SELECTED STUDIES

"Research motivated not by grant or commercial interest, but by curiosity and fascination."
- Aidan Cockburn (1973)

Imagine yourself as a detective assigned to solve a series of ‘cold case’ murders – ones where the victims have been dead for 500, 1000, or even 5,000 years! The members of the Paleopathology Association (PPA) routinely tackle such mysteries as they examine skeletal remains, mummified bodies, and sometimes even works of art in their efforts to understand how illness and death strike the living.

The term ‘paleopathology’ was coined in 1892 from two Greek words, ‘palaeos’ (ancient) and ‘pathos’ (suffering). The Association is a scholarly society made up of anthropologists, physicians and other medical professionals, historians, and archaeologists who are united by their common interest in disease and its manifestations in populations of the past. It was organized in 1973 by a group of scientists gathered at the Detroit Institute of Arts in February, 1973, for a seminar on the study of ancient human remains, sponsored by Wayne State University School of Medicine, the Smithsonian Institution, and DIA. The seminar included lectures on different aspects of paleopathology, and featured the autopsy of a very cold case, the mummy of a 30-40 year-old man from Ancient Egypt who died around 700 B.C. (Cockburn 1973). The unwrapping and examination took 8 hours, and included radiographic and gross examination of skeletal injuries (degenerative arthritis in the lower spine, and osteomyelitis in the lower left leg), and the analysis of tissue samples from the aorta, trachea, eyeball, heart, and other internal organs.

The main organizer of the seminar was T. Aidan Cockburn, a public health physician whose decades of clinical experience in England, Ceylon, Pakistan, West Africa, and Canada had inspired a deep curiosity about the origins of human infectious diseases (Cockburn 1963). He and his wife Eve, an experienced scientific writer and editor, along with three other seminar participants (Robin A Barraco, William, H. Peck, and Theodore A. Reyman) agreed at the seminar to found a ‘Paleopathology Club’, and issue No. 1 of the Paleopathology Newsletter was published a few months later. The response from their seminar colleagues and other interested professionals was so encouraging that the informal ‘Club’ soon developed into the ‘Paleopathology Association’ (PPA), which held regular meetings in conjunction with the annual springtime meeting of the American Association of Physical Anthropologists.

“From little acorns, mighty oaks grow…”, and so it was with the PPA. In 1999, the Association was formally organized as an incorporated not-for-profit scientific society, and in 2000 elected its first Officers and Board of Directors. Today it proudly enrolls a membership of c. 500 professionals and students from 40 countries in North and South America, Europe, Asia, and Australia, and continues to publish a quarterly Newsletter (the current issue, December 2002, is No. 120) as well as Occasional Papers and the scientific programs of its annual North American and biennial European meetings. Membership is open to anyone who is interested in the history of diseases; no professional degrees or technical expertise are required. The Paleopathology Association maintains a website (www.paleopathology.org) that provides updated information on upcoming meetings, short courses in paleopathology offered at various universities, the annual and biennial meetings as well as meeting of other related professional associations, and excerpts from the Paleopathology Newsletter. PPA has grown substantially in membership and geographical representation, but the main scientific focus has never wavered. The Latin motto of PPA, ‘Mortui viventes docent’, may be translated as “the dead teach the living”. From that first autopsy in 1973, conducted according to the most-up-to-date medical procedures, the emphasis has always been on research directed at advancing scientific understanding of the sources, mechanisms, and treatments of illness in humans and other animals.

One major topic is the historic relationship between humans and their parasites. The great majority of infectious diseases do not affect the human skeletal system, hence the importance of mummified bodies for such investigations. (Web site link: www.nationalgeographic.com/channel/mummy/index.html.) For example, studies of ancient Egyptian bodies have revealed evidence for the antiquity of schistosomiasis, an infection of the liver by the parasitic fluke Schistosoma that still plagues Nile River villagers today (Cockburn and Cockburn 1980; Cockburn, Cockburn, and Reyman 1998). And other infectious diseases such as smallpox, trachoma, bubonic plague, and influenza leave traces in soft tissues preserved either naturally or artificially (Aufderheide and Rodríguez-Martín 1998).

Some diseases, however, do leave distinctive marks on bones, and their progress through human populations can be carefully traced through paleopathological research. For example, one disease known to the ancients that still affects millions of human victims today is malaria. It can cause changes in the skull bones of children, and has been identified from ancient sites in Greece and Italy (Angel 1971, Grmek 1983). Another such disease is tuberculosis, whose slow wasting death was described by the Greek physician Hippocrates (Cockburn 1963, Grmek 1983). Until recently the earliest cases came from Ancient Egypt, leading most paleopathologists to suggest that the human disease was a consequence of the domestication of cattle (that is, a mutation of bovine tuberculosis). However, the discovery of pathogens of the Mycobacterium tuberculosis complex in Native American mummified lung tissue from the Pacific coast of Chile and Peru (Buikstra 1980), where the only domesticated animals were camelids (alpaca, llama, and vicuña), guinea pigs, and ducks, broadens this interpretation to suggest that other mammalian carries of M. bovis might also be implicated. Leprosy, the dreaded bane of Mediterranean lands since the time of the Old Testament, has been identified in the bones of early Near Eastern Christian monastics and in remains from the cemeteries of Medieval European leprosaria (Aufderheide and Rodríguez-Martín 1998). And the complex of related diseases known as the treponematoses (deadly venereal syphilis and its less harmful cousins, endemic syphilis, yaws, and pinta) has now been identified in both Eastern and Western hemispheres as far back as 200 BC (Dutour et al 1994).

Until the late 20^th Century, identification of these diseases relied upon macroscopic, microscopic, and radiographic examinations of specific forms of changes in bone caused either by the microorganisms themselves or by the human host’s immune system defenses. However, paleopathologists now may employ powerful new molecular techniques to recover actual traces of the genetic material (ancient DNA, or aDNA) of the pathogens themselves, or chemical traces of the host’s antibodies manufactured against the microbial invaders. This new technology makes it possible to identify not only those few individuals in an ancient population sample who exhibit the most characteristic skeletal pathology of tuberculosis or leprosy, but also other infected individuals whose clinical symptoms were less ‘classic’ in form or extent. And it also enables paleopathologists to study the spread of diseases like bubonic plague that are ‘invisible’ in skeletal remains. (Web site link: www.pbs.org/wnet/secrets)

Other aspects of illness studied by paleopathogists include traumatic injuries and methods of treatment developed to repair them. For example, the practice of trepanation (opening the cranial vault by drilling or cutting) is a very ancient surgical technique used at least 2,000 years ago in both Eastern and Western Hemispheres (Brothwell and Sandison 1967, Roberts and Manchester 1995.) Opening the skull may have been an attempt used to treat symptoms of mental illness, but there is abundant evidence that it often had the very practical application of treating depressed fractures by relieving the pressure from bone splinters and intra-cranial bleeding. It seems amazing to learn that many patients survived this operation, some of them several times, since the surgery was performed with stone or bronze tools!

Paleopathologists are often intent on identifying the cause of death in ancient bodies, but they also employ a wide array of investigative techniques to learn about the daily lives of their ‘patients’. For example, severe illness or poor nutrition can affect growing bones and teeth, producing distinctive ‘stress markers’ (sections of malformed bone, dental enamel, or dentine) that chart an individual's childhood health. Repeated physical activities such as horseback riding, archery, rowing, or agricultural labor can ‘overdevelop’ certain groups of muscles and affect their bony sites of attachments. And sophisticated molecular analyses of hair, fingernails, skin, and bone can reveal the ingestion of distinctive chemical compounds from medicinal plants such as the opium poppy, whose use is described in ancient medical texts from eastern Mediterranean archaeological sites.

The science of paleopathology brings us close to our ancestors in a particularly intimate way, by revealing the secrets of their very bodies, their pains and remedies, the effects of daily toil, the sadness of premature death, but also the joys of recovery from injuries and survival to a ripe old age. The dead truly do teach the living – they teach us to value our modern improvements in health, our victories over deadly infectious diseases, and our machines that free us from painful labors, but also our studies of their bodies teach us to appreciate the courage, perseverance, and compassion of our ancestors.

Members of the PPA at reception opening of the XIV PPA European
Meeting in Coimbra, Portugal (August 2002) Left-Right: Ebba During
(Sweden), Debra Reinhard (USA), Jane Buikstra (USA; PPA President-Elect),
Della Collins Cook (USA), Mary L. Powell (USA) and Karl Reinhard (USA).

Cockburn, Eve. 1994. The Paleopathology Association: Mortui Viventes Docent. Eres 5 (1): 135-147.

Cockburn, Eve and Theodore A. Reyman. 1982. Paleopathology. Journal of the American Medical Association 248 (4): 472-473.

Cockburn, T. Aidan. 1973. Death and Disease in Ancient Egypt. Science 181: 470-471.

Cockburn, T. Aidan. 1978. Paleopathology and its Association. Journal of the American Medical Association 240 (2): 151 – 153.

Angel, J. Lawrence. 1971. The People of Lerna: Analysis of a Prehistoric Aegean Population. Washington: Smithsonian Institution Press.

Brothwell, Don R. 1987. The Bog Man and the Archaeology of People. Cambridge: Harvard University Press.

Cockburn, T.Aidan and Eve Cockburn (editors). 1980. Mummies, Disease, and Ancient Cultures. 1st edition. Cambridge: Cambridge University Press.

Cockburn, T. Aidan, Eve Cockburn, and Theodore A. Reyman (editors). 1998. Mummies, Disease, and Ancient Cultures. 2nd edition. Cambridge: Cambridge University Press.

Don R. Brothwell and A.T. Sandison (Editors). 1967. Diseases in Antiquity. Springfield: C.C. Thomas.

Grmek, Mirko D. 1983. Les Maladies à l’Aube de la Civilisation Occidentale. Paris: Payot. (Published in English in 1989 as Diseases in the Ancient Greek World, Baltimore: Johns Hopkins University Press.

Roberts, Charlotte A. and Keith Manchester. 1995. The Archaeology of Disease. 2^nd edition. Ithica: Cornell University Press.

Aufderheide, Arthur C. and Conrado Rodríguez-Martín. 1998. The Cambridge Encyclopedia of Human Paleopathology. Cambridge: Cambridge University Press.

Buikstra, Jane E. (Editor) 1980. Prehistoric Tuberculosis in the Americas. Evanston: Northwestern University Archaeological Program, Scientific Paper No. 5.

Dutour, Olivier, Palfí, György, Berato, Jacques, and Brun, Jean-Pierre (editors). 1994. L'Origine de la Syphilis en Europe, avant ou après 1493?. Paris: Editions Errance.

Ortner, Donald J. and Walter G.J. Putschar. 1985. Identification of Pathological Conditions in Human Skeletal Remains. 2^nd edition. Washington: Smithsonian Institution Press.

Steinbock, R. Ted. 1976. Paleopathological Diagnosis and Interpretation. Springfield: C.C. Thomas.

www.paleopathology.org. The official web site of the Paleopathology Association, with information about membership, meetings, web sites on related topics, and articles from the Paleopathology Newsletter.

www.pbs.org/wnet/secrets. The archives on “Secrets of the Dead”, an educational science series of the Public Broadcasting Service (PBS) that examines historical events involving death. Among the recent programs in this series that dealt with paleopathology, one focused on the human genetic mutations that protected some populations against bubonic plague in England (Mystery of the Black Death), and another one described the search for the origins of venereal syphilis (The Enigma of Syphilis).

www.nationalgeographic.com/channel/mummy/index.html. “The Mummy Road Show”, an educational series on the National Geographic Channel, follows Paleopathology Association members Ronald Beckett and Gerald Conlogue, both professional radiologists, as they travel around the world to conduct scientific studies of mummified bodies.

Mary Lucas Powell, BA, MA, PhD, is an adjunct assistant professor Department of Anthropology, University of Kentucky. She has a plethora of publications and is the chief editor of the Paleopathology Newsletter (official publication of the Paleopathology Association). Her email is: mpowell@uky.edu.

The PPA's latest newsletter issue (Number 120) was published in December 2002. The editors of the newsletter are: Mary Lucas Powell (Editor), Eve Cockburn (Editor Emerita) and the following 8 associate editors: Felipe Cárdenas-Arroyo (Latin America), Patrick D. Horne (Canada), Juliet Cleaves Brundige (Asia), Elizabeth Miller (USA), Christine Hanson (Annotated Bibliography), Conrado Rodrígues-Martín (Europe), Gary Heathcote (Oceania and Pacific Rim), and Nancy Lovell (Doctoral Dissertations).