Charlotte Roberts and Keith Manchester, The Archaeology of Disease. 2nd ed. Ithaca: Cornell University Press, 1995. Pp. x, 243. $39.95. ISBN 0-8014-3220-0.
Reviewed by L.J. Bliquez, University of Washington, email@example.com.
This is not an original work of scholarship but an outline or handbook of palaeopathology, defined as the study of disease and trauma in ancient populations. Classicists need to be advised at the start that palaeopathology employs the term "ancient" quite broadly. Indeed, the authors discuss material extending from Palaeolithic times to the 17th century.
According to the Preface, the book represents a complete revision and updating of its first edition produced by Manchester alone in 1983. I do not at present have access to that volume, but the bibliography of the new edition, which contains over six hundred items, includes many post 1983 entries. The revision therefore must be extensive. The authors do not say which of them is responsible for what (arousing particular curiosity when one encounters an anonymous reference to "the author" on p. 190), although a fair idea can be gained from their original research contributions listed in the bibliography.
Roberts and Manchester say that they have produced the book for "interested readers" as well as for "scholars in the discipline." In fact, the focus really seems on "interested readers," as they have clearly written at a level that allows for use of the volume by the non-specialist. For this reason they have not attempted to make the book complete (p. 14), and they are usually careful to define technical terms and to describe in layman's language the causes and natures of the various diseases and traumatic conditions of interest.
As its emphasis is on bones, it is appropriate that the book starts with a handy diagram of the human skeleton. Appropriately, it is richly illustrated throughout with photographs (not always labelled with all the information one would like), tables, and drawings.
The authors begin with definitions and a discussion of the problems faced by the palaeopathologist. The chief difficulty is the one faced by all investigators of things ancient: the evidence is often not nearly as complete as we should like. For palaeopathology it consists in the main of skeletal material which is often incomplete, poorly preserved, confined to the adult population and, as it represents only the dead population, does not necessarily shed light on the health of the contemporary living population. Very desirable would be abundant ancient soft tissue samples, but little survives of this material with remarkable exceptions: Egyptian mummies, the "bog bodies" of north-western Europe, the "Iceman," etc. Literary sources, representations in art, latrine deposits, and even comparison with some contemporary cultures are useful in helping to fill in the picture. But without the soft tissue, it is often difficult to associate the traces of disease on bones with a specific condition; that is, to be certain of the causes of osteal lesions. To take a simple example, "Harris lines" on bones (pp. 164, 175-177) are evidence of arrested growth in an individual. But what was the cause of the arrested growth: malnutrition, a disease, or emotional stress? And, if a disease was the cause, what disease? These are just some of the problems connected with the use of Harris lines for palaeopathological analyses. Another kind of problem is presented by epidemic infections such as plague. These diseases will have so quickly killed their victims that skeletal material offers no testimony to their presence at all. So, qualifications and caveats occur with great frequency throughout the book, and this may cause some readers to wonder if the effort that goes into palaeopathology is really worth it.
For this reason it is good that the introductory pages are also given over to the history and development of palaeopathology. The modern approach is to consider the nature of ancient disease in the context of environmental and cultural factors (the "bio-cultural method"); in short, palaeopathology is an interdisciplinary study. But tracing the history of the discipline and its evolving methodology also helps to demonstrate its value; for it shows how far palaeopathology has come in a short period of time. An epilogue discusses the prospects for progress in the future if, for example, microscopy and radiography could be more generally applied, and if techniques for the extraction of DNA are improved. Through examination of DNA more information about infections such as malaria, cholera and plague, which do not affect the skeleton, might be secured.
The material is well arranged. After the chapters on the nature of palaeopathology and its methods and attendant problems there are chapters covering the general topics of congenital, dental, joint, infectious, metabolic-endocrene, and neoplastic diseases. These chapters are each broken down into the specific disease conditions that fall under the general rubric. The topics incorporated into the discussion of each disease include: its symptoms, its causes and origins, the marks it leaves on the skeleton, the bones affected, the frequency and range (both spatial and chronological) of its occurrence in the past, its social consequences, and reference to particularly interesting specimens illustrating various points made in the discussion. A long chapter on trauma is similarly handled. Of particular interest to this reviewer was the chapter on Infectious Diseases with sections on tuberculosis (now thought to have existed in the New World before Columbus and again becoming a threat), leprosy (which bears an analogy to AIDS from both the point of view of those unfortunates who contracted it and the healthy population which shunned its victims), and treponemal diseases (including venereal syphilis, the precise origins of which are still in dispute). Throughout, the discussion is liberally documented as, in addition to their own experience, the authors draw on the impressive bibliography that they have assembled. Of course, one could always cite a missing item or two that should have been included; but in fact one is much more impressed with what is in the bibliography. I note that it even contains such recent productions as M. Grmek's essay on the representation of leprosy in art ("La lépre a-t-elle été représentée dans l'iconographie antique?" PACT 34: 147-156), which can only have appeared while the volume was in its final stages of production.
As with any handbook the going is sometimes rather cut and dried and the reader will probably be more inclined to consult individual sections of interest as opposed to going right through. As one theme that emerges is the tremendous suffering endured by our ancestors, occasionally empathetic expressions break through to relieve the tedium of the handbook style. This is particularly true of the section of the chapter on Neoplastic Disease which treats malignant cancers. Dealing with evidence in the skull of a third to fifth dynasty Egyptian for a nasopharyngeal cancer we are told (p. 193): "Scarcely can we imagine the suffering of this individual with a foul, fungating cancer relentlessly advancing through the roof of the mouth to protrude into the mouth itself. Death must surely have been a welcome relief from this bleeding ulcerated obstruction to swallowing, talking and decent life." Sometimes the businesslike handbook style provoked a chuckle from this reviewer, as in the chapter on trauma. While reading of evidence for such delightful practices as scalping, cannibalism, defleshing, and a variety of gruesome wounds, I became hopeful that one particular Anglo-Saxon might get off with just a mild arrow wound which did no more than create pain, bleeding, and a minor opening in the spinal canal. No such luck. "This [injury] was insignificant because the victim shortly became subject to a tremendous blow to the right side of the back of the head (p. 83)."
Not only are the chronological parameters of palaeopathology extensive but its physical evidence comes from every inhabited continent. Of necessity therefore The Archaeology of Disease covers a lot of ground. As a result there is little in the book of direct interest for classicists. As far as the Greco-Roman world is concerned, classicists will be particularly interested in the discussion of leprosy. Since the oldest skeletal evidence for it in the Mediterranean world dates to the second century B.C., the authors entertain the view of those arguing that leprosy originated in the east and may have been brought to the Mediterranean world by Alexander's army. The first physical evidence for the disease in Western Europe occurs in the fourth century of our era, meaning perhaps that leprosy was introduced from the Mediterranean by camp followers accompanying the Roman Imperial legions (p. 45 ff.). The evidence for anaemia as evidenced by several hundred Romano-British skeletons (p. 167), and the evidence for rickets in Roman Hungary (p. 175) make one wonder how widespread these metabolic conditions were elsewhere and at other times in the Greco-Roman world. And Roman complaints about gout are vividly illustrated by three Romano-British skeletons (pp. 122-123). Also relevant is physical evidence and bibliography cited for the practice of crucifixion (p. 87) and for trepanation of the skull, as described by Hippocrates and Celsus. The discussion here might have benefitted by the skeletal evidence for trepanation by crown drill presented by O. H. Urban, M. Teschler-Nicola and M. Schultz ("Die latenezeitlichen Gräbfelder von Katzelsdorf und Guntramsdorf," Niederösterreich, Archaeologia Austriaca 69  13-104).
There are a few statements at which a classicist balks. It is not true that Mark Antony was a Roman emperor (p. 33). Furthermore, although there are anecdotes recorded about the emperors Tiberius and Alexander Severus and dwarfs, it is not apparent that they retained dwarfs as "counsellors" (p. 33-34). Overall, however, I find little to criticize and much to appreciate in The Archaeology of Disease. Anyone generally interested in the history of medicine in antiquity will want to keep this useful reference book at hand.