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List of Contributors

Amanda M. Agnew, School of Health and Justyna J. Miszkiewicz, School of Archaeology &
Rehabilitation Sciences, The Ohio State University, Anthropology, Australian National University,
Columbus, OH, United States Canberra, ACT, Australia
Megan B. Brickley, Department of Anthropology, Marc F. Oxenham, School of Archaeology &
McMaster University, Hamilton, ON, Canada Anthropology, Australian National University,
Jane E. Buikstra, Arizona State University, Tempe, AZ, Canberra, ACT, Australia
United States; Arizona State University, Phoenix, AZ, Andrew T. Ozga, Center for Evolution and Medicine,
United States Tempe, AZ, United States; Institute for Human
Morgana Camacho, Pathoecology Laboratory, School of Origins, Tempe, AZ, United States
Natural Resources, University of Nebraska - Lincoln, Rebecca Redfern, Centre for Human Bioarchaeology,
United States Museum of London, London, United Kingdom
Mary E. Cole, Department of Anthropology, The Ohio Karl Reinhard, Pathoecology Laboratory, School of
State University, Columbus, OH, United States Natural Resources, University of Nebraska - Lincoln,
Sharon DeWitte, University of South Carolina, SC, United States
United States Charlotte A. Roberts, Department of Archaeology,
Bruno Frohlich, Department of Anthropology, Durham University, Durham, United Kingdom
Smithsonian Institution, Washington, DC, United Anne C. Stone, School of Human Evolution and
States; Department of Anthropology, Dartmouth Social Change, Tempe, AZ, United States; Center
College, Hanover, NH, United States for Evolution and Medicine, Tempe, AZ, United
Anne L. Grauer, Loyola University Chicago, Chicago, States; Institute for Human Origins, Tempe, AZ,
IL, United States United States
Rebecca Kinaston, Department of Anatomy, School of Samuel D. Stout, Department of Anthropology,
Biomedical Sciences, University of Otago, Dunedin, The Ohio State University, Columbus, OH, United
New Zealand States
Haagen D. Klaus, Department of Sociology and Richard Thomas, School of Archaeology and Ancient
Anthropology, George Mason University, Fairfax, VA, History, University of Leicester, Leicester, United
United States Kingdom
Mary Lewis, University of Reading, Reading, United Monica Tromp, Department of Anatomy, School of
Kingdom Biomedical Sciences, University of Otago, Dunedin,
New Zealand; Department of Archaeology, Max
Niels Lynnerup, Department of Forensic Medicine,
Planck Institute for the Science of Human History,
University of Copenhagen, Copenhagen, Denmark
Jena, Germany
Carina Marques, Research Centre for Anthropology and
Chiara Villa, Department of Forensic Medicine,
Health (CIAS), Department of Life Sciences,
University of Copenhagen, Copenhagen, Denmark
University of Coimbra, Coimbra, Portugal; Department
of Anthropology, William Paterson University, Wayne, Tony Waldron, University College London, London,
NJ, United States United Kingdom
Simon Mays, Historic England, Portsmouth, United Anna Willis, College of Arts, Society & Education,
Kingdom James Cook University, Townsville, QLD, Australia

xiii
Preface

One of the last times I saw Don Ortner in his office at the of specific conditions were invited to take Don’s (and
Department of Anthropology of the Natural History Walter Putschar’s) chapters and rework them to reflect
Museum, he gestured to the shelves and filing cabinets new knowledge. Each invited author accepted, which is a
where he had been beginning to accumulate sources for measure of their professionalism and their respect for
the third edition of Identification of Pathological Don.
Conditions in Human Skeletal Remains. As we who In creating the current organization, I have deleted
mourn him know only too well, he died unexpectedly on information about basic osteological methods, such as esti-
April 29, 2012, and this task remained undone. Hoping mating age-at-death and biological sex. These are now
that at least a partial manuscript existed, I asked Bruno covered in much greater detail in a variety of basic and
Frohlich, a close colleague of Don’s at the National advanced osteology texts. We have introduced distinctive
Museum of Natural History, about evidence of the chapters on normal and abnormal bone development,
volume’s progress. As the person who assumed the chal- imaging, radiology, and ancient pathogen DNA and micro-
lenging task of sorting Don’s office, Bruno indicated that biomes. The chapter on dental disease now also includes
there was nothing of substance, no outline, no negotia- biochemical methods for estimating diet (paleodiet). In
tions with a press. some cases, conditions have been shuffled between chap-
Thus, it was obvious that organizing a new edition ters, their realignment reflecting contemporary thought.
would require starting with the Ortner (2003) volume and Faced with deciding whether to follow my vision of
revising. The alternative, letting the fine second edition paleopathology in the 21st century or to attempt to guess
become increasingly out of date, a piece of history but what Don might have wanted 15 years after the previous
not a useful teaching and research aid, seemed an edition and 6 years after his death, I have chosen the for-
unhappy choice. New volumes by other authors would no mer. In reflecting upon the many stimulating and open
doubt appear, but in my opinion that energy and expertise discussions that Don and I have had about the field, I am
could be better directed toward advancing knowledge in convinced that he would approve. I have therefore de-
other ways rather than “reinventing the wheel.” emphasized “classification” in the diagnostic process, and
Following discussions with colleagues in paleopathol- I have added a chapter that recognizes social theoretical
ogy and the Ortner family, primarily Don’s widow Joyce approaches to interpreting pathological conditions. In
and son, Don, Jr., I agreed to explore publication options addition, attempting to recognize related specialties, chap-
and consider how the volume might be revised to reflect ters on mummy science and animal paleopathology have
new knowledge and the further integration of the study of also been added. It is my personal view that the 21st cen-
health into perspectives on the past. After discussions tury will witness remarkable new knowledge of disease
with several presses, it seemed prudent to choose histories and disease transmission that unites the study of
Elsevier, as they could readily provide the text and image zoonotic and human infections, facilitated by molecular
files from the second edition. I wish to thank them most studies. The biomolecular “revolution,” however, will
sincerely for their support and patience throughout this continue to complement and augment our studies of
protracted process. human remains, which will continue to be as fundamen-
There have been many decisions along the way. tally important to the study of ancient disease as Don and
Initially, and with sage advice from many colleagues, Walter recognized in their 1981 volume.
such as Anne Grauer and Charlotte Roberts, I generated a A final word should be added about authorship.
proposal for Elsevier, which included an outline of the Several chapter authors asked that Don be included as a
volume, as it appears here. Recognizing that a collabora- co-author, as I also felt appropriate for the volume as a
tive effort would be needed to update the core chapters on whole. As there are prohibitions against attributing post-
pathological conditions, specialists in the paleopathology humous authorship, I decided to follow the biomedical

xv
xvi Preface

model and entitle this volume Ortner’s Identification of and original chapters. I sincerely hope that you find it
Pathological Conditions in Human Skeletal Remains, 3rd useful in your research and teaching, as you advance the
edition. vibrant field of paleopathology during the 21st century.
So here it is! It wouldn’t have been possible without
Don’s (and Walter’s) exemplary prototype, as well as the
Jane E. Buikstra
many colleagues who so willingly contributed revisions
Arizona State University
A Tribute to Don Ortner

It is a great honor to be asked to write this tribute for the recruited as an Assistant Curator in 1969, becoming
third edition of Don’s Identification of Pathological Curator of Physical Anthropology in 1976.
Conditions in Human Skeletal Remains. Charlotte had Following a strongly influential meeting with Adolph
attended Don’s 1985 Short Course in Paleopathology at Schultz at the University of Zurich in Switzerland who
the Smithsonian Institution, Washington, DC (the fifth studied wild shot primate pathology, he was convinced
and final one there), and we both met Don at the that “paleopathology could make a valuable contribution
Paleopathology Association European Meeting in Madrid to science if the research was founded on a thorough
in 1986. He indicated that he was “looking for a hook on knowledge of anatomy, physiology and the mechanisms
which to hang his hat” in Europe and do research and of disease processes” (Powell, 2012: 91). The rest is his-
teaching. We proposed the University of Bradford, and he tory. This set the stage for the rest of his career. His meet-
accepted the University’s invitation to be an Honorary ing with pathologist Walter Putschar led to Ortner and
Visiting Professor. Thus began a long and enduring rela- Putschar (1981) and Don’s considerable work for that first
tionship and collaboration with the Smithsonian edition benefited from his experience working with
Institution, and a long and close friendship between the pathology reference collections in European museums.
Ortners and the Manchesters, and Charlotte and family. Highlighting these collections as beneficial to understand-
This friendship has endured to the present, long past ing how disease processes affect bones has led to much
Don’s untimely tragic death, and is exemplified by the more work on documented skeletal collections in paleo-
endearing label applied to Don, with typical Yorkshire pathological research. Don was deeply involved with
bluntness, by Keith’s wife’s aunt: “the Big Bug from paleopathology at many levels, including service to the
America.” field, and he headed up the Paleopathology Association
Research collaborations at the University developed, (PPA) as President from 1999 to 2001. In terms of
especially in tuberculosis and leprosy, and in 1988 the research, Don has contributed much to the literature
first (Bradford) Short Course in Paleopathology was run. beyond his books. He was particularly proud of his
It ran seven times, with the final one in 2008. Don’s achievements in developing diagnostic criteria for scurvy
involvement at Bradford had continued for several years and rickets, and documenting the effect of the early stages
by then, and during that time he and his wife Joyce had of leprosy on the facial bones. He was open to debates in
explored much of the county of Yorkshire, and become paleopathology, and welcomed interactions with younger
the owners of “Yorkshire passports”! scholars where he could help. He was always willing to
Don started his career with an undergraduate degree talk to anybody about paleopathology, young, old, ama-
(BA) in Zoology with a minor in chemistry. This is interest- teur or highly experienced.
ing when compared to the late Don Brothwell, whose first In particular, we would like to emphasize Don’s com-
degree was a BSc in Anthropology and Archaeology mitment to research-led education in paleopathology, epit-
(including zoology and geology), and the fact that Don omized by many activities. Three are prominent. Firstly,
Ortner was inspired by a primatologist to move into looking the hugely successful short courses in paleopathology
at past disease. A Masters degree in Anthropology followed with a worldwide participation helped many “graduates”
at Syracuse University, where he also did the physical along the road to successful careers, including one of the
anthropology course taught by Gordon Bowles, who had authors (Ortner et al., 2012). Secondly, these courses ran
studied under EA Hooton. He then completed a PhD in alongside the many workshops in paleopathology Don led
1969 at the University of Kansas (the effects of ageing and at the annual meetings of the PPA, starting in 1985, and
disease on the micromorphology of human compact bone). gave people the opportunity to engage with different path-
He worked for some time as a Museum Technician in the ological conditions at theoretical and practical levels.
Department of Anthropology at the National Museum of There is no underestimating the time Don (and his compa-
Natural History at the Smithsonian Institution, Washington, triot Bruce Ragsdale, a pathologist) spent putting the
DC (with JL Angel and TD Stewart), and then was workshops together. They remain a legacy for PPA

xvii
xviii A Tribute to Don Ortner

meetings today. Thirdly, this volume has become the have been incredibly pleased to see this new edition and
mainstay for scholars working in paleopathology. the developments the volume has taken, and happy to see
The first edition of this book had been published in Jane head it up.
1981, well before his link with Bradford began (“Don’s This new edition of Don’s seminal work in paleopa-
Bible”). This marked a turning point in the global evolution thology will clearly take us well into the 21st century and
and development of paleopathology. Previous publications, set the stage for research and teaching in this field. In so
whilst important in establishing paleopathology as a disci- doing, it takes into account developments in the field over
pline and documenting global evidence for disease in antiq- the last 15 years, showing particularly how nonhuman
uity, lacked the scientific and clinical rigor of Don’s book paleopathology, paleoparasitology, and biomolecular anal-
in elucidating diagnostic and differential diagnostic paleo- yses have an increasing part to play in the reconstruction
pathological criteria for different diseases. The second edi- of the origin, evolution, and history of disease. It also
tion was produced in the prime years of his involvement at illustrates that paleopathology is rapidly progressing as a
Bradford (Ortner, 2003). In that edition Don wrote 20 of the multimethod-driven discipline fit for the future, and one
23 chapters; authoring virtually all the chapters was no that embraces other disciplines across the arts, humanities,
mean achievement. These two editions had focused on a social sciences, and sciences.
classificatory system of disease, whilst incorporating and
integrating clinical and epidemiological aspects.
Charlotte Roberts and Keith Manchester
His writings on the basic biology of bone, on patho-
logical processes, and on clinical and scientific methodol-
ogy create a baseline for this third edition which, whilst
maintaining a classificatory base, has diversified and REFERENCES
expanded into broader aspects and concepts of paleopa- Ortner, D.J., 2003. Identification of Pathological Conditions in Human
thology. This appropriately includes methodological Skeletal Remains, second ed. Smithsonian Institution Press,
developments. We believe that this edition is a just and Washington, DC.
fitting tribute to Don’s immense and unequaled contribu- Ortner, D.J., Putschar, W.G.J., 1981. Identification of Pathological
tion to the totality of paleopathology, making it an Conditions in Human Skeletal Remains. Smithsonian Institution
accepted and important component of anthropology, Press, Washington, DC.
Ortner, D.J., Knüsel, C., Roberts, C.A., 2012. Special courses in human
archeology, and clinical medicine. The chapters of the
skeletal paleopathology. In: Buikstra, J.E., Roberts, C.A. (Eds.), The
current edition, by necessity, have been reworked by a Global History of Paleopathology. Pioneers and Prospects.
range of authors from both the Old and New Worlds, but University Press, Oxford, pp. 684 693.
the work Don put into the chapters of the previous Powell, M.L., 2012. Donald J. Ortner. In: Buikstra, J.E., Roberts, C.A.
volumes provided a very strong base with which the new (Eds.), The Global History of Paleopathology. Pioneers and
chapter authors could work. We are sure that Don would Prospects. University Press, Oxford, pp. 89 96.
Chapter 1

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

This third edition of the Identification of Pathological The seminar series was held yearly through 1974. By
Conditions in Human Skeletal Remains updates and that time the logistics of obtaining funds to offer the
expands upon the topical coverage of earlier works pub- series, arranging for students to come from many univer-
lished by Ortner and Putschar (1981) and Ortner (2003). sities, including those outside the United States, and
In this chapter, we develop a “roadmap” for the structure assembling an outstanding faculty for the 10-week series
and organization of this volume. First, we present the his- of lectures and laboratory sessions raised serious ques-
tory of this landmark volume from the perspectives of tions about whether this was the most cost-effective
Donald J. Ortner (first and second editions) and Jane E. method for enhancing the quality and direction of
Buikstra (third edition). In these sections, and elsewhere, research in skeletal paleopathology. It also highlighted the
our goals have included retaining Don’s voice, so there need for a comprehensive reference work on diseases of
are many portions of the second edition that are retained the skeleton that might be encountered in archeological
throughout the volume. We also acknowledge those indi- skeletal remains. I discussed this issue with Dr. Putschar
viduals and institutions who have contributed to its devel- and we decided that many more scholars interested in
opment over the past 30 1 years. We then introduce the skeletal paleopathology would have access to the sub-
objectives for this third edition, outlining those chapters stance of the seminar series if the information in the lec-
that have been reorganized as well as those chapters that tures and laboratory sessions was incorporated into a
have been added to this edition, which cover a new range well-illustrated and comprehensive reference work on
of related fields integral to the development of 21st cen- pathological conditions that affect the human skeleton.
tury paleopathology. Finally, we will introduce and In the summer of 1974, with the support of a grant
review the format of the volume and its organization. from the Smithsonian Research Foundation (now the
Smithsonian Scholarly Studies Program), Dr. Putschar
and I, accompanied by our wives, Florence Putschar and
HISTORY OF THE FIRST EDITION FROM Joyce E. Ortner, and my three children, traveled exten-
sively in Great Britain and several European countries for
DONALD J. ORTNER more than three months visiting educational and research
The first edition of this book was the result of a joint col- centers that had significant collections of documented
laboration between Dr. Walter G. J. Putschar and me. Dr. human skeletal pathology. In selecting these centers, we
Putschar was an internationally known, consultant pathol- leaned heavily on the advice of the late Dr. Cecil J.
ogist at Massachusetts General Hospital in Boston, MA, Hackett, a physician who had worked for several years in
who had a special interest in diseases of the human skele- Uganda where he had treated hundreds of patients suffer-
ton. We began our professional relationship in 1970 when ing from yaws. This experience led to a research interest
he accepted my invitation to be the principal lecturer in a in treponematosis, and Dr. Hackett wrote his doctoral dis-
seminar series on human skeletal paleopathology that I sertation on the clinical, radiological, and anatomical
was organizing at the Smithsonian Institution. The first manifestations of yaws (Hackett, 1947). Following his
Paleopathology Seminar Series was held in 1971 and career in Uganda, Dr. Hackett settled in England where
brought several leading authorities on skeletal disease, he continued his research on treponematosis, its history
paleopathology, and related subjects to the Smithsonian and skeletal manifestations. As part of this research he
Institution to present a series of lectures to a select group visited many of the major European collections of ana-
of scholars interested in skeletal paleopathology. tomical pathology that contained documented cases of
Ortner’s Identification of Pathological Conditions in Human Skeletal Remains. DOI: https://doi.org/10.1016/B978-0-12-809738-0.00001-6
© 2019 Elsevier Inc. All rights reserved. 1
2 Ortner’s Identification of Pathological Conditions in Human Skeletal Remains

syphilis. Hackett’s research on these cases resulted in the Alexander Müller); Pathology Museum of the University
publication of his classic monograph (Hackett, 1976) on of Graz (Prof. Dr. Max Ratzenhofer); Pathology Museum
the skeletal manifestations of syphilis, yaws, and trepo- of the University of Innsbruck (Prof. Dr. Albert Probst
narid (bejel). His knowledge of these collections and and Prof. Dr. Josef Thurner, Salzburg, Austria).
which ones were likely to serve the objectives Dr. Czechoslovakia: National Museum, Department of
Putschar and I had set out to achieve was an invaluable Anthropology, Prague (Dr. Emanuel Vičk, Dr. Milan
asset. Sfloukal and Dr. H. Hanākovā). England: The Natural
During our visit to these institutions, Dr. Putschar and History Museum, London (Dr. Theya Molleson and
I studied and photographed hundreds of cases of skeletal Rosemary Powers); Guy’s Hospital Medical School,
disease. In addition to the photographic record we made Gordon Pathology Museum, London; The Royal College
of these cases, we often were able to obtain autopsy or of Surgeons of England, Wellcome Museum, London (Dr.
museum records that provided descriptive details and a Martin S. Israel); The Royal College of Surgeons of
diagnosis for the cases. Radiographic films were acquired England, Hunterian Museum, London (Elizabeth Allen);
for some of the cases. Dr. Putschar dictated his observa- St. George’s Hospital Medical School, Pathology
tions about each case and these observations were subse- Museum, London; Westminster Hospital School of
quently transcribed and organized by Mrs. Putschar. In Medicine, Pathology Museum, London. France: (Prof. Y.
some cases, Dr. Putschar’s diagnostic opinions were at Le Gal and Prof. Andrè Batzenchlager). Scotland: The
variance with the diagnosis given in the catalog and this Royal College of Surgeons of Edinburgh (Prof. Eric C.
difference was duly noted in his observations. Most often, Mekie, Dr. Andrew A. Shivas, Violette Tansy, Turner,
however, the diagnosis given in the catalogs was plausible McKenzy). Switzerland: Anthropological Institute of the
if not reasonably certain. University of Zurich (Dr. Wolfgang Scheffrahn);
We began the task of writing the book shortly after Historical Museum, Chur (Dr. H. Erb); Institute of
completing our European research in 1974. In 1979, we Pathological Anatomy of the University of Zurich (Prof.
submitted the completed manuscript to the Smithsonian Dr. Erwin Uehlinger, Prof. Dr. Christoph E. Hedinger,
Institution Press for publication as part of the Smithsonian and Aschwanden); Natural History Museum, Bern (Prof.
Contributions to Anthropology series. The manuscript Dr. Walter Huber). Dr. Cecil J. Hackett, an associate of
was reviewed by the Department of Anthropology, exter- the Royal Orthopaedic Hospital, did much to expedite our
nal reviewers, the Director’s office of the National work in London, England, and offered several helpful
Museum of Natural History, and the Press. After approval suggestions regarding collections in other countries that
on all levels, editing and production took an additional proved valuable to our study.
several months and the book was published in December The product of this 1974 survey was more than 1200
of 1981 as Smithsonian Contributions to Anthropology, photographs, both black and white and color (taken by
Number 28. A hard-cover edition was published in 1985 me) of approximately 500 pathological specimens jointly
that was identical to the first edition except for the addi- studied. For some cases, we were able to obtain x-ray
tion of an index. 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,
Acknowledgments for the First Edition radiographs, and the transcripts of case descriptions is
The initial research conducted for the first edition of this available for study at the Department of Anthropology,
book was an extensive survey in 1974 by Dr. Putschar National Museum of Natural History, Smithsonian
and me of documented skeletal pathology in 16 European Institution, Washington, DC. Many of them are used as
pathology and anthropology collections in six countries. illustrations in this book.
This survey was supported by the Smithsonian Research A number of people made significant contributions
Foundation and Hrdlička Fund. The following list of these during the preparation of the manuscript. Paula Cardwell,
institutions and the staff members who assisted our survey Elenor Haley, and particularly Katharine Holland typed
of their collections is inadequate recognition of the many initial drafts. Marguerite (Monihan) Guthrie and Elizabeth
courtesies extended during our work. Sadly, many collea- Beard typed the final draft. Marcia Bakry prepared some
gues who provided this assistance have since retired or of the drawings. A special note of appreciation goes to
died. Furthermore, some of the collections have been Jacqui Schulz for the many unpaid hours spent preparing
moved from the site where we studied them and some the remaining drawings and getting the photographic
probably no longer exist. However, it remains appropriate illustrations ready for publication. Photographic enlarge-
to acknowledge the contribution they have made to both ments were prepared by H.E. Daugherty and Agnes I.
editions of this book. Austria: Federal Pathologic- Stix. Stix also assisted in editing and typing the manu-
Anatomy Museum, Vienna (Dr. Karl von Portele and Dr. script. David Yong, Edward Garner, and Dwight Schmidt
 Introduction Chapter | 1 3

provided valuable technical assistance. The staff of the and maintaining the data base. Dwight Schmidt and
library of the Smithsonian Institution, particularly Janette Stephen Hunter were responsible for doing the actual
Saquet, was most helpful. Dr. J. Lawrence Angel, Dr. T. inventory of the human skeletal collection. This inventory
Dale Stewart, and Dr. Douglas H. Ubelaker, members of required that all human remains in the collection be com-
the Department of Anthropology, Smithsonian Institution, pared with the catalog record to ensure that the skeleton had
have made valuable suggestions, as have Dr. Saul Jarcho been cataloged and that the catalog record was accurate.
(New York City) and Dr. George Armelagos (University This meant opening thousands of drawers and handling
of Massachusetts, Amherst, MA). The staff of the more than 36,000 partial to complete human skeletons.
Smithsonian Institution Press, particularly Albert L. While they were engaged in this task, Schmidt and
Ruffin, Jr., managing editor, series publications, and, Joan Hunter were encouraged to identify any cases of skeletal
B. Horn, senior editor, deserve special recognition for pathology and bring them to my attention. Both Schmidt
their assistance from the conceptualization through publi- and Hunter were enthusiastic and highly motivated. They
cation of the book. Finally, the wives of both authors became skilled at identifying pathological cases and this
have been intimately involved with the preparation of the added immeasurably to the quality and quantity of archeo-
book. Florence Putschar spent hundreds of volunteer logical and anatomical cases of skeletal disease in the
hours organizing photographs, typing, preparing the bibli- human skeletal collection of the NMNH. One of the frus-
ography, editing, and otherwise making her remarkable trating aspects of the research Dr. Putschar and I had con-
abilities available to the project. Joyce Ortner has also ducted on the NMNH pathological materials was the lack
assisted in obtaining illustrative material and skeletal of accessible and reliable information on the archeologi-
specimens. cal dating of the human remains. The grant from NIH pro-
vided funding to hire an archeologist, Dr. James Krakker,
to review the archeological field records and publications
HISTORY OF THE SECOND EDITION
to determine as accurately as possible the archeological
FROM DONALD J. ORTNER dates for much of the human skeletal collection.
Since Dr. Putschar and I completed the manuscript for the After a cluster of pathological cases had been identi-
first edition, much has changed in the study of ancient fied, Dr. Putschar would come to the Museum for several
skeletal diseases. The Paleopathology Association, estab- days and the two of us would review each one, and he
lished in 1973 with fewer than two dozen members, is would dictate his observations on the pathogenesis and
now a thriving international scientific association with differential diagnosis. During these visits, Mrs. Putschar
more than 600 members worldwide that holds annual would transcribe the dictation and organize the notes. The
meetings in the United States and biennial meetings in result was the identification and documentation of many
Europe. There is now a scientific journal devoted to additional cases of skeletal paleopathology that added
paleopathology1 and another new journal in which this greatly to our knowledge of disease in antiquity and our
subject is an important emphasis. A bibliography of ability to diagnose diseases encountered in archeological
paleopathology (both the published edition and the sup- remains.
plements) contains more than 26,000 citations, many of One of the interesting dimensions of this exercise was
which were published in the last 20 years (Tyson, 1997). the enthusiasm with which Dr. Putschar reviewed these
My own research interest and experience has devel- cases. Virtually every pathological specimen brought new
oped as well. In 1984 I received a 3-year grant from the knowledge and insight about pathogenesis to both of us.
National Institutes of Health (NIH; grant AR 34250) to Because of Dr. Putschar’s vast previous experience with
conduct a survey of pathological cases in the human skel- skeletal disease in many countries, it surprised me that he
etal collections at the National Museum of Natural was still finding new insights as he studied these cases.
History (NMNH). This survey was superimposed on a The lesson he repeatedly emphasized was that archeologi-
major effort by the Museum to create an electronic data cal remains offer the potential to see the expression of
base of our catalog that required that the anthropological disease in an entire skeleton and usually in the untreated
collections be inventoried. Several people were involved state. This is rarely possible in a modern clinical context.
in this inventory, but three members of the technical staff He also stressed that careful observation of the type and
deserve particular mention: Marguerite (Monihan) distribution pattern of lesions within the skeletal specimen
Guthrie, who typed much of the manuscript of the first provided insight regarding pathogenesis that complemen-
edition of this book, was responsible for creating, editing, ted other sources of information about the disease process.
Since 1979, research methodology has also benefitted
1. Refers to the Journal of Paleopathology, founded by Luigi Capasso, from some major breakthroughs in technology. Computed
which has been published by the Abruzzo Anthropological Association tomography has brought new understanding to our knowl-
since 1987. edge of skeletal radiology and pathology. Archeological
4 Ortner’s Identification of Pathological Conditions in Human Skeletal Remains

skeletal tissue has been found to be a remarkably good Inevitably the progress made in both medical knowl-
substrate for the preservation of ancient biomolecules, edge and paleopathology during the past 20 years means
including DNA. Recovery of identifiable genetic material that the revisions for this edition are substantial. However,
from pathogens has been reported (e.g., Kolman et al., much of the insight and understanding of pathology that
1999) and this is only the early stage of this research. The Dr. Putschar brought to the first edition remains relevant
remarkable power of the personal computer has provided and wherever possible I have retained his language and
new ways to manage data and visualize the patterns of perspectives on skeletal disease. This second edition owes
pathology that we encounter in archeological skeletal much to his knowledge and experience.
remains. The first edition of this book was prepared using
an electric typewriter. I am using a computer word pro-
cessing system for this edition and I often listen to the
Acknowledgments for the Second Edition
music of Mozart being played through my computer while In the first edition of this book, I acknowledged the assis-
I work. I doubt that Dr. Putschar would have approved of tance of those who contributed so substantially to its prep-
listening to Mozart while writing. Among many other aration. Some of these people have since died, but the
interests, he had a passionate enthusiasm for classical kindness of all who gave of their time and expertise
music and especially the music of Mozart, a fellow remains a wonderful memory. Since the publication of the
Austrian by birth. Mozart, in his view, must be listened to first edition many additional people have shared their
and appreciated without distractions. knowledge and made collections and many additional
We also know much more about the skeletal manifes- cases of pathology available for my research. These
tations of disease in archeological human remains and include the following institutions and people. Australia:
this has led to greater diagnostic certainty for many patho- The Shellshear Museum, Sydney (Prof. Jonathan Stone
logical conditions. Medical knowledge has continued to and Kenneth Parsons); The Australian Museum, Sydney
grow, with new insight about the causes of and relation- (Phillip Gordon and Dr. Ronald Lampert); The South
ships between skeletal diseases. Not surprisingly the ter- Australian Museum, Adelaide (Dr. Graeme Pretty).
minology in medicine and paleopathology has continued Denmark: The Danish National Museum, Cophenhagen
to change to reflect the new knowledge acquired about (Prof. Vilhelm Møller-Christensen). England: The
skeletal diseases. Department of Archaeological Sciences, The University
All of these changes argue for a revision of the first of Bradford, Bradford (Arnold Aspinall, Dr. Keith
edition that will address the new knowledge about both Manchester, Dr. Charlotte Roberts, Anthea Boylston,
skeletal pathology and paleopathology that has developed Jason Maher, Prof. Mark Pollard, and Dr. Carl Heron);
in the last 20 years. Regrettably, Dr. Putschar did not live The Rheumatology Unit, Bristol University, Bristol (Dr.
to see the development of many of these innovations or to Juliet Rogers and Prof. Paul Dieppe); The Canterbury
participate in this revision. While attending professional Archaeological Trust, Canterbury (Paul Bennett and
meetings in Scotland in early October 1985 he and Mrs. Trevor Anderson); English Heritage, Ancient Monuments
Putschar visited a medieval castle site near Edinburgh. Laboratory, London (Dr. Simon Mays). Norway: The
During the visit he fell and hit his head on the stone ruins. Department of Anatomy, University of Oslo (Prof. Dr.
He developed a hematoma on the brain that subsequently Per Holck and Inger Saelebakke); The Leprosy Museum
required surgery. On their return to the United States he of Bergen (Prof. Lorentz M. Irgens). Scotland: The Royal
and Mrs. Putschar received more bad news when she was College of Surgeons of Edinburgh (Dr. I. S. Kirkland).
diagnosed with terminal cancer. Despite these health pro- Switzerland: The Institute of Pathological Anatomy,
blems they both insisted that before Dr. Putschar’s sur- University of Zurich (Prof. Dr. Ph. U. Heitz and Prof. A.
gery he go ahead with the lectures he had promised to R. von Hochstetter). United States: The Bishop Museum,
deliver on skeletal disease for the last seminar series on Honolulu, Hawaii (Dr. Donald Duckworth, Dr. Yosiniko
skeletal paleopathology held at the Smithsonian H. Sinoto, and Toni Han); The Peabody Museum,
Institution from October 21 through November 8, 1985. Harvard University (Dr. David Pilbeam and Dr. Lane
Although his balance was affected by his injury, and he Beck); The San Diego Museum of Man (Rose Tyson);
was deeply troubled by Mrs. Putschar’s illness, his lec- The Lowie Museum (now the Phoebe Apperson Hearst
tures were models of clarity and provided a remarkable Museum of Anthropology), University of California,
learning experience for all who heard him. Mrs. Putschar Berkeley, California.
died on December 31, 1985. The Putschars had a wonder- In 1987 I was appointed Visiting Professor of
ful marriage and her death was a devastating loss for him. Paleopathology at the University of Bradford, Bradford,
Dr. Putschar’s health declined following two surgeries to England. Since 1988, I have been in residence in the
control the bleeding in his brain and he died on April 5, Department of Archaeological Sciences at the University
1987 at the age of 83. for varying lengths of time almost every year. This has
 Introduction Chapter | 1 5

been a remarkably valuable experience and I am very Smithsonian Institution, have invested countless hours in
grateful for the wonderful collegial relationships that have organizing bibliographic source materials and illustrations
developed over the years and the generous hospitality for this book. They have created computer data bases for
extended to me and my family. These colleagues include the references and photographs that greatly facilitated my
Arnold Aspinall, the Chairman of the Department when I work. Stix in particular has had the responsibility of orga-
was first appointed, Dr. Keith Manchester, Dr. Charlotte nizing the various electronic files of figures, tables, text,
Roberts (now at the University of Durham), Prof. Mark figure legends and references and keeping changes in one
Pollard, who followed Mr. Aspinall as Department file congruent with the other. Their contributions to this
Chairman, and Dr. Carl Heron, the current Department edition are substantial and I am in their debt. Marcia
Chairman. The skeletal collection in the department, par- Bakry, Scientific Illustrator, Department of Anthropology,
ticularly the remarkable collection of human remains National Museum of Natural History, Smithsonian
from the medieval cemetery in Chichester, England, asso- Institution, is responsible for preparing the digitized
ciated with the Hospital of St. James and St. Mary figures for the book. Using the powerful software avail-
Magdalene have been of great help in furthering my able today for manipulating digitized photographic
knowledge of human skeletal paleopathology. Many of images, she has been able to improve significantly the
the people buried in this cemetery were lepers and their quality of the figures used in this edition and deserves my
skeletons provide crucial insight regarding the skeletal deepest thanks and that of the reader who will benefit
manifestations of this dreaded disease. from her skilled work. Dr. Margaret R. Dittemore, Branch
In 1992 I had a casual conversation about my research Librarian, Anthropology Branch Library, Smithsonian
with a friend of many years, David Malin, a sales repre- Institution Libraries, and her colleagues in the library
sentative for Siemens Medical Systems, Inc. He offered to were crucial in identifying and obtaining source materials
try and arrange access to CT equipment at a Siemens used in the book. I am also indebted to Roxie Walker and
facility. His efforts put me in contact with Matthew the Institute of Bioarchaeology (formerly the
Riemann (now retired), the director of the Training and Bioanthropology Foundation) for grants that partially sup-
Development Center for Siemens Medical Systems, Inc. ported the preparation of this edition.
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. OBJECTIVES OF THE FIRST AND SECOND
At that time Mr. Falkowski was the senior instructor for
technical training of engineers and service technicians
EDITIONS
who service Siemens CT scanners in North America. There are many sources of information on the history of
When the facility was not being used for training we were disease, including ancient medical documents, historical
able to use the equipment to scan paleopathological cases. records, art, and the physical remains of ancient people
Eventually the Training and Development Center moved including both soft tissues and skeletons. Undoubtedly,
to Cary, North Carolina, and I and my Smithsonian col- human skeletons represent the most ubiquitous source of
league, Dr. Bruno Frohlich, continued to use the equip- information on ancient diseases. This fact must be tem-
ment at no cost during windows in the training schedule. pered with the knowledge that relatively few morbid con-
Access to this equipment proved to be a powerful ditions affect the skeleton in a way that leaves visible
research tool and most of the CT images included in this changes in dry bones. In spite of this limitation, the study
edition were generated on Siemens equipment. of skeletal pathology in archeological materials can pro-
CT scanning equipment at the Siemens training facility vide time depth to our understanding of disease and con-
is upgraded periodically to the newest models manufac- tribute to our knowledge regarding the role of disease in
tured by Siemens. On one occasion Dr. Frohlich learned human adaptation. In addition, skeletal paleopathology
that a Siemens Somatom AR-T scanner was to be replaced may also broaden our understanding of disease as it
with a new model. He suggested that Siemens donate the affects bone tissue. The paleopathologist often has access
older model to the Smithsonian. After approval on all rele- to all portions of the skeleton, a situation rarely realized
vant levels the equipment was given to the Museum and is in modern pathology or radiology. This means that the
now used in support of the research endeavors of the gross pattern and distribution of the morbid condition in
museum staff. The expertise and the many hours of assis- all areas of the skeleton can be studied in detail.
tance provided by Mr. Falkowski and his colleagues at To provide reliable standard specimens for dry bone
Siemens continues to be of major value to my research. diagnosis, the reference cases used as a basis for the first
Agnes Stix, Museum Specialist, and Janet Beck, two editions of this book were primarily from the period
Volunteer Research Assistant, Department of between AD 1750 and 1930. Ortner felt that earlier than
Anthropology, National Museum of Natural History, this range the medical data were too ambiguous and later,
6 Ortner’s Identification of Pathological Conditions in Human Skeletal Remains

the pathologic manifestations were too altered by surgery, I—who had enjoyed so many pleasant lunches with Don
chemotherapy, radiation therapy, and, above all, by the when I could sneak away from meetings of the National
use of antibiotics. For this reason, the first two editions Museum of Natural History’s Repatriation Committee or
turned to the great medical and anatomical collections of other Washington responsibilities—could not bear to walk
Great Britain and of continental Europe. The British col- by his office door for nearly a year, finding other circui-
lections proved in many ways to be the most useful, tous routes to reach the Rose Seminar room of the
because they were made by physicians and surgeons, who NMNH’s Anthropology Department. Don’s achievements
were at all times interested in documenting clinical and were celebrated both at the Smithsonian, during an event
historical data. Yet even this material is not necessarily held during the autumn of 2012, and at the annual meet-
identical to manifestations seen in archeological specimens. ing of the Paleopathology Association, held during the
As Ortner noted, his compiling these editions highlighted 2013 annual meeting, April 9 and 10. Fortunately, Powell
the fact that even the great pathological anatomists of ear- (2012) had been able to convince Don to be interviewed
lier times made mistakes in differential diagnosis. for a chapter in the Global History of Paleopathology
This book was intended mainly to serve as a text and (Buikstra and Roberts, 2012), wherein details of his life
atlas of dry bone pathology, regardless of whether or not and scholarly contributions may be found. I can add only
each entity had been identified in paleopathology. For that he was an enthusiastic supporter of the fledgling
that reason, as many aspects as possible of documented, International Journal of Paleopathology, ably contribut-
dry bone pathology were illustrated, especially because ing one of the Inaugural Essays and serving as an
the original skeletal collections can never be duplicated Associate Editor. He rolled up his sleeves upon many
and may ultimately disappear. In the paleopathological occasions to review articles and offer sage advice to
discussions in these earlier editions, emphasis was laid on junior colleagues.
careful and critical study of published reports and of In discussions with Don’s family, especially his part-
actual specimens, bringing a variety of types of evidence ner Joyce and Don Jr., who sounds remarkably like his
to bear on arriving at a reasonable diagnostic assumption. father, it became clear that they would be supportive of a
Even so, multiple possibilities and uncertainties often third edition of Identification of Pathological Conditions
remained. Not the least of these problems was the ambig- in Human Skeletal Remains, under my editorship.
uous and confusing terminology about the nature of path- Discussions with Bruno Frohlich, who was helping the
ological conditions and the chronology of archeological Department of Anthropology in archiving the materials
specimens in published reports. from Don’s office, made it clear that Don had only just
This book was written primarily with the needs of the embarked on the project. No publisher had been identi-
biological anthropologist and archeologist in mind, with fied, nor was there a proposal. Given this situation, I
the hope that they would be able to recognize the abnor- began plans for the project. In creating the proposal, first
malities seen in archeological human skeletal material discussed with the Smithsonian Press, who were not
they excavate or study. This book was also meant to high- enthusiastic about the project due to concerns with copy-
light the importance of recovering all mineralized tissues, right issues, I reflected upon the many productive discus-
including the small bones of the hands and feet, during sions in which I had engaged with Don. These convinced
excavation of a burial. Ortner also was interested in gen- me that he would have wanted the volume revision not to
erating a broader readership with different backgrounds, second guess “what Don might have wanted,” but rather
though, and emphasized the importance of including his- to reflect the status of paleopathology at the time the revi-
torians of medicine and disease, orthopedic surgeons, sion appeared. This meant continuing to emphasize the
radiologists, pathologists, and physicians, who may be basic empirical evidence upon which paleopathological
called upon to interpret skeletal lesions in dry specimens identifications are based, but also to reflect the dynamic
or who are interested in extending their understanding to nature of paleopathology today. Given the mentorship and
the more detailed gross expressions of skeletal disease. 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
HISTORY OF THE THIRD EDITION FROM it our best effort. It is with this spirit that we have
approached the volume.
JANE E. BUIKSTRA When I approached Elizabeth Brown, Senior
Don Ortner was just embarking upon the third edition of Acquisitions Editor at Elsevier, about the project, she was
this important volume at the time of his unanticipated enthusiastic in support. We have tried to maintain the many
death on April 29, 2012, following a brief illness. For strengths of the earlier editions, while also adding new
those of us who had been close to Don professionally methodological advances (molecular and parasitology),
and/or personally, our grief was profound. For example, mentioning closely related and increasingly convergent
 Introduction Chapter | 1 7

research topics (animal paleopathology; mummy science) Putschar’s) core contributions in bone disease through
and emphasizing the interdisciplinarity of paleopathology revised and new chapters that manifest the contemporary
in exploring themes based in the social sciences and human- breadth and depth of the discipline of paleopathology.
ities. When approached, colleagues in paleopathology and This third edition updates the previous volumes
related disciplines signed on enthusiastically, bringing their through the addition of recent medical information on
special expertise to this important initiative. skeletal disorders and the latest relevant literature on
Don and I agreed about most aspects of paleopathol- human skeletal paleopathology. This work also adds chap-
ogy, especially the need for detailed descriptions of path- ters on current methods being used in research on skeletal
ological changes, for standard terminology, to appreciate paleopathology. These include increased reliance on
limitations of early clinical accounts as well as those of imaging, including CT methods, histology, and analysis
the antibiotic era, and for rigorous applications of differ- of ancient DNA. In addition, chapters covering closely
ential diagnostic methods. I am less concerned than he related subjects, such as diet (including isotopes, micro-
about classification, and therefore this topic will be less wear, colon contents, (macro/micro fossils; pollen), dental
visible in this third edition. I sincerely hope that we have calculus, dental caries), mummy science, animal paleopa-
done justice to Don’s fundamental contributions to the thology, and paleoparasitology have been added. Given
discipline of paleopathology, while recognizing key the contemporary availability of numerous texts covering
developments since his seminal 2003 publications. basic osteology, in this edition chapters on biological pro-
filing and osteobiographical methods have been deleted.
These topics are now introduced briefly in Chapter 3, and
Acknowledgments for the Third Edition Chapter 2 now offers an extended history of paleopathol-
First and foremost, I would like to acknowledge the ogy, current issues in the field, and the importance of rig-
Ortner family in their support of this initiative. The orous differential diagnosis. The volume is further framed
Department of Anthropology, especially its Chair during by an expanded discussion of important themes for con-
the period of project development, Torben Rick, along sideration in this paleopathological research (Chapter 3).
with Don’s long-term collaborator, Bruno Frohlich have As was the case for the first two editions of this vol-
been immensely reassuring. The editor is extremely ume, the most fundamental objective of this third edition
appreciative of the enthusiasm and expertise of the colla- is to provide an integrated, detailed discussion of the
borators, whose wisdom is represented here. The editorial gross pathology of the human skeleton to facilitate rigor-
and content editorial assistance of Katelyn Bolhofner has ous differential diagnosis of these pathologies in human
improved clarity and accuracy throughout the develop- skeletal remains from archaeological contexts. In addition
ment of the volume. Additional polish has been added by to this foundation, the objectives of this third edition
the skills of Sylvia Cheever in final stages of the process. include: emphasizing careful consideration of contempo-
Anne Grauer’s careful proof-reading and apt suggestions rary clinical literature in diagnosis, encouraging knowl-
have improved the final production, which is deeply edge in epidemiology, animal paleopathology,
appreciated. Many of the authors wish to express their parasitology, and molecular and chemical advances in
gratitude to Don Brothwell for his scholarship and per- contextualizing skeletal analyses, and presenting advances
sonal encouragement of our research, both in human and in imaging, data collection, and diagnostic approaches
in animal paleopathology. Finally, the assistance and arising from such related fields as forensic science, dental
encouragement from Elsevier, including Elizabeth Brown, anthropology, biogeochemistry, and molecular science.
Pat Gonzalez, and the production team have been essen-
tial to the success of the project.
FORMAT OF THE VOLUME
While texts in paleopathology all agree that classification
OBJECTIVES OF THE THIRD EDITION is an important aspect of disease diagnosis, there is no gen-
More than 30 years have passed since the landmark eral agreement upon the number of classes of disease. As
Identification of Pathological Conditions in Human Ortner (2012) notes, Reznick’s orthopedic radiology text
Skeletal Remains (Ortner and Putschar, 1981) was pub- recognizes 17 categories. Aufderheide and Rodrı́guez-
lished, followed by the second edition (Ortner, 2003) over Martı́n (1998)’s paleopathology text recognizes 13, while
a decade ago. The field and the profession of paleopathol- both editions of the Ortner volumes focus upon 12.
ogy have changed markedly over this period, in no small Influenced by Lent Johnson, Ragsdale and various cowor-
part due to the influence of these volumes. Ortner had kers (Ragsdale and Miller, 1996; Ragsdale and Lehmer,
planned but not begun writing a third edition at the time 2012) have asserted the utility of seven basic disease cate-
of his sudden death, and this volume represents the com- gories, readily recalled through the use of the acronym
pletion of this project, reflecting his (and Walter VITAMIN (see Table 1.1, adapted from Ragsdale and
8 Ortner’s Identification of Pathological Conditions in Human Skeletal Remains

(2012: 263) emphasized that the important point “is the

TABLE 1.1 Ragsdale’s Seven Basic Disease Categories need to understand the pathogenesis and, where possible,
1 V Vascular the cause of the disorder and not let the assignment to a
specific category of disease obscure our understanding of
2 I Innervation/mechanical
the basic bone biology of disease.”
3 T Trauma/repair
4 A Anomaly
5 M Metabolic
ABBREVIATIONS
6 I Inflammatory/immune The illustrations in this book are of specimens from many
institutions. The following abbreviations are used in the
7 N Neoplasms
legends to avoid repetition of lengthy institutional names
and locations. This list includes institutions that had path-
ological cases used in both the first and second editions.
Lehmer, 2012: 230). Roberts and Manchester (third AFIP Armed Forces Institute of Pathology, Washington,
edition, 2010) also organize their discussion in The DC, United States
Archaeology of Disease into seven categories. AIUZ Anthropological Institute, University of Zurich,
After emphasizing the need for histology and recogni- Zurich, Switzerland
tion of disease processes, Ragsdale and Lehmer (2012: ANM National Museum of Anthropology, Prague, Czech
247) close with the assertion, “that only through detailed Republic
BMNH British Museum, The Natural History Museum,
descriptions and diagnoses to general disease categories,
London, England
will a stronger methodological basis for comparative
CGH Department of Pathology, Charleston General
research in paleopathology be reached.” They argue, based Hospital, Charleston, WV, United States
upon evidence from four workshops held at the paleopa- CISC Coimbra Identified Skeletal Collection,
thology meetings (Miller et al., 1996) that assignments to Departamento de Ciências da Vida, Universidade de
disease categories are more accurate than specific diagno- Coimbra, Portugal
ses. While these conclusions do reflect the empirical data DPUS Department of Pathology, University of Strasbourg,
from the Workshops, questions about the relative experi- Strasbourg, France
ence of the participants remains. In addition, the degree to FM Field Museum of Natural History, Chicago, IL,
which comparisons across 7, 12, 13, or 1 categories are United States
meaningful in interpreting the past must, of course, depend FPAM Federal Pathologic-Anatomy Museum, Vienna, Austria
HM Hunterian Museum, The Royal College of Surgeons
upon the research question addressed or the hypothesis
of England, London, England
posed. Further, the issue of contexts—environmental, tem-
IEC International Exchange Collection, Departamento
poral, cultural—must be considered. de Ciências da Vida, Universidade de Coimbra,
As Ortner (2012) emphasizes, disease classifications Coimbra, Portugal
emphasize cause or pathogenesis of a disease. In that, IPAZ Institute of Pathological Anatomy, University of
e.g., bacterial pathogenesis can be a cause, pathogenesis Zurich, Zurich, Switzerland
would seem to be the overarching category. Many dis- LLAC- Luı́s Lopes Anthropological Collection, Museu Bocage,
eases have multiple causes, and classifications become MUHNAC Museu Nacional de História Natural e da Ciência,
complex. Metabolic diseases, due to disturbances in oste- Lisbon, Portugal
oid formation and mineralization, are often associated MGH Department of Pathology, Massachusetts General
with nutritional deficiencies. Similarly, erosive arthropa- Hospital, Boston, MA, United States
NHMB Natural History Museum, Bern, Switzerland
thies are typically classified as joint disorders, even
NMNH National Museum of Natural History, Smithsonian
though an infection may trigger the response.
Institution, Washington, DC, United States
This volume will follow the previous editions in its PMES Pathology Museum, The Royal College of Surgeons
classification of disease conditions: trauma, infectious dis- of Edinburgh, Edinburgh, Scotland
eases, circulatory disorders, reticuloendothelial and WM Wellcome Museum, The Royal College of Surgeons
hematopoietic disorders, metabolic disorders, endocrine of England, London, England
disorders, congenital and neuromechanical disorders, dys-
plasias, tumor and tumor-like disorders, joint disorders,
dental and jaw disorders, and miscellaneous disorders. A REFERENCES
few specific disorders have been moved to more Aufderheide, A.C., Rodrı́guez-Martı́n, C., 1998. The Cambridge
completely reflect contemporary knowledge of pathogene- Encyclopedia of Human Paleopathology. Cambridge University
sis. In reference to the process of classification, Ortner Press, Cambridge.
 Introduction Chapter | 1 9

Buikstra, J.E., Roberts, C.A. (Eds.), 2012. The Global History of Ortner, D.J., Putschar, W.J.P., 1981. Identification of Pathological
Paleopathology: Pioneers and Prospects. Oxford University Press, Conditions in Human Skeletal Remains. Smithsonian Institution
New York. Press, Washington, DC.
Hackett, C., 1947. The Bone Lesions of Yaws in Uganda. Thesis. Powell, M.L., 2012. Donald J. Ortner (1938 ). In: Buikstra, J.E.,
University of London, London. Roberts, C.A. (Eds.), The Global History of Paleopathology:
Hackett, C., 1976. Diagnostic criteria of syphilis, yaws and treponarid Pioneers and Prospects. Oxford University Press, New York,
(treponematoses) and of some other diseases in dry bones. pp. 89 96.
Sitzungsberichte der Heidelberger Akademie der Wissenschaften Ragsdale, B.D., Lehmer, L.M., 2012. A knowledge of bone at the cellu-
Mathematisch-naturwissenschaftliche Klasse, Abhandlung 4. lar (histological) level is essential to paleopathology. In: Grauer, A.
Springer-Verlag, Berlin. (Ed.), A Companion to Paleopathology. Wiley-Blackwell, New
Kolman, C., Centurion-Lara, A., Lukehart, S., Owsley, D., Tuross, N., York, pp. 227 259.
1999. Identification of Treponema pallidum subspecies pallidum in a Ragsdale, B.D., Miller, E., 1996. Workshop A. Skeletal Disease
100-year-old skeletal specimen. J. Infect. Diseases 180, 2060 2063. Workshop VIII: several of the seven basic categories of disease.
Miller, E., Ragsdale, B.D., Ortner, D.J., 1996. Accuracy in dry bone In: Cockburn, E. (Ed.), Papers on Paleopathology Presented at the
diagnosis: a comment on palaeopathological methods. Int. J. 23rd Annual Meeting of the Paleopathology Association, Durham,
Osteoarchaeol. 6 (3), 221 229. North Carolina. Paleopathology Association, Detroit, p. 1.
Ortner, D.J., 2003. Identification of Pathological Conditions in Human Roberts, C.A., Manchester, K., 2010. The Archaeology of Disease.
Skeletal Remains. Academic Press, New York. Cornell University Press, New York.
Ortner, D.J., 2012. Differential diagnosis and issues in disease classifica- Tyson, R. (Ed.), 1997. Human Paleopathology and Related Subjects.
tion. In: Grauer, A. (Ed.), A Companion to Paleopathology. Wiley- An International Bibliography. San Diego Museum of Man,
Blackwell, New York, pp. 250 267. San Diego.
Chapter 2

A Brief History and 21st Century

Challenges
Jane E. Buikstra1 and Sharon DeWitte2
1
Arizona State University, Tempe, AZ, United States, 2University of South Carolina, SC, United States

In this chapter, we consider the history of paleopathology highlighting some of the issues and major developments
and a few of the fundamental issues faced by practitioners in the field over the past 200 years.
in the development of this field. We then turn to a discus- The history of paleopathology in many ways parallels
sion of the current state of paleopathology, reviewing the development of most other scientific disciplines. The
methodological and theoretical issues encountered in 21st early publications consist of a body of descriptive litera-
century paleopathology. In this regard, we discuss the dif- ture in which abnormalities encountered by an observer
ferential diagnosis of pathological conditions in archeolo- are described against the background of what is normal.
gical skeletal remains, suggesting avenues by which Much of this early research was no more than an anatomi-
paleopathologists may pursue more rigorous diagnosis. cal account of these abnormal conditions with little if any
Finally, we discuss the important contribution of paleoe- attempt to explore the biological or pathological signifi-
pidemiology in the advancement of this field, as well as cance of what was being described. The earliest work
considering the ramifications of the osteological paradox focused on nonhuman paleontological specimens (e.g.,
in such work. Esper, 1774; Cuvier, 1820). Warren (1822) included a dis-
cussion of artificial cranial deformation in human skulls
of indigenous North Americans in his book titled, A
A BRIEF HISTORY OF PALEOPATHOLOGY Comparative View of the Sensorial and Nervous Systems
Paleopathology has been defined in recent decades as the in Man and Animals. In 1861 in Paris, Gosse published
study of disease, both human and nonhuman, in antiquity another study of artificial cranial deformation. In the fol-
using a variety of different sources, including human lowing decades, the question of the origin of syphilis
mummified and skeletal remains, ancient documents, began to be debated with intensity (e.g., Jones, 1876;
illustrations from early books, painting and sculpture Virchow, 1898). This debate marks one of the earliest
from the past, and analysis of coprolites (Ortner, 2003: 8) attempts to use archeological human remains to resolve
More recently, this definition has been reevaluated and an important biomedical problem. And toward the end of
expanded to reflect the crucial interplay of biomedical the 19th century, R.W. Shufeldt proposed that the term
and social sciences and the humanities in the development “paleopathology” be used to describe “all diseased or
and future of the field (Buikstra et al., 2017). A compre- pathological conditions found fossilized in the remains of
hensive history of paleopathology has recently been writ- extinct or fossil animals” (Shufeldt, 1892: 679).
ten (Buikstra and Roberts, 2012), and there are several As the term “paleopathology” began to be used in the
other older summaries of this history that readers who early 20th century, this period witnessed a marked expan-
have a specific interest in the subject may wish to consult sion of published reports on ancient disease. Particularly
(e.g., Jarcho, 1966; Angel, 1981; Ubelaker, 1982; notable is the work of Sir Marc Armand Ruffer (1910) on
Armelagos, 1997; Aufderheide and Rodriguez-Martin, Egyptian mummies, and the studies on Nubian skeletal
1998). Thus, a detailed history of paleopathology that material by Wood-Jones (1908, 1910) and Elliot-Smith
includes research using all the varied sources of potential and Wood-Jones (1910). In the United States, Aleš
information is beyond the scope of this book. Here, we Hrdlička (1914) published some observations on the
offer a brief summary of the history of paleopathology, pathology of ancient Peruvian skulls. In 1923, Moodie’s

Ortner’s Identification of Pathological Conditions in Human Skeletal Remains. DOI: https://doi.org/10.1016/B978-0-12-809738-0.00002-8

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