Paleopathology and the biocultural nature of disease
Bioarchaeologists have been on the forefront of contributions to method and theory in the understanding of ancient health. For several regions in the U.S., there are health chronologies spanning hundreds of years. For example, Walker (1996) documented health and dietary reconstruction for the ancient inhabitants living in Southern California; these data highlight the diversity of adaptations to coastal environments. Using a multimethodological approach involving analysis of a number of skeletal lesions and detailed reconstruction of the environment, Walker demonstrated that ancient people living in marginal island environments (ca. 800 bc to ad 1150) show greater evidence of health problems than those who lived on the mainland where food was more abundant and diverse. The islanders were shorter in stature (160 versus 162 cm) and had more lesions indicative of anemia (75% vs. 25%). In addition to clarifying the relationship between resources and health conditions, Walker also showed that there were changes over time with health conditions worsening (increases in infectious disease from 20% to 30%) because of contaminated drinking sources and diarrheal disease.
Other regions of the U.S. have also provided scientific data from the human remains on important questions concerning social hierarchy and colonization. For example, Larsen (2015) has focused on health patterns for inhabitants of the Georgia Bight, and Buikstra and Cook (1980), Milner and colleagues (1991), and Spencer (2013) have provided detailed pathology data for groups living in the ancient Illinois River Valley. Lovejoy (1985) provided analyses of health conditions for the large and well-preserved Libben site in Ohio, and Goodman and co-workers (1984) revealed health changes over time for Dickson Mounds in Illinois. The southeastern regions of the U.S. have yielded abundant skeletal material that has been analyzed by Powell and colleagues (1991). The American Southwest has likewise provided relatively large skeletal collections from numerous sites and health conditions from these have been summarized by Stodder and colleagues (2002) and Martin and colleagues (2001).
In thinking about these kinds of population level studies, it is important to keep in mind that those events that are regarded as demographic or pathological on the aggregate scale are life-history events on the individual level and are important to members of the extended social grouping (Swedlund 1994). Birth, weaning, puberty, sicknesses, marriages, and death are biological and cultural transitional periods that find expression through ritual and other cultural behaviors in virtually all societies. These life-history events also provide the underpinning for generational histories, and they are also points of focus for kin and group identities. Taken in their cumulative context, life histories provide the data for the estimation of larger population processes that effect growth and regulation, dispersal and density, structure and composition, migration and immigration, and health and injury. Finally, life-history events provide a tangible and graphic reminder of how a society is doing because when these events are disrupted, it tears at the social fabric of societies. The loss of an infant to a family, when warfare takes young males, or when a disease ravages through a group—all present tangible experiences requiring ideological and adaptive responses on individual and population levels.
Hrdlicka, one of the founders of the American Association of Physical Anthropology (AAPA), was one of the first scholars to systematically collect data on diseases from ancient skeletal remains from a variety of archaeological sites in the U.S. and Mexico. Trained as a physician and an anthropologist, he viewed human biology within an evolutionary and comparative framework. His monograph, titled
Physiological and Medical Observations among the Indians of the Southwestern United States and Northern Mexico (1908), was the first examination of skeletal remains to document pathology (Buikstra et al., 2012). He noted with some surprise the absence of vitamin deficiencies and presented an overall listing of degenerative and traumatic pathologies. He looked at bones from a variety of sites, but he did not interpret the findings within an archaeological context, limiting his ability to interpret the meaning of those diseases within a broader context.
In the 1930s, there was a major methodological breakthrough in skeletal biology with Hooton conducting the first large-scale systematic analysis of human remains from Pecos Pueblo in New Mexico (1930). What is important about the study is that Hooton conducted a population-level analysis using both quantitative and qualitative assessments of genetics, stature, disease status, and biological characteristics. One chapter is devoted to paleopathology, and in it Hooton provides physical anthropologists with a new way of interpreting the findings using epidemiological methods (Hooten 1930: 306—330). Epidemiology is the branch of medicine that deals specifically with understanding the patterns and frequencies of various diseases by variables such as age, sex, ethnicity, class, and geographic area. Hooton was the first to analyze pathologies by age and sex and was able to provide a demographic orientation that to this day is one of the founding principles of paleopathology.
