Synthesis and conclusions 



Arthur C. Aufderheide and Donald J. Ortner 



Authors of the many excellent manuscripts presented at this 

 symposium were asked to include a special focus on either 

 evaluation of extant support for traditional interpretations 

 ("current synthesis") or indentification of potential new areas 

 of research or improved methods of doing current research 

 ("future options"). Both the depth and the breadth of their 

 resjxjnse has been a source of special satisfaction to this 

 conference's organizers. The discussed topics can be viewed 

 from several perspectives, including the following: 



I . In what ways can studies in paleopathology con- 

 tribute TO AN understanding OF THE ORIGIN AND TRANS- 

 MISSION OF DISEASES? Clearly, epidemiologic suggestions 

 can be derived from the simple establishment of the antiquity 

 of a given disease. In their respective articles, Brothwell 

 traces measles to the Late Neolithic, and Manchester finds 

 convincing descriptions of tuberculosis as early as the fourth 

 millenium B.C. in Europe (Buikstra and Williams by at least 

 A.D. 700 in the New World) and leprosy in Egyptian bones 

 during the second century B.C. (Andersen traces textual evi- 

 dence to the third century A.D.). Using art sources Dequecker 

 identifies rheumatoid arthritis in paintings nearly three cen- 

 turies before its description by Sydenham in 1676. Gerszten 

 and Allison moved back the search for histologically docu- 

 mented primary cancer to a facial rhabdomyosarcoma in a 

 South American mummy dated to about a.d. 500. 



An alternative approach is embodied in Brothwell's sug- 

 gestion that zoonoses may reveal the evolutionary origin of 

 diseases. He notes that domesticates may transmit diseases 

 (cattle: tuberculosis; birds: ornithosis; cats, sheep and pigs: 

 toxoplasmosis). Furthermore, the dairying activities of early 

 pastoralists exposed them to brucellosis, bovine tuberculo- 

 sis, and a host of other conditions commonly resident in such 

 animal populations. He suggests that the unravelling of para- 

 site evolution could yield an unexpected harvest of informa- 

 tion regarding hominid interactive behavior. 



Manchester's meticulous dissection of the chronology of 

 tuberculosis and leprosy prevalence in England demonstrates 

 how paleopathology can provide data not retrievable by any 

 other current methods: disease interaction producing new 

 disease patterns. His study reveals how the crowded living 

 conditions of medieval urbanism fueled a rapid rise in pulmo- 

 nary tuberculosis, generating a population who.se tuberculin- 



Zagreb l\ileopaihology Symp. 1988 



positive immune status crossreacted with the leprosy bacillus 

 to suppress expression of the latter disease (an observation of 

 potential therapeutic value in areas of current leprosy en- 

 demicity). 



Integration of cultural information with physical evidence 

 can both define and become predictive of behavioral aspects 

 of disease susceptibility. Rose and Hartnady clearly spell out 

 the tragic relationship of high infant mortality and infections 

 among post-Reconstruction North American blacks and their 

 socioeconomic misery with accompanying malnutrition. 

 This process is mirrored also in Owsley's documentation of 

 decreasing femur cortex thickness among midwestem Native 

 Americans following contact, and in Goodman's demonstra- 

 tion of dental hypoplasia in disadvantaged subgroups of 

 Mexican children. Kelley also notes that the socially disrup- 

 tive effect of a major epidemic on an isolated population can, 

 together with other aspects of their life style, be sufficiently 

 profound so as to account for the documented high preva- 

 lence and mortality of such infections among Native Ameri- 

 cans in the early colonial period without resort to a hypoth- 

 esized inherent biological susceptibility greater than that of 

 immigrating Caucasians. 



These observations can spawn a host of research studies: 

 Manchester's reported disease relationships need to be inves- 

 tigated in other locales, both archeological and in modem, 

 living populations. Some of Brothwell's provocative sugges- 

 tions can be tested with existing methods while evolving 

 technology such as viral DNA probes may become suffi- 

 ciently sensitive so as to permit tracing specific viruses 

 through past millenia. Goodman's research model seeks evi- 

 dence that dental enamel defects refiect serious health prob- 

 lems in a simultaneous study of both ancient and modem 

 populations. A similar approach could be applied to test the 

 observations of Kelley, Owsley, Rose and Hartnady, exploit- 

 ing the fact that appropriately selected modem populations 

 can permit assessment of socioeconomic status, malnutrition 

 and other effects of interest more precisely than is possible in 

 an ancient skeletal population alone. 



2. The above observations also provide a partial and posi- 

 tive response to Pfciffer's question: Can paleopathology 



BE predictive OF CONTEMPORARY HEALTH PATTERNS? and 



vice versa. She points out, however, that there are presently 



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