18 Palaeopathology

Dr. Vijeta Dr. Vijeta

Contents:

Introduction
Development of Palaeopathology
Palaeopathology: An overview
Neanderthal Man
Summary

Learning Objectives:

1. To study the Palaeopathology of human remains

2. To study the background information relevant to human palaeodemography

3. To study the importance of human Palaeopathology

Introduction

Palaeopathology is an important discipline for the scientific study of man as it provides: background information relevant to palaeodemography; material evidence, valuable for historic as well as prehistoric times, of a varying disease spectrum in the past; evidence of heritable variation, in respect of congenital anomalies due to a genetic basis, ranging from possible single gene differences to chromosomal aberrations; the frequency of traumatic injury and disease, degenerative joint diseases; helps us answer questions regarding the antiquity of the disease and its causes. For instance, the study of the skeletal remains of the earlier populations of the area help us compare the incidence of the disease in that area today, e.g. bone cancer in present day Tennessee, Alabama and Georgia; indications of diseases like tuberculosis, healed fractures, arthritis, and rickets; not only informs us about the history of the human disease, but can also occasionally help elucidate the causes of certain diseases, as well; and age progression of dental decay. It was combined with palaeodemography to obtain a population perspective on health as equilibrium with disease.

Development of Palaeopathology

“Palaeopathological studies gained great impetus in the second half of the 19th century, the period of Broca and Virchow. The pathology of a society reflects its general conditions and growth and offers, therefore, valuable clues to an understanding of the total society.”

Aufderheide and Rodriguez-Martin (1998) categorize the history of the development of palaeopathology into four phases: Antecedent (Renaissance to mid nineteenth century), Genesis (mid-nineteenth century to First World War), Interbellum Consolidation Phase (1913-45) and New Palaeopathology (1946 to present). In the first phase, work concentrated mainly on prehistoric animals, but there was recognition that studying human disease would be beneficial to exploring the history of past human populations. At, the end of this period, the first application of the microscope to examining the Egyptian mummified tissue is noted, but there was ‘little scientific precision and the specimens (were viewed) as curiosities, not as sources of medical, pathological or historical knowledge’. The second phase had much more of an anthropological focus, and large skeletal collections were available for study. As Aufderheide and Rodriguez-Martin (1998) pointed out, although ‘racial’ studies were the norm, pathological conditions in these collections were noted, especially by the German physician Rudolf Virchow (1821-1902). Again, it was mainly case studies that were reported and there was little consideration of what the occurrence of disease meant in epidemiological terms. The French were instrumental from the late nineteenth century in developing the discipline of palaeopathology (e.g. Paul Broca, 1824-80) who published work particularly on the evidence for Peruvian trepanation (Buikstra and Cook, 1980). At this time, too, the first palaeopathology manual was published in America in 1886 by William Whitney. In the third phase, palaeopathology expanded and methods beyond visual (macroscopic) examination were used more often to investigate pathological lesions and improve diagnosis, in addition to statistical analysis (Buikstra and Cook, 1980). This is described as the evolution of palaeopathology as a scientific discipline. Sir Marc Armand Ruffer (1858) promoted the term ‘palaeopathology’ as defining the scientific study of disease. The final phase is marked by an increased recognition of the link between palaeopathology and epidemiology and demography with much more of a focus on raising hypothesis and testing them with skeletal data from large numbers of individuals (Aufderheide and Rodriguez-Martin, 1998).

The widely held view that the discipline of palaeopathology began in 1774 with the publications of Esper’s account of a lesion seen in some fossil cave bear bones found in caves in Bavaria takes its origin from Moodie’s Paleopathology. Various authors who have followed Moodie have perpetuated at least one of the errors in the passage from his book. Sarton in his contemporary review of Moodie’s book simply repeats more or less verbatim what Moodie wrote while Douglas Uberlaker identifies the correct Esper and questions the diagnosis of osteosarcoma but still considers Esper’s publication as the event that inaugurated palaeopathology as a scientific discipline (Waldron, 2015).

Palaeopathology: An overview

Though soil type seems to have little influence on early decomposition of bone, there is no doubt that different soils have different effects in the long-term preservation of bone. Major pathological changes in the bone may be simulated by erosion due to rodent teeth, beetles, plant roots, high winds, etc. Some relatively rare diseases, but of characteristic appearance in bone, may be confidently diagnosed than many common lesions. Many other killing diseases leave no imprint on the bones. The commonest disease to be found in the ancient bones is arthritis. Osteoarthritic changes have been reported in Neanderthal man from Shanidar, La-Chapelle-aux-Saints and Cro-Magnon man. The other most common change in the ancient bones is no specific inflammation (Cornwall, 1956; Brothwell, 1963).

Palaeopathology, devoted to the study and diagnosis of diseases in ancient human remains, provides medical insights on the history and ecology of modern human diseases. For instance, childhood illness or malnutrition can be detected by abnormalities in tooth enamel and bone mineralization. Many palaeopathologists have described evidence of infection around the middle ear and air sinuses in many cultures. ‘Rhodesian man from Broken Hill in Zambia seems to have both dental and ear infections. Specific infections like TB are well documented by the ancient remains. There exist skeletal evidences for leprosy, syphilis, poliomyelitis, variety of tumours, osteosarcoma, and carcinoma etc. Lengyel (1968) reported the existence of a correlation between: sex and citrate concentration; individual’s biological age and the amount of calcium carbonate and collagen contained in the vertebrae; and the degree of bone composition and its chemical and micro- morphological structure (Seth, 2003).

Anthropologists have been interested in human well being, which is a balance of mankind with disease parasites and environmental stresses. On the other hand, palaeonutrition has two aspects: response of bone and teeth, and the trace element record in the bone. The first healed fractures of animals as evidenced by callus are found in Permian reptiles. A healed fracture was also found in the Neanderthal man, Cro-Magnon man, the European Neolithic, and the American pre-Columbian, especially in Peru. The latter prevalence might be due to the use of special weapons like the maces. Numerous arrowheads have been found in the European Neolithic and in pre- Columbian America, embedded especially in the vertebrae and extremities. Bone density achieved in early childhood is the major determinant of risk of osteoporotic fracture. Up to 60 per cent of women suffer osteoporotic fractures as a result of low bone density, which is under strong genetic control acting through effects on bone turnover. This genetic component can be ascribed to a simple allelic change in the receptor for 1,2,5 dihydroxy-vitamin D, one of the hormones controlling calcium metabolism (Mundy, 1994). Irrespective of the molecular biological or physiological mechanisms, Morrison and co-workers (1994) have identified a gene locus associated with a major part of the strong genetic effect on bone density and indeed more than half of the adjusted population variation in bone density (Seth,2003).

Fig-1: Osteoarthritis of the patello-femoral compartment of the knee showing marginal

osteophyte, eburnation and pitting on the joint surface. Scoring in the direction of movement of

the joint is clearly seen on the eburnated area.

(Source: Waldron, 2015)

Periostitis ossificans (inflammation) was first reported in Permian reptiles, later in the early mammals and eventually in the Neolithic man.

Numerous prehistoric bone lesions have been described as syphilitic; they (bones) being morphologically stronger.

Evidence of dwarfism, achondroplastic and cretinistic, has been found in Egypt – in the skeletons and statues. Congenital anomalies of the vertebral column (spina bifida) and of the sternum have been reported from the Neolithic of Europe and Peru.

Next to traumatism, arthritis is the oldest and most widespread pathological lesion reported in Palaeopathology. Among the hominids, arthritis has been observed all over since Neanderthal man. Chronic arthritis of the hip joint is reported in La-Chapelle-aux-Saints, temporo-maxillary arthritis in Krapina Man (Neanderthal Man), Melanesians, pre-Columbians and in New Caledonia. Numerous other joints are affected in Neanderthals, Upper Palaeolithic men (Cro -Magnon), Neolithic Europeans and the Pre-Columbian Amerindians.

Fig: 2-Rib lesions as seen in skeleton 187

(Source: Roberts, 2016: Robert J Terry Collection, Department of Anthropology, National Museum of

Natural History, Smithsonian Institution, Washington DC)

Spondylitis of the cervico-dorsal and the lumbar region is seen in the La-Chapelle-aux-Saints, Cro-Magnon, European Neolithic, early Egyptian and the pre-Columbian American man. A characteristic feature of spondylitis is the changing seat of lesion along the vertebral column. For instance, in early man and the primitives, lumbar spondylitis is frequent, whereas dorsal and cervical are rare. In modern man, involvement of this is often found. These localizations of the pathological areas indicate places of stress and strain as also the living conditions and posture of the individuals under reference.

Rickets and bone tumours in prehistoric men are generally rare compared to those found in the present day men. Dental pathology was first reported amongst the Neanderthals (pyorrhea) and then among the Neolithic, especially in Scandinavia.

Fig -2: Rickets in the lower limb long bones of skeleton (3–4 years old)

(Source: Roberts, 2016: from Coach Lane, North Shields, Tyne and Wear, England.)

Only a small number of diseases leave their marks on the bones. However, in mummies, the soft parts are preserved to a certain extent. Arteriosclerosis has been observed in the Peruvian mummies, while pleurisy, congenital atrophy of the’ kidneys, gallstones and liver cirrhosis etc have been demonstrated in the Egyptian mummies. The human skeletal and mummified remains from precontact cultures of the New World provide more direct evidence of disease. Unfortunately, only a few or relatively small number of diseases that affect humans leave any trace of their presence in the skeletons, and some diseases affect bones in similar ways, making an accurate diagnosis difficult. Diseases that affect the skeleton are most commonly long-term ailments such as arthritis, chronic infections, and certain dietary deficiencies. Most illnesses that kill people quickly, particularly acute infectious diseases such as influenza, small pox, typhoid, and measles, do not leave any of their marks on the skeleton. Palaeopathologists are, therefore, limited to a narrow field of inquiry (Seth, 2003).

Human skeletal remains of 24 individuals from complex mortuaries (ca 900 B.C. to 200 B.C.) in La Libertad, Guayas Province, Ecuador show artificial cranial deformation, relatively high frequency of infectious diseases, relatively low frequency of carious lesions (4 per cent), and no signs of trauma or porotic hyperostosis. This suggests that the population had a relatively rapid rate of dental attrition, which produced dentin exposure before the age of 20 and loss of most of the crown by the age of 50 years. The estimated mean living statures of these was 153 cm for females and 170 cm for males; the adult (Ubelaker, 1988).

Recent studies of skeletal and dental stress indicators in the New World remains have shown that health problems were common. Furthermore, morbidity seems to have increased through time in many areas of the New World with increased dependence on agriculture. For instance, studies of human remains recovered from archaeological excavations in Ecuador document that 8,000 years ago; populations who lived in coastal Ecuador had low levels of infectious disease, anemia, dental caries, and various measures of nutritional stress. Samples of human remains from more recent time periods in Ecuador show regular temporal increases in the frequencies of these problems, apparently resulting from a more sedentary way of life and a less varied diet. As populations grew larger, and with a shift in subsistence began to live in more permanent settlements, sanitation problems inevitably developed, leading to an increase in infectious disease. There are increasing numbers of cases highly suggestive of treponemal infections in pre-Columbian New World skeletal remains: yaws, endemic syphilis, venereal syphilis, etc. Population densities probably never reached levels necessary to sustain and spread many of the infectious diseases, such as influenza, typhoid, measles, smallpox, that were common ailments in Europe and West Africa in the late 15th century. Studies of human remains are invaluable for explaining and understanding the human past in as much as the nutritional stress, diet, disease processes, factors affecting mortality and life expectancy, biological responses to environmental stressors, and aging of ancestors is concerned (Seth, 2003).

A major theoretical focus in skeletal research concerns delineation and explanation of human skeletal and dental responses to changing subsistence patterns involved in the transition from hunting and gathering to an agricultural economy based primarily on corn. Traditionally, this transition has been viewed as a positive additive innovation that provided a dependable food supply, increased population density, and an improved lifestyle. In the light of recent osteological studies, however, this view requires qualification. Certain hazards accompanied over-dependence on this food source. The transition to agriculture was followed by increase in infectious diseases, pre-adult mortality, dental defects, dental caries, cranial pathology, and post-cranial periosteal reactions. Skeletal and dental health declined and individual size and robusticity was reduced (Seth, 2003).

Enamel hypoplasia is discernible as pits or shallow transverse grooves, especially in the canines and molars; the tooth is only slightly affected in most of these cases. This hypoplasia has been reported in Australopithecus crassidens – aranthropus, Telanthropus capensis, Homo erectus – Pithecanthropus pekinensis and Spy 11-Neanderthal man. Hypercementosis is found to be present in fossil men: three Neanderthal specimens show some root swelling, for instance, Gibraltar I, La Ferrassie I, Monsempron; Rhodesian man shows beginning of apical Hypercementosis resulting from a low-grade infection of the tooth Dental caries has been reported in the australopithecine apes. Earliest examples of well defined caries have been found in the maxillary I and II molars of Australopithecus crassidens, Telanthropus capensis, Es Skhul. signs of caries in Homo erectus (Pithecanthropus) and eleven carious teeth in Upper Pleistocene Rhodesian I. Upper Palaeolithic teeth from Europe show some evidence of caries. Mesolithic groups reveal presence of carcinogenic factors (refined carbohydrates, honey, and pulpy plants) well before the Neolithic revolution (i.e., cereal cultivation and dietary refinement). Evidence of periodontal infection is found during the Neanderthal times.

Neanderthal Man

Many of the vertebrae, especially the cervical, of La- Chapelle-aux-Saints exhibit arthritic processes along the margins of their bodies, odontoid process is abnormally deflected from the median plane, articular surfaces of the atlanto-axial joints exhibit osteoarthritis change, other vertebrae are affected by a deforming osteoarthritis. As a consequence, the vertebrae are reduced in height. There also exists a flattening and deformation of the right mandibular condyle – osteoarthritis of the temporo-mandibular joint (peculiar flattening of the right condyle). Straus and Cave (1953- 61) observed even more severe flattening and deformation in the La Quina and La Ferrassie mandibles, also obviously the result of temporo-mandibular osteoarthritis. Both these condyles are pathologically distorted.

Alveolar borders of the La Chapelle skull underwent extensive resorption during life resulting in loss of most of the teeth ante mortem – result of prolonged and extensive periodontal disease. Spinal and coaxial osteoarthritis is present in other Neanderthal specimens too. Arthritis is an extremely ancient malady and goes back to the Mesozoic era where it was found in the giant reptiles now extinct (Moody, 1923).

Bone Tumor on the Kanam mandible may be responsible for the ascription of a Homo sapiens type of chin to this specimen (Montagu, 1957).

Angel (1966) found the growth of Greek culture between 800 AD and 500 BC connected with such phenomenon as an increase in body size, life-span, and population volume and a decrease in arthritis, dental pathology, osteoporosis and infant mortality; also noticed a decrease in health after 400 BC. Schultz (1981) found a high degree of infestation with plasmodia filarial and trypanosome in the ancestor’s of man in view of the biological relationships. Considerations of the domestication process and the cultural dynamics involved are important, but somewhat less attention has been given to the dietary utilization of resources. What is especially lacking is the consideration of the synergistic effects of the presence of the pathogens in animals and human susceptibility to diseases. Mixed farming and pastoral adaptations have been characteristic of some areas for significant periods of time. Since pathogens and human populations have adapted to each other through time, the epidemiological perspective should be productive in this regard. Local and regional variations in the resources, population distribution, environmental factors affecting health, nutritional adequacy of food resources, and the nature of the pathogens still must be considered. Skeletal populations occasionally lack association with organic archaeological refuse sufficient to permit neat discrimination between stages of economic change. In a few instances, associated economies are postulated almost entirely from associated artifacts and site distributions supplemented by data from skeletons themselves. Palaeopathological studies suffer from the facts that skeletal populations are almost always skewed representations of living groups and that the skewing may not be the same in any two populations. They suffer from the fact that different analyses have been performed in different regions and often on different populations from the same region, making both interregional comparisons and inter-population comparisons within a region more difficult (Seth, 2003).

Summary

Palaeopathology was defined in 1910 by Sir Marc Armand Ruffer (Aufderheide and Rodriguez-Martin, 1998) as the science of diseases whose existence can be demonstrated on the basis of human and animal remains from ancient times. The study of palaeopathology examines the evolution and progress of disease through long periods of time and looks at how humans adapted to changes in their environment. Broadly speaking, it provides: background information relevant to palaeodemography; material evidence, valuable for historic as well as prehistoric times, of a varying disease spectrum in the past; evidence of heritable variation, in respect of congenital anomalies due to a genetic basis, ranging from possible single gene differences to chromosomal aberrations; the frequency of traumatic injury and disease, degenerative joint diseases; helps us answer questions regarding the antiquity of the disease and its causes. For instance, the study of the skeletal remains of the earlier populations of the area help us compare the incidence of the disease in that area today, e.g. bone cancer in present day Tennessee, Alabama and Georgia; indications of diseases like tuberculosis, healed fractures, arthritis, and rickets; not only informs us about the history of the human disease, but can also occasionally help elucidate the causes of certain diseases, as well; and age progression of dental decay. It was combined with palaeodemography to obtain a population perspective on health at equilibrium with disease.

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References

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