306 • Arthur C. Aufderheide and Donald J. Ortner 



constraints inherent in the methods of paleopathology which 

 prevent such studies from contributing novel data. Principal 

 among these is the difficulty in defining the genetic homoge- 

 neity of an ancient ptipulation when studying the genetic 

 component of a condition such as the "New World Syn- 

 drome" among native North Americans. Now that DNA can 

 be extracted from archeological skeletal tissue and amplified 

 (Tuross. pers. comm.) and with increasing availability of 

 DNA probes for the highly polymorphic HLA system, it is 

 conceivable some of these constraints may be ameliorated. 



3. The anatomists' contention of an intimate relation- 

 ship BETWEEN STRUCTURE AND BIOLOGICAL FUNCTION in 



normal tissues applies equally todiseased ones. While admit- 

 ting frequent difficulties, Stirland suggests that enthesiopa- 

 thies, hypertrophic crests, and skeletal response to repetitive 

 microtrauma can be used to identify occupationally induced 

 changes in appropriately selected populations. Martin notes 

 the negative counterpart, pointing out that bone growth arrest 

 secondary to severe matabolic stress is reflected in histologic 

 evidence of increased skeletal remodeling with decreased 

 calcification. Microradiography and radiation absorptio- 

 metric measurements of bone mineral density reflect similar 

 changes. Both grossly evident and electron microscopical 

 alterations are produced in the enamel of children's develop- 

 ing teeth when such metabolic insults occur in a pediatric 

 population. Routine application of these methods, however, 

 will become predictive at a useful and reliable level only 

 when sufficient human clinical, animal, and paleopathologi- 

 cal research studies have defined the precise sensitivity and 

 specificity of these measures. 



4. While paleopathology is often labeled a "young sci- 

 ence," this symposium has revealed it is old enough to have 

 developed an area of vulnerability sufficiently serious to 

 threaten its potential for flourishing growth: lack of meth- 

 odological STANDARDIZATION. Sincc most skeletal collec- 

 tions are of small or modest size, prevalence data can only be 

 computed for many conditions by combining multiple, inde- 

 pendent reports. If the authors of the many articles so 

 painstakingly reviewed by Gladykowska-Rzeczycka (docu- 

 menting tumors in middle and eastern Europe) had all used a 

 standardized reporting form which included a complete bone 

 inventory and other vital data, then their value would have 

 been considerably enhanced by making comparative, quan- 

 titative estimates possible. Perhaps even more important is 

 the assumption that paleopathological taxonomy is equatable 

 with clinical disease classification, when in fact the observa- 

 tional database of each is shared only in part with the other. 

 The paleopathologist enjoys an unobstructed view of every 

 bone in the skeleton, but lacks clinical symptomatology, soft 

 tissue biopsy and autopsy information as well as results of 

 chemical and metabolic studies. A significant contribution 

 by this symposium is the unveiling of the need for an inves- 

 tigative development of a classification of bone alterations 



based solely on paleopathological observations, and then 

 testing its utility by using it to develop a differential diagnosis 

 list of diseases classified as clinical conditions. 



An additional threat to the intellectual health of this field is 

 the lack of a general body of theory, as noted in the introduc- 

 tory section of this volume. 



5. The paleopathology database which is traditionally gen- 

 erated largely on the basis of gross skeletal structural features 

 is now being enhanced by new and sometimes exotic 

 STUDY methods. Some of these promise to provide the type 

 of data that has been restricted to date to biochemical studies 

 of living individuals' blood samples. Imagine the informa- 

 tional legacy of infectious disease history which could be 

 harvested if Tuross's reported demonstration of immu- 

 noglobulin in bone extract could be refined through further 

 research into identification of bacteria-specific antibody! In 

 the same manner, the first step in testing Angel's hypothesis 

 of the interdependence of thalassemia and malaria in the 

 Mediterranean would become possible if Ascenzi's identi- 

 fication of hemoglobin's globin chain structure could be es- 

 tablished on a firm and reproducible basis. While less broad- 

 ly applicable. Baud's and Kramar's studies dealing with 

 crystallographic structure of tissue calcifications already 

 have some etiological predictive value, for example, the 

 presence of apatite and whitlockite predict a tuberculous 

 cause of the calcifying lesion. Wider use of bone histology. 

 both light microscopical and ultrastructural, would surely 

 identify a broader range of features useful for its diagnostic 

 applications. 



Textual and artistic methods as reported here by Andersen, 

 Chase, Dequecker, and Urteaga can make nonquantitative 

 but specific contributions in spite of their inherent limitations 

 of time and artistic license. Blackman et al.'s elegant recon- 

 struction of a fatal sequence of renal pathophysiological 

 events was made possible by the study of anatomic and 

 chemical changes in mummified soft tissues. Newer radi- 

 ological methods, especially computerized tomography, can 

 provide information through uncluttered views of internal 

 structure (Lewin), supplemented by density information 

 which can be particularly helpful in studies of unwrapped 

 human mummies. Investigations designed to determine />rf.r- 

 ervation of the various proteins of diagnostic interest in 

 different forms of mummification would be helpful 

 (Aufderheides). Extraction of human DNA from an 8000- 

 year-old brain by Hauswirth et al. promises exciting poten- 

 tial, especially now that the polymerase chain reaction (PRO 

 can amplify even the smallest quantities of recovered DNA to 

 the point of reactivity with diagnostic nuclear probes. Many 

 technical difficulties remain to be overcome, not the least of 

 which constitutes concern for the degree of postmortem mo- 

 lecular damage with loss or substitution of various bases. 

 Nevertheless, research directed at overcoming these prob- 

 lems is highly justified in view of the anticipated rich re- 

 wards, such as diagnostic screening for genes coding for 



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