PALEOPATHOLOGY: METHODS AND PROBLEMS

Because direct evidence of disease among ancient human beings is very limited, we will have
to seek out a variety of indirect approaches in order to reach at least a tentative
understanding of the prehistoric world. For example, studies of our closest relatives, the
great apes and monkeys, have shown that living in a state of nature does not mean freedom
from disease. Wild primates suffer from many disorders, including arthritis, malaria, hernias,
parasitic worms, and impacted teeth. Our ancestors, the rst naked apes, presumably
experienced disorders and diseases similar to those found among modern primates during a
lifespan that was truly nasty, brutish, and short. Neverthe- less, prehistoric peoples
gradually learned to adapt to harsh environ- ments, quite unlike the mythical Garden of
Eden. Eventually, through cultural evolution, human beings changed their environment in
unprece- dented ways, even as they adapted to its demands. By the domestication of
animals, the mastery of agricultural practices, and the creation of densely populated
settlements, human beings also generated new patterns of disease. Paleopathologists must
use a combination of primary and second- ary evidence in order to draw inferences about
prehistoric patterns of disease. Primary evidence includes bodies, bones, teeth, ashes, and
charred or dried remains of bodies found at sites of accidental or inten- tional human
burials. Secondary sources include the art, artifacts, and burial goods of preliterate peoples,
and ancient documents that describe or suggest the existence of pathological conditions.
The materials for such studies are very fragmentary, and the over-representation of the hard
parts of bodiesbones and teethundoubtedly distorts our por- trait of the past. Indeed
the possibility of arriving at an unequivocal diagnosis through the study of ancient remains is
so small that some scholars insist that the names of modern diseases should never be
conferred on ancient materials. Other experts have systematically cataloged paleo- lithic
ailments in terms of congenital abnormalities, injury, infection, degenerative conditions,
cancers, deciency diseases, and that all-too- large category, diseases of unknown etiology.
Nevertheless, by combining a variety of classical and newly emerg- ing techniques, scientists
can use these fragmentary materials to gain new insights into the patterns of ancient lives.
The study of human remains from archaeological contexts may also be referred to as bio-
archaeology, a eld that encompasses physical anthropology and archaeology. Funerary
customs, burial procedures, and environmental con- ditions, such as heat, humidity, soil
composition, can determine the state of preservation of human remains. Cremation, in
particular, could create severe warping and fragmentation of the remains. Bodies might be
buried in the ground shortly after death, covered with a mound of rocks (cairn burial), or
placed on a scaffold and exposed to the elements. Both nomadic and settled people might
place a body in some type of scaffold as a temporary measure if the death occurred when
the groundwas frozen. Later, the skeletal remains could be interred with appro- priate
ceremonies. In some cemeteries the dead might be added to old graves, causing the
commingling of bones. Added confusion arises from ritual mutilation of the body, the
admixture of grave goods and gifts, which may include body parts of animals or grieving
relatives, and dis- tortions due to natural or articial mummication. Burrowing animals and
looters might also disturb burial sites and change the distribution of bones. Catastrophes,
such as oods, earthquakes, landslides, and mas- sacres, may provide information about a
large group of individuals during one moment in time. Despite the increasing sophistication
and power of the new analyti- cal techniques employed in the service of paleopathology,
many uncer- tainties remain, and all results must still be interpreted with caution. Since the
last decades of the twentieth century, scientists have exploited new methods, such as DNA
amplication and sequencing, the analysis of stable isotopes of carbon and nitrogen, and
scanning electron microscopy in order to ask questions about the health, lifestyle, and
culture of ancient peoples. Scanning electron microscopy has been used to examine patterns
of tooth wear and enamel defects caused by stress and growth disruption, and the effect of
workload on the structure of limb bones. Where possible, chemical investigations of trace
elements extracted from ancient bones and hair can provide insights into ancient dietary
patterns and quality of life. Lead, arsenic, mercury, cadmium, copper, and strontium are
among the elements that can be identied in hair. The analysis of stable isotopes of carbon
and nitrogen provides insights into bone chemistry and diet, because the ratios of the stable
isotopes of carbon and nitrogen found in human and animal remains reect their ratios in
the foods consumed. Thus, the relative importance of plant and animal foods in the diet of
prehistoric populations can be estimated. Differences in ratios found in human bones for
different time periods may reveal changes in diet. For example, scientists determined the
relative amounts of carbon 13 and nitrogen 15 in the bones of human beings living in various
parts of Europe more than twenty thousand years ago. These studies suggested a diet that
was high in sh, shellsh, and waterfowl. Analyses of the isotopes in the bones of
Neanderthals, in contrast, suggested that their dietary proteins came largely from the esh
of larger prey animals. Today, and presumably in the past, most infections involved soft
tissue rather than bones, but bones and teeth are the primary source of paleopathological
information. Scientists can subject skeletal remains to X-rays, CT (computer tomographic)
imaging, chemical analysis, and so forth. The bones may reveal evidence about an
individuals history of health and disease, age and cause of death.Specic injuries identiable
in ancient remains included fractures, dislocations, sprains, torn ligaments, degenerative
joint disease, ampu- tations, penetrating wounds, bone spurs, calcied blood clots, nasal
septal deformities, and so forth. Projectile weapons, such as spears and arrows, have been
found in fossilized vertebrae, sternum, scapula, humerus, and skulls. But projectile tips
embedded in bone are rare, either because healers extracted them, or, most likely, the
projectile point that caused a fatal injury lodged in soft tissues. In some cases long-term sur-
vival occurred after penetrating wounds, as indicated by projectile parts that were
incorporated into the injured bone and retained as inert foreign objects. In favorable cases,
the type of injury and the length of time that elapsed between the traumatic event and
death can be estimated. Bones usually heal at relatively predictable rates. Survival and
healing suggest some form of treatment, support, and care during convalescence. Some
skeletons exhibit fractures that resulted in deformities that must have caused difculty in
walking, chronic pain, and degenerative joint dis- ease. The fact of survival suggests the
availability of effective assistance during convalescence and after recovery. During healing,
bone is usually replaced by bone. Sometimes, however, healing is faulty; complications
include osteomyelitis, delayed or nonunion, angular deformities, bone spurs in adjacent soft
tissues, calcied blood clots, growth retardation, aseptic necrosis, pseudoarthrosis (brous
tissue is substituted for bone), and degenerative joint disease (traumatic arthritis). Bone is a
dynamic living tissue constantly being modied in response to the stimulus of growth, and to
physiological and pathologi- cal stresses. Many factors, such as age, sex, nutrition,
hormones, heredity, and illness, affect the bones. Heavy labor or vigorous exercise can result
in increases in bone mass. Degenerative processes change the size, shape, and conguration
of the skeleton and its individual bones. The skeleton can be modied by inammation of
the joints (arthritis) and by decreases in bone density (osteoporosis). Bones respond to
changes in their environment, especially the mechanical environment created by body
weight and muscle forces. The morphology of a bone, therefore, records the mechanical
forces exerted on it during life. Usually, paleopathologists are interested in bones that
display obvious pathology, but normal bones can provide evidence of body size, behavior,
degree of sexual dimorphism, activities, workloads, and posture. Bones may, therefore,
testify that an individual habitually performed heavy lifting, pushing, pulling, carrying,
standing, stooping, walking, running, or squatting. For example, a peculiarity of the ankle
joint, known as a squatting facet, is found in people who spend much of their times in a
squatting position. Thus, the absence of squatting facets distinguishes those who sat in
chairs from those who did not.Most diseases do not leave specic signs in the skeleton, but
tuberculosis, yaws, syphilis, and some fungal infections may leave diag- nostic clues.
Twentieth century studies suggest that the skeleton is affected in about one to two percent
of tuberculosis patients. The kinds of bone lesions caused by syphilis are generally different
from those caused by tuberculosis. Congenital syphilis may produce the so-called
Hutchinsons incisor defect. Leprosy often results in damage to the bones of the face,
ngers, and toes. Because hormones regulate the growth and development of all parts of
the body, a malfunction of the endocrine glands may leave signs in the bones. Some
peculiarities in ancient skeletal remains have been attributed to abnormalities of the
pituitary and thyroid glands. However, because of recent changes in patterns of disease,
physicians, unlike paleopathologists, rarely see the results of historically signicant severe,
untreated infectious diseases. Various cancers may be identiable in skeletal remains.
Although primary bone cancers are probably rare, many other cancers may spread to the
bone. Some relatively uncommon conditions, such as osteomyelitis and various benign
tumors of the bone and cartilage, have been of particular interest to paleopathologists
because they are easily recognized. Various forms of malnutrition, such as rickets, scurvy,
and anemia, may cause abnormalities in the structure of the bone (porotic hyperos- tosis).
Rickets was rare during Neolithic times, but became increasingly common as towns and
cities grew. Osteomalacia, an adult form of rick- ets, can cause collapse of the bones of the
pelvis, making childbirth a death sentence for mother and fetus. The presence of calcied
blood clotsinmanyskeletonsmightreecttheprevalenceofscurvyinaparticu- lar population.
Given heavy or chronic exposure, some soil elements, such as arsenic, bismuth, lead,
mercury, and selenium, can cause toxic effects that leave their mark on the bones. Porotic
hyperostosis is a pathological condition characterized by porous, sieve-like lesions that are
found in ancient human skulls. These lesions may be caused by mal- nutrition and infectious
diseasesiron deciency anemia or inam- matory processes, bleeding associated with
scurvy, or certain diseases (rickets, tumors). Generally, it is difcult to determine the specic
cause of such defects. Moreover, postmortem damage can simulate these conditions.
Although tooth decay and cavities are often thought of as the results of a modern diet,
studies of contemporary primitives and research on ancient skeletons disprove this
assumption. Dental problems and dis- eases found in human remains include dental attrition
due to diet, temporomandibular joint derangement, plaque, caries, abscesses, tooth crown
fractures, tooth loss, and so forth. Analysis of dental microwear patterns by scanning
electron microscopy and microwear measurements began in the 1980s. Microscopic pits,
scratches on tooth surfaces, andsurface attrition reveal patterns of wear caused by abrasive
particles in food. Abrasive wear could lead to infection and tooth loss. Dental dis- orders
were often worse in women, because of the effects of pregnancy and lactation, and the use
of teeth and jaws as tools. In general, the condition of bones and teeth provides a history of
health and disease, diet and nutritional deciencies, a record of severe stresses or workload
during life, and an approximate age at death. Bone fractures provide a record of trauma,
which might be followed by infection or by healing. Before the nal closure of the epiphyses,
the growing bones are vulnerable to trauma, infections, and growth disorders. Stresses
severe enough to disrupt growth during childhood result in transverse lines, usually called
Harris lines or growth arrest lines, which are visible in radiographs of the long bones of the
body. Because Harris lines suggest severe but temporary disturbance of growth, a
population suffering from chronic malnutrition has fewer transverse lines than one exposed
to periodic or seasonal starvation. Starvation, severe malnutrition, and severe infection may
also leave characteristic signs in the teeth, microdefects in dental enamel known as
pathological striae of Retzius, enamel hypoplasias, or Wilson bands. Severe episodes of
infant diarrheas, for example, can disrupt the devel- opment of teeth and bones. Scanning
electron micrography makes it possible to observe disruptions in the pattern of these lines,
but there is still considerable uncertainty about the meaning of pathological striae of
Retzius. Archaeological chemistry, the analysis of inorganic and organic materials, has been
used in the discovery, dating, interpretation, and authentication of ancient remains. This
approach provides many ways of reconstructing ancient human cultures from bits of stone
tools, ceramics, textiles, paints, and so forth. By combining microscopy with chemical
analysis, scientists can recover information about the manu- facture and use of ancient
artifacts because such objects carry with them a memory of how they were manipulated
in the past. Perhaps the most familiar aspect of archaeological chemistry is the carbon-14
method for dating ancient remains. Carbon-14 dating is especially valuable for studying
materials from the last ten thousand years, the period during which the most profound
changes in cultural evolution occurred. Multidisciplinary groups of scientists have combined
their expertise in archaeology, chemistry, geophysics, imaging technology, and remote
sensing as a means of guiding nondestructive investigations of sensitive archeological sites.
As the techniques of molecular biology are adapted to the questions posed by
paleopathologists, new kinds of information can be teased out of the surviving traces of
proteins and nucleic acids found in some ancient materials. Improvements in
instrumentation allow archaeologists to analyze even smaller quantities of biological
materials. For example, by using mass spectrometry and lipid bio- markers chemists can
distinguish between human and other animal remains.