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Paleoepidemiology of a central California prehistoric population from CA-Ala-329 Dental disease.

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AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 81:333-342 (1990)
Paleoepidemiology of a Central California Prehistoric Population
From CA-Ala-329: Dental Disease
ROBERT JURMAIN
Department of Anthropology, Sun Jose State University, Sun Jose,
California 95192
KEY WORDS
Dental attrition, Periodontal disease, Dental ab-
scesses
ABSTRACT
Ala-329 is a prehistoric central California site located on the
southeastern margin of San Francisco Bay, dating from approximately 500 AD
up to pre-European contact. A large earth mound, Ma-329, has yielded many
well preserved burials, approximately 300 of which are included in this study.
The most common pathological lesions seen in this population are in the
dentition. Advanced attrition is pervasive, affecting all individuals with teeth
in occlusion for 2 years or more. Deciduous teeth are involved even in very
young children and often show severe wear before replacement. In the
permanent dentition, all elements are involved by the second decade; in the
oldest age category (41+ years), all individuals show severe wear throughout
their dentitions. In fact, by the end of the third decade, the majority of
individuals have no enamel remaining. Mild periodontal involvement is found
in 74%of adults, socket resorption in 53%,and abscesses in 31%of the relevant
sample. Interestingly, although dental abscesses are found more than twice as
often among males, socket resorption is seen more often among females.
Dental caries are seen in only 10 individuals. The high incidence of periodontal
remodeling, socket resorption, and dental abscesses is probably a secondary
result of severe dental attrition. It is hypothesized that a large quantity of
abrasives in the diet is responsible for the extreme degree of attrition, in fact,
among the most severe for any population yet described.
“Something is always going wrong with our teeth. They don’t last
anything like a lifetime, usually. What chain of events in evolution
should we thank for our mouthfuls of rotting crockery?”
-Kurt Vonnegut, Galapagos, 1985
The dentition acts as a primary interface
with our environment. The teeth function
crucially as the first agents of food processing and secondarily as tools. Through their
repeated exposure t o wear and infectious
organisms, the teeth can also be among the
first vital systems to fail, and the consequences can be catastrophic.
Dental diseases have long been a problem
in human evolution. For exam le, the Broken Hill cranium shows marke c rdental wear
and multiple abscesses, and the La
Chapelle-aux-Saints 1individual had lost 14
and possibly 15 teeth by the time he died
(Trinkaus, 1985). Moreover, contemporary
nonhuman primates also are commonly af-
@ 1990 WILEY-LISS, INC.
fected by poor dental health. In one group of
Gombe chimpanzees, severe attrition and
resultant abscesses are the most common
pathological lesions encountered (Kilgore,
1989).
The health consequences of dental disease
have been noted by paleopathologists in a
wide variety of recent human populations
(e.g.,Hinton, 1981; Costa, 1982; Puech et al.,
1983; Tal and Tau, 1984; Molnar and Molnar, 1985; Hall et al., 1986; Clarket et al.,
1986).Among prehistoric California populations, some of the most frequent and severe
Received December 9,1988; accepted May 11,1989.
334
R. JURMAIN
manifestations of dental involvement have
been seen (Leigh, 1928; Molnar, 1971;
Walker, 1978; Reinhardt, 1983). The prehistoric central California population reviewed
here is certainly among the most severely
affected of any group yet reported.
MATERIALS AND METHODS
Ala-329 is a large earth mound site located
on the southeastern side of San Francisco
Bay, approximately 20 miles north of San
Jose (Fig. 1). This central coast region between San Francisco and Monterey Bays
was populated at the time of European contact by a group of linguistically related tribes
of the Costanoan language family. Not representing any actual political entity, Costanoans (or Ohlones, as they are often called)
were segmented into relatively small ethnic
groupings or tribelets, each speaking its own
language, as different from each other as
French from Spanish, and inhabiting its own
local territory. In the eighteenth century,
along the eastern bay, about 2,000 individuals spoke dialects of the Chochenyo language, and this linguistic group in turn was
made up of several tribelets, comprising anywhere from 50 to 500 people each. The annual subsistence round probably crossed ecological zones that took the inhabitants from
the bayshore at least as far inland as the
(, SAN
JOSE
0
scale
0
20 miles
i
Fig. 1. Location of site Ca-Ala-329,southeastern San
Francisco Bay, central California coast.
uplands of the neighboring eastern mountain range.
Large mound sites such as Ala-329 have
traditionally been interpreted as habitation
sites of fairly large, mostly sedentary populations. However, ongoing analysis of the
rich archeologicalassemblages from this site
(Leventhal, 1989) suggests that this mound
may have served as a special-purpose mortuary complex. Ala-329 thus may include the
accumulated burials from more than one
large village community. The representativeness (culturally and biologically) of this
important site, with its obvious demographic
implications is also currently under review.
Although it is now located approximately
2.5 miles inland, the site probably once stood
adjacent to the bayshore, surrounded by
saltwater marshes. Radiometric (14C) age
estimates indicate that most burials were
interred between 500 AD and just before
European contact (Leventhal, 1989).
An extensive site, the earth mound extend
133m x 90 m x 4 m (high) and no doubt still
contains several hundred burials. Favorably
positioned as it was along the bayshore, the
area allowed easy access to shellfish, fish,
and waterfowl as well as upland stands of
oak, yielding their all-important acorns. In
addition, seeds, berries, roots, and varied
small, medium-sized, and large mammals
were locally abundant. Without question,
this region had one of the richest and most
diverse subsistence bases in all of North
America. Accordingly, it is no surprise that
central California is estimated to have had,
at the time of European contact, among the
highest population densities anywhere
north of Mexico (Cook, 1976; Ubelaker,
1988). As we will see, however, this rich
subsistence base with its patterned means of
extraction was not without its costs.
The number of burials retrieved from Ala329 from excavations conducted primarily
during the 1960s totaled more than 400. The
sample available for analysis in this study,
that portion excavated by San Jose State
University field classes, consists of 298 individuals. Of these, the most relevant group for
most of the present analyses is the 195 aged
and sexed individuals with adult dentitions
(311 years of a g e b 1 0 7 males and 88 females. Individuals were sexed and aged using standard osteological procedures. Subadults were aged on the basis of dental
fmmation and eruption (Ubelaker, 1978) as
well as epiphyseal union (Bass, 1987).
Adults were assessed primarily on the basis
DENTAL. DISEASE IN PREHISTORIC CALIFORNIA
of pubic symphysis remodeling, initially using the Todd system (Todd, 1920), but later
rechecked for the entire collection using the
modification developed by Katz and Suchey
(Katz and Suchey, 1986; Gillett, 1987).In all
cases sex and age were independently assessed by the author and a minimum of two
other observers. Overall, the condition of
burials is good to excellent; this collection
represents one of the largest and best preserved osteological samples from any single
site in the western United States.
Paleopathological changes of the teeth and
jaws were evaluated by visual means on the
gross specimens, occasionally supplemented
by radiogra hs. All dentitions were ineluded, whet er complete or fragmentary.
Dental attrition was scored using Molnar’s
(1971) eight-stage system. This method and
others much like it (Murphy, 1959) have
been the most widely applied (e.g., Hinton,
1981; Reinhardt, 1983; Smith, 1984; Hall
et al., 1986). Other more complex systems to
measure dental attrition have been used,
with some success for the molar row especially (Walker, 1978; Scott, 1979). However,
the easily applied ordinal scale was chosen
because it differentiates primary from secondary dentin and can be used for all dental
elements, and the results can be compared
with those of other studies. In addition, an
ordinal scale was used to describe surface
periosteal changes, scored as slight, moderate, or severe on the basis of how much
periosteal hypertrophic bone was deposited.
335
!
RESULTS
Attrition
The most common dental pathology is severe attrition, manifested throughout the
dental row. Such involvement is pervasive in
this population, affecting all individuals
with teeth in occlusion for 2 years or more. In
fact, for adult dentition (age 11 years and
above) in 98.8% of cases (N = 171), at least
one tooth had moderate or severe involvement (score of 4 or higher). Of these, 82.5%
had more than 10 elements at least moderately worn. Looking at only severe involvement (6 and above), 82.5% of cases had at
least one tooth affected, and, for extremely
severe involvement (Molnar’s 81, where no
enamel remains, 66.1% of individuals have
at least one tooth involved (Fig. 2).
When the upper or lower dentitions are
considered separately, the results are similar; 97.5%of upper dentitions (N = 161)and
98.1% of lower dentitions (N = 160) display
Fig. 2. Advanced dental attrition, typical of adults in
fourth decade; male, aged 31-40 years.
some moderate involvement. The most commonly affected element is consistently the
first molar in both the upper and lower jaws,
with the M l s displaying severe involvement
between 69% and 72% of the time. Conversely, the least affected element is the
third molar, again in both upper and lower
jaws (severely involved 28% for the ULM3,
39% for the URM3, and 54% for both lower
third molars) (Table 1).
In fact, the modal involvement for all teeth
(with the exception of third molars) is level 8,
i.e., wearing down to the roots and consequently usually exposing the pulp cavity.
This frequency of extreme involvement is all
the more remarkable when we consider that
this is by no means a population of older
individuals. The average age at death for
individuals aged 11years and above is 30.6
years for males and 31.7 years for females.
The pattern with advancing age shows
that, again except for the third molars, by
the teens all elements are 100% involved to
some degree. By the third decade (ages
21-30 years), the minimum wear on any
tooth (excepting the third molars) is level 3,
and severe involvement ranges from 30% to
80%. By age 41+ years, everyone shows
severe involvement for all teeth, except for
third molars. These age-related patterns are
unambiguous in all relevant dental elements,
but for purposes of demonstration are shown
for two representative teeth, the upper right
central incisor and upper right first molar
(Tables 2 and 3).
336
R.JURMAIN
TABLE 1. Patterns of dental attrition in adults (aged 11 years and older)
N
Upper
RM3
RM2
RM1
RP2
RPl
RC
RI2
RIl
LI 1
LIZ
LC
LP1
LP2
LM1
LM2
LM3
Mean
C'
M
F
C'
M
F
Frequency severe
(6 or higher)' (%)
98
120
111
115
130
132
103
107
103
111
132
126
119
112
120
85
55
66
60
66
68
72
55
60
58
56
72
66
67
63
65
49
40
48
47
44
57
55
46
43
40
51
56
56
47
44
49
32
4.33
5.54
6.52
5.77
5.85
5.83
5.53
5.59
5.61
5.59
5.74
5.56
5.63
6.39
5.57
4.36
4.62
5.79
6.58
5.82
5.98
5.99
5.58
5.68
5.71
5.78
5.72
5.58
5.60
6.46
5.72
4.67
3.98
5.25
6.45
5.61
5.72
5.67
5.50
5.40
5.48
5.31
5.70
5.48
5.68
6.39
5.39
4.03
39.2
58.3
70.3
63.5
63.1
61.4
52.4
56.1
58.2
56.8
64.4
56.3
58.0
72.3
59.2
28.2
98
140
134
123
129
134
108
80
82
99
138
132
125
131
136
95
53
76
72
66
67
72
63
48
48
57
72
69
69
70
73
54
40
59
56
52
58
56
40
28
30
38
59
57
50
54
57
38
5.24
5.77
6.26
5.75
5.78
5.79
5.58
5.89
5.66
5.72
5.95
5.74
5.62
6.31
5.66
5.22
5.47
5.86
6.24
5.73
5.80
5.86
5.75
6.27
5.85
5.93
5.89
5.58
5.56
6.35
5.71
5.54
4.80
5.59
6.25
5.60
5.76
5.73
5.40
5.39
5.30
5.39
6.05
5.91
5.56
6.15
5.53
4.60
54.1
64.3
72.4
64.2
63.6
59.7
51.8
57.5
53.7
56.6
64.5
61.4
60.0
71.8
61.8
53.7
Lower
RM3
RM2
RM1
RP2
RP1
RC
RI2
RI1
LI1
LIZ
LC
LP1
LP2
LM1
LM2
LM3
:Males and females combined.
After Molnar (1971).
TABLE 2. Upper right central incisor, pattern of attrition b y age category'
Age
category (years)
N
1
2
3
4
5
6
7
8
11-20
21-30
31-40
41t
20
28
36
8
-
5 (25.0)
l(3.6)
10 (50.0)
9 (32.1)
l(2.8)
5 (25.0)
3 (10.7)
-
-
-
-
8 (26.8)
3 (8.3)
3 (10.7)
12 (33.3)
2 (25.0)
1 (3.6)
7 (19.4)
2 (25.0)
3 (10.7)
13 (36.1)
4 (50.0)
-
-
-
-
-
'Percentage frequencies shown in parentheses. Attrition scores after Molnar (1971).
TABLE 3. Upper right first molar, pattern of attrition b y age category'
Age
category (years)
N
1
2
3
4
5
6
7
8
11-20
21-30
31-40
41+
24
33
36
7
-
1 (4.2)
6 (25.0)
-
-
-
8 (33.3)
5 (13.2)
-
-
9 (37.5)
2 (6.1)
6 (18.2)
l(2.8)
10 (30.3)
8 (22.2)
-
-
10 (30.3)
27 (75.0)
7 (100.01
-
-
-
-
'Percentage frequencies shown in parentheses. Attrition scores after Molnar (1971)
DENTAL DISEASE IN PREHISTORIC CALIFORNIA
337
In the deciduous dentition, early onset of periodontal involvement. Molnar and Molsevere attrition is also seen, but the patterns nar (1985) suggest the term “ostetitis,” but
are more difficult to delineate; only 34 indi- “gingivitis” is also frequently employed.
viduals (age 10 years and under) have any Most researchers agree that more severe
teeth preserved; and a substantial portion of disease leading to resorption of the alveolar
these individuals are under 2 years of age. crest and involvement of the periodontal ligConsidering that infants were not weaned ament should be termed “periodontitis.”
until 18-20 months (Roland, 19591, onset as
In this study, only the mild surface lesions
of the alveolar bone are scored, most seen as
early as occurs is remarkable.
Of those children with some teeth, 47.1% slight hypertrophic reactions. The more sehave at least one element moderately in- vere manifestations of alveolar resorption
volved, and 14.7% have a t least one tooth were not systematically scored due to the
severely involved. Only 5.9% of cases have confounding problems of overeruption of
any “hypersevere” (grade 8 ) involvement. It teeth as well as postmortem damage (probappears that, in this population, following lems well recognized by others; Molnar and
eruption, it takes about 2 years for a tooth to Molnar, 1985: Clarke et al., 1986). Among
show moderate attrition and about 5-10 the Ala-329 population, frequent exposure
years to become severely involved. The de- directly through the pulp cavity appears to
ciduous teeth are obviously replaced before have been the major focus of severe infection.
Some surface periodontal involvement is
much severe wear can take place (Table 4).
seen in 74% of adults, with moderate and
Periodontal disease
severe lesions displayed 46% of the time. In
One immediate result of severe attrition the oldest age category, 82% (73%moderate/
and continued irritation by abrasives from severe) of upper jaws and 77% (48%
the diet is inflammation of gum tissues. In moderate/severe) of lower jaws are involved
certain circumstances, initial inflammatory (Fig. 3). However, no sex differences in perireactions can result probably more from mi- odontal incidences are observed.
When bone loss proceeds to an advanced
crotrauma to the soft tissue immediately
adhering to the bone than directly from bac- degree or tooth anchors are weakened, anteterial infection. In the clinical as well as the mortem loss of teeth and socket resorption
paleopathological literature, a variety of can ensue. Here again frequencies of such
terms have been used for these mild forms of lesions are high. Among adults (221 years of
age), 52% display socket resorption. For
those individuals showing such antemortem
tooth loss, the average number of sockets
TABLE 4. Patterns of dental attrition in subadults
resorbedis 4.6 in the upperjaw and 5.0 in the
laeed 10 Years or less). deciduous dentition
lower jaw. The most common location of
Frequency severe
antemortem loss and socket resorption is in
N
Mean
(6 or higher) (W)
the posterior row (premolars and molars),
Upper
accounting for 93% of involvement in the
2.53
RM2
19
upper jaw and 71% in the lower jaw. Again,
16.0
2.76
25
RM1
the trend with age is marked; among the
2.07
RC
15
oldest age group (41-t years of age), 75% of
R12
4.5
2.23
22
RI1
2.06
18
upper and 66% of lower jaws are affected
LI 1
4.5
2.65
17
(Fig. 4). When considering complete resorp5.2
2.53
L12
19
tion of sockets (where the alveolus is mostly
2.50
16
LC
filled-in), a sex difference is manifested, with
24
20.8
3.04
LM1
LM2
18
5.6
2.61
females almost twice as affected as males
Lower
(P < .01).
10.5
19
RM2
2.84
The final sequel to advanced attrition is
22
9.1
RM1
3.00
severe infection once the pulp cavity has
6.7
15
2.20
RC
22
2.23
RI2
been exposed, often leading to abscesses.
RI 1
19
2.53
Among individuals aged 11years and older,
I,I 1
20
2.45
30% had at least one abscess. Most of the
L12
19
2.32
5.2
individuals have only one or two abscesses,
6.2
LC
16
2.69
LMI
23
2.56
8.7
but one unfortunate victim (a 31-40-year-old
LM2
19
2.47
5.2
male) had nine abscesses. Apparently untreated, some infections progressed t o a se‘After Molnar (1971).
~~
338
R.JURMAIN
1O O % l
90%
80%
70%
60%
50%
40%
30%
20%
10%
'
0-10
'
11-20
'
21-30
31-40
I
41+
'
Fig. 3. Frequency of periodontal involvement by age.
Males and females combined.
80%
UPPER J A W
70%
60%
50%
40%
30%
20%
10%
11-20
21-30
31-40
41+
"Adult"
Fig. 4. Frequency of involvement of socket resorption
and antemortem tooth loss by age. Males and females
combined.
vere degree, yielding abscesses greater than
10 mm in diameter (Fig. 5 ) . Suggestive of an
interaction with progressive wear, the frequency of abscesses also shows marked increase with age (Fig. 6).
As with socket resorption, abscesses show
a predilection for the posterior dentition,
appearing there 79% of the time. In addition,
there is a marked tendency for upper compared to lower jaw involvement. In those
cases when only one jaw is affected, 78% of
the time it is the maxilla that is involved.
Here also a significant sex difference
(P < .05) is observed, but in the opposite
direction from the pattern for socket resorption; for abscesses, males are the more commonly affected, 39% compared to 21% for
females.
Other dental conditions
In addition to severe attrition and the
related periodontal involvement noted
above, a few other types of dental problems
are seen occasionally in the Ma-329 popula-
339
DENTAL DISEASE IN PREHISTORIC CALIFORNIA
Fig. 5. Large, well healed abscess of maxilla; male,
aged 41-50 years.
50%
-
50
0
UPPER JAW
38%
40%-
30%
-
LOWER JAW
20%
10%-
1
8%
Fig. 6. Frequency of involvement of dental abscesses
by age. Male and females combined.
tion. Dental caries are found but rarely, seen
in only 10 individuals, who together have a
total of 21 lesions. As in other studies, the
molars are most often affected, accounting
for 18 of the observed carious lesions. Although this is a preagricultural population,
and the caries rate should thus be expected
to be fairly low, the incidence in Ala-329 is
unusually low compared to other nonagricultural groups (e.g., groups from Oregon; Hall
et al., 1986).
Indeed the caries rate at Ala-329 summed
for all elements is a mere .57%,exceedingly
low even in comparison to other California
samples (one-tenth to one-twentieth as involved)(Walker and Erlandson, 1986)(Table
5).A simple explanation may account for the
low caries rate at Ala-329. In that caries are
diagnosed as characteristic defects in
enamel, the lack of enamel from wear in most
adults makes complete ascertainment of caries impossible. Of note in this regard is that,
340
R. JURMAIN
1928).Precise comparative data are difficult
to locate owing to differences in methodology. Among the best data available are those
Canada Verde
Skull Gulch A
Skull Gulch B
reported by Hall et al. (19861,using Molnar’s
N2
Freq.
N2
Freq.
N2
Freq.
rating system, for prehistoric residents of
1,718
13.3
251
10.8
934
6.3
Oregon.
Average attrition levels for their total
‘Data from Walker and Erlandson (1986). Males and females
combined.
sample (from five locations) for individuals
*N = total for all dental elements.
aged 15 years and older range between 3.8
and 5.7 for the maxilla and between 4.2 and
5.4 for the mandible excluding third molars.
In comparison with Table 1,it is obvious the
Ala-329 individuals show markedly more
of the 10 individuals with caries, eight are dental attrition, ranging on average between
under 30 years of age.
5.5 and 6.5 in the maxilla and between 5.6
A few cases of supernumerary teeth were and 6.3 in the mandible (again, excluding
also found (in nine individuals). Finally, third molars).
eight cases of severe malocclusion or
Another study (Molnar, 1971) does not
maleruption were observed in this group. present the results in quite such an interThis lesion is not usually threatening, but, in pretable fashion, but comparative histoone dramatic case (a female 17-21 years old), grams indicate that a group from the Central
a midline defect and maleruption of an incisor through the maxilla, just below the nasal Valley of California (nearby but distinct from
cavity, apparently led to a severe inflamma- Bay Area populations) had teeth significantly more worn than comparative samples
tory response (Fig. 7).
from the southwestern United States or the
Valley of Mexico. Indeed, for severe wear
(score of 6 or higher), the California group
DISCUSSION
was two t o four times more frequently afBad teeth are perhaps a curse not just for fected than the other two groups and athumans but for all mammals that live suffi- tained maximum frequencies for the first
ciently long. What is most striking in the molars approaching 85%. These frequencies
Ala-329 population is not that dental disease actually exceed those from Ala-329, where
is common but its early onset and severity of incidence of “severe” wear (i.e., 6 or higher)
involvement. Osteologists have realized for ranges as low as 28.2% for the upper left
some time that dental problems are often third molar and reaches a maximum of
dramatic among native Californians (Leigh, 72.4% for the lower first molar.
TABLE 5. Caries Frequency in three California
Populations from Santa Rosa Island’
Fig. 7. Malerupted teeth as a result of midline developmental defect; female, aged 17-21 years.
DENTAL DISEASE IN PREHISTORIC CALIFORNIA
Reinhardt (1983) does not present quantified data for dental attrition but does describe how severely wear can progress in
materials he surveyed from southern California. In fact, he extends Molnar’s scale t o a
stage 9 defined as “NOcrown enamel, roots
functioning in occlusion, all teeth very short
and multiroot teeth dehisced or nearly so” (p.
231).Reinhardt hypothesizes that the severe
wear can lead to lingual tilting of teeth and
other problems and defines a “severe attrition syndrome.” In the Ala-329 sample, individuals frequently showed attrition patterns
this severe; in these cases, they were coded
as “8+” in a manner very similar t o that of
Reinhardt but for purposes of analysis were
included with other stage 8 scores.
The underlying etiology for the extreme
degree of dental attrition seen at Ala-329
and in other native California groups most
probably is related to the abrasive nature of
the diet consumed by these peoples. Smith
(1984) finds that the buccolingual angle of
molar wear is increased in agriculturists
compared to hunting-gathering groups. She
hypothesizes that the difference in patterning results from less lateral excursion or less
puncture-crushing in agriculturists, perhaps as a function of the less tough and less
fibrous nature of their food. In addition,
Hinton (1981, 1982) also suggests that in
hunter-gatherers more extreme wear is
found, since in agriculturists, with fewer
seeds, etc., in their diets, less strenuous mastication may have been required.
At this point, it is not possible to state
conclusively which components of the diet
among prehistoric Californians, such as
those at Ala-329, exerted the most stress on
their teeth. It can be argued, however, that
the amount of grit in the diet should have
been a major factor. The diet of prehistoric
inhabitants along San Francisco Bay no
doubt contained large amounts of abrasives.
Quartz grit from sandstone mortarshnd pestles along with spalled fragments of cooking
stones, all used in the preparation of acorns,
as well as other abrasives introduced with
shellfish processing, inevitably placed severe stress on the teeth of all individuals. In
addition, anterior teeth may have been further abraded through use in processing fibers for baskets and cordage for twine (Molnar, 1972; Schulz, 1977; Larsen, 1985).
In any event, by the time individuals were
in their midtwenties, little enamel remained
anywhere in their dentitions. High frequencies of periodontal inflammation, tooth loss,
341
socket resorption, and dental abscesses can
all be explained as results of severe attrition.
Moreover, once the teeth could no longer
perform normal mastication, intake of adequate nutrients must have posed a major
problem. In fact, the high rate of mortality in
this population before age 40 years (17.4%
lived past age 41 years) may in part be
explained by this phenomenon. Thus the
constant wear can ultimately have catastrophic consequences for dental and overall
health.
ACKNOWLEDGMENTS
For their help in carrying out this research, grateful thanks go to Lorna Pierce,
Rhonda Gillett, and Margaret Binns. I also
thank Lynn Klgore and Alan Leventhal for
their help in preparation of the manuscript.
Most especially, I acknowledge Prof. Bert
Gerow for kindly providing access to the
collection. Support for this research was provided by a San Jose State University Foundation Research Grant.
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