6 • Donald J. Ortner 



Figure 1 . Destructive lesions of anterior, lum- 

 bar vertebral bodies and sacrum. (Child about 1 2 

 years from medieval cemetery associated with 

 hospital of St. James and St. Mary Magdalene, 

 Chichester, England.) 



course, be done in isolation from modem medicine, but will 

 stimulate questions for medical colleagues which address 

 classificatory problems of paleopathology in terms of the 

 data and observations unique to that discipline. 



We also need to achieve an improved understanding of the 

 theoretical implications of our findings in paleopathology. 

 Does, for example, an increased prevalence of skeletal infec- 

 tious disease in a skeletal sample mean that the living group 

 of people represented by this sample was less healthy than a 

 skeletal sample which has fewer cases of infectious disease? 

 There are complex immunological, pathological, and demo- 

 graphic issues in such a situation that must be understood 

 before reasonable conclusions can be reached. Angel's (e.g., 

 1966) studies of skeletal changes in thalassemia and the sig- 

 nificance of evidence for this disease in archeological skele- 

 tal samples from the Eastern Mediterranean provide a semi- 

 nal example of this kind of research. 



Methodological issues in paleopathology 



One of the problems in paleopathology may be an over- 

 reliance on clinical diagnostic criteria. Paleopathologists try 

 to fit their observations into a descriptive and classificatory 

 system that has been developed for different objectives, 

 namely the treatment of living patients. There are many fea- 

 tures apparent in a paleopathological skeleton that have no 

 direct correlate in clinical medicine. For example, the obser- 

 vation in the medical literature that spinal tuberculosis usu- 

 ally predelicts the vertebral bodies (e.g., Schinzet al. 1951- 

 1952:571; Resnick and Niwayama 1981:217; Ortner and 

 Putschar 1981:145) may mean only that radiological evi- 

 dence for involvement of the posterior elements is rarely 

 observed. 



A case of spinal lesions in the skeleton of a 12-year-old 

 child (Burial no. S-21 1) from the cemetery site associated 

 with the medieval hospital of St. James and St. Mary Mag- 

 dalene in Chichester, England, illustrates the problem. De- 

 structive lesions are apparent on the anterior surface of the 

 vertebral bodies in the lower spine and sacrum (Figure 1). 

 Periosteal reactive bone is seen on some of the vertebral 

 arches (Figure 2). Other bones in the skeleton are not af- 

 fected. 



Figure 2. Proliferative, reactive bone on lumbar vertebral 

 arches. (Child about 12 years from medieval cemetery asso- 

 ciated with hospital of St. James and St. Mary Magdalene, 

 Chichester, England.) 



Zitfirvh Pateopalhology Symp. 1988 



