Ortner’s Identification of Pathological Conditions in Human Skeletal Remains Ortner’s Identification of Pathological Conditions in Human Skeletal Remains Third Edition Edited by Jane E. Buikstra Arizona State University, Tempe, AZ, United States AcademicPressisanimprintofElsevier 125LondonWall,LondonEC2Y5AS,UnitedKingdom 525BStreet,Suite1650,SanDiego,CA92101,UnitedStates 50HampshireStreet,5thFloor,Cambridge,MA02139,UnitedStates TheBoulevard,LangfordLane,Kidlington,OxfordOX51GB,UnitedKingdom Copyrightr2019ElsevierInc.Allrightsreserved. Nopartofthispublicationmaybereproducedortransmittedinanyformorbyanymeans,electronicormechanical, includingphotocopying,recording,oranyinformationstorageandretrievalsystem,withoutpermissioninwritingfrom thepublisher.Detailsonhowtoseekpermission,furtherinformationaboutthePublisher’spermissionspoliciesandour arrangementswithorganizationssuchastheCopyrightClearanceCenterandtheCopyrightLicensingAgency,canbe foundatourwebsite:www.elsevier.com/permissions. 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BritishLibraryCataloguing-in-PublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloging-in-PublicationData AcatalogrecordforthisbookisavailablefromtheLibraryofCongress ISBN:978-0-12-809738-0 ForInformationonallAcademicPresspublications visitourwebsiteathttps://www.elsevier.com/books-and-journals Publisher:StacyMasucci AcquisitionEditor:ElizabethBrown EditorialProjectManager:PatGonzalez ProductionProjectManager:BharatwajVaratharajan CoverDesigner:MatthewLimbert CoverphotobyHaagenD.KlausandcourtesyoftheSmithsonianInstitutionNationalMuseumofNaturalHistory. TypesetbyMPSLimited,Chennai,India 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,UnitedStates Canberra,ACT,Australia Megan B. Brickley, Department of Anthropology, Marc F. Oxenham, School of Archaeology & McMasterUniversity,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, UnitedStates Tempe, AZ, United States; Institute for Human MorganaCamacho, PathoecologyLaboratory,Schoolof Origins,Tempe,AZ,UnitedStates Natural Resources, University of Nebraska - Lincoln, Rebecca Redfern, Centre for Human Bioarchaeology, UnitedStates MuseumofLondon,London,UnitedKingdom Mary E. Cole, Department of Anthropology, The Ohio Karl Reinhard, Pathoecology Laboratory, School of StateUniversity,Columbus,OH,UnitedStates Natural Resources, University of Nebraska - Lincoln, Sharon DeWitte, University of South Carolina, SC, UnitedStates UnitedStates Charlotte A. Roberts, Department of Archaeology, Bruno Frohlich, Department of Anthropology, DurhamUniversity,Durham,UnitedKingdom 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,UnitedStates for Evolution and Medicine, Tempe, AZ, United Anne L. Grauer, Loyola University Chicago, Chicago, States; Institute for Human Origins, Tempe, AZ, IL,UnitedStates UnitedStates Rebecca Kinaston, Department of Anatomy, School of Samuel D. Stout, Department of Anthropology, The Ohio State University, Columbus, OH, United Biomedical Sciences, University of Otago, Dunedin, States NewZealand Haagen D. Klaus, Department of Sociology and Richard Thomas, School of Archaeology and Ancient History, University of Leicester, Leicester, United Anthropology, George Mason University, Fairfax, VA, Kingdom UnitedStates Mary Lewis, University of Reading, Reading, United Monica Tromp, Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Kingdom New Zealand; Department of Archaeology, Max Niels Lynnerup, Department of Forensic Medicine, Planck Institute for the Science of Human History, UniversityofCopenhagen,Copenhagen,Denmark Jena,Germany Carina Marques, Research Centre for Anthropology and Chiara Villa, Department of Forensic Medicine, Health (CIAS), Department of Life Sciences, UniversityofCopenhagen,Copenhagen,Denmark University of Coimbra, Coimbra, Portugal;Department ofAnthropology,WilliamPaterson University,Wayne, Tony Waldron, University College London, London, UnitedKingdom NJ,UnitedStates Simon Mays, Historic England, Portsmouth, United Anna Willis, College of Arts, Society & Education, JamesCookUniversity,Townsville,QLD,Australia Kingdom 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 informationaboutbasicosteologicalmethods,suchasesti- 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,andancientpathogenDNAandmicro- 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 tionswithapress. some cases, conditions have been shuffled between chap- Thus, it was obvious that organizing a new edition ters,theirrealignmentreflectingcontemporarythought. 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- otherwaysratherthan“reinventingthewheel.” 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,attemptingtorecognizerelated 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 protractedprocess. 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, Walterrecognizedintheir1981volume. 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 tiveeffortwouldbeneededtoupdatethecorechapterson 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. vibrantfieldofpaleopathologyduringthe21stcentury. So here it is! It wouldn’t have been possible without Don’s (and Walter’s) exemplary prototype, as well as the JaneE.Buikstra many colleagues who so willingly contributed revisions ArizonaStateUniversity 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 CuratorofPhysicalAnthropologyin1976. 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.Thissetthestagefortherestofhiscareer.Hismeet- 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)andDon’sconsiderableworkforthatfirst 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 andrickets,anddocumentingtheeffect oftheearlystages 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 theownersof“Yorkshirepassports”! 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)inZoologywithaminorinchemistry.Thisisinterest- teurorhighlyexperienced. 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 mitmenttoresearch-lededucationinpaleopathology,epit- (including zoology and geology), and the fact that Don omized by many activities. Three are prominent. Firstly, Ortnerwasinspiredbyaprimatologisttomoveintolooking the hugely successful short courses in paleopathology atpastdisease.AMastersdegreeinAnthropologyfollowed 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 1969attheUniversityofKansas(theeffects ofageingand at the annual meetings of the PPA, starting in 1985, and disease on the micromorphology of human compact bone). gavepeopletheopportunitytoengagewithdifferentpath- 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 ThereisnounderestimatingthetimeDon(andhiscompa- NaturalHistoryattheSmithsonianInstitution,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 ATributetoDonOrtner meetings today. Thirdly, this volume has become the have been incredibly pleased to see this new edition and mainstayforscholarsworkinginpaleopathology. the developments the volume has taken, and happy to see The first edition of this book had been published in Janeheaditup. 1981, well before his link with Bradford began (“Don’s This new edition of Don’s seminal work in paleopa- Bible”).Thismarkedaturningpointintheglobalevolution 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,ittakes intoaccountdevelopments inthe fieldover plineanddocumentingglobalevidencefordiseaseinantiq- the last 15 years, showing particularly how nonhuman uity, lacked the scientific and clinical rigor of Don’s book paleopathology,paleoparasitology,andbiomolecularanal- 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 tionwas producedinthe prime years ofhisinvolvement at illustrates that paleopathology is rapidly progressing as a Bradford(Ortner,2003).InthateditionDonwrote20ofthe multimethod-driven discipline fit for the future, and one 23 chapters; authoring virtually all the chapters was no thatembracesotherdisciplinesacrossthearts,humanities, mean achievement. These two editions had focused on a socialsciences,andsciences. classificatory system of disease, whilst incorporating and integratingclinicalandepidemiologicalaspects. CharlotteRobertsandKeithManchester 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 REFERENCES maintaining a classificatory base, has diversified and 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.,Knu¨sel,C.,Roberts,C.A.,2012.Specialcoursesinhuman archeology, and clinical medicine. The chapters of the skeletalpaleopathology.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 UniversityPress,Oxford,pp.684(cid:1)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.UniversityPress,Oxford,pp.89(cid:1)96. Chapter 1 Introduction JaneE.Buikstra ArizonaStateUniversity,Tempe,AZ,UnitedStates 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, researchinskeletalpaleopathology.Italsohighlightedthe 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 301 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- pathologicalconditionsthataffect thehumanskeleton. tury paleopathology. Finally, we will introduce and In the summer of 1974, with the support of a grant reviewtheformatofthevolumeanditsorganization. from the Smithsonian Research Foundation (now the Smithsonian Scholarly Studies Program), Dr. Putschar and I, accompanied by our wives, Florence Putschar and FROM Joyce E. Ortner, and my three children, traveled exten- HISTORY OF THE FIRST EDITION DONALD J. ORTNER sively in Great Britain and several European countries for 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- ofscholarsinterestedinskeletalpaleopathology. tomical pathology that contained documented cases of Ortner’sIdentificationofPathologicalConditionsinHumanSkeletalRemains.DOI:https://doi.org/10.1016/B978-0-12-809738-0.00001-6 ©2019ElsevierInc.Allrightsreserved. 1 2 Ortner’sIdentificationofPathologicalConditionsinHumanSkeletalRemains syphilis. Hackett’s research on these cases resulted in the Alexander Mu¨ller); 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 Vicˇk, Dr. Milan asset. Sfloukal and Dr. H. Hana¯kova¯). 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 ofSurgeons ofEngland, 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. Andre` 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,thediagnosisgiveninthecatalogswasplausible McKenzy). Switzerland: Anthropological Institute of the ifnotreasonablycertain. 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, InstitutionPressforpublicationaspartoftheSmithsonian 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 provedvaluabletoourstudy. 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 tionofanindex. 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. illustrationsinthisbook. This survey was supported by the Smithsonian Research A number of people made significant contributions FoundationandHrdlicˇkaFund.Thefollowinglistofthese during the preparation of the manuscript. Paula Cardwell, institutionsandthestaffmemberswhoassistedoursurvey Elenor Haley, and particularly Katharine Holland typed of their collections is inadequate recognition of the many initial drafts.Marguerite(Monihan)GuthrieandElizabeth 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