A Companion to Paleopathology

Anne L. Grauer, Anne L. Grauer

• Publisher: Wiley-Blackwell
• Year: 2011
• ISBN:
  9781444345926
• Edition: 1
• Topic: Social Sciences
• Subtopic: Physical Anthropology
• Index: Social Sciences

A Companion to Paleopathology offers a comprehensive overview of this rapidly growing sub- field of physical anthropology.

• Presents a broad overview of the field of paleopathology, integrating theoretical and methodological approaches to understand biological and disease processes throughout human history
• Demonstrates how paleopathology sheds light on the past through the analysis of human and non-human skeletal materials, mummified remains and preserved tissue
• Integrates scientific advances in multiple fields that contribute to the understanding of ancient and historic diseases, such as epidemiology, histology, radiology, parasitology, dentistry, and molecular biology, as well as archaeological, archival and historical research.
• Highlights cultural processes that have an impact on the evolution of illness, death and dying in human populations, including subsistence strategies, human environmental adaptations, the effects of malnutrition, differential access to resources, and interpersonal and intercultural violence

CHAPTER 1

Introduction: The Scope of Paleopathology

Anne L. Grauer

The field of paleopathology, quite simply, entails the study of ancient disease. However, nothing is “quite simple” within this scientific discipline. As noted by Buikstra (2010), defining the term “ancient” can be as complex as defining the term “disease.” In part, this is due to our preconceived notions about these terms. “Ancient,” for instance, conjures thoughts of prehistoric or early historic life, dating hundreds to thousands of years ago. The term “disease” is often used to imply harmful changes caused by invading pathogens. Within paleopathology, however, the terms “ancient” and “disease” hold more nuanced, and even contested meaning. For instance, determining what material will be paleopathologically examined often relies upon the origin of the sample and/or the question being posed, rather than the date the individual(s) died. In many states throughout the U.S., human remains are considered “old” and are recovered archaeologically, rather than forensically (or under the auspices of funeral directors), when they are deemed to be over 100 years old. Hence, large numbers of human remains from as recently as the late 19th and early 20th centuries have been studied by paleopathologists. These are hardly “ancient” by most definitions. Yet, the information gained from these skeletal remains about human disease in the past is enormous.

The term “disease” is similarly complex. The colloquial use of the word, which often alludes to “infection,” ignores the complex processes and body changes that a wider definition of “disease” would encompass. If discrete pathogens (such as viruses or bacteria) are viewed as the sole cause of disease, then paleopathological investigation would be limited to exploring remnants of the body’s immunological response. Indeed, understanding what triggered an immune response in the past, how the response was triggered, and/or variation in the responses between individuals and populations are important goals which provide great insight into the past. But they are also extremely limiting. The term “disease” within paleopathology (and the medical community) is broader and more encompassing. Stedman’s Medical Dictionary (26th edition, 1995) defines disease, in part, as “an interruption, cessation, or disorder of body functions, systems, or organs … A morbid entity characterized usually by at least two of these criteria: recognized etiological agent(s), identifiable group of signs and symptoms, or consistent anatomical alterations…” (p. 492). Adopting this definition leads researchers to evaluate many types of conditions affecting the human body, including those with potential sociocultural etiologies, such as malnutrition, interpersonal violence, and deliberate body modification. Thus, paleopathological focus might begin with recognition of bony changes that are quantified and qualified: that is, recognition of “consistent anatomical alterations”; but continues with the exploration of singular or multifactoral causes of these alterations and the ramifications of the conditions on our understanding of human life. It is with these broad perspectives and goals that paleopathologists view the past.

A BRIEF HISTORY OF PALEOPATHOLOGY

As Dorothy Salisbury Davis, the 20th-century crime fiction writer quipped, “History’s like a story in a way: it depends on who’s telling it.” Chronicling the development of paleopathology is no exception. Individual perspectives shape the scope, direction, and intent of the discourse, resulting in many crafted explanations and interpretations. Within this volume a number of researchers look back to the roots, and follow the development of particular aspects of our field. Alongside their visions of the past, are histories told by a number of other researchers, including Moodie (1923), Williams (1929), Wells (1964), Janssens (1970), Jarcho (1966a), Brothwell and Sandison (1967), Buikstra and Cook (1980), Angel (1981), Ubelaker (1982), Buikstra and Beck (2006), Grauer (2008), and Buikstra (2010). The multiple interpretations reflect the complex and multidisciplinary nature of paleopathology.

To many, the inception of paleopathology can be found in the 19th century, with physicians and anatomists such as Rudolf Virchow (1821–1902), Frederic Wood Jones (1879–1954), and Grafton Elliot Smith (1871–1937) developing interests in recognizing disease in ancient human bone and mummies. Their training and expertise in human anatomy, identification of disease, and diagnosis, allowed them to make associations between the presence of lesions on bone (and in mummified tissues) and potential causes. In particular, Sir Marc Armand Ruffer (1859–1917), a professor of bacteriology and the first director of the British Institute of Preventive Medicine (argued to be the true “pioneer of palaeopathology” by Sandison (1967)), published numerous articles on disease in Egyptian mummies. His careful approach, which relied on comparisons of clinical manifestations of disease to lesions found in ancient remains, paved the way for histological and radiographic investigation into ancient disease within paleopathology today.

As the early 20th century took hold, a new approach towards understanding disease in the past developed, much to the credit of Earnest Hooton (1887–1954). While most of the work conducted on human skeletal remains in North America was intertwined with agendas within physical anthropology (that is, heavily focused on metric analyses and the recording of human physical variation), Hooton set off in a new direction. Trained in the classics, he examined the presence of disease in wider context. His unit of analysis moved from the individual to the population. Along with publishing his detailed metric and morphological data on Native American remains from Pecos Pueblo (Hooton 1930), he incorporated a broader body of data into his work: archaeological data. The presence of pathological conditions such as trauma, dental disease, and osteoarthritis, for instance, were inventively viewed across space and time, and interpreted alongside the effects of a changing environment, food preparation, diet, and the presence of infectious disease. As promising as Hooton’s synthesis appeared, however, it was not until decades later that his approach was rigorously adopted by others.

This is not to imply that work within paleopathology remained stagnant in the mid 20th century. On the contrary, Møller-Christensen, working with Danish material and particularly interested in leprosy, brought to paleopathology rigorous criteria for diagnosis coupled with a population approach (e.g. Møller-Christensen 1961). Similarly, Calvin Wells, publishing prolifically for two decades starting from the 1950s, provided paleopathologists with a large body of work that systematically evaluated the presence of a wide variety of skeletal conditions, and provided a benchmark from which other researchers could measure their rigor. The work of Ackerknecht (1953, 1965) offered a synthesis of many paleopathologists’ work, as he sought to highlight the field’s contributions to our understanding of the past.

During these same decades a division within paleopathology, as practice in North America and in Europe, took root (Roberts 2006; Mays 2010). In Europe, researchers tended to have medical backgrounds and focused on the presence of disease in particular individuals, leading to the publication of descriptive case studies. In North America, researchers were commonly trained in physical anthropology, and employed an anthropological approach to their inquiry. They had access to large samples of skeletons derived from archaeological excavations. Both trajectories had their flaws. Both came under fire in the 1960s. Brothwell and Sandison (1967), for instance, speaking to the “European approach” posited that “the time has come for some form of palaeopathological stock-taking and pooling of recently collected data” (Brothwell and Sandison 1967:xiv). Their volume sought to provide the field with a compendium of skeletally recognized conditions and diseases. Here, insights into the antiquity and geographical scope of skeletal lesions, as well as radiographic, histological, and photographic documentation were provided. On the other side of the Atlantic, Jarcho (1966b) was calling for a “revival of paleopathology” in the U.S. He criticized the direction that field had taken, which contributed to weak methodological work, the unsystematic collection of data, and the increasing marginalization of paleopathology from both the medical and archaeological communities.

In the decades that followed, substantial strides were taken within paleopathology. Great efforts were made to strengthen diagnostic criteria of diseases. This included providing careful descriptions of lesions in dry bone and firm clinical foundations for differential diagnosis (see Steinbock 1976; Ortner and Putschar 1981; Aufderheide and Rodriguez-Martin 1998; Ortner 2003). Methods to standardize data recording were offered by Ragsdale (1992), who argued for the careful use of description and classification of disease, and by Buikstra and Ubelaker (1994) and Brickley and McKinley (2004) who sought to devise comprehensive and systematic means of recording osteological data. Theoretical strides were also made. Slowly, paleopathological attention moved away from questions such as “what disease is this?” and “when was this disease first found in humans?” to questions of “how” and “why”. Huss-Ashmore et al. (1981), Armelagos et al. (1982), and Cohen and Armelagos (1984), for instance, offered ways in which paleopathological investigation could shed light on human nutrition and subsistence strategies, and how subsistence strategies could impact the presence of disease. Brothwell (1982), while exploring the promise of the field of environmental archaeology, offered provocative ways in which understanding details of complex urban environments might lead to a new understanding of host–pathogen relationships.

Throughout these decades new questions regarding the history of human disease were posed. Why, for instance, do some populations suffer from conditions that others do not? Why has the presence of some diseases seemingly changed over time? How might a wide range of variables affect the presence of diseases and disease processes? How might differences in human social interaction affect the host–pathogen relationship? Perhaps, it can be argued, the most profound changes within paleopathology have not come from focusing on populations rather than individuals, but rather have arisen with the influence and inclusion of different theoretical paradigms. These have recently been adopted in efforts to answer questions, and were borrowed from and expanded upon from other fields.

NEW DIRECTIONS IN PALEOPATHOLOGY

The multidisciplinary and multifocal approaches which characterized the history of paleopathology remain today and serve, in part, as sources of potential and tension within the field. As in the past, researchers today are not uniformly trained to be paleopathologists. They can be trained in medicine, dentistry, archaeology or physical anthropology, and choose to focus (sometimes only occasionally) on paleopathological questions and the examination of skeletal or mummified remains. Increasingly, however, making a productive contribution today to paleopathology not only requires superb familiarity with bone and/or preserved tissue, it requires a firm knowledge of microbiology, physiology, biochemistry, medicine, archaeology, history, and human culture, to name a few. Hence, the formulation of new questions within paleopathology has required even more of researchers, as they seek new means of obtaining answers. Recent efforts, for instance, to diagnose disease more accurately and to place it into an evolutionary context have led researchers to adopt technologically sophisticated techniques, such as tissue imaging and genetic testing. Similarly, efforts to understand environmental variables contributing to health and disease in the past are using sophisticated biochemical tests to explore stable isotopes and trace elements in bone. The technical knowledge needed to complete the requisite techniques, let alone to allow reasonable interpretation of the results (or manage the financial expense), has encouraged researchers to become more specialized and/or to seek to collaborate with specialists who may or may not be familiar with paleopathology at all. The promise of new information fuels a growing tension between the specialist and the generalist. Hence, it can be argued that the singular term “paleopathology” truly masks the variation and complexity within the field.

Productively contributing to paleopathology does not solely rely on technology. It can also be achieved through the development and implementation of new theories and approaches. Interestingly, for all the past published reflections on the field of paleopathology, few have delved into the theoretical premises upon which the discipline has been built. Taking it a step further, it could be argued that the topic is staunchly ignored. There are a number of ways that this oversight can be interpreted. First, perhaps one could argue that paleopathological research is an a-theoretical endeavor—meaning that there are no underlying assumptions being made or that multiple interpretations of data are not possible. This seems a bit preposterous. One of the key tenets upon which paleopathologists build their arguments is that disease processes occurring today are similar to those in the past, i.e. that pathogenesis does not change over time. We clinically identify the presence of a disease in modern humans, and assert that finding the same indicators on tissue samples from the past indicates that the identical pathogen or disease process was responsible. This is, in fact, a key reason why clinical case studies have been so important to paleopathological research. But recent work on the genera Mycobacterium (e.g., Monot et al. 2009) and Treponema (e.g., Hardham et al. 1997), calls this assumption into question, as the evolutionary paths of these pathogens are complex. If we argue that pathogens are capable of genetically changing over time, which might alter how they affect their hosts, then we must grapple with the assumption made in paleopathology that they do not.

An alternative interpretation is that exploring theoretical underpinnings is relatively new to paleopathology. Although paleopathology today is considered a scientific endeavor, its early practitioners were men of medicine, with their strengths resting in the application of biological knowledge to healing, not scientific research. But a huge component of paleopathology has incorporated scientific analyses of archaeological data for at least forty years. Shouldn’t it have been inevitable that we also adopt archaeological theory? We haven’t. Paleopathologists have been selective in their use of archaeological theory, opting consistently to apply the “processual approach” in spite of archaeology’s (and other fields such as anthropology, evolutionary biology, and genetics) ensuing labile and provocative paradigms. The processual approach, stemming from a labeled “New Archaeology”, germinated in the works of Willey and Phillips (1958), and more specifically tackled issues of mortuary analysis with publications by Binford and Binford (1968), Saxe (1970), and Binford (1971). The premise of the processual approach was that through rigorous and quantitative scientific investigation of mortuary remains, researchers could begin to piece together social dimensions of the past. Social dimensions, such as status, were viewed as predictable and recognizable responses to human environmental adaptation. The approach was deemed “positivist” and “deterministic” by opponents, who argued, in part, that developing scientific and statistical correlations between material artifacts within space and time did not equal “objective truth” about the past (e.g. Hodd...