Diseases in the Pre Roman World

In the past 15,000 years, epochal social and cultural changes have created fundamentally different relationships between humankind and the environment. One of the most important innovations has been the domestication of plants and animals, a major factor in the gradual establishment of agriculture as the world's predominant economic base. The development of agriculture brought an increase in seden-tism, in which human groups lived in more or less permanent communities.

Associated with farming was the domestication of animals and, in some societies, nomadic pastoral-ism. By about 6000 B.C., animal husbandry provided a relatively widespread and stable source of high-quality protein in the Near East. Moreover, the protein was typically produced in ways that did not compete directly for agricultural land resources. Domestic herds grazed on agricultural land after the harvest (Bentley 1987) or on land that was fallow, marginal, or inadequate for farming.

The greater control that agriculture and the domestication of animals gave people over food production resulted in food surpluses. Surplus food created the potential for the emergence of specialists such as craftsmen, merchants, and a ruler class, which are essential components of urban society, another major social change. Urbanism began in the Near East during the Chalcolithic Age (c. 4000-3200 B.C.) but had its major efflorescence during the Early Bronze Age (c. 3200-2000 B.C.)

The advent of agriculture, the domestication of animals, and the development of urbanism had a significant impact on human health. Although agriculture dramatically increased the calories that could be produced by a given individual, the emphasis on a few cultigens increased the vulnerability of agricultural societies to famine and malnutrition (Cohen 1984a). Innovations associated with agriculture, such as irrigation, greatly heightened exposure to some infectious diseases. Plowing the soil itself probably increased the risk of acquiring fungal diseases. Sedentary communities, unlike hunting and gathering societies, which usually changed their living areas often, lived amid their own detritus with its inherent risk of causing disease (Wells 1978). The domestication of animals brought the potential of contracting animalborne diseases (zoonoses). Urbanism brought increased population sizes and densities and a greater likelihood of exposure to dropletborne infectious agents. Extended trade and commerce, activities associated with urban society, enhanced the spread of infectious organisms between geographic areas (Cockburn 1963).

However significant these changes were, direct evidence of their having caused disease is difficult to obtain. Paleopathology, the study of ancient disease, is hampered by several limitations. Two of the most important of these are the nature of our sources and the way in which we study and interpret the data.

Our current sources of data on disease in the pre-Roman world include ancient texts that describe disease, archeological cultural artifacts that portray the effects of disease on the human body, and human skeletal and mummy remains recovered from archeological sites. There are many difficulties in utilizing some of these sources.

Although skeletal and mummy remains would appear to be a promising source of information, most diseases suffered by individuals in antiquity, and many that caused death, leave no evidence in soft-tissue remains or in bone as observed by gross or microscopic methods. In addition, attributing the relatively few conditions that do occur in the skeleton to a specific morbid syndrome is often difficult. These problems make the interpretation of the biological significance of skeletal disease difficult. However, although our sources may have limitations, much can be learned if these restrictions are kept in mind. Even tentative observations can provide the basis for further clarification and/or debate. We are hopeful that current avenues of research will provide new data and stimulate the development of new methods. For example, the work of M. Y. El-Najjar and colleagues (1980) and that of N. Tuross (1991) suggest the possibility of recovering immunoglobulins from archeological tissues, including bone.

The second and perhaps most serious limitation to the study of prehistoric human disease is that imposed by the methodological and theoretical inadequacies of current research. There is no universally accepted descriptive methodology that ensures comparability between published sources, which hampers any attempt to integrate the data presented in the literature. In addition, as will be discussed in relation to infectious diseases, paleopathology has not yet reached a theoretical consensus on the significance of many skeletal diseases.

In spite of the limitations and problems in the field of paleopathology, we have attempted some in terpretation of the data. In addition, we have included findings of other researchers who have sought evidence of trends of certain conditions for sites in specific geographic regions. However, we strongly emphasize the tentative nature of these findings and the need for greater methodological rigor in future research.

In this essay, we focus on research involving human physical remains from the Old World, beginning with the Mesolithic period (about 10,000 B.C. in the Near East) and ending with the emergence of the Roman Empire. Because of the considerable chronological and geographic scope of the essay, and because of the complexity of understanding disease in antiquity, particularly in relation to modern medical experience, we briefly discuss some relevant concepts, trends, and factors.

First, it must be emphasized that the transitions between hunter-gatherer, agricultural, and urban societies occurred at various times in different areas of the Old World. For example, while the Near East was in the early stages of farming with some town life (c. 8000-5000 B.C.), Europe was still at a hunter-gatherer subsistence level. Therefore, at a specific point in time the health problems encountered by the human populations in these two areas were different.

Second, the relationship between humans and disease is continually evolving. Over time, the virulence of infectious organisms tends to become attenuated, while the human host population tends to evolve a more effective immune response to infectious organisms (Cockburn 1963). The implication of these two trends is that with the passage of time a given infectious disease is likely to become a less serious threat to life and develop a more chronic pathogenesis.

Third, the expression of disease can be influenced by many factors (e.g., age and environment). In general, the risk of disease increases with the age of the individual. With the exception of many Third World countries, people today live 30 to 40 years longer than they did in antiquity. This greatly increased longevity is a very recent development in human history and means that the prevalence of many diseases common among modern Western peoples, such as cancer and heart disease, is probably much greater than it was in antiquity. Environmental conditions, both geographic and cultural, can also influence the expression of disease. For example, exposure to smoke from wood-burning fires may be a factor in the prevalence of nasopharyngeal tumors in archeological skeletons (Wells 1977).

Finally, a helpful distinction can be made between specific and nonspecific disease (Buikstra 1976). Specific disease refers to those conditions in a skeleton that can be attributed to one of a fairly limited number of disease syndromes (e.g., anemia or leprosy). Nonspecific disease is an abnormal condition of a skeleton (e.g., periostitis, dental hypoplasia, and Harris's lines) that cannot be attributed to a discrete morbid syndrome. In a sense, specific and nonspecific diseases represent the polar extremes of a conceptual gradient.

In samples of archeological human skeletons, approximately 15 percent show evidence of significant disease. The incidence of specific disease syndromes varies among geographic areas and cultures, as does the expression of diseases, but generally the most common pathological conditions seen in archeological human skeletons include trauma, infection, arthritis, and dental disease. These conditions will be the focus of our discussion. In addition, because of current interest, we will briefly discuss anemias and tumors. Most of the other general categories of disease (e.g., dysplasias and metabolic diseases) are represented by at least one syndrome that affects the skeleton, but archeological evidence for these syndromes tends to be rare. Differential diagnosis is often difficult, and low frequencies create severe limitations in reaching paleoepidemiological conclusions.

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