1 Paleopathology and Paleomedicine

INTRODUCTION
One of our most appealing and persistent myths is that of the Golden Age, a time before the
discovery of good and evil, when death and dis- ease were unknown. But, scientic
evidencemeager, fragmentary, and tantalizing though it often isproves that disease is
older than the human race and was not uncommon among other species. Indeed, stud- ies
of ancient fossil remains, skeletons in museum collections, animals in zoos, and animals in
the wild demonstrate that arthritis is widespread among a variety of medium and large-sized
mammals, including aardvarks, anteaters, bears, and gazelles. Evidence of infection has been
found in the bones of prehistoric animals, and in the soft tissues of mummies. Modern
diagnostic imaging techniques have revealed evidence of tumors in fossilized remains. For
example, researchers performing CT-scans of the brain case of a 72-million-year-old gorgo-
saurus discovered a brain tumor that probably impaired its balance and mobility. Other
abnormalities in the specimen suggested that it had suffered fractures of a thigh, lower leg,
and shoulder. Thus, understanding the pattern of disease and injury that aficted our
earliest ancestors requires the perspective of the paleopathologist. Sir Marc Armand Ruffer
(18591917), one of the founders of paleopathol- ogy, dened it as the science of the
diseases that can be demonstrated in human and animal remains of ancient times.
Paleopathology provides information about health, disease, death, environment, and culture
in ancient populations. In order to explore the problem of disease among the earliest
humans, we will need to survey some aspects of human evolution, both biological and
cultural. In Descent of Man and Selection in Relation to Sex (1871) Charles Darwin argued
that human beings, like every other species, evolved from previous forms of life by means of
natural se- lection. According to Darwin, all the available evidence indicated that man is
descended from a hairy, tailed, quadruped, probably arboreal in its habits. Despite the
paucity of the evidence available to him, Darwin suggested that the ancient ancestor of
modern human beings was related to that of the gorilla and the chimpanzee. Moreover, he
predicted that the rst humans probably evolved in Africa. Evidence from the study of
fossils, stratigraphy, and molecular biology suggests that the separation of the human line
from that of the apes took place in Africa about ve million to eight millionyears ago. The
fossilized remains of human ancestors provide valuable clues to the past, but such fossils are
very rare and usually incomplete. South African anatomist Raymond Dart made the rst
substantive discovery of human ancestors in Africa in the 1920s when he identied the
famous fossils known as Australopithecus africanus (South African Ape-man). The most
exciting subsequent twentieth-century discoveries of ancient humanancestorsare
associatedwiththe workofLouis andMaryLeakey and that of Donald Johanson. Working
primarily at sites in Olduvai Gorge and Laetoli in Tanzania, Mary and Louis Leakey identied
many hominid fossils, including Australopithecus boisei and Homo habilis. Johansons most
important discovery was the unusually complete skeleton of a primitive australopithecine
(Australopithecus afarensis), commonly referred to as Lucy. New hominid remains
discovered at the beginning of the twenty-rst century stimulated further controversy about
the earliest hominid ancestors, as well as those of the chimpanzee. Paleoanthropology is a
eld in which new discoveries inevitably result in the re-examination of previous ndings
and great debates rage over the identication and classication of tiny bits of bones and
teeth. Further discoveries will no doubt add new insights into the history of human evolution
and create new disputes among paleoanthropologists. Scientists also acknowledge that
pseudopaleopathologic conditions can lead to misunderstanding and misinterpretation
because they closely resemble disease lesions, but are primarily the result of postmortem
pro- cesses. For example,because the primary chemical saltsin bones are quite
solubleinwater,soilconditionsthatareconducivetoleachingoutcalcium
cancausechangesinboneslikethoseassociatedwithosteoporosis.Despite
alltheambiguitiesassociatedwithancientremains,manytraumaticevents and diseases can be
revealed by the methods of paleopathology. Insights from many different disciplines,
including archeology, his- torical
geography,morphology,comparativeanatomy,taxonomy,genet- ics, and molecular biology
have enriched our understanding of human evolution. Changes in DNA, the archive of
human genealogy, have been used to construct tentative family trees, lineages, and possible
patterns of early migrations. Some genes may reveal critical distinctions between humans
and other primates, such as the capacity for spoken language. Anatomically modern humans
rst emerged some 130,000 years ago, but fully modern humans, capable of sophisticated
activities, such as the production of complex tools, works of art, and long distancetrade,
seem to appear in the archaeological record about 50,000 years ago. However, the
relationship between modern humans and extinct hominid lines remains controversial. The
Paleolithic Era, or Old Stone Age, when the most important steps in cultural evolution
occurred, coincides with the geological epoch known as the Pleistocene or Great Ice Age,
which ended about 10,000 years ago with the last retreat of the glaciers. Early humans were
hunter-gatherers, that is, opportunistic omnivores who learned to make tools, build shelters,
carry and share food, and create uniquely human social structures. Although Paleolithic
technology is characterized by the manufacture of crude tools made of bone and chipped
stones and the absence of pottery and metal objects, the people of this era produced the
dramatic cave paintings at Lascaux, France, and Altamira, Spain. Presumably, they also
produced useful inventions that were fully bio- degradable and, therefore, left no traces in
the fossil record. Indeed, during the 1960s feminist scientists challenged prevailing
assumptions about the importance of hunting as a source of food among hunter- gatherers.
The wild grains, fruits, nuts, vegetables, and small animals gathered by women probably
constituted the more reliable components of the Paleolithic diet. Moreover, because women
were often encum- bered by helpless infants, they probably invented disposable digging
sticks and bags in which to carry and store food. The transition to a newpattern of food
production through farming and animal husbandry is known as the Neolithic Revolution.
Neolithic or New Stone Age peoples developed crafts, such as basket-making, pot- tery,
spinning, and weaving. Although no art work of this period seems as spectacular as the
Paleolithic cave paintings in France and Spain, Neolithic people produced interesting
sculptures, gurines, and pottery. While archeologists and anthropologists were once
obsessed with the when and where of the emergence of an agricultural way of life, they are
now more concerned with the how and why. Nineteenth-century anthropologists tended to
classify human cultures into a series of ascending, progressive stages marked by the types of
tools manufac- tured and the means of food production. Since the 1960s new analytical
techniques have made it possible to test hypotheses about environmen- tal and climatic
change and their probable effect on the availability of food sources. When the idea of
progress is subjected to critical analysis rather than accepted as inevitable, the causes of the
Neolithic trans- formation are not as clear as previously assumed. Given the fact that hunter-
gatherers may enjoy a better diet and more leisure than agricul- turalists, prehistoric or
modern, the advantages of a settled way of life are obvious only to those who are already
happily settled and well fed. The food supply available to hunter-gatherers, while more
varied than the monotonous staples of the agriculturalist, might well be precarious and
uncertain. Recentstudiesoftheoriginsofagriculturesuggestthatitwasalmost universally
adopted between ten thousand and two thousand years ago, primarily in response to
pressures generated by the growth of the human population. When comparing the health of
foragers and settled farmers, paleopathologists generally nd that dependence on a specic
crop resulted in populations that were less well nourished than hunter- gatherers, as
indicated by height, robustness, dental conditions, and so forth. In agricultural societies, the
food base became narrower with dependence on a few or even a single crop. Thus, the food
supply might have been adequate and consistent in terms of calories, but decient in
vitamins and minerals. Domestication of animals, however, seemed to improve the
nutritional status of ancient populations. Although the total human population apparently
grew very slowly prior to the adoption of farming, it increased quite rapidly thereafter.
Prolonged breast feeding along with postpartum sexual prohibitions found among many
nomadic societies may have maintained long intervals between births. Village life led to
early weaning and shorter birth intervals. The revolutionary changes in physical and social
environment associated with the transition from the way of life experienced by small mobile
bands of hunter-gatherers to that of sedentary, relatively dense populations also allowed
major shifts in patterns of disease. Permanent dwellings, gardens, and elds provide
convenient niches for parasites, insects, and rodents. Stored foods are likely to spoil, attract
pests, and become contaminated with rodent excrement, insects, bacteria, molds, and
toxins. Agricultural practices increase the number of calories that can be produced per unit
of land, but a diet that overemphasizes grains and cereals may be decient in proteins,
vitamins, and minerals. Lacking the mobility and diversity of resources enjoyed by hunters
and gatherers, sedentary populations may be devastated by crop fail- ures, starvation, and
malnutrition. Migrations and invasions of neigh- boring or distant settlements triggered by
local famines may carry parasites and pathogens to new territories and populations.
Ironically, worrying about our allegedly unnatural and articial modern diet has become so
fashionable that people in the wealthiest nations have toyed with the quixotic idea of
adopting the dietary patterns of ancient humans or even wild primates. In reality, the food
supply available to prehistoric peoples was more likely to be inadequate, monotonous,
coarse, and unclean.