The implementation of saqia water-wheel irrigation in ancient Nubia allowed for an expansion of cultivatable land and is considered a primary factor behind the settlement growth along the Middle Nile Valley prior to and over the course of the medieval period (~375–1500 CE). However, these anthropogenic influences are believed to have created conditions favorable to mosquito populations and concomitantly, may have resulted in elevated malaria during the medieval period. The first goal of the dissertation was to investigate this hypothesis in examining skeletal remains excavated from two cemeteries at the Fourth Cataract site of Mis Island. Towards this objective, a method was used that involved assessing the presence of five skeletal lesions that have been implicated in malarial infection. To build on current perceptions of these lesions, the second goal of this research was to examine the lesions’ association with age of the individual and the association among the lesions. For one of these lesions—femoral cribra—there is a need to further understand variation in the lesion’s external appearance and the bone processes underlying its expression. Therefore, the third focus of this dissertation explored several variables visible on the lesion’s surface possibly associated with “activity” and “severity” which were also investigated using micro-computed tomography (micro-CT) methods. A relatively high estimated prevalence of malaria was observed in the skeletal remains excavated from Mis Island. These findings are consistent with the hypothesis of elevated malaria in the region during the medieval period associated with the effects of settlement growth and expansion of irrigated land that accompanied saqia agriculture intensification. Comparisons were also conducted between the two Mis Island cemeteries to examine potential temporal differences, and between sex and age cohorts to investigate relative exposure and possible endemicity of malaria. In comparing the two cemeteries, no significant differences in estimated malarial infection were found. Additionally, no significant differences in estimated malaria were observed between males and females. A significant association between estimated malaria and age was found, and the elevated frequencies across age groups may indicate a primarily endemic type of malaria in the region during the medieval period. In examining the association between the suite of lesions studied in this dissertation and age of the individual, the observed age-related patterns of the porous lesions were consistent with the hypothesis that their formation may be related to anemia. Furthermore, significant associations were observed between these lesions in the subadult age groups, but not among adults. These significant associations were between most of the porous lesions included in the suite of lesions and suggest shared processes involved in their formation. The results of femoral cribra’s possible “activity” and “severity” based on its external appearance provided preliminary support for such interpretations. Femoral cribra lesions estimated to be active or healing from the surface followed an age-related pattern anticipated for such statuses. Additionally, micro-CT analyses demonstrated trabecular differences in lesions that appeared healing consistent with more bone-forming processes. Investigating the severity of femoral cribra suggested a possible lesion progression of increased trabecular exposure and size visible on the surface which may be associated with resorptive processes and/or marrow hyperplasia.
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