Synthesis and conclusions • 307 



congenital disease conditions (cystic fibrosis, Huntington's, 

 and others already available), ability to demonstrate close 

 genetic relationship through the HLA system, identification 

 of specific infectious pathogens (Mycobacterium tuber- 

 culosis, Salmonella sp., Legionella) including retroviruses 

 such as HIV and others. Completion of the present effort to 

 map the entire human genome can be expected to expand 

 these applications manyfold. All of these methods, however, 

 are in their infancy. Collectively they will require an enor- 

 mous amount of investigative effort before the contributions 

 of their application have been defined at a useful level. 



6. This symposium has also identified new evidence (or 

 critically reviewed existing evidence) which suggests alter- 

 natives TO THE TRADITIONAL VIEWS OF PATHOGENESIS for a 



variety of conditions. Stuart-Macadam identifies multiple 

 observations inconsistent with the concept of porotic hyper- 

 ostosis as a product of congenital anemia. She reminds us 

 that a departure from the norm may be adaptive, when she 

 points out the iron-deficiency anemia so common in milk-fed 

 infants may have a protective effect against bacterial infec- 

 tions. While not denying the role of malnutrition in the pro- 

 duction of certain dental enamel defects, both Dahlberg as 

 well as Kocsis and Marcsik note that developmental defects 

 may be responsible for others. Studies are needed to establish 

 clear separation of these two, divergent pathogenetic mecha- 

 nisms if interpretational confusion is to be avoided. Vyhnanek 

 and Stioukal also note that accumulating evidence relating to 

 the biological behavior of transverse (Harris' ) lines of bone 

 growth arrest needs to be refined and incorporated into our 

 interpretative process if we are to escape errors inherent in 

 the relatively simplistic application common for this method 

 to date. Kelley's postulate that environmental, not genetic, 

 factors can explain the high frequency and mortality of cer- 

 tain infectious diseases among native North Americans also 

 should be tested. This need not necessarily await develop- 

 ment of sophisticated methods of DNA analysis. Clinical 

 tuberculosis treatment records already exist which, if appro- 

 priately selected and studied, may be capable of identifying 

 whether or not Native American tissue and immune re- 

 sponses to both the disease and treatment differ from those 

 of Caucasians. Coupled with detailed epidemiological stud- 

 ies a database useful in evaluating this question may be pos- 

 sible. 



Urteaga warns that the nasal destructive changes attributed 

 to leprosy in Europe may be lacking in Amazonian lepers, 

 and that such changes in the latter region can be duplicated by 

 leishmaniasis. Brothwcll notes the high probability that bru- 

 cellosis was present among early European pastoralists and 

 argues the need for studies which would define patterns of 

 skeletal changes diagnostic for this disease, which could then 

 be employed for its recognition in archeological skeletons. 

 Roberts makes a good argument for her complaint that the 

 physical evidence of trauma contains much more informa- 

 tion than is usually derived from it by conventional studies. 



Zagreb Paltopalhology Symp. 1988 



Her interdisciplinary approach appears to offer anthropo- 

 logically useful information not only for reconstruction of 

 circumstances leading to the injury and of treatment admin- 

 istered, but also for prediction of specific fomis of subse- 

 quent dysfunction caused by the lesions. 



While the references to tuberculosis by many symposium 

 authors have been recorded above in other contexts, it may be 

 useful to concentrate these concerns within this discussion. 

 Buikstra and Williams's simulation studies suggest the dis- 

 ease should not have survived in North America under the 

 conditions of their study and stipulations. It would be useful 

 to repeat these, probably for different locales at different 

 periods. Their suggestion that alternative organisms may 

 produce identical skeletal changes may be testable with mod- 

 em laboratory animal studies and perhaps in ancient skeletal 

 tissue after some of the newer diagnostic methods (molecular 

 biology?) discussed above become available. Such methods 

 might also lend themselves very well to pursue the patho- 

 genic role played by atypical mycobacteria although useful 

 information could already be derived from thorough current 

 environmental studies with conventional methodology. The 

 ultimate availability of reliable nuclear probes for the various 

 mycobacterial species and variants can be expected to permit 

 studies directed at Brothwell's question whether M. tuber- 

 culosis was derived from the avian or bovine strain. In trac- 

 ing the antiquity of tuberculosis such methods applied to the 

 earlier examples of Egyptian skeletal lesions (Morse et al. 

 1964) would also be useful, as well as those of the South 

 American mummies (Allison et al. 1973). Kelley and 

 Micozzi's 1984 assertion that localized rib periostitis reflects 

 tuberculous empyema needs to be verified, most easily in 

 mummies where empyemas of both tuberculous and non- 

 tuberculous nature occur. Not only do Manchester's noted 

 disease patterns resulting from interaction between tuber- 

 culosis and leprosy need to be checked in other geographical 

 areas, but it would be useful also to design investigations for 

 the evaluation of his assumption that during the Early Middle 

 Ages gastrointestinal tuberculosis affected both village and 

 urban areas equally because it was dependent upon herd, not 

 human population size. 



Paleopathologists have also been criticized for their reluc- 

 tance to integrate their data with that generated by medical 

 historians. Occasional examples exist which demonstrate its 

 potential usefulness (Handler et al. 1986). and it is not diffi- 

 cult to visualize other possibilities. 



In summary, these presentations succeed in achieving the 

 symposium's goals: "Current synthesis and future options." 

 The ultimate adoption of even a fraction of the new methods 

 discussed can be expected to change the nature of pal- 

 eopathologic study more during the coming decade than it 

 has enjoyed during the past century. The editors hope pub- 

 lication of these manuscripts will serve as a useful guide and 

 stimulant to future paleopathology investigations. 



