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History and development of paleopathology.

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AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 56:509-515(1981)
History and Development of Paleopathology
J. LAWRENCE ANGEL
Department of Anthropology, Smithsonian Institution, Washington, D.C.
20560
KEY WORDS
Paleonutrition, Social biology, Paleodemography,
Paleopathology, Disease
ABSTRACT
In the nineteenth century, accurate descriptive studies, often
dealing with pre-Columbian “syphilis,”were made by Virchow, J. Jones, and Putnam. HrdliEka, Moodie, Ruffer, and others in the early twentieth century carried
out research on subjects ranging from trephination to schistosomiasis. However,
it was not until Hooton, Williams, Stewart, Wells, and others (1930 to 1965)that
paleopathology was combined with paleodemography to get a population perspective on health as an equilibrium with disease. Not until recently, with the creative
summaries of Jarcho and Brothwell, have we had bone pathologists (LentJohnson
and especially Putschar) and others (Moseley in blood, Cockburn and Allison in
epidemiology and mummies) working actively with physical anthropologists and
historians. This cooperation has triggered a major revival in the study of bone
physiology and responses to disease (Ortner),disease ecology, demography and
health, and paleonutrition (Goldstein,Laughlin, Cook and Buikstra, Ubelaker, Angel). New techniques range from histology to immunochemistry and now involve a
host of young investigators.
From its beginning in the nineteenth century, specialists in other fields, physicians as
often as historians, did paleopathology for the
fun of it, as amateurs, and luckily this is still
true. Our real interest is human health, which
is a balance of mankind with disease parasites
and environmental stresses. Pathology, the
study of effects of these parasites and of afflictions of all sorts, focuses mainly on the handicaps with only a glance a t our ability to carry
them. Paleopathology’s focus deep in the past
is much narrower still, like a telephoto, infrared satellite picture of a city on earth, limited
to surviving features: dry bones, mummies,
and archaeologicalremains includingcoprolites.
Later we have medical texts ranging from
the Nineveh tablets and the Smith papyrus to
Homer, Hippocrates, and Galen (excellently
condensed in Guido Majno’s, 1976, book).
These ancient observations we must synthesize with more restricted data from the bones
(cf. Clabeaux, 1969).
From the nineteenth century we have isolated observations, as pathology itself matured, ranging from trauma and trephinations
(cf. Stewart, 1958) to rickets, Pott’s disease,
and syphilis. Rudolf Virchow saw rickets in the
Neandertal skull vault (Virchow, 1872; cf.
Ivanhoe, 1970)and commented on the latter in
some Tennessee skeletons (Jarcho, 1966).Such
American physicians as S. Morton and Joseph
0002-9483/8115604-0509%02.500 1981 ALAN R. LISS, INC.
Jones, and anthropologists like Putnam, Mason, and Boas were interested in the New
World origin of “syphilis,” or, better in hindsight, of some form of treponematosis. The
new concept of disease prevalence or frequency
did appear in Welcker’s (1888)worldwide survey of cribra orbitalia (one marker for anemic
response), but no surveys of ancient rickets, of
tuberculosis, or even of arthritis matched the
clinical interest in these diseases.
Some interest in frequencies marks the work
of such turn-of-the-century figures as G. Elliot
Smith (1910), W.R. Dawson, F. Wood Jones,
Marc A. Ruffer, and others who dealt with the
masses of skeletons and mummies - Dawson
(1967) says 30,000-excavated by the British
in Nubia. These workers and others in the early
twentieth century devised the NaCO, method
of rehydrating mummy tissue and then staining and sectioning it to reveal tissue differentiation and decay. Such diseases as Ascaris infestation and schistosomiasis (Ruffer, 1910, reprinted 1967)were identified, and in this context Ruffer reintroduced the term “paleopathology” (apparently used before, then forgotten). The excitement of this second period
was in skilled clinical diagnoses in mummies
and museum bones of many diseases-from
Delivered at the University of Virginia, Charlottesville, December
11-12, 1980.
510
J.L. ANGEL
gastrointestinal parasites, aortic aneurysm via
tuberculosis, cancer, and congenital defects
like spina bifida, to fractures, traumata, and
war injuries like those in ancient Peru, and
trephinations (cf. Stewart, 1958). Metabolic
and genetic disease, like the anemias or alkaptonuria, were only just being differentiated
clinically (Garrod, 1909),and one could not expect these to be identified yet in ancient bones
and mummies. Ale3 Hrdlizka’s (1914)description of “osteoporosis symmetrica”-now better
called porotic or spongy hyperostosis (Angel,
1964a, 1967a,b, 1978b; Hamper1 and Weiss,
1955) - could not identify this yet as a metabolic response. In direct response to R. Ross’s
1897 discovery of the malarial plasmodium
(Ackerknecht, 1965) and the work of Grassi
and Celli on its anopheline transmission and
spread, W.H.S. Jones (1907) clarified the historical importance of the malarias. But the paleopathological confirmation only came later.
Even though Stephanos (1884)had established
ecology of disease in a Virchovian manner a
century ago, workers in the second major period of paleopathology largely ignored the work
of Jones and other historians, and made no
synthesis. World War I ended this creative
phase before paleopathology had done more
than accumulate a lot of haphazard though
intriguing descriptions. There was no continuing interest in making a real statistically controlled relation between mankind and disease.
Perhaps the best summary of all this work, improved by later diagnoses, is Calvin Wells’s
(1964)excellent popular book, Bones, Bodies
and Disease. Yet Jarcho and others looked
back to this descriptive period as a golden age
of paleopathology.
The period between world wars was one of
specialization, idealism, and depression
against which my own generation reacted, all
the more so because anthropology was one of
the binding and synthesizing sciences. My own
introduction to it, in 1934 at a summer field
school of the University of New Mexico, was
Clyde Kluckhohn’s insistence that we learn climate, geology, soils, botany, zoology, human
biology, and disease patterns as well as anthropology in order to do archeology or to understand the living culture of any region. This sort
of interdisciplinary breadth, vital for paleopathology’s effective growth, seems to have
frightened off the pathologists as well as the
more orthodox clinicians until the past decade
or so. I vividly recall that when I was teaching
in a very professionally proper medical school,
pathologists there and elsewhere said that
they knew nothing about dry bone and doubted
that anthropologists could learn much either.
Orthopedists (e.g., Lent Johnson [1964], C.
Goff), anatomists, hematologists (Moseley,
Wintrobe),and surgeons were much more helpful, and the medical historians (Major, 1936;
Zinsser, 1935, reprinted 1967; Stearn and
Stearn, 1945; Ackerknecht, 1962, 1965) indirectly egged us on. Buikstra and Cooks recent
critical appraisal of American palaeopathology
(1980) quotes Hooton (1930), Stewart (1966),
and Jarcho (1966) expressing a similw pessimism: Diagnosis of ancient lesions was uncertain even with x-ray study, partly because
pathological bones often became isolated from
their skeletons (either in collective burials or
from museum “selection”)and largely because
of lack of cooperative research on recent and
modern living (and dying) populations.
Moodie’s major synthesis (1923)completes the
multiplicitous work of the prewar era rather
than setting out on a new cooperative course,
and even through the Wenner-Gren Foundation (Ackerknecht, 1962) no new start came.
Jarcho (1966:25) points out that paleopathology vanished from the pathological literature
until 1956!
The person who started to reverse this withdrawal was Hooton, by his publications, by his
teaching, and especially by his insistent stress
on the population as the unit of study. As one
example, with Herbert U. Williams he tackled
the problem of porotic hyperostosis, seen as
anemia with nutritional and other causes. In
particular he was the pioneer in paleodemography (1930),and consistently stressed the need
for adequate statistical samples. HrdliEka,
Stewart, Goldstein, Grant, Gregg, Laughlin,
Morse, Newman, Pales, Hoyme and Bass,
Wells and others, as well as Hooton’s own students, made adequate samples their goal. But
change has been slow. Despite great postwar
help from the Wenner-Gren Foundation there
have been too few of us to keep up with the
skeletons excavated or, still often, discarded.
Most of us have not easily afforded x-rays,
elaborate microscopes and preparation equipment, or, now, the really expensive spectrographic eqbipment needed for trace mineral analyses. On the other hand, 35-mm photography has become a constant and necessary tool
for all of us within the past generation. I t is
hard to recall the time before we had good color
slides of morphologic changes. This has helped
enormously with diagnoses, especially in rescuing dry bone or x-ray comparative data from
the recent period before antibiotics prevented
HISTORY AND DEVELOPMENT OF PALEOPATHOLOGY
the full expression of diseases caused by treponemes, mycobacteria, and many cocci.
During this whole period of transition from
description to statistical analyses of ancient
disease the successive editors of the American
Journal of Physical Anthropology encouraged
paleopathology. Stewart in particular did so.
After Tony De Palma’s founding of the journal
Clinical Orthopaedics (in 1953 with Stewart,
Garn, and Angel as advisory editors for anthropology) and several early papers on paleopathology - Stewart on fifth lumber separated
arch (1956) and Angel on hip joint (1964) publication of much basic work on bone formation and growth began, further developed
when Urist (1966) took over the editorship.
McLean and Urist likewise started the series of
Hard Tissue Symposia (Budy, 1968) to promote this basic study. And detailed original
work on bone in laboratories from UCLA,
Stanford, and Michigan to the Smithsonian
have laid a basis for better understanding of
immature and mature bone response to physiologic insult or specific injury. The electron
microscope made much of their work possible.
The modern period of multiple technologies
has a triple start: (1)Saul Jarcho’s (1966)not
entirely optimistic symposium held in Washington in 1965; (2) Brothwell and Sandison’s
(1967)widespread net; and (3)the Cockburns’s
Paleopathology Association, run most successfully on a low key editorially but involving
a series of international conferences in England, Canada, and France; also conferences at
meetings of the American Association of Physical Anthropologists. The Paleopathology Association was founded after the 1973 dissection of the mummy PUM I1 (Cockburn, 1973;
Cockburn et al., 1975; Cockburn, 1978).Aidan
and Eve Cockburn’s (1978) editorship of the
Palaeopathology Newsletter holds together
this growing international group which includes pathologists and other medical scientist
as much as anthropologists. The newer Paleopathology Club of Marvin J. Allison and E.
Gerszten is based on the International Academy of Pathology rather than our association
(AAPA) and brings in a somewhat more clinical audience. I t is worth recalling that all
through the postwar decades of frustrating
lack of contact with pathologists we individually included examples of disease and health
in our reports. And we refused to accept a professional paleopathology association imposed
from outside (e.g., at the Berkeley AAPA
meetings in 1966). This individual amateur
persistence added to but diffused the pres-
511
sures which produced such syntheses as Goldstein’s (1969)review, Dan Morse’s (1969)Midwest survey, George Armelagos et al.’s bibliography (1971),Crain’s (1971)bibliography, and
much more recently the carefully balanced
guide book of Steinbock (1976) and the Cockburns’s penetrating coverage on mummies
(1980).
This work of Aidan and Eve Cockburn puts
together broadly the results of four very successful dissections of Egyptian mummies
which involved a long list of people ranging
from Egyptologists (W.H. Peck) to physiological biochemists (T.A. Reyman, R.A. Barraco);
others include J.L. Angel, I.F. Burton, G.
Hart, P. Horne, P. Lanzkowsky, P.K. Lewin,
F.P. Saul, F. Stenn, E. Strouhal, and M. Zimmerman. In particular the Detroit research on
PUM I1 (Cockburn, 1973; Cockburn et al.,
1975) and his subsequent appearance on exhibit at the Smithsonian Institution (Washington) and at the University Museum (Philadelphia) have roused public interest in paleopathology. Many others of us have organized
symposia on paleopathology at American Anthropological Association and AAPA
meetings.
At the Smithsonian in 1969 we started the
Bone Biology Program under Don Ortner in response to research needs. In response to student demand for training in paleopathology
many universities now have courses or programs. A t the Smithsonian Don Ortner persuaded pathologist Walter Putschar of Massachusetts General Hospital to come and give,
from 1972 to 1975, summer courses in which
we all took part (cf. Putschar, 1966 a, b). Many
graduate students benefited. After funds for
this teaching gave out, Qrtner and Putschar
(1981)gathered from all over Europe preantibiotic bone data for a massive descriptive synthesis now in press at the Smithsonian Institution. Among physical anthropologists there is
a truly massive rise in interest in paleopathology and in all the effects of environment during postnatal life, partly in reaction to past
overemphasis on genetics (in a false hope that
all discrete traits of the skeleton would turn
out to be genetic markers) and now in reaction
against the more absurd of the claims of sociobiology. I find it ironical that real social biology, the study of social interactions with biological changes within and between populations, includes paleopathology and has a largely ecologic aim, for example in Stewart’s (1960)
and St. Hoyme’s (1959)stress on the cold filter
as a guard against pre-Columbiandisease from
512
J.L. ANGEL
Asia (cf. Newman, 1976).To match this rise in
interest among anthropologists we need a similar spread of attention among pathologists,
such as Allison, Cockburn, Gerszten,
Putschar, Zimmerman, and among biochemists. This exchange of interests and skills is indeed happening, and we can profit from it with
only a little increase in research money.
The multiple technologies now available
range from the microscope and the scanning
electron microscope (which extend morphology) to the emission spectrograph and just
plain chemical assays of metals or of carbon
isotopes. Many are well beyond the original
training of those of us doing functional anatomy of bone or mummy tissue and seeing such
changes indicating disease as periostitis, joint
remodeling and various atrophies versus hypertrophies (Johnson, 1964; Ortner 1972,1975;
Putschar, 1966).
Buikstra and Cook (1980)see this activity in
eight or nine different areas. I use four: (1)patterns of traits necessary to limit diagnosis the Virchovian approach; (2) social biology: relation of ancient disease and health to society;
(3) demography and health, including aging,
epidemics, and trauma; and (4)growth, related
mainly to nutrition, including the real breakthrough in bone chemistry.
(1)Diagnoses remain properly tentative. Hypertrophic arthritis as opposed to infectious
arthritis is clear. New World treponematoses
as opposed to yaws or to Old World syphilis or
periostitis trauma is a much less clear contrast
(Hackett, 1975, 1976; Stewart and Spoehr,
1952; Stewart and Quade, 1968). Allison’s
(1973, 1979) identification of pre-Columbian
tuberculosis in Andean mummies becomes
quite certain with his identification of the mycobacterium. Without this the lytic lung and
bone lesions could be blastomycosis or histoplasmosis. The varieties of anemia are in part
distinguishable from ecologic context (Angel,
1967a, b, 197813;cf. Moseley, 1965,1974).Buikstra and Cook (1980)write: “Our best strategy
lies in (a)developing appropriate disease models based in recent disease experience; (b)careful observation of abnormal processes in bone;
and (c)detailed comparison of data with predictions from our model.” Often there is no clear
cause for such a condition as widespread periostitis of long bones. For example, effects of
deficiencies of Vitamin C (Ortner and Putschar, 1981) or extreme excess of Vitamin A
(Zimmerman,1981)may be hard to distinguish
from a disseminated infection.
(2)In social biology one of the clearest interactions between environment, society, and disease relates anophelines, falciparum malaria,
and abnormal hemoglobins. In particular ecologic settings different degrees of anemia (porotic hyperostosis), from very severe (in a few of
many dead children) to mild (in 10-30% of
adults), are best explained in this way (Angel
1967a, b. 1971, 1978a, b). Beyond this we are
getting immunochemical proof of presence of
the malarial plasmodium (Cockburn, personal
communication, 1981). Especially in the New
World there are other ecologies for porotic hyperostosis (Cockburn and Cockburn, 1977; ElNajjar, 1976; El-Najjar and Robertson, 1976).
Similarly, rickets is an ecologically and socially determined disease (Loomis, 1967, 1970;
Dick, 1922) with quite clear skeletal indications. The arthritides are permanent reminders
of environmental and immunologic stress
(Cockburnet al. 1979).Trauma is often obvious
(Angel, 1974a; Stewart, 1968).
(3)Our best demographic indicator of overall
health, adult longevity, is getting more attention. One can use this simply (Angel, 1975),in
age-pyramids (Laughlin, 197411975),in deathcurves (Angel, 1971; Ubelaker, 1974), and in
complete or partial life tables (Armelagos and
McArdle, 1975).Other aspects of demography
and microevolution tie in with paleoepidemiology (Roney, 1966; Cockburn, 1967; Buikstra,
1977; El-Najjar and Allison, 1978),malaria, tuberculosis, and other diseases such as small
pox (Ubelaker, 1976; Stearn and Stearn, 1945).
(4)Paleonutrition has two aspects -response
of bone and teeth (Cook, 1979; Cook and Buikstra, 1979; Hoyme and Bass, 1962; St. Hoyme
and Koritzer, 1976; Hadjimarkos and Bonhorst, 1962; Angel, 1975, 1976, 1978b; Angel
and Olney, 1981); and trace element record in
bone (Brown, 1974; Boaz and Hampel, 1978;
Schoeninger, 1979; Bisel, 1980; Sillen, 1981).
Strontium, zinc, magnesium and phosphate,
usually taken relative to calcium concentration
in the bones of people and of the animals eaten
(and, ideally, compared with soil concentrations), tell us about nutrients incorporated in
bone. Pelvis (Angel, 1978a)and skull base (Angel and Olney, 1981) tend to flatten if protein
or Vitamin D in diet is inadequate. This is seen
in a 5-1370 significant decrease in flattening
between recent dissecting room and later middle-class skeletons. It is more striking from
well-nourishedUpper Paleolithic down to early
farming groups and fluctuates back up to
modern.
HISTORY AND DEVELOPMENT OF PALEOPATHOLOGY
We can simplify paleopathology’s history into four phases: descriptive, in the nineteenth
century, analytic in the earlier twentieth century, both synthetic and specialized from 1930
to about 1970, and increasingly probing and interdisciplinary from 1970 into the future. I
think we are more aware now that the past of
mankind, distant and immediate, is the only
experimental situation we can study. This historical sketch is not a complete current overview; for that I refer you to Buikstra and Cook
(1980).
We are still all amateurs in paleopathology
looking toward a bright cooperative future.
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