Is paleopathology a relevant predictor of contemporary health patterns? • 13 



case for prediction through homology, hut a more general 

 analogous argument will more likely be appropriate in most 

 cases. 



Nature of paleopathological evidence 



The physical remains that form the basis for most pal- 

 eopathological study have both attractive and unattractive 

 features. Their attractive characteristics include their poten- 

 tial time depth. It is possible to examine the physical remains 

 of a cultural lineage ranging over thousands of years, and 

 hence ascertain the antiquity of certain maladies, as well as 

 how they vary with behavioral or environmental shifts. Sim- 

 ilarly, paleopathological evidence often allows observations 

 of great geographic breadth. A particular condition can be 

 traced throughout an environmental zone, or between one 

 cultural lineage and its neighbors. Nonmummified remains 

 offer a view of skeletal and dental changes that is unobscured 

 by overlying soft tissue: there is no need to find noninvasive 

 modes of investigation or to weigh the value of information 

 gathered against the danger of radiating the patient. In most 

 dry and mummified remains, evidence is of unmodified, 

 untreated disease processes. Hence, there is no need to factor 

 out iatrogenic effects. 



On the other hand, paleopathological evidence is seriously 

 limited. When we approach the remains clinically, the ab- 

 sence of .soft tissue severely limits the accuracy of a dilTcr- 

 ential diagnosis. There is no opportunity to establish symp- 

 tomatology, no disease progress to follow. Hence our 

 confidence in our diagnosis is often limited. Further limita- 

 tions on diagnosis are imposed by the relatively nonspecific 

 reactions of bone tissue to extrinsic stressors. Paleopatholo- 

 gists must be particularly cautious diagnosticians. 



Perhaps the remains' most serious fault for purposes of 

 health status prediction is their serendipitous nature. Patterns 

 of human burial and mummification are very diverse, and 

 retrieval of remains is relatively rare. Phillip Tobias noted in 

 1982 that South African hominids were represented by 51 1 

 individuals spanning over 3 million years; that is, one indi- 

 vidual for every 5871 years {Tobias 1983). So too. the evi- 

 dence of more recent human populations is sporadically dis- 

 tributed and not much more complete. Because of this lack of 

 control over sampling, paleopathological evidence tells of a 

 disease's existence but not of its prevalence nor its incidence 

 (Moore et al. 1980). This seriously limits our ability to pre- 

 dict the probability of a condition's modern occurrence. 



Nevertheless, progress has been made in establishing an 

 epidemiological approach to paleopathology, in which fea- 

 tures due to abnormal bone remodeling dynamics (or enamel 

 formation) are observed in all elements from all skeletons of 

 an archeological skeletal scries, and patterns of incidence are 

 tested against specific models (Buikstra and Cook 1980). 

 Further, there are certain special ethnographic settings in 

 which the skeletal remains recovered may approximate an 



unbiased sample of a Mendelian population. The practice of 

 ossuary burial among Iroquoian people of southern Ontario is 

 one example of such a setting (Trigger 1969,1976). 



Given this list of .strengths and weaknesses, I will identify 

 a number of conditions which particularly jeopardize north- 

 em Indian and Inuit health, and attempt to see what insights 

 or predictions the paleopathology of these groups may offer. 

 The discussion of current native health problems is not com- 

 plete, but rather emphasizes skeletal traits, or conditions 

 which may be linked in some way to skeletal metabolism. 



Health problems of Native Americans 



The conditions of greatest public health interest among Na- 

 tive Americans are those of the so-called "New World Syn- 

 drome": obesity, adult-onset diabetes mellitus, gallstones, 

 and gallbladder cancer (Weiss et al. 1984). Other conditions 

 to which Native Americans appear particularly susceptible 

 include the infectious diseases tuberculosis and otitis media, 

 plus a number of hereditary or partially hereditary condi- 

 tions: hereditary polymorphic light eruption, rheumatoid ar- 

 thritis, oral clefts, hyperbilirubinemia, Polydactyly, and con- 

 genital dislocation of the hip(Sieversand Fisher l98l;Criss 

 1 985). Not all these conditions show a high relative incidence 

 in all native groups. Furthermore, other conditions not listed 

 here may constitute major health problems for some Native 

 American groups. Among many groups, alcoholism and cir- 

 rhosis are common causes of morbidity and mortality. Acci- 

 dents account for more fatalities among natives than among 

 non-natives for a variety of reasons. 



Note that neoplasms and coronary heart disease, which are 

 the most common causes of mortality among middle class 

 North Americans, are not major cau.ses of mortality among 

 Native Americans. This is at least partially explained by the 

 relative youth of the native population. In Canada, only 3% 

 of the native population is over age 65 years compared to 9% 

 over age 65 among non-native Canadians (Statistics Canada 

 1984). In 1981 , Indian males could expect to live an average 

 of 9.5 years fewer than the Canadian national male popula- 

 tion, while Indian women could expect to live an average of 

 lO.Oyears fewer than the national female population (Maoet 

 al. 1986). In the United States, too. the median age of natives 

 is low: 20.5 years, as compared to 28.9 years for White 

 Americans (Criss 1985). 



Relevance of paleopathology 

 to congenital conditions 



Several of the hereditary conditions listed above are manifest 

 in the skeleton, and could be traced through paleopathologi- 

 cal cases. Polydactyly is the most prevalent major birth de- 

 fect in natives at 2.4 per KKM) live births (Niswandcr el al. 

 1975). Its antiquity has been argued from prehistoric rock art 

 depictions (Wcllmann 1972). However we cannot ascertain 



Zagreb Paleopathology Symp. 1988 



