Anemia

Anemia, an insufficiency of red blood cells (RBC) and hemoglobin for oxygen-carrying needs, results from a variety of disease processes, some of which have existed since ancient times.

It was defined in quantitative terms in the mid-nineteenth century, but before that the evidence of anemia is found in the descriptions of pallor or in the occurrence of diseases that we now know cause anemia.

For example, lead poisoning decreases RBC production and was apparently widespread in Rome. Intestinal parasites cause iron deficiency anemia and were known to exist in ancient times. Parasites found in paleopathological specimens include many that can cause intestinal blood loss and anemia. Congenital abnormalities in RBC metabolism (including glucose 6-phosphate dehydrogenase [G6PD] deficiency and various forms of thalassemia and sickle-cell anemia ) were probably also present in ancient times.

All of these, including thalassemia, protect against malaria, and the incidence of the relatively mild, heterozygotic thalassemia minor probably increased in the Mediterranean region after the appearance of falciparummalaria, the most fatal type of the disease. Iatrogenic anemia was also common throughout most of recorded history, because bleeding was considered therapeutic from Greek and Roman times until the midnineteenth century.

Pernicious Anemia

Awareness of this type of anemia appears in the second half of the nineteenth century. Thomas Addison of Guy’s Hospital described a severe, usually fatal form of anemia in 1855. Macrocytes were recognized by George Hayem in 1877; he also noted a greater reduction of hemoglobin than of RBCs in pernicious anemia (PA). In 1880, Paul Ehrlich found large nucleated RBCs in the peripheral blood containing dispersed nuclear chromatin; he called them megaloblasts, correctly concluding that they were precursors of Hayem’s giant red cells that had escaped from the marrow.

Iron Deficiency

Anemia Iron deficiency anemia is by far the most common cause of anemia in every part of the world today. It undoubtedl y existed in ancient times as well. In this condition, fingernails develop double concave curvature, giving them a spoon shape ( koilonychia ). A Celtic temple at Nodens, in Gloucestershire, England, built in Ascelpian style after the Romans had left Britain in the fourth century A.D., contains a votive offering of an arm fashioned crudely pro ximally but with increasing detail distally; it shows characteristic koilonychia.

Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency

Favism, or hemolytic anemia due to ingestion of fava beans, is now known to occur in individuals deficient in G6PD. The Mediterranean type of G6PD deficiency is found in an area extending from the Mediterranean basin to northern India, an area corresponding to Alexander’s empire. Sickness resulting from ingestion of beans was probably recognized in ancient Greece, forming the basis for the myth that Demeter, Greek goddess of harvest, forbade members of her cult to eat beans. Pythagoras, physician and mathematician of the fifth century B.C. who had a great following among the Greek colonists in southern Italy, also seems to have recognized the disorder, since he, too, forbade his followers to eat beans. It is in that area of southern Italy that the incidence of G6PD deficiency is highest.

Sickle-Cell Disorders

Sickle-cell disorders have existed in human populations for thousands of years. However, the discovery of human sickle cells and of sicklecell anemia was first announced in the form of a case report by James Herrick at the Association of American Physicians in 1910. In 19 04, Herrick had examined a young blac k student from Grenada who was anemic; in the blood film he observed elongated and sickle-cell-shaped RBCs.

Thalassemia

Thalassemia, an inherited form of anemia, results from the deficient synthesis of a portion of the globin molecule and is also thought by some to have stabilized in the face of malaria. A variety of forms exist, based on the chain and site within a specific chain at which the genetically determined defect exists. It has been suggested that thalassemia originated in Greece and spread to Italy when it was colonized by Greeks between the eighth and sixth century B.C. At present, it is most frequent in areas where ancient Greek immigration was most intense: Sicily, Sardinia, Calabria, Lucania, Apulia, and the mouth of the Po.

Porotic Hyperostosis

Chronic anemia from any cause produces bone changes, which can be recognized in archaeological specimens. These changes, called porotic hyperostosis (or symmetrical hyperostosis) result from an overgrowth of bone marrow tissue, which is apparently a compensatory process. Today, porotic hyperostosis is seen classically in X-rays of patients with congenital hemolytic anemias, as well as in children with c hronic iron deficiency anemia. This is especiall y the case when the iron deficiency occurs in premature infants or is associated with protein malnutrition or rickets.