifestations make a compelling case. This finding is significant because very few cases of this rare disease have been identified in the archaeological record, making each new discovery critical for understanding its historical prevalence and expression.
Life and Death for a Byzantine Child
This individual case provides a poignant window into the realities of childhood health and disease in the Byzantine world. The presence of a rare, and likely genetic, disorder demonstrates that such conditions existed long before they were clinically described in the 20th century. Furthermore, the fact that the child lived to be approximately three years old suggests they received care. Despite the pain and physical challenges associated with the disease, the child was nourished and supported by its community for several years.
The burial alongside another child, with associated grave goods, reinforces the idea that this child was a valued member of its society. The find contributes to a growing body of bioarchaeological research that uses skeletal evidence to reconstruct the lived experiences of past populations, particularly those of children, who are often underrepresented in historical texts. The bones of the child from Aphrodisias tell a silent story of suffering, resilience, and care in a world far removed from our own.