Ortner's Identification of Pathological Conditions in Human Skeletal Remains

By Jane E. Buikstra

Ortner's Identification of Pathological Conditions in Human Skeletal Remains, Third Edition, provides an integrated and comprehensive treatment of the pathological conditions that affect the human skeleton. As ancient skeletal remains can reveal a treasure trove of information to the modern orthopedist, pathologist, forensic anthropologist, and radiologist, this book presents a timely resource. Beautifully illustrated with over 1,100 photographs and drawings, it provides an essential text and material on bone pathology, thus helping improve the diagnostic ability of those interested in human dry bone pathology.

• Presents a comprehensive review of the skeletal diseases encountered in archaeological human remains
• Includes more than 1100 photographs and line drawings illustrating skeletal diseases, including both microscopic and gross features
• Based on extensive research on skeletal paleopathology in many countries
• Reviews important theoretical issues on how to interpret evidence of skeletal disease in archaeological human populations

• Language: English
• Publisher: Academic Press
• Release date: Jan 29, 2019
• ISBN: 9780128099018

Book preview

Ortner’s Identification of Pathological Conditions in Human Skeletal Remains

Third Edition

Edited by

Jane E. Buikstra

Arizona State University, Tempe, AZ, United States

Table of Contents

Cover image

Title page

Copyright

List of Contributors

Preface

A Tribute to Don Ortner

Chapter 1. Introduction

Abstract

History of the First Edition From Donald J. Ortner

History of the Second Edition From Donald J. Ortner

Objectives of the First and Second Editions

History of the Third Edition From Jane E. Buikstra

Objectives of the Third Edition

Format of the Volume

Abbreviations

References

Chapter 2. A Brief History and 21st Century Challenges

Abstract

A Brief History of Paleopathology

21st Century Paleopathology

Paleoepidemiology

References

Chapter 3. Themes in Paleopathology

Abstract

Social and Identity Theory

Structural Violence

Ancient Humans and Impairment, Disability, and Care

Osteobiography in Paleopathology

References

Chapter 4. Fundamentals of Human Bone and Dental Biology: Structure, Function, and Development

Abstract

Skeletal Structure, Function, and Cellular Basis of Bone Biology

Skeletogenesis and Bone Modeling

Bone Remodeling

Tooth Structure and Formation

Conclusions

References

Chapter 5. Abnormal Bone: Considerations for Documentation, Disease Process Identification, and Differential Diagnosis

Abstract

Abnormal Bone: General Considerations and Gross Appearance

Description of Abnormal Bone

Differential Diagnosis

Cases of Abnormal Bone: Modeling Description, Identification, and Differential Diagnoses

Conclusion

References

Chapter 6. Histomorphology: Deciphering the Metabolic Record

Abstract

Introduction

Histomorphology: Deciphering the Metabolic Record

Why Bones Break: Histomorphometric Assessment of Bone Strength and Fragility

Pathology and Histomorphometry

Conclusion

References

Chapter 7. The Role of Imaging in Paleopathology

Abstract

Why Is Medical Imaging Important?

A Brief History of Radiology in Paleopathology

Basic Principles and Terminology

Radiographic Appearance of Pathologic Conditions

Other Bone Changes and Radiography

Taphonomic Alterations

Other Imaging Modalities

Conclusion

References

Chapter 8. Ancient DNA in the Study of Ancient Disease

Abstract

Introduction to Ancient DNA

Applications of Ancient DNA

Future Prospects for Ancient Pathogen Research

References

Chapter 9. Trauma

Abstract

Introduction

Trauma

Summary and Conclusions

References

Chapter 10. Infectious Disease: Introduction, Periostosis, Periostitis, Osteomyelitis, and Septic Arthritis

Abstract

Introduction

Periostitis or Periostosis

Osteomyelitis

Changes in Specific Bones

Paleopathology of Osteomyelitis

Septic Arthritis

Summary

References

Chapter 11. Bacterial Infections

Abstract

Introduction

Tuberculosis

Leprosy

Treponematosis, Treponemal Infection, or Treponemal Disease (TD)

Brucellosis

Glanders

Actinomycosis and Nocardiosis

Plague

References

Chapter 12. Fungal, Viral, Multicelled Parasitic, and Protozoan Infections

Abstract

Fungal Infections

Viral Infections

Multicelled Parasitic Infections

Protozoan Infections

Sarcoidosis

References

Chapter 13. Parasitology

Abstract

Bringing Ortner Forward in Time and Application: Echinococcus granulosus

Archeological Data Violating Clinical Predictions Signal Fruitful Areas of Investigation: The Case of Enterobius vermicularis

Chagas Disease, Mummies, and Molecular Biology: Adjusting Clinical Perspectives

Lice Reflect Social Organization, Interaction, and Privation

Cemetery Studies: Korea and Central Russia AD 1500–1800

Conclusion

References

Chapter 14. Circulatory, Reticuloendothelial, and Hematopoietic Disorders

Abstract

Circulatory Disorders

Other Disorders Associated With Osteonecrosis

Other Diseases Associated With Trauma and Vascular Deficiency

Reticuloendothelial Disorders

Hematopoietic Disorders

Thalassemia and Sickle Cell Anemia

Iron-Deficiency Anemia

References

Chapter 15. Metabolic Disease

Abstract

Introduction

Vitamin C Deficiency

Subadult Scurvy

Adult Scurvy

Vitamin D Deficiency

Rickets

Osteomalacia

Co-occurrence of Rickets and Scurvy

Osteoporosis

Fluorosis

Hyperostosis Frontalis Interna

References

Chapter 16. Endocrine Disturbances

Abstract

Introduction

Pituitary Disturbances

Paleopathology

Other Endocrine Disturbances

Pathology

Paleopathology

References

Chapter 17. Congenital and Neuromechanical Abnormalities of the Skeleton

Abstract

Introduction

Skull

Spine

Ribs and Sternum

Pelvis

Extremities

References

Chapter 18. Skeletal Dysplasias and Related Conditions

Abstract

Introduction

Defects in Endochondral Bone Formation

Multiple Epiphyseal Dysplasias

Acromesomelia

Léri–Weill Dyschondrosteosis

Mucopolysaccharidosis

Defects in Intramembranous Bone Formation

Cleidocranial Dysplasia

Osteopetrosis

Metaphyseal Dysplasia (Pyle’s Disease)

Progressive Diaphyseal Dysplasia (Camurati–Engelmann’s Disease)

Melorheostosis (Leri’s Disease)

Osteopoikilosis

Osteopathia Striata

References

Chapter 19. Tumors of Bone

Abstract

Introduction

Primary Benign Tumors

Primary Malignant Bone Tumors

Bone Metastases

Abbreviations

References

Chapter 20. Joint Disease

Abstract

Osteoarthritis

Other Conditions With Proliferation or Eburnation

The Erosive Arthropathies

The Sero-Negative Arthropathies

The Crystal Arthropathies

Septic Arthropathy

References

Chapter 21. The Dentition: Development, Disturbances, Disease, Diet, and Chemistry

Abstract

Introduction

Dental Development

Disturbances in Dental Development

Identifying Dental Wear and Oral Disease

Interpreting Oral Health

Dental Chemistry

Dental Calculus

References

Chapter 22. Mummies and Paleopathology

Abstract

Paleopathological Examination of Mummies

Mummy Paleopathology

Conclusion

References

Chapter 23. Nonhuman Animal Paleopathology—Are We so Different?

Abstract

Introduction

Research Foci Within Nonhuman Animal Paleopathology

Areas of Departure

Areas of Commonality

Toward Closer Integration

Acknowledgments

References

Chapter 24. Postscript

Abstract

The Future of Paleopathology

References

Index

Copyright

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List of Contributors

Amanda M. Agnew,     School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States

Megan B. Brickley,     Department of Anthropology, McMaster University, Hamilton, ON, Canada

Jane E. Buikstra

Arizona State University, Tempe, AZ, United States

Arizona State University Sharon DeWitte, University of South Carolina

Arizona State University, Phoenix, AZ, United States

Morgana Camacho,     Pathoecology Laboratory, School of Natural Resources, University of Nebraska - Lincoln, United States

Mary E. Cole,     Department of Anthropology, The Ohio State University, Columbus, OH, United States

Sharon DeWitte,     University of South Carolina, SC, United States

Bruno Frohlich

Department of Anthropology, Smithsonian Institution, Washington, DC, United States

Department of Anthropology, Dartmouth College, Hanover, NH, United States

Anne L. Grauer,     Loyola University Chicago, Chicago, IL, United States

Rebecca Kinaston,     Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand

Haagen D. Klaus,     Department of Sociology and Anthropology, George Mason University, Fairfax, VA, United States

Mary Lewis,     University of Reading, Reading, United Kingdom

Niels Lynnerup,     Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark

Carina Marques

Research Centre for Anthropology and Health (CIAS), Department of Life Sciences, University of Coimbra, Coimbra, Portugal

Department of Anthropology, William Paterson University, Wayne, NJ, United States

Simon Mays,     Historic England, Portsmouth, United Kingdom

Justyna J. Miszkiewicz,     School of Archaeology & Anthropology, Australian National University, Canberra, ACT, Australia

Marc F. Oxenham,     School of Archaeology & Anthropology, Australian National University, Canberra, ACT, Australia

Andrew T. Ozga

Center for Evolution and Medicine, Tempe, AZ, United States

Institute for Human Origins, Tempe, AZ, United States

Rebecca Redfern,     Centre for Human Bioarchaeology, Museum of London, London, United Kingdom

Karl Reinhard,     Pathoecology Laboratory, School of Natural Resources, University of Nebraska - Lincoln, United States

Charlotte A. Roberts,     Department of Archaeology, Durham University, Durham, United Kingdom

Anne C. Stone

School of Human Evolution and Social Change, Tempe, AZ, United States

Center for Evolution and Medicine, Tempe, AZ, United States

Institute for Human Origins, Tempe, AZ, United States

Samuel D. Stout,     Department of Anthropology, The Ohio State University, Columbus, OH, United States

Richard Thomas,     School of Archaeology and Ancient History, University of Leicester, Leicester, United Kingdom

Monica Tromp

Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand

Department of Archaeology, Max Planck Institute for the Science of Human History, Jena, Germany

Chiara Villa,     Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark

Tony Waldron,     University College London, London, United Kingdom

Anna Willis,     College of Arts, Society & Education, James Cook University, Townsville, QLD, Australia

Preface

One of the last times I saw Don Ortner in his office at the Department of Anthropology of the Natural History Museum, he gestured to the shelves and filing cabinets where he had been beginning to accumulate sources for the third edition of Identification of Pathological Conditions in Human Skeletal Remains. As we who mourn him know only too well, he died unexpectedly on April 29, 2012, and this task remained undone. Hoping that at least a partial manuscript existed, I asked Bruno Frohlich, a close colleague of Don’s at the National Museum of Natural History, about evidence of the volume’s progress. As the person who assumed the challenging task of sorting Don’s office, Bruno indicated that there was nothing of substance, no outline, no negotiations with a press.

Thus, it was obvious that organizing a new edition would require starting with the Ortner (2003) volume and revising. The alternative, letting the fine second edition become increasingly out of date, a piece of history but not a useful teaching and research aid, seemed an unhappy choice. New volumes by other authors would no doubt appear, but in my opinion that energy and expertise could be better directed toward advancing knowledge in other ways rather than reinventing the wheel.

Following discussions with colleagues in paleopathology and the Ortner family, primarily Don’s widow Joyce and son, Don, Jr., I agreed to explore publication options and consider how the volume might be revised to reflect new knowledge and the further integration of the study of health into perspectives on the past. After discussions with several presses, it seemed prudent to choose Elsevier, as they could readily provide the text and image files from the second edition. I wish to thank them most sincerely for their support and patience throughout this protracted process.

There have been many decisions along the way. Initially, and with sage advice from many colleagues, such as Anne Grauer and Charlotte Roberts, I generated a proposal for Elsevier, which included an outline of the volume, as it appears here. Recognizing that a collaborative effort would be needed to update the core chapters on pathological conditions, specialists in the paleopathology of specific conditions were invited to take Don’s (and Walter Putschar’s) chapters and rework them to reflect new knowledge. Each invited author accepted, which is a measure of their professionalism and their respect for Don.

In creating the current organization, I have deleted information about basic osteological methods, such as estimating age-at-death and biological sex. These are now covered in much greater detail in a variety of basic and advanced osteology texts. We have introduced distinctive chapters on normal and abnormal bone development, imaging, radiology, and ancient pathogen DNA and microbiomes. The chapter on dental disease now also includes biochemical methods for estimating diet (paleodiet). In some cases, conditions have been shuffled between chapters, their realignment reflecting contemporary thought.

Faced with deciding whether to follow my vision of paleopathology in the 21st century or to attempt to guess what Don might have wanted 15 years after the previous edition and 6 years after his death, I have chosen the former. In reflecting upon the many stimulating and open discussions that Don and I have had about the field, I am convinced that he would approve. I have therefore de-emphasized classification in the diagnostic process, and I have added a chapter that recognizes social theoretical approaches to interpreting pathological conditions. In addition, attempting to recognize related specialties, chapters on mummy science and animal paleopathology have also been added. It is my personal view that the 21st century will witness remarkable new knowledge of disease histories and disease transmission that unites the study of zoonotic and human infections, facilitated by molecular studies. The biomolecular revolution, however, will continue to complement and augment our studies of human remains, which will continue to be as fundamentally important to the study of ancient disease as Don and Walter recognized in their 1981 volume.

A final word should be added about authorship. Several chapter authors asked that Don be included as a co-author, as I also felt appropriate for the volume as a whole. As there are prohibitions against attributing posthumous authorship, I decided to follow the biomedical model and entitle this volume Ortner’s Identification of Pathological Conditions in Human Skeletal Remains, 3rd edition.

So here it is! It wouldn’t have been possible without Don's (and Walter’s) exemplary prototype, as well as the many colleagues who so willingly contributed revisions and original chapters. I sincerely hope that you find it useful in your research and teaching, as you advance the vibrant field of paleopathology during the 21st century.

Jane E. Buikstra, Arizona State University

A Tribute to Don Ortner

It is a great honor to be asked to write this tribute for the third edition of Don’s Identification of Pathological Conditions in Human Skeletal Remains. Charlotte had attended Don’s 1985 Short Course in Paleopathology at the Smithsonian Institution, Washington, DC (the fifth and final one there), and we both met Don at the Paleopathology Association European Meeting in Madrid in 1986. He indicated that he was looking for a hook on which to hang his hat in Europe and do research and teaching. We proposed the University of Bradford, and he accepted the University’s invitation to be an Honorary Visiting Professor. Thus began a long and enduring relationship and collaboration with the Smithsonian Institution, and a long and close friendship between the Ortners and the Manchesters, and Charlotte and family. This friendship has endured to the present, long past Don’s untimely tragic death, and is exemplified by the endearing label applied to Don, with typical Yorkshire bluntness, by Keith’s wife’s aunt: the Big Bug from America.

Research collaborations at the University developed, especially in tuberculosis and leprosy, and in 1988 the first (Bradford) Short Course in Paleopathology was run. It ran seven times, with the final one in 2008. Don’s involvement at Bradford had continued for several years by then, and during that time he and his wife Joyce had explored much of the county of Yorkshire, and become the owners of Yorkshire passports!

Don started his career with an undergraduate degree (BA) in Zoology with a minor in chemistry. This is interesting when compared to the late Don Brothwell, whose first degree was a BSc in Anthropology and Archaeology (including zoology and geology), and the fact that Don Ortner was inspired by a primatologist to move into looking at past disease. A Masters degree in Anthropology followed at Syracuse University, where he also did the physical anthropology course taught by Gordon Bowles, who had studied under EA Hooton. He then completed a PhD in 1969 at the University of Kansas (the effects of ageing and disease on the micromorphology of human compact bone). He worked for some time as a Museum Technician in the Department of Anthropology at the National Museum of Natural History at the Smithsonian Institution, Washington, DC (with JL Angel and TD Stewart), and then was recruited as an Assistant Curator in 1969, becoming Curator of Physical Anthropology in 1976.

Following a strongly influential meeting with Adolph Schultz at the University of Zurich in Switzerland who studied wild shot primate pathology, he was convinced that paleopathology could make a valuable contribution to science if the research was founded on a thorough knowledge of anatomy, physiology and the mechanisms of disease processes (Powell, 2012: 91). The rest is history. This set the stage for the rest of his career. His meeting with pathologist Walter Putschar led to Ortner and Putschar (1981) and Don’s considerable work for that first edition benefited from his experience working with pathology reference collections in European museums. Highlighting these collections as beneficial to understanding how disease processes affect bones has led to much more work on documented skeletal collections in paleopathological research. Don was deeply involved with paleopathology at many levels, including service to the field, and he headed up the Paleopathology Association (PPA) as President from 1999 to 2001. In terms of research, Don has contributed much to the literature beyond his books. He was particularly proud of his achievements in developing diagnostic criteria for scurvy and rickets, and documenting the effect of the early stages of leprosy on the facial bones. He was open to debates in paleopathology, and welcomed interactions with younger scholars where he could help. He was always willing to talk to anybody about paleopathology, young, old, amateur or highly experienced.

In particular, we would like to emphasize Don’s commitment to research-led education in paleopathology, epitomized by many activities. Three are prominent. Firstly, the hugely successful short courses in paleopathology with a worldwide participation helped many graduates along the road to successful careers, including one of the authors (Ortner et al., 2012). Secondly, these courses ran alongside the many workshops in paleopathology Don led at the annual meetings of the PPA, starting in 1985, and gave people the opportunity to engage with different pathological conditions at theoretical and practical levels. There is no underestimating the time Don (and his compatriot Bruce Ragsdale, a pathologist) spent putting the workshops together. They remain a legacy for PPA meetings today. Thirdly, this volume has become the mainstay for scholars working in paleopathology.

The first edition of this book had been published in 1981, well before his link with Bradford began (Don’s Bible). This marked a turning point in the global evolution and development of paleopathology. Previous publications, whilst important in establishing paleopathology as a discipline and documenting global evidence for disease in antiquity, lacked the scientific and clinical rigor of Don’s book in elucidating diagnostic and differential diagnostic paleopathological criteria for different diseases. The second edition was produced in the prime years of his involvement at Bradford (Ortner, 2003). In that edition Don wrote 20 of the 23 chapters; authoring virtually all the chapters was no mean achievement. These two editions had focused on a classificatory system of disease, whilst incorporating and integrating clinical and epidemiological aspects.

His writings on the basic biology of bone, on pathological processes, and on clinical and scientific methodology create a baseline for this third edition which, whilst maintaining a classificatory base, has diversified and expanded into broader aspects and concepts of paleopathology. This appropriately includes methodological developments. We believe that this edition is a just and fitting tribute to Don’s immense and unequaled contribution to the totality of paleopathology, making it an accepted and important component of anthropology, archeology, and clinical medicine. The chapters of the current edition, by necessity, have been reworked by a range of authors from both the Old and New Worlds, but the work Don put into the chapters of the previous volumes provided a very strong base with which the new chapter authors could work. We are sure that Don would have been incredibly pleased to see this new edition and the developments the volume has taken, and happy to see Jane head it up.

This new edition of Don’s seminal work in paleopathology will clearly take us well into the 21st century and set the stage for research and teaching in this field. In so doing, it takes into account developments in the field over the last 15 years, showing particularly how nonhuman paleopathology, paleoparasitology, and biomolecular analyses have an increasing part to play in the reconstruction of the origin, evolution, and history of disease. It also illustrates that paleopathology is rapidly progressing as a multimethod-driven discipline fit for the future, and one that embraces other disciplines across the arts, humanities, social sciences, and sciences.

Charlotte Roberts and Keith Manchester

References

1. Ortner DJ. Identification of Pathological Conditions in Human Skeletal Remains second ed. Washington, DC: Smithsonian Institution Press; 2003.

2. Ortner DJ, Putschar WGJ. Identification of Pathological Conditions in Human Skeletal Remains Washington, DC: Smithsonian Institution Press; 1981.

3. Ortner DJ, Knüsel C, Roberts CA. Special courses in human skeletal paleopathology. In: Buikstra JE, Roberts CA, eds. The Global History of Paleopathology Pioneers and Prospects. Oxford: University Press; 2012;684–693.

4. Powell ML. Donald J Ortner. In: Buikstra JE, Roberts CA, eds. The Global History of Paleopathology Pioneers and Prospects. Oxford: University Press; 2012;89–96.

Chapter 1

Introduction

Jane E. Buikstra,    Arizona State University, Tempe, AZ, United States

Abstract

This chapter includes the histories of the first two editions by Don Ortner, along with a statement outlining the development of this third edition, including the manner in which it builds on the fundamental concepts of the earlier volumes. Acknowledgments for all three editions appear, along with the abbreviations for the institutions at which the images reproduced in this volume were taken.

Keywords

Diagnosis; history; human paleopathology; Ortner; Putschar

This third edition of the Identification of Pathological Conditions in Human Skeletal Remains updates and expands upon the topical coverage of earlier works published by Ortner and Putschar (1981) and Ortner (2003). In this chapter, we develop a roadmap for the structure and organization of this volume. First, we present the history of this landmark volume from the perspectives of Donald J. Ortner (first and second editions) and Jane E. Buikstra (third edition). In these sections, and elsewhere, our goals have included retaining Don’s voice, so there are many portions of the second edition that are retained throughout the volume. We also acknowledge those individuals and institutions who have contributed to its development over the past 30+ years. We then introduce the objectives for this third edition, outlining those chapters that have been reorganized as well as those chapters that have been added to this edition, which cover a new range of related fields integral to the development of 21st century paleopathology. Finally, we will introduce and review the format of the volume and its organization.

History of the First Edition From Donald J. Ortner

The first edition of this book was the result of a joint collaboration between Dr. Walter G. J. Putschar and me. Dr. Putschar was an internationally known, consultant pathologist at Massachusetts General Hospital in Boston, MA, who had a special interest in diseases of the human skeleton. We began our professional relationship in 1970 when he accepted my invitation to be the principal lecturer in a seminar series on human skeletal paleopathology that I was organizing at the Smithsonian Institution. The first Paleopathology Seminar Series was held in 1971 and brought several leading authorities on skeletal disease, paleopathology, and related subjects to the Smithsonian Institution to present a series of lectures to a select group of scholars interested in skeletal paleopathology.

The seminar series was held yearly through 1974. By that time the logistics of obtaining funds to offer the series, arranging for students to come from many universities, including those outside the United States, and assembling an outstanding faculty for the 10-week series of lectures and laboratory sessions raised serious questions about whether this was the most cost-effective method for enhancing the quality and direction of research in skeletal paleopathology. It also highlighted the need for a comprehensive reference work on diseases of the skeleton that might be encountered in archeological skeletal remains. I discussed this issue with Dr. Putschar and we decided that many more scholars interested in skeletal paleopathology would have access to the substance of the seminar series if the information in the lectures and laboratory sessions was incorporated into a well-illustrated and comprehensive reference work on pathological conditions that affect the human skeleton.

In the summer of 1974, with the support of a grant from the Smithsonian Research Foundation (now the Smithsonian Scholarly Studies Program), Dr. Putschar and I, accompanied by our wives, Florence Putschar and Joyce E. Ortner, and my three children, traveled extensively in Great Britain and several European countries for more than three months visiting educational and research centers that had significant collections of documented human skeletal pathology. In selecting these centers, we leaned heavily on the advice of the late Dr. Cecil J. Hackett, a physician who had worked for several years in Uganda where he had treated hundreds of patients suffering from yaws. This experience led to a research interest in treponematosis, and Dr. Hackett wrote his doctoral dissertation on the clinical, radiological, and anatomical manifestations of yaws (Hackett, 1947). Following his career in Uganda, Dr. Hackett settled in England where he continued his research on treponematosis, its history and skeletal manifestations. As part of this research he visited many of the major European collections of anatomical pathology that contained documented cases of syphilis. Hackett’s research on these cases resulted in the publication of his classic monograph (Hackett, 1976) on the skeletal manifestations of syphilis, yaws, and treponarid (bejel). His knowledge of these collections and which ones were likely to serve the objectives Dr. Putschar and I had set out to achieve was an invaluable asset.

During our visit to these institutions, Dr. Putschar and I studied and photographed hundreds of cases of skeletal disease. In addition to the photographic record we made of these cases, we often were able to obtain autopsy or museum records that provided descriptive details and a diagnosis for the cases. Radiographic films were acquired for some of the cases. Dr. Putschar dictated his observations about each case and these observations were subsequently transcribed and organized by Mrs. Putschar. In some cases, Dr. Putschar’s diagnostic opinions were at variance with the diagnosis given in the catalog and this difference was duly noted in his observations. Most often, however, the diagnosis given in the catalogs was plausible if not reasonably certain.

We began the task of writing the book shortly after completing our European research in 1974. In 1979, we submitted the completed manuscript to the Smithsonian Institution Press for publication as part of the Smithsonian Contributions to Anthropology series. The manuscript was reviewed by the Department of Anthropology, external reviewers, the Director’s office of the National Museum of Natural History, and the Press. After approval on all levels, editing and production took an additional several months and the book was published in December of 1981 as Smithsonian Contributions to Anthropology, Number 28. A hard-cover edition was published in 1985 that was identical to the first edition except for the addition of an index.

Acknowledgments for the First Edition

The initial research conducted for the first edition of this book was an extensive survey in 1974 by Dr. Putschar and me of documented skeletal pathology in 16 European pathology and anthropology collections in six countries. This survey was supported by the Smithsonian Research Foundation and Hrdlička Fund. The following list of these institutions and the staff members who assisted our survey of their collections is inadequate recognition of the many courtesies extended during our work. Sadly, many colleagues who provided this assistance have since retired or died. Furthermore, some of the collections have been moved from the site where we studied them and some probably no longer exist. However, it remains appropriate to acknowledge the contribution they have made to both editions of this book. Austria: Federal Pathologic-Anatomy Museum, Vienna (Dr. Karl von Portele and Dr. Alexander Müller); Pathology Museum of the University of Graz (Prof. Dr. Max Ratzenhofer); Pathology Museum of the University of Innsbruck (Prof. Dr. Albert Probst and Prof. Dr. Josef Thurner, Salzburg, Austria). Czechoslovakia: National Museum, Department of Anthropology, Prague (Dr. Emanuel Vičk, Dr. Milan Sfloukal and Dr. H. Hanākovā). England: The Natural History Museum, London (Dr. Theya Molleson and Rosemary Powers); Guy’s Hospital Medical School, Gordon Pathology Museum, London; The Royal College of Surgeons of England, Wellcome Museum, London (Dr. Martin S. Israel); The Royal College of Surgeons of England, Hunterian Museum, London (Elizabeth Allen); St. George’s Hospital Medical School, Pathology Museum, London; Westminster Hospital School of Medicine, Pathology Museum, London. France: (Prof. Y. Le Gal and Prof. Andrè Batzenchlager). Scotland: The Royal College of Surgeons of Edinburgh (Prof. Eric C. Mekie, Dr. Andrew A. Shivas, Violette Tansy, Turner, McKenzy). Switzerland: Anthropological Institute of the University of Zurich (Dr. Wolfgang Scheffrahn); Historical Museum, Chur (Dr. H. Erb); Institute of Pathological Anatomy of the University of Zurich (Prof. Dr. Erwin Uehlinger, Prof. Dr. Christoph E. Hedinger, and Aschwanden); Natural History Museum, Bern (Prof. Dr. Walter Huber). Dr. Cecil J. Hackett, an associate of the Royal Orthopaedic Hospital, did much to expedite our work in London, England, and offered several helpful suggestions regarding collections in other countries that proved valuable to our study.

The product of this 1974 survey was more than 1200 photographs, both black and white and color (taken by me) of approximately 500 pathological specimens jointly studied. For some cases, we were able to obtain x-ray films as well. Dr. Putschar described the specimens in detail on tape, and included original autopsy and clinical data where available. This collection of photographs, radiographs, and the transcripts of case descriptions is available for study at the Department of Anthropology, National Museum of Natural History, Smithsonian Institution, Washington, DC. Many of them are used as illustrations in this book.

A number of people made significant contributions during the preparation of the manuscript. Paula Cardwell, Elenor Haley, and particularly Katharine Holland typed initial drafts. Marguerite (Monihan) Guthrie and Elizabeth Beard typed the final draft. Marcia Bakry prepared some of the drawings. A special note of appreciation goes to Jacqui Schulz for the many unpaid hours spent preparing the remaining drawings and getting the photographic illustrations ready for publication. Photographic enlargements were prepared by H.E. Daugherty and Agnes I. Stix. Stix also assisted in editing and typing the manuscript. David Yong, Edward Garner, and Dwight Schmidt provided valuable technical assistance. The staff of the library of the Smithsonian Institution, particularly Janette Saquet, was most helpful. Dr. J. Lawrence Angel, Dr. T. Dale Stewart, and Dr. Douglas H. Ubelaker, members of the Department of Anthropology, Smithsonian Institution, have made valuable suggestions, as have Dr. Saul Jarcho (New York City) and Dr. George Armelagos (University of Massachusetts, Amherst, MA). The staff of the Smithsonian Institution Press, particularly Albert L. Ruffin, Jr., managing editor, series publications, and, Joan B. Horn, senior editor, deserve special recognition for their assistance from the conceptualization through publication of the book. Finally, the wives of both authors have been intimately involved with the preparation of the book. Florence Putschar spent hundreds of volunteer hours organizing photographs, typing, preparing the bibliography, editing, and otherwise making her remarkable abilities available to the project. Joyce Ortner has also assisted in obtaining illustrative material and skeletal specimens.

History of the Second Edition From Donald J. Ortner

Since Dr. Putschar and I completed the manuscript for the first edition, much has changed in the study of ancient skeletal diseases. The Paleopathology Association, established in 1973 with fewer than two dozen members, is now a thriving international scientific association with more than 600 members worldwide that holds annual meetings in the United States and biennial meetings in Europe. There is now a scientific journal devoted to paleopathology¹ and another new journal in which this subject is an important emphasis. A bibliography of paleopathology (both the published edition and the supplements) contains more than 26,000 citations, many of which were published in the last 20 years (Tyson, 1997).

My own research interest and experience has developed as well. In 1984 I received a 3-year grant from the National Institutes of Health (NIH; grant AR 34250) to conduct a survey of pathological cases in the human skeletal collections at the National Museum of Natural History (NMNH). This survey was superimposed on a major effort by the Museum to create an electronic data base of our catalog that required that the anthropological collections be inventoried. Several people were involved in this inventory, but three members of the technical staff deserve particular mention: Marguerite (Monihan) Guthrie, who typed much of the manuscript of the first edition of this book, was responsible for creating, editing, and maintaining the data base. Dwight Schmidt and Stephen Hunter were responsible for doing the actual inventory of the human skeletal collection. This inventory required that all human remains in the collection be compared with the catalog record to ensure that the skeleton had been cataloged and that the catalog record was accurate. This meant opening thousands of drawers and handling more than 36,000 partial to complete human skeletons.

While they were engaged in this task, Schmidt and Hunter were encouraged to identify any cases of skeletal pathology and bring them to my attention. Both Schmidt and Hunter were enthusiastic and highly motivated. They became skilled at identifying pathological cases and this added immeasurably to the quality and quantity of archeological and anatomical cases of skeletal disease in the human skeletal collection of the NMNH. One of the frustrating aspects of the research Dr. Putschar and I had conducted on the NMNH pathological materials was the lack of accessible and reliable information on the archeological dating of the human remains. The grant from NIH provided funding to hire an archeologist, Dr. James Krakker, to review the archeological field records and publications to determine as accurately as possible the archeological dates for much of the human skeletal collection.

After a cluster of pathological cases had been identified, Dr. Putschar would come to the Museum for several days and the two of us would review each one, and he would dictate his observations on the pathogenesis and differential diagnosis. During these visits, Mrs. Putschar would transcribe the dictation and organize the notes. The result was the identification and documentation of many additional cases of skeletal paleopathology that added greatly to our knowledge of disease in antiquity and our ability to diagnose diseases encountered in archeological remains.

One of the interesting dimensions of this exercise was the enthusiasm with which Dr. Putschar reviewed these cases. Virtually every pathological specimen brought new knowledge and insight about pathogenesis to both of us. Because of Dr. Putschar’s vast previous experience with skeletal disease in many countries, it surprised me that he was still finding new insights as he studied these cases. The lesson he repeatedly emphasized was that archeological remains offer the potential to see the expression of disease in an entire skeleton and usually in the untreated state. This is rarely possible in a modern clinical context. He also stressed that careful observation of the type and distribution pattern of lesions within the skeletal specimen provided insight regarding pathogenesis that complemented other sources of information about the disease process.

Since 1979, research methodology has also benefitted from some major breakthroughs in technology. Computed tomography has brought new understanding to our knowledge of skeletal radiology and pathology. Archeological skeletal tissue has been found to be a remarkably good substrate for the preservation of ancient biomolecules, including DNA. Recovery of identifiable genetic material from pathogens has been reported (e.g., Kolman et al., 1999) and this is only the early stage of this research. The remarkable power of the personal computer has provided new ways to manage data and visualize the patterns of pathology that we encounter in archeological skeletal remains. The first edition of this book was prepared using an electric typewriter. I am using a computer word processing system for this edition and I often listen to the music of Mozart being played through my computer while I work. I doubt that Dr. Putschar would have approved of listening to Mozart while writing. Among many other interests, he had a passionate enthusiasm for classical music and especially the music of Mozart, a fellow Austrian by birth. Mozart, in his view, must be listened to and appreciated without distractions.

We also know much more about the skeletal manifestations of disease in archeological human remains and this has led to greater diagnostic certainty for many pathological conditions. Medical knowledge has continued to grow, with new insight about the causes of and relationships between skeletal diseases. Not surprisingly the terminology in medicine and paleopathology has continued to change to reflect the new knowledge acquired about skeletal diseases.

All of these changes argue for a revision of the first edition that will address the new knowledge about both skeletal pathology and paleopathology that has developed in the last 20 years. Regrettably, Dr. Putschar did not live to see the development of many of these innovations or to participate in this revision. While attending professional meetings in Scotland in early October 1985 he and Mrs. Putschar visited a medieval castle site near Edinburgh. During the visit he fell and hit his head on the stone ruins. He developed a hematoma on the brain that subsequently required surgery. On their return to the United States he and Mrs. Putschar received more bad news when she was diagnosed with terminal cancer. Despite these health problems they both insisted that before Dr. Putschar’s surgery he go ahead with the lectures he had promised to deliver on skeletal disease for the last seminar series on skeletal paleopathology held at the Smithsonian Institution from October 21 through November 8, 1985. Although his balance was affected by his injury, and he was deeply troubled by Mrs. Putschar’s illness, his lectures were models of clarity and provided a remarkable learning experience for all who heard him. Mrs. Putschar died on December 31, 1985. The Putschars had a wonderful marriage and her death was a devastating loss for him. Dr. Putschar’s health declined following two surgeries to control the bleeding in his brain and he died on April 5, 1987 at the age of 83.

Inevitably the progress made in both medical knowledge and paleopathology during the past 20 years means that the revisions for this edition are substantial. However, much of the insight and understanding of pathology that Dr. Putschar brought to the first edition remains relevant and wherever possible I have retained his language and perspectives on skeletal disease. This second edition owes much to his knowledge and experience.

Acknowledgments for the Second Edition

In the first edition of this book, I acknowledged the assistance of those who contributed so substantially to its preparation. Some of these people have since died, but the kindness of all who gave of their time and expertise remains a wonderful memory. Since the publication of the first edition many additional people have shared their knowledge and made collections and many additional cases of pathology available for my research. These include the following institutions and people. Australia: The Shellshear Museum, Sydney (Prof. Jonathan Stone and Kenneth Parsons); The Australian Museum, Sydney (Phillip Gordon and Dr. Ronald Lampert); The South Australian Museum, Adelaide (Dr. Graeme Pretty). Denmark: The Danish National Museum, Cophenhagen (Prof. Vilhelm Møller-Christensen). England: The Department of Archaeological Sciences, The University of Bradford, Bradford (Arnold Aspinall, Dr. Keith Manchester, Dr. Charlotte Roberts, Anthea Boylston, Jason Maher, Prof. Mark Pollard, and Dr. Carl Heron); The Rheumatology Unit, Bristol University, Bristol (Dr. Juliet Rogers and Prof. Paul Dieppe); The Canterbury Archaeological Trust, Canterbury (Paul Bennett and Trevor Anderson); English Heritage, Ancient Monuments Laboratory, London (Dr. Simon Mays). Norway: The Department of Anatomy, University of Oslo (Prof. Dr. Per Holck and Inger Saelebakke); The Leprosy Museum of Bergen (Prof. Lorentz M. Irgens). Scotland: The Royal College of Surgeons of Edinburgh (Dr. I. S. Kirkland). Switzerland: The Institute of Pathological Anatomy, University of Zurich (Prof. Dr. Ph. U. Heitz and Prof. A.R. von Hochstetter). United States: The Bishop Museum, Honolulu, Hawaii (Dr. Donald Duckworth, Dr. Yosiniko H. Sinoto, and Toni Han); The Peabody Museum, Harvard University (Dr. David Pilbeam and Dr. Lane Beck); The San Diego Museum of Man (Rose Tyson); The Lowie Museum (now the Phoebe Apperson Hearst Museum of Anthropology), University of California, Berkeley, California.

In 1987 I was appointed Visiting Professor of Paleopathology at the University of Bradford, Bradford, England. Since 1988, I have been in residence in the Department of Archaeological Sciences at the University for varying lengths of time almost every year. This has been a remarkably valuable experience and I am very grateful for the wonderful collegial relationships that have developed over the years and the generous hospitality extended to me and my family. These colleagues include Arnold Aspinall, the Chairman of the Department when I was first appointed, Dr. Keith Manchester, Dr. Charlotte Roberts (now at the University of Durham), Prof. Mark Pollard, who followed Mr. Aspinall as Department Chairman, and Dr. Carl Heron, the current Department Chairman. The skeletal collection in the department, particularly the remarkable collection of human remains from the medieval cemetery in Chichester, England, associated with the Hospital of St. James and St. Mary Magdalene have been of great help in furthering my knowledge of human skeletal paleopathology. Many of the people buried in this cemetery were lepers and their skeletons provide crucial insight regarding the skeletal manifestations of this dreaded disease.

In 1992 I had a casual conversation about my research with a friend of many years, David Malin, a sales representative for Siemens Medical Systems, Inc. He offered to try and arrange access to CT equipment at a Siemens facility. His efforts put me in contact with Matthew Riemann (now retired), the director of the Training and Development Center for Siemens Medical Systems, Inc. in Iselin, NJ. Riemann was supportive and asked two members of his staff, Valere Choumitsky and Blaise Falkowski, to do what they could to assist my research. At that time Mr. Falkowski was the senior instructor for technical training of engineers and service technicians who service Siemens CT scanners in North America. When the facility was not being used for training we were able to use the equipment to scan paleopathological cases. Eventually the Training and Development Center moved to Cary, North Carolina, and I and my Smithsonian colleague, Dr. Bruno Frohlich, continued to use the equipment at no cost during windows in the training schedule. Access to this equipment proved to be a powerful research tool and most of the CT images included in this edition were generated on Siemens equipment.

CT scanning equipment at the Siemens training facility is upgraded periodically to the newest models manufactured by Siemens. On one occasion Dr. Frohlich learned that a Siemens Somatom AR-T scanner was to be replaced with a new model. He suggested that Siemens donate the older model to the Smithsonian. After approval on all relevant levels the equipment was given to the Museum and is now used in support of the research endeavors of the museum staff. The expertise and the many hours of assistance provided by Mr. Falkowski and his colleagues at Siemens continues to be of major value to my research.

Agnes Stix, Museum Specialist, and Janet Beck, Volunteer Research Assistant, Department of Anthropology, National Museum of Natural History, Smithsonian Institution, have invested countless hours in organizing bibliographic source materials and illustrations for this book. They have created computer data bases for the references and photographs that greatly facilitated my work. Stix in particular has had the responsibility of organizing the various electronic files of figures, tables, text, figure legends and references and keeping changes in one file congruent with the other. Their contributions to this edition are substantial and I am in their debt. Marcia Bakry, Scientific Illustrator, Department of Anthropology, National Museum of Natural History, Smithsonian Institution, is responsible for preparing the digitized figures for the book. Using the powerful software available today for manipulating digitized photographic images, she has been able to improve significantly the quality of the figures used in this edition and deserves my deepest thanks and that of the reader who will benefit from her skilled work. Dr. Margaret R. Dittemore, Branch Librarian, Anthropology Branch Library, Smithsonian Institution Libraries, and her colleagues in the library were crucial in identifying and obtaining source materials used in the book. I am also indebted to Roxie Walker and the Institute of Bioarchaeology (formerly the Bioanthropology Foundation) for grants that partially supported the preparation of this edition.

Objectives of the First and Second Editions

There are many sources of information on the history of disease, including ancient medical documents, historical records, art, and the physical remains of ancient people including both soft tissues and skeletons. Undoubtedly, human skeletons represent the most ubiquitous source of information on ancient diseases. This fact must be tempered with the knowledge that relatively few morbid conditions affect the skeleton in a way that leaves visible changes in dry bones. In spite of this limitation, the study of skeletal pathology in archeological materials can provide time depth to our understanding of disease and contribute to our knowledge regarding the role of disease in human adaptation. In addition, skeletal paleopathology may also broaden our understanding of disease as it affects bone tissue. The paleopathologist often has access to all portions of the skeleton, a situation rarely realized in modern pathology or radiology. This means that the gross pattern and distribution of the morbid condition in all areas of the skeleton can be studied in detail.

To provide reliable standard specimens for dry bone diagnosis, the reference cases used as a basis for the first two editions of this book were primarily from the period between AD 1750 and 1930. Ortner felt that earlier than this range the medical data were too ambiguous and later, the pathologic manifestations were too altered by surgery, chemotherapy, radiation therapy, and, above all, by the use of antibiotics. For this reason, the first two editions turned to the great medical and anatomical collections of Great Britain and of continental Europe. The British collections proved in many ways to be the most useful, because they were made by physicians and surgeons, who were at all times interested in documenting clinical and historical data. Yet even this material is not necessarily identical to manifestations seen in archeological specimens. As Ortner noted, his compiling these editions highlighted the fact that even the great pathological anatomists of earlier times made mistakes in differential diagnosis.

This book was intended mainly to serve as a text and atlas of dry bone pathology, regardless of whether or not each entity had been identified in paleopathology. For that reason, as many aspects as possible of documented, dry bone pathology were illustrated, especially because the original skeletal collections can never be duplicated and may ultimately disappear. In the paleopathological discussions in these earlier editions, emphasis was laid on careful and critical study of published reports and of actual specimens, bringing a variety of types of evidence to bear on arriving at a reasonable diagnostic assumption. Even so, multiple possibilities and uncertainties often remained. Not the least of these problems was the ambiguous and confusing terminology about the nature of pathological conditions and the chronology of archeological specimens in published reports.

This book was written primarily with the needs of the biological anthropologist and archeologist in mind, with the hope that they would be able to recognize the abnormalities seen in archeological human skeletal material they excavate or study. This book was also meant to highlight the importance of recovering all mineralized tissues, including the small bones of the hands and feet, during excavation of a burial. Ortner also was interested in generating a broader readership with different backgrounds, though, and emphasized the importance of including historians of medicine and disease, orthopedic surgeons, radiologists, pathologists, and physicians, who may be called upon to interpret skeletal lesions in dry specimens or who are interested in extending their understanding to the more detailed gross expressions of skeletal disease.

History of the Third Edition From Jane E. Buikstra

Don Ortner was just embarking upon the third edition of this important volume at the time of his unanticipated death on April 29, 2012, following a brief illness. For those of us who had been close to Don professionally and/or personally, our grief was profound. For example, I—who had enjoyed so many pleasant lunches with Don when I could sneak away from meetings of the National Museum of Natural History’s Repatriation Committee or other Washington responsibilities—could not bear to walk by his office door for nearly a year, finding other circuitous routes to reach the Rose Seminar room of the NMNH’s Anthropology Department. Don’s achievements were celebrated both at the Smithsonian, during an event held during the autumn of 2012, and at the annual meeting of the Paleopathology Association, held during the 2013 annual meeting, April 9 and 10. Fortunately, Powell (2012) had been able to convince Don to be interviewed for a chapter in the Global History of Paleopathology (Buikstra and Roberts, 2012), wherein details of his life and scholarly contributions may be found. I can add only that he was an enthusiastic supporter of the fledgling International Journal of Paleopathology, ably contributing one of the Inaugural Essays and serving as an Associate Editor. He rolled up his sleeves upon many occasions to review articles and offer sage advice to junior colleagues.

In discussions with Don’s family, especially his partner Joyce and Don Jr., who sounds remarkably like his father, it became clear that they would be supportive of a third edition of Identification of Pathological Conditions in Human Skeletal Remains, under my editorship. Discussions with Bruno Frohlich, who was helping the Department of Anthropology in archiving the materials from Don’s office, made it clear that Don had only just embarked on the project. No publisher had been identified, nor was there a proposal. Given this situation, I began plans for the project. In creating the proposal, first discussed with the Smithsonian Press, who were not enthusiastic about the project due to concerns with copyright issues, I reflected upon the many productive discussions in which I had engaged with Don. These convinced me that he would have wanted the volume revision not to second guess what Don might have wanted, but rather to reflect the status of paleopathology at the time the revision appeared. This meant continuing to emphasize the basic empirical evidence upon which paleopathological identifications are based, but also to reflect the dynamic nature of paleopathology today. Given the mentorship and encouragement that Don had so freely provided to so many of us, I also believe that he would have wanted our generation(s) to leave our imprint upon the work—giving it our best effort. It is with this spirit that we have approached the volume.

When I approached Elizabeth Brown, Senior Acquisitions Editor at Elsevier, about the project, she was enthusiastic in support. We have tried to maintain the many strengths of the earlier editions, while also adding new methodological advances (molecular and parasitology), mentioning closely related and increasingly convergent research topics (animal paleopathology; mummy science) and emphasizing the interdisciplinarity of paleopathology in exploring themes based in the social sciences and humanities. When approached, colleagues in paleopathology and related disciplines signed on enthusiastically, bringing their special expertise to this important initiative.

Don and I agreed about most aspects of paleopathology, especially the need for detailed descriptions of pathological changes, for standard terminology, to appreciate limitations of early clinical accounts as well as those of the antibiotic era, and for rigorous applications of differential diagnostic methods. I am less concerned than he about classification, and therefore this topic will be less visible in this third edition. I sincerely hope that we have done justice to Don’s fundamental contributions to the discipline of paleopathology, while recognizing key developments since his seminal 2003 publications.

Acknowledgments for the Third Edition

First and foremost, I would like to acknowledge the Ortner family in their support of this initiative. The Department of Anthropology, especially its Chair during the period of project development, Torben Rick, along with Don’s long-term collaborator, Bruno Frohlich have been immensely reassuring. The editor is extremely appreciative of the enthusiasm and expertise of the collaborators, whose wisdom is represented here. The editorial and content editorial assistance of Katelyn Bolhofner has improved clarity and accuracy throughout the development of the volume. Additional polish has been added by the skills of Sylvia Cheever in final stages of the process. Anne Grauer’s careful proof-reading and apt suggestions have improved the final production, which is deeply appreciated. Many of the authors wish to express their gratitude to Don Brothwell for his scholarship and personal encouragement of our research, both in human and in animal paleopathology. Finally, the assistance and encouragement from Elsevier, including Elizabeth Brown, Pat Gonzalez, and the production team have been essential to the success of the project.

Objectives of the Third Edition

More than 30 years have passed since the landmark Identification of Pathological Conditions in Human Skeletal Remains (Ortner and Putschar, 1981) was published, followed by the second edition (Ortner, 2003) over a decade ago. The field and the profession of paleopathology have changed markedly over this period, in no small part due to the influence of these volumes. Ortner had planned but not begun writing a third edition at the time of his sudden death, and this volume represents the completion of this project, reflecting his (and Walter Putschar’s) core contributions in bone disease through revised and new chapters that manifest the contemporary breadth and depth of the discipline of paleopathology.

This third edition updates the previous volumes through the addition of recent medical information on skeletal disorders and the latest relevant literature on human skeletal paleopathology. This work also adds chapters on current methods being used in research on skeletal paleopathology. These include increased reliance on imaging, including CT methods, histology, and analysis of ancient DNA. In addition, chapters covering closely related subjects, such as diet (including isotopes, microwear, colon contents, (macro/micro fossils; pollen), dental calculus, dental caries), mummy science, animal paleopathology, and paleoparasitology have been added. Given the contemporary availability of numerous texts covering basic osteology, in this edition chapters on biological profiling and osteobiographical methods have been deleted. These topics are now introduced briefly in Chapter 3, and Chapter 2 now offers an extended history of paleopathology, current issues in the field, and the importance of rigorous differential diagnosis. The volume is further framed by an expanded discussion of important themes for consideration in this paleopathological research (Chapter 3).

As was the case for the first two editions of this volume, the most fundamental objective of this third edition is to provide an integrated, detailed discussion of the gross pathology of the human skeleton to facilitate rigorous differential diagnosis of these pathologies in human skeletal remains from archaeological contexts. In addition to this foundation, the objectives of this third edition include: emphasizing careful consideration of contemporary clinical literature in diagnosis, encouraging knowledge in epidemiology, animal paleopathology, parasitology, and molecular and chemical advances in contextualizing skeletal analyses, and presenting advances in imaging, data collection, and diagnostic approaches arising from such related fields as forensic science, dental anthropology, biogeochemistry, and molecular science.

Format of the Volume

While texts in paleopathology all agree that classification is an important aspect of disease diagnosis, there is no general agreement upon the number of classes of disease. As Ortner (2012) notes, Reznick’s orthopedic radiology text recognizes 17 categories. Aufderheide and Rodríguez-Martín (1998)’s paleopathology text recognizes 13, while both editions of the Ortner volumes focus upon 12. Influenced by Lent Johnson, Ragsdale and various coworkers (Ragsdale and Miller, 1996; Ragsdale and Lehmer, 2012) have asserted the utility of seven basic disease categories, readily recalled through the use of the acronym VITAMIN (see Table 1.1, adapted from Ragsdale and Lehmer, 2012: 230). Roberts and Manchester (third edition, 2010) also organize their discussion in The Archaeology of Disease into seven categories.

Table 1.1

After emphasizing the need for histology and recognition of disease processes, Ragsdale and Lehmer (2012: 247) close with the assertion, that only through detailed descriptions and diagnoses to general disease categories, will a stronger methodological basis for comparative research in paleopathology be reached. They argue, based upon evidence from four workshops held at the paleopathology meetings (Miller et al., 1996) that assignments to disease categories are more accurate than specific diagnoses. While these conclusions do reflect the empirical data from the Workshops, questions about the relative experience of the participants remains. In addition, the degree to which comparisons across 7, 12, 13, or 1 categories are meaningful in interpreting the past must, of course, depend upon the research question addressed or the hypothesis posed. Further, the issue of contexts—environmental, temporal, cultural—must be considered.

As Ortner (2012) emphasizes, disease classifications emphasize cause or pathogenesis of a disease. In that, e.g., bacterial pathogenesis can be a cause, pathogenesis would seem to be the overarching category. Many diseases have multiple causes, and classifications become complex. Metabolic diseases, due to disturbances in osteoid formation and mineralization, are often associated with nutritional deficiencies. Similarly, erosive arthropathies are typically classified as joint disorders, even though an infection may trigger the response.

This volume will follow the previous editions in its classification of disease conditions: trauma, infectious diseases, circulatory disorders, reticuloendothelial and hematopoietic disorders, metabolic disorders, endocrine disorders, congenital and neuromechanical disorders, dysplasias, tumor and tumor-like disorders, joint disorders, dental and jaw disorders, and miscellaneous disorders. A few specific disorders have been moved to more completely reflect contemporary knowledge of pathogenesis. In reference to the process of classification, Ortner (2012: 263) emphasized that the important point is the need to understand the pathogenesis and, where possible, the cause of the disorder and not let the assignment to a specific category of disease obscure our understanding of the basic bone biology of disease.

Abbreviations

The illustrations in this book are of specimens from many institutions. The following abbreviations are used in the legends to avoid repetition of lengthy institutional names and locations. This list includes institutions that had pathological cases used in both the first and second editions.

AFIP Armed Forces Institute of Pathology, Washington, DC, United States

AIUZ Anthropological Institute, University of Zurich, Zurich, Switzerland

ANM National Museum of Anthropology, Prague, Czech Republic

BMNH British Museum, The Natural History Museum, London, England

CGH Department of Pathology, Charleston General Hospital, Charleston, WV, United States

CISC Coimbra Identified Skeletal Collection, Departamento de Ciências da Vida, Universidade de Coimbra, Portugal

DPUS Department of Pathology, University of Strasbourg, Strasbourg, France

FM Field Museum of Natural History, Chicago, IL, United States

FPAM Federal Pathologic-Anatomy Museum, Vienna, Austria

HM Hunterian Museum, The Royal College of Surgeons of England, London, England

IEC International Exchange Collection, Departamento de Ciências da Vida, Universidade de Coimbra, Coimbra, Portugal

IPAZ Institute of Pathological Anatomy, University of Zurich, Zurich, Switzerland

LLAC-MUHNAC Luís Lopes Anthropological Collection, Museu Bocage, Museu Nacional de História Natural e da Ciência, Lisbon, Portugal

MGH Department of Pathology, Massachusetts General Hospital, Boston, MA, United States

NHMB Natural History Museum, Bern, Switzerland

NMNH National Museum of Natural History, Smithsonian Institution, Washington, DC, United States

PMES Pathology Museum, The Royal College of Surgeons of Edinburgh, Edinburgh, Scotland

WM Wellcome Museum, The Royal College of Surgeons of England, London, England

References

1. Aufderheide AC, Rodríguez-Martín C. The Cambridge Encyclopedia of Human Paleopathology Cambridge: Cambridge University Press; 1998.

2. Buikstra JE, Roberts CA, eds. The Global History of Paleopathology: Pioneers and Prospects. New York: Oxford University Press; 2012.

3. Hackett C. The Bone Lesions of Yaws in Uganda Thesis London: University of London; 1947.

4. Hackett C. Diagnostic criteria of syphilis, yaws and treponarid (treponematoses) and of some other diseases in dry