264 • James M. Tenney 



CT SCAN. This modality has markedly increased the accura- 

 cy of osteolytic bone lesion diagnosis and is considerably 

 more sensitive. All else being equal CT scan can detect a 

 smaller lesion than simple x-ray can. It is also of great help in 

 soft tissue paleopathology (Pahl 1980:189; Wong 1981:101; 

 Notman et al. 1986:95) since it both shows involvement of 

 soft tissue adjacent to bone better than x-ray alone, and po- 

 tentially also the relation of the tumor to body organs in situ 

 in the mummy bundle before these relations have been de- 

 stroyed by autopsy. 



MAGNETIC RESONANCE IMAGING. MRI is of little ValuC at 



present in paleopathology owing to the lack of moisture in 

 mummified tissue and bone (Notman et al. 1986:95). 



XERORADIOGRAPH Y . This produces a positive picture (as op- 

 posed to the x-ray negative) and shows lesions of less density 

 (such as osteolytic lesions) to better advantage. This proved 

 helpful in finding a soft tissue pleural mass in a Peruvian 

 mummy (Heinemann 1974). 



Future 



What can we hope for in the future to improve diagnostic 

 accuracy in paleopathology? 



LINES OF RESEARCH 



Serologic procedures as they currently exist are not too prom- 

 ising. For example, CEA is nonspecific and subject to inter- 

 fering substances under the best of circumstances. The basic 

 problem lies in quantitation, as neither weight nor volume 

 applies unless on a "per gram of tissue" basis. Even this basis 

 is difficult to compare among individual specimens. Since 

 most carcinomas mimic the function of the primary tissue in 

 which they have arisen and carry on many of the same chemi- 

 cal processes, serologic diagnoses are dependent more on 

 quantitative results than on qualitative ones. Most current 

 tumor serologic procedures require careful handling and 

 sometimes even rapid freezing of the specimen to prevent 

 loss of antigen/antibody potency. 



Histology still remains the best hope, and efforts to recon- 

 stitute dry tissue and make respectable slides should con- 

 tinue. Practically though, when a lung is concentrated and 

 reduced to the thickness of a piece of paper it is hard to 

 imagine that a meaningful slide could ever be made. Some 

 experimental work has shown that this is nevertheless possi- 

 ble (Zimmerman 1977). Another potential avenue is that of 

 histochemistry (special stains). Of these, immunoperoxidase 

 is promising. Here a specific, peroxidase-labelled antibody 

 is incubated with the tissue containing the suspected tumor 

 antigen. The tumor portion then stains preferentially and 

 more or less specifically. These labeled antibodies are com- 

 mercially available and in use currently for breast, colon, and 

 prostate carcinomas, as well as many others. 



Endoscopy should be mentioned as a means of obtaining 

 small amounts of tissue for histologic study (Notman et al. 

 1986:94). 



SUGGESTIONS FOR FUTURE NOMENCLATURE 



Provocative titles which cannot be well substantiated should 

 not be used. For example "possible concomitant syphilis and 

 leprosy in a population of cave dwellers," aside from piquing 

 interest as to how anyone could make such a diagnosis, 

 causes a serious problem. The article may become classified 

 as syphilis, leprosy, or both, with the "possible" omitted. The 

 key words will appear in the literature as such, become incor- 

 porated in the future statistics, and may even be used as a 

 basis for the existence of a given disease at a given place and 

 time. 



Diagnoses should be uniform. For example the word "tu- 

 mor" should be limited to neoplasia; "tumor-like process" 

 should be used in other appropriate instances. 



A diagnosis should be related somehow to the probability 

 that it is correct, and the criteria used clearly stated. A differ- 

 ential diagnosis should be included, along with reasons, if 

 any, why one particular diagnosis is favored over the others. 

 Unless the diagnosis is almost certain, it should be omitted 

 from the title and key reference words. If the diagnosis is 

 based on statistical probability, it should be stated how the 

 statistics were derived, that is, which populations are being 

 compared. 



VALUE OF MUSEUMS AND LARGE COLLECTIONS 



While it is desirable to have assemblages containing large 

 numbers of known examples of a given disease, the purpose 

 is more that of teaching pathology than in comparing individ- 

 uals. A large series of individual skeletons showing known 

 metastatic breast carcinoma will look very much like a large 

 series showing known metastatic lung carcinoma. An un- 

 known individual case therefore cannot be fitted into either 

 category with any degree of certainty. The severity of a dis- 

 ease itself is not a scalar quantity, since it reflects the pres- 

 ence of many factors. Its description can only be in relative 

 terms: "A worse than B worse than C" (Medawar 1974: 180). 



Conclusions 



Paleopathology is a young science and has developed few 

 tools to date. An important application of paleopathology is 

 that of assisting other scientists, such as paleoepidemiolo- 

 gists and paleodemographers. In addition, historians need 

 data in assessing the presence and extent of disease, along 

 with what effects it might have had upon its victims individu- 

 ally or as a population. A knowledge of the past distribution 

 and cause of disease helps with the modem understanding of 

 that disease. Matters of population resistance and suscep- 

 tibility are reflected by the general health of the population. 



Zagreb Paleopathology Symp. 1988 



