10 • Donald J. Ortner 



initial, often acute, phase of infection before the skeletal 

 manifestations occur (Ortner and Hunter 1981). This implies 

 a good immune response and a relatively healthy individual, 

 in contrast with a person having the same disease who dies 

 before the bone tissue is affected by the disease process. 



It is at least theoretically possible that evidence of skeletal 

 infectious disease may really be evidence of a good immune 

 response to disease, and thus evidence of relatively good 

 health. Certainly such an immune response is not as effective 

 as one that successfully rids the body of the infectious organ- 

 isms during the early stages of the disease. Nevertheless, it is 

 clear that many of the infectious conditions encountered in 

 archeological skeletons represent a long-temi chronic re- 

 sponse to the infectious agent. Resolution of the implications 

 of this observation requires careful attention to demographic 

 data, among other things, for the skeletal sample in question. 

 1 would want to know, for example, that individuals with 

 evidence of skeletal disease were dying at a younger average 

 age than individuals without such evidence. It also requires 

 an understanding of the immunological responses to disease 

 and their relationship to skeletal involvement. The point to be 

 made is that, as paleopathoiogists begin to ask questions 

 concerning the meaning of our observations, we must be very 

 careful that our assumptions take into consideration all of the 

 possible skeletal responses to disease. 



Resolution of many of these questions regarding the mean- 

 ing of our data and observations involves complex issues and 

 knowledge inherent in several disciplines. Nevertheless, it is 

 essential that paleopathology make a significant effort to 

 move beyond the diagnostic phase of research , and ask ques- 

 tions about the biological and evolutionary significance of 

 our findings. At the very least, we need to clarify the role 

 disease has played in the complex process of adaptation be- 

 tween human groups and their environment. 



in the last ten thousand years there have been major 

 changes in mankind's relationship with the environment. The 

 predominant economic subsistence pattern has shifted from 

 hunting-gathering to agriculture. There have been major 

 changes in settlement patterns with relatively dispersed, 

 mobile human groups giving way to sedentary, major con- 

 centrations in small geographical areas as in the cities of 

 today. Both of these epochal changes must have had a major 

 impact on the prevalence of many diseases, but particularly 

 on infectious conditions, thus representing a major challenge 

 for research in paleopathology. 



Conclusions 



The flood of books and papers on paleopathology in the past 

 twenty years is beginning to reveal some interesting scien- 

 tific opportunities as well as some fundamental theoretical 

 and methodological problems. These must be addressed if 

 paleopathology is to make further significant contributions to 

 both anthropological and medical theory and knowledge. 



Perhaps the most serious problem is the current inability to 

 use most of the data on paleopathology found in published 

 sources for comparative research. There is considerable vari- 

 ability, both in the quality of paleopathological observations 

 and in the types of disease conditions included in the data 

 protocols of the source materials. A partial solution to this 

 problem would be to develop and dis.seminate descriptive 

 terminology and methodology that are less dependent on a 

 sophisticated knowledge of pathology and radiology. The 

 emphasis would be on careful description of abnormal condi- 

 tions rather than reaching a diagnostic conclusion. Such a 

 procedure will permit independent review of differential di- 

 agnosis in publications on paleopathology. We also need to 

 reach a consensus on the minimal types of diseases that 

 should be included in all paleopathological studies. 



Such descriptive methodology would permit a more mean- 

 ingful way of integrating data and observations from multiple 

 research sources. It is now very difficult for one person to 

 collect all the data needed for a regional study of paleopathol- 

 ogy. The relatively few cases (ca. fifteen percent) affected by 

 disease in a skeletal sample requires screening large numbers 

 of skeletons in order to obtain meaningful data. Problems in 

 funding, access, travel, and the sheer amount of material 

 available for study mean that we must develop a methodol- 

 ogy that will permit independent analysis by scholars who 

 may not be able to study the original specimens. It is likely 

 that there will always be problems in doing this, but the 

 development and widespread use of a rigorous descriptive 

 methodology with a precise terminology for skeletal lesions 

 and their location in the skeleton would bring this goal much 

 closer to reality. If carefully done, such data can be rein- 

 terpreted by other observers and integrated with data from 

 other similar studies. Computer-aided design software offers 

 an important potential research tool in recording distribution 

 patterns of skeletal disease. 



Emerging technology, particularly in the areas of chemis- 

 try and microscopy (both light and scanning electron micro- 

 scopes), may offer important insight for paleopathological 

 research. Bone is a tissue, as well as an organ, and responds 

 to a variety of systemic conditions at the molecular, micro- 

 scopic as well as at the gross level of biological organization. 

 Immunoproteins can now be detected at the parts per billion 

 level. If antibodies, or other proteins linked to the disease 

 response in the body, survive in archeological skeletal tissue 

 they can now almost certainly be detected and analyzed. 

 Currently, 1 am collaborating in preliminary research on im- 

 munoproteins in archeological bone tissue that is promising. 

 Other chemical studies of abnormal bone tissue can also 

 assist in understanding the pathological process involved 

 (Von Endt and Ortner 1982). Such research may open up new 

 and important sources of data in paleopathology. 



Paleopathology has made minimal effort to use micro- 

 scopic data in archeological specimens, because the biolog- 

 ical significance of many microscopic features apparent in 



Zagreb Paleopathology Symp 1988 



