In this essay we have presented a broad overview of the specific diseases that may have existed in the pre-Roman Old World and outlined general patterns of health that may have been present as human society became increasingly complex. But because of the limitations imposed by the sources and the research methods used, the picture is incomplete.

From skeletal and mummy material we are fairly certain that, depending on geographic location, pre-Roman populations suffered from a number of infectious diseases (i.e., multicellular parasites, tuberculosis, poliomyelitis, periostitis, osteomyelitis, and, late in the pre-Roman era, leprosy). Most of these populations were also exposed to trauma, particularly in the form of head wounds and forearm fractures. Osteoarthritis, particularly of the spine, was prevalent, and some groups suffered from erosive joint disease. Anemia was present and apparently fairly common in some geographic locations and time periods. Tumors were rare. Determining the frequencies and geographic site of origin of some of these abnormal conditions will have to await future research.

One of the most intriguing ideas that has emerged from our review of infectious diseases is the possibility that tuberculosis became a problem in the Neolithic period. Greater population densities, seden-tism, and close contact with domestic animals are all factors that, in theory, could have led to the emergence of tuberculosis as a serious health problem in the Neolithic. J. McGrath (1986) argues that large populations may not be needed for mycobacterial infections. This may be true, but it is equally true that some types of bacteria are more likely to be maintained in a host population when the population is large. A careful restudy of spines in Old World archeological skeletal samples would be most useful in clarifying this point.

Outlining general patterns of health has been equally elusive. With respect to nonspecific disease conditions (e.g., periostitis, osteitis, dental hypo plasia), the data seem inconsistent; there is variation among sites within the same time period, as well as among different time periods. In general, however, from the Mesolithic to the Neolithic there seems to be a trend toward increased frequencies of nonspecific disease conditions. Whether this trend is indicative of a decline in population health in the Neolithic is a question that remains, in our opinion, problematic. As we have suggested, an increased frequency of nonspecific lesions of bone may indicate a more effective immune response; individuals with nonspecific lesions of bone usually must have survived an acute phase to enter the chronic phase of a disease process.

For the urban periods, the same theoretical difficulties exist. In several areas the frequencies of enamel hypoplasias continue to increase from the Neolithic, indicating increasing childhood stress. However, the frequencies for nonspecific infectious skeletal lesions do not always increase.

Ascertaining the relation between skeletal disease and morbidity in antiquity requires great care. For example, is dental hypoplasia representative of an acute phase of a disease process occurring during late fetal life and childhood? Is periostitis indicative of chronic disease reflecting a good immune response? Issues of this type will have to be clarified before generalizations about population health can be made.

The epochal nature of the cultural change that took place between the Mesolithic and Roman periods offers an opportunity to study several important problems in human biocultural adaptation. Further research will require a much more effective descriptive and research methodology. We also need to give more careful thought to the meaning of our observations in a skeletal sample relative to the health of the living parent population.

Donald J. Ortner and Gretchen Theobald

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