The Ambassadors Research Foundation presents a new series of articles entitled, "Maladies of Ancient Populations: Through Modern Eyes." The first article is written by Prof. Mary L. Powell, an international paleopathologist. We invite all experts in this field to present their contributions in this series.
"Though paleopathology is
not yet an exact science, it is clear that the discipline has made
notable advances in the past century, and will continue its vigorous development in the new millennium."
THE STUDY OF HUMAN SUFFERING
By Prof. Mary L. Powell
Chief Editor, the Paleopathology Newsletter
Paleopathology, the study of disease in past human populations, had its beginnings in one of the key interests of humanistic scholars during the European Renaissance, the study of life in the prehistoric past. The term was coined in 1892 by the American physician, R.W. Schufeldt, from two Greek words: palaios, ancient, and pathos, suffering. Strangely shaped fossilized bones of unknown animals were often mistaken for the remains of ancient humans, such as the fossil pachyderm bones representing human ‘giants’ described by the Swiss anatomist Felix Platter in the late 16th Century, or the 18th Century identification of a fossil amphibian skeleton as a man drowned in the Biblical flood (Aufderheide and Rodriguez-Martin 1998:2). Various types of skeletal pathology including trauma, arthritis, inflammatory lesions, and neoplasms were identified by physicians and anatomists in Quarternary cave bears, hyenas, cave lions, and other mammals, and Johann Friederich Esper's 1774 report of an osteosarcoma in the femur of a cave bear has been hailed as the first true paleopathological study (Cockburn 1997:xv; Ubelaker 1982:337).
The development of paleopathology as a scientific discipline with a specifically human focus was stimulated by archaeological excavations in the 18th and 19th Century of large numbers of skeletonized or mummified human remains in the New and Old Worlds. Sir Marc Armand Ruffer, a noted French physician, pioneered innovative research on Egyptian mummies; the chemical solution which he created is still employed today for rehydrating dessicated organs for histological examination.
The evolution of paleopathology from a minor interest of Renaissance antiquarians and "harmless pastime" of Victorian physicians into a modern scientific discipline in the 20th Century has been reviewed in detail by a number of scholars. Book-length overviews written by prominent European paleopathologists include Calvin Wells' Bones, Bodies, and Disease (1964), Erwin H. Ackerknecht's History and Geography of the Most Important Diseases (1965), and Paul A. Janssens'Palaeopathology: Diseases and Injuries of Prehistoric Man (1970). These authors strongly encouraged collaborations with medically-trained scholars, to refine accuracy of diagnoses based on dry bone specimens. However, two edited volumes that appeared during this time, Saul Jarcho's Human Palaeopathology (1966) and Don R. Brothwell and A.T. Sandison's Diseases in Antiquity (1967), lamented the lack of theoretical focus and methodological advances in the discipline. In 1971, George J. Armelagos and colleagues published the first comprehensive Bibliography of Human Paleopathology, which included 1778 individual international contributions. A quarter century later, in 1997, the San Diego Museum of Man issued a massive volume titled Human Paleopathology and Related Subjects, An International Bibliography, edited by Elerick and Tyson, which includes more than 18,000 individual contributions.
Aidan & Eve Cockburn - the father and mother of the Paleopathology Association
The first paleopathological study to focus exclusively on skeletal evidence of disease in ancient North America was Joseph Jones' 1876 report on burials from a Late Prehistoric site in the Nashville Basin of Tennessee. This treatise introduced a theme that dominated American paleopathology throughout the late 19th and early 20th Centuries: the antiquity of syphilis. Jones, a physician in the Confederate Army during the Civil War, drew extensively upon his own biological training and clinical experience for his diagnosis of syphilis, and employed both macroscopic and histological examination of inflammatory lesions. His careful approach to diagnosing past diseases by reference to current medical knowledge provided a powerful model for the subsequent theoretical and methodological development of American paleopathology, as well as an informed examination of one of its enduring themes.
In 1930, physical anthropologist Ernest A. Hooton of Harvard University published the first comprehensive study of health in a specific prehistoric Native American population, The Indians of Pecos Pueblo. Hooton based his interpretations on his careful examination of all of the skeletons from this site, not just a few ‘interesting specimens’, and carefully evaluated his findings within the site-specific cultural, behavioral, ecological, and temporal contexts. This epidemiological and biocultural approach allowed him to link specific types of age- and sex-specific pathology with patterns of diet, food preparation, and habitual activities such as farming, hunting, warfare, etc. and patterns of observed skeletal pathology. He presented tables of frequency data on specific conditions, including osteoarthritis, trauma, inflammatory lesions, and porotic hyperostosis (which he called "osteoporosis symmetrica"), evaluated general levels of population health for the different time periods represented at the site, and suggested that syphilis had been present.
Two physical anthropologists in the Department of Anthropology at the National Museum of Natural History, T. Dale Stewart and J. Lawrence Angel, published extensively on many different topics in paleopathology during their long careers. Stewart (1968, 1970, 1973, 1979, among many others; see Elerick and Tyson 1997)was particularly interested in the effects of diet and cultural practices upon skeletal and dental structures, the history of pre-modern surgery, forensic anthropology, skeletal pathology, and Native American populations of the New World. Angel (1966, 1971, 1987, among many others; see Elerick and Tyson 1997) focused his attentions upon patterns of health and disease in the ancient Eastern Mediterranean and among free and enslaved African-Americans in the Middle Atlantic region of the United States. Both scientists also applied their seasoned osteological expertise to forensic anthropology, emphasizing the importance of individualized pathological and morphological features in the establishment of personal identity.
Two comprehensive review articles in the early 1980s outlined the rise of paleopathology in the United States: "Palaeopathology: An American Account by Jane E. Buikstra and Della C. Cook (1980) in Annual Review of Anthropology, and"The Development of American Paleopathology", by Douglas H. Ubelaker (1982), in Frank Spencer's edited volume, A History of American Physical Anthropology, 1930-1980. In both reviews, the authors applauded the new focus over the past decade on detailed differential diagnosis (based upon carefully constructed models of disease processes) and on explicit integration of biocultural context, dietary reconstruction, analyses of growth and development, and paleodemographical analysis into interpretations of skeletal pathology.
During the last three decades of the 20th Century, interdisciplinary projects involving archaeologists, biological anthropologists (including paleopathologists), historians, ethnographers, and other scholars have successfully created multi-dimensional reconstructions of specific lifeways in the past. For example, a series of long-term multidisciplinary bioarchaeological projects directed by Jane Buikstra and colleagues at the Kampsville Archaeological Center have examined prehistoric Native American lifeways in different regions of the Lower Illinois Valley (Buikstra 1976, 1981). Another outstanding example is the La Florida bioarchaeological project, coordinated by biological anthropologist Clark S. Larsen and archaeologist David Hurst Thomas over the past two decades (Larsen 2001). This project examines changes from early prehistoric to Colonial times in the patterns of health, disease, mortality, and osteological markers of habitual activity patterns in Native American populations of the northern portion of La Florida (southern Georgia and northern Florida).
The last quarter of the 20th Century saw the appearance of a series of books written specifically to guide paleopathologists in performing differential diagnosis of specific diseases. The first was R. Ted Steinbock's Paleopathological Diagnosis and Interpretation (1976). It opens with a discussion of bone as a biological organ system, emphasizing that pathological skeletal morphology can only be recognized and interpreted by reference to normal patterns of growth and development. Subsequent chapters focus on specific categories of disease affecting bone: trauma, hematological disorders, metabolic bone disease, arthritis, and tumors, and selected specific (treponematosis, tuberculosis, leprosy) and non-specific (pyogenic osteomyelitis) infections. Another landmark text was Donald J. Ortner and Walter G.J. Putschar 's Identification of Pathological Conditions in Human Skeletal Remains (1981) updated by Ortner in 2003 (Fig. 1). It covered far more conditions than Steinbock’s shorter volume and featured almost 800 photographic illustrations of pathological specimens from medical and museum collections around the world. Some publications adopted the atlas format: the Atlas of Human Paleopathology (1982) by Marc A. Kelley and Michael R. Zimmerman, and the Regional Atlas of Bone Disease (1990) by Robert W. Mann and Sean P. Murphy. Others were explicitly comprehensive in nature, such as The Cambridge Encyclopedia of Human Paleopathology (1998) by Arthur C. Aufderheide and Conrad Rodríguez-Martín (Fig. 2), an excellent companion volume to The Cambridge World History of Human Disease (Kiple 1993) published five years earlier. Some texts from this period were devoted to the analysis of naturally or artificially desiccated bodies, such as Aidan and Eve Cockburn's edited volume, Mummies, Disease, and Ancient Cultures (1980) which was expanded in a second edition (Cockburn, Cockburn, and Reyman 1998).
Recent advances in American paleopathology include molecular investigations of ancient microbial DNA and metabolites of earlier forms of infectious diseases. Refined methods of DNA "fingerprinting" had been used successfully to identify index cases in modern localized outbreaks of antibiotic-resistant tuberculosis by comparing different strains of M. tuberculosis pathogens, and recovery protocols of DNA from ancient human tissues have now been standardized (Roberts and Buikstra 2003). Comparisons of ancient mycobacterial DNA recovered from skeletal individuals from archaeological sites in Germany, England, Hungary, Scotland, Turkey, Illinois, and Canada with DNA "profiles" of members of the modern Mycobacterium tuberculosis complex (principally M. tuberculosis and M. bovis, the two species that most commonly infect mammalian hosts) suggest that tuberculosis has an exceedingly ancient "pedigree" as a human disease. The majority of these molecular studies have focused upon a 123 base-pair segment of DNA unique to the M. tuberculosis complex, known as IS6110 (Salo et al 1994). At the 1997 International Congress on "The Evolution and Palaeoepidemiology of Tuberculosis" in Szeged, Hungary (Palfi et al 1999) (Fig. 3 & 4), the recovery and interpretation of mycobacterial DNA and RNA were discussed, as well as another new molecular technique based upon detection of mycolic acids produced by pathogenic mycobacteria inside infected human hosts. This method has been successfully applied to bone samples from identified tuberculous patients in a historic hospital cemetery (Newcastle Infirmary) as well as to samples from pathological and non-pathological skeletons from two archaeological sites in England (Gernaey et al 1999, in Palfi et al 1999).
Arguments pro and contra the pre-Columbian New World presence of another major infectious disease, venereal syphilis, have been debated for some five centuries, beginning soon after the dramatic "outbreak" in 1493 in southern Europe. At the first International Congress on the Evolution and Paleoepidemiology of Infectious Diseases (ICEPID), held in Toulon, France, in 1993 (Dutour et al 1994) (Fig. 5), this question was reexamined by a broad range of scholars employing the most current evidence from historical, medical, archaeological, and paleopathological research conducted on a large number of New and Old World population samples. No clear consensus was reached on the origin of venereal treponemal disease, but the Precolumbian presence of some form of treponemal disease is (at the present time) more clearly apparent in the American bioarchaeological record than in its European counterpart. Molecular investigations of treponemal disease have lagged behind similar studies of ancient tuberculosis, but the first successful identification of prehistoric treponemal antibody in an pre-Columbian Native American skeleton from Virginia (Ortner, Tuross, and Stix 1992) will surely stimulate further research in this area.
Jane E. Buikstra, President-Elect of the PPA (2003-2005)
Paleopathology at the new millenium: professional and international in nature
In 1985, the first “Short Course in Paleopathology” organized by Donald J. Ortner at the Department of Anthropology, National Museum of Natural History (Smithsonian Institution) drew participants (both teachers and students) from all over the world for three weeks of intensive focus of workshops and lectures on a wide range of topics and methodologies, incorporating hands-on examination of pathological specimens from the Department’s extensive skeletal collections. In 1988, Ortner and Arthur C. Aufderheide continued this international coverage by organizing a symposium titled ‘Human Paleopathology: Current Syntheses and Future Options’ for the International Congress of Anthropological and Ethnological Sciences in Zagreb, Yugoslavia (Ortner and Aufderheide 1991). This symposium included numerous participants in Ortner’s 1985 Smithsonian Short Course, as well as other paleopathologists from all over the world. The presenters were charged with summarizing important advances in specific aspects of human health and disease from ancient times to the present. Ortner’s research and teaching efforts (including subsequent Short Courses in Paleopathology offered at the Smithsonian and the University of Bradford, UK) have spearheaded the Smithsonian Institution’s strong international presence in paleopathology, as have Aufderheide’s efforts in organizing and maintaining the International Mummy Registry.
The 1st and 2nd International Congresses on Evolution and Paleoepidemiology of Infectious Diseases noted above, convened in the 1990s and focused, respectively, on syphilis (Toulon, France) and tuberculosis (Budapest and Szeged, Hungary), were organized by European paleopathologists but American participation was strong, in part because of the presence of these two diseases among prehistoric and historic Native American populations. However, American paleopathological research was also well represented at the 3rd ICEPID held in 1997 at the University of Bradford, England (Fig.6), even though the ‘disease of focus’, Hansen’s disease (also known as leprosy) was apparently absent from the Western Hemisphere before the 16th Century AD. The same was true for the 4th ICEPID in 2001 in Marseille, France, which focused on the history of bubonic plague (the "Black Death"), although that disease as well was apparently absent from the Americas before extensive European contact.
Although artificially or naturally mummified human remains are not so common in North American as South America, Europe, Egypt, or Asia, an interest in their scientific analysis stimulated the formation in 1973 of a scholarly society, the Paleopathology Association, “an informal group of scientists from many disciplines, whose common link is that they are interested in disease in ancient times.” (Cockburn 1994:135). The Paleopathology Association had its origin in a working group of US and Canadian scholars (joined by a colleague from Czechoslovakia) who convened in Detroit, Michigan, for a symposium co-sponsored by Wayne State University Medical School, the Smithsonian Institution, and the Detroit Institute of Arts. The focus of the symposium was the carefully conducted multidisciplinary autopsy of an Egyptian mummy (PUM II) on loan from the Pennsylvania University Museum (Cockburn 1994). The five founders were Aidan and Eve Cockburn, Theodore A. Reyman, Robin A. Barraco, and William H. Peck, who had conducted two previous autopsies of mummies (DIA I in 1971 and PUM I in 1972). The Cockburns and Reyman subsequently published two editions of a world-wide paleopathological study of mummies (Cockburn and Cockburn 1980, Cockburn, Cockburn and Reyman 1998) (Fig. 7). The success of the first edition stimulated further interest in the scientific analysis of mummified remains, leading eventually to the organization of a series of World Congresses on Human Mummies: 1992 (Tenerife, Canary Islands), 1995 (Cartagena de Indias, Colombia), 1998 (Arica, Chile), and 2001 (Nuuk, Greenland), with another planned for 2004 (Torino, Italy). Arthur C. Aufderheide (2003), founder of the International Mummy Registry, recently published a monumental and detailed worldwide survey of scientific studies of mummies, covering more than 200 years of investigations of naturally and artificially mummified bodies. But perhaps the most unusual scholarly publication on this topic appeared in 1998 by Paleopathology Association member Christine Quigley, Modern Mummies, a serious treatise on methods of preservation of the human body in the 20th Century.
Both the size and the interests of the Paleopathology Association members have expanded in the past quarter of a century to include the entire universe of human health and disease. The Paleopathology Association has held annual meetings since 1974 (co-jointly with the American Association of Physical Anthropology since 1980), and the European members have sponsored biennial meetings since 1976, which include practical workshops, roundtable discussions, and both focused symposia and general sessions of podium and poster presentations. Since 1973, PPA has published a quarterly Newsletter (Fig. 8 - Current Editor Mary Powell [left] and Editor Emerita Eve Cockburn) containing research articles and reports, notices of upcoming professional conferences of interest, comments and inquiries about specific topics and cases, abstracts of recent theses and dissertations on paleopathological topics, and a regular series of annotated bibliograpic references (including journal articles, books, films, and most recently, websites).
The motto of the Association ("mortui viventes docent", the dead teach the living) (Fig. 9) celebrates not only the ancient Classical World interests of many members but also the unbroken tradition of scholarly interest in past human societies reaching back more than three millennia in the Near East. Yet it most definitely looks forward to the future as well, sponsoring the first Aidan and Eve Cockburn Student Award for an outstanding presentation at the annual North American meeting in 2000 and the first Bioanthropology Foundation Award for a poster presentation at the XIII Biennial European Members meeting in Chieti, Italy, that same year, and fostering mentoring partnerships and providing editorial assistance to non-native English language speakers for presentations and publications. The membership of the Paleopathology Association has grown steadily both in numbers and in diversity since its founding in 1973. By 1978, it included more than 300 members representing 22 countries. In 2000, it included more than 500 anthropologists, historians of medicine, physicians and others (including museums, libraries, and research institutions) representing 35 countries on 6 continents (only Antarctica lacks a member, not surprisingly). Nearly half of the current members reside in the USA or Canada. The membership during its first two decades consisted was heavily weighted towards senior professionals, but at the present time nearly 30% are undergraduate or students, primarily in anthropology. Male members outnumbered female members (88% vs 12%) in the "Brief Biographies" published in Nos. 3 and 4 of the PPA Newsletter in 1973, but by 1999 the two sexes were almost equally represented in the Membership Database: 245 women (47%) and 273 men (53%).
Another scholarly society, the Paleopathology Club (Fig. 10), was formed in the late 1970s as an affiliate of the International Academy of Pathologists. This society sponsors annual meetings with presented papers and symposia on specific topics, held in conjunction with the International Academy of Pathology, United States and Canadian Division. Its focus has differed from the beginning from that of the Paleopathology Association, though both share the same interest on health and disease in past human populations. It serves as a network for exchanging information among its members about specific pathological cases and disorders, and each issue of its Newsletter contains one or two slides illustrating a problematical case, on which members are invited to comment. The Paleopathology Club has been sponsored since its formation by the pathologists Marvin J. Allison and Enrique Gerszten, of the Medical College of Virginia, Virginia Commonwealth University. Their efforts at publicizing the importance of paleopathological research among physicians and other medical scientists has served to encourage closer interdisciplinary collaborations between medicine and anthropology.
Paleopathology is well represented in major professional journals of anthropology , including American Journal of Physical Anthropology, American Antiquity, Midcontinental Journal of Archaeology, Southeastern Archaeology, as well as Archaeology (published by the American Institute of Archaeology for general readers). Two new journals devoted totally or primarily to paleopathology have appeared in Europe in the last two decades, the Journal of Paleopathology (1989) (Fig. 11) , published in Italy, and the International Journal of Osteoarchaeology (1991) (Fig. 12), published in England. Both journals include several North American paleopathologists on their editorial staffs and regularly feature articles, research reports, and book reviews by North American contributors.
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)
Over the past century and a half, the discipline of paleopathology has expanded its original focus from specific individual cases towards a broad inter-disciplinary interpretation of health status of individuals and populations based on simultaneous interpretation of a wide range of biological, cultural, and environmental data (Beck and Buikstra 2004). It is now a well-recognized research focus within the discipline of bioarchaeology (Larsen 1997) and draws upon the latest advances in biomedicine, nutrition, and genetic analysis. "Molecular medicine" applied to ancient samples provides new insights into the evolution of infectious diseases, even those that leave no visible marks on the skeleton. New techniques in medical imaging technology, unavailable even in the 1970’s, are now widely employed, and actual autopsies of mummified human remains have been largely replaced by less destructive examinations of internal structures and tissues through the use of computer axial tomography, endoscopic examination, and even magnetic resonance imaging (though this latter technique is less effective because of the extremely low moisture content of mummified tissues). Several books written for the non-specialist reader (Brothwell 1987, Larsen 2000) (Fig. 13) provide excellent introductions to this fascinating and growing field. Though paleopathology is not yet an exact science, it is clear that the discipline has made notable advances in the past century, and will continue its vigorous development in the new millennium.
|Note: This article will appear in expanded form as “The Evolution of American Paleopathology”, by Mary Lucas Powell and Della Collins Cook, in A History of American Bioarchaeology, Lane A. Beck and Jane E. Buikstra, editors, 2004. Washington DC: Smithsonian Institution Press.|
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Angel, J. Lawrence (1966). Porotic Hyperostosis, Anemias, Malarias, and Marshes in the Prehistoric Eastern Mediterranean. Science 153(3737):760-763.
(1971). The People of Lerna. Washington: Smithsonian Institution Press
Angel, J. Lawrence, Jennifer Olsen Kelley, Michael Parrington, and Stephanie Pinter (1987). Life Stresses of the Free Black Community as Represented by the First African Baptist Church, Philadelphia, 1823-1841. American Journal of Physical Anthropology 74(2):213-229.
Armelagos, George J., James H. Mielke, and John Winters (compilers). (1971). Bibliography of Human Paleopathology. Research Reports Number 8. Amherst: University of Massachusetts Department of Anthropology.
Aufderheide, A.C. (2003). The Scientific Study of Mummies. Cambridge: Cambridge University Press.
Aufderheide, Arthur C., and Conrado Rodríguez-Martín (1998). The Cambridge Encyclopedia of Human Paleopathology. New York: Cambridge University Press.
Brothwell, Don R. (1987). The Bog Man and the Archaeology of People. Cambridge: Harvard University Press.
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(1981). Mortuary practices, palaeodemography and palaeopathology: a case study from the Koster site (Illinois). In: The Archaeology of Death, Robert Chapman, Ian Kinnes, and Klaus Randsborg, eds., pp. 123-132. London: Cambridge University Press.
(1992). Diet and Disease in Late Prehistory. In: Disease and Demography in the Americas,. John W. Verano and Douglas H. Ubelaker, eds., pp. 87-101. Washington, D.C.: Smithsonian Institution Press.
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(2000). Skeletons in our Closet: Revealing our Past through Bioarchaeology. Princeton: Princeton University Press.
(2001). Bioarchaeology of Spanish Florida, the Impact of Colonialism. Gainesville: The University of Florida Press.
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Quigley, Christine (1998). Modern Mummies: The Preservation of the Human Body in the Twentieth Century. Jefferson, NC: McFarland and Company, Inc.
Roberts, Charlotte A., Mary E. Lewis, and Keith Manchester, editors (2002). The Past and Present of Leprosy. Oxford: Archaeopress.
Roberts, Charlotte A. and Jane E. Buikstra (2003). Tuberculosis: Old Disease, New Awakening. Gainesville: University Press of Florida.
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Mary Lucas Powell, BA, MA, PhD, is an adjunct assistant professor Department of Anthropology at the University of Kentucky. She has a plethora of publications and is the chief editor of the Paleopathology Newsletter (official publication of the Paleopathology Association - www.paleopathology.org). Her email is: firstname.lastname@example.org.