Diagnosis of occupationally related paleopathology • 41 



Another activity-related skeletal study by Dutour (1986) 

 postulates enthesopathies as indicators of activities in two 

 Neolithic populations. There are. however, problems with 

 this work. Both groups studied were small, consisting of only 

 41 skeletons in total. Of these 21 were unsexable. Dutour 

 does not differentiate between enthesis, attachments of mus- 

 cles, and syndesmoses, attachments of ligaments (1986:224). 

 He calls all his observed lesions enthesopathies although 

 some are in areas of ligamentous and not tendinous insertion. 

 This is particularly important since it concerns his recon- 

 struction of a possible archer (1986:222). Here, the en- 

 thesopathies of the right radius have been combined with 

 degenerative changes to the synovial joints at both elbows 

 and with developments of muscle insertions on both humeri. 

 All these changes are not enthesopathies and the synovial 

 joint changes may be age related. Dutour does not appear to 

 take such age-related degeneration into account when dis- 

 cussing the etiology of the lesions. It is clear, however, from 

 the literature that enthesopathies are degenerative in nature 

 and are "common in older individuals" (Resnick and 

 Niwayama 1981:1297). Apart from using such categories as 

 "juvenile," "mature adult" and, in one case, "aged male," no 

 indication of age ranges is given. In attempting to diagno.se 

 activity-related changes, the relative ages of the individuals 

 concerned are of importance. When enthesopathies which 

 are not metabolic or inllammatory in origin are thought to be 

 degenerative in nature, then age becomes a key question. 

 However, as the changes concerned may be accelerated by 

 trauma or chronic stress ( Resnick and Niwayama 1 98 1 : 1 3(X)) 

 and, therefore, activity, the picture may be more complex 

 than would appear from Dutour's paper. The problem is once 

 again one of specificity. 



In a recent paper. Waldron ( 1 987) discussed a site in which 

 there is some documentary evidence of occupation from buri- 

 al registers. Although this work is only in its early stages it is 

 of great interest. Of the 336 adults so far examined from 

 Christ Church. Spitalfields, 37.2% have osteoarthritis. This 

 occurs most commonly in the spine, but the shoulders and 

 hands are also involved. The hands are of particular interest 

 since Spitalfields was a very important silk-weaving center, 

 and the disease here may be related to occupational factors. 



One of the problems associated with the diagnosis of occu- 

 pationally related pathology is concerned with current termi- 

 nology. An example is the use of the term "degenerative 

 change." Some specialists use it to denote age-related 

 changes, while others are concerned with the deterioration of 

 joint surfaces resulting in destruction or proliferation of 

 bone. Ortner( 1968: 141) studied two large skeletal groups in 

 order to classify degenerative change in the humeral elbow. 

 This study uses the term in the latter sense and stresses the 

 importance of handedness, sex, and cultural practices in de- 

 generative change. Ortner (1968:144) also emphasizes the 

 significance of age in the degree of degeneration in a joint, 

 and discusses mechanical stress, anatomy, and heredity as 

 other determining factors. 



Zagreb Paleopaihotogy Symp. I98H 



These skeletal studies, while subject to inherent problems, 

 do attempt to describe possible occupationally related 

 changes and to categorize some of them. 



Clinical studies 



The traditional clinical postulate has been that in os- 

 teoarthritis, particularly of the spine, an occupational com- 

 ponent is present. In the public as well as the specialist mind, 

 pathology of joints has often been associated with usage. 

 This is reflected in the popular terminology often associated 

 with overuse syndromes, such as "tennis elbow." However, 

 the modern clinical view of the role of activity in the develop- 

 ment of osteoarthritis is, to say the least, ambivalent. The 

 traditional view is represented by studies such as those on 

 coal miners (Lawrence 1955), dockyard workers (Anderson 

 and Duthie 1963), and by some theoretical works (Radin et 

 al. 1972). Other work, however, such as that by Hadler, 

 presents a different view. In his first study, Hadler stresses the 

 anecdotal nature of much of the clinical correlation between 

 activity and some musculoskeletal disease, and points out 

 that the amount of true clinical information is somewhat 

 inadequate. He suggests alternative strategies for clinical 

 studies to gather the necessary information (1977:1023). 

 These studies are implemented in later work on patterns of 

 repetitive, stereotyped usage in the hands of female textile 

 workers ( Hadler etal. 1978; Hadler 1980). It is clear that this 

 later work considers degenerative joint disease to be a highly 

 prevalent process of aging throughout the entire population, 

 and not confined to specific groups; repetitive, stereotyped 

 tasks and side are both involved in the degenerative syn- 

 drome. 



Anderson found in a study of manual workers that, after 

 allowing for age, heavier work significantly increased the 

 likelihood of rheumatic complaints in general and degenera- 

 tive disc disease in particular, but not of osteoarthritis of the 

 other joints (1974:523). He also concluded that such disea.ses 

 are likely to develop earlier among heavy manual workers 

 (1974:524). In a later study. Anderson identified the impor- 

 tance of side, age, biochemical changes and their genetic 

 bases, and chronic irritation in the development of os- 

 teoarthritis (1984:431 ). He argued "that the development of 

 degenerative changes can be triggered in those at risk" either 

 by a severe impact which damages the cartilaginous joint 

 lining, or by chronic stress over a long period producing 

 fatigue in a joint. Both posture and mobility were seen to be 

 important in these changes. 



Lockshin et al. (1969) surveyed arthritic complaints in 

 more than 1 1(K) men from three mining communities in West 

 Virginia. The main differences between the groups were that 

 in the 60-69 age group. 68.9% of miners had osteoarthritis of 

 the cervical spine grades 2-4. conipared with 56.9% of non- 

 miners (1969:24). Unlike similar British work (Lawrence 

 1955). these authors found no difference in the prevalence of 

 disc degeneration m the lumbar spine between miners and 



