Palaeopathology

Opening remarks

In the discussion that followed the first presentation in the original seminar series, one member of the audience raised the possibility that palaeopathology provided an antidote to the relativism that currently afflicts much historiography of medicine. According to the relativists, all the medical historian can, and must, do is operate with the disease categories of past sufferers. Plague as it was understood by its victims in the fourteenth or seventeenth century is literally not the same disease as plague defined by the results of modern laboratory investigation. The Black Death and Yersinia pestis are incommensurable. Retrospective diagnosis (what was the Plague of the Philistines?) is therefore ruled out. The medical historian is confined to the study of past representations of disease, not the diseases themselves, which have no biological reality independent of the way in which they are observed or experienced at the time of their appearance.

Students of the medical past, whether of the Year 1000 or any other period, may not, however, agree that the history of disease is beyond their province. They may want to know what people suffered from as well as how they tried to treat themselves. Palaeopathology, which usually means the skeletal evidence of burial sites, seems to offer a way into the history of suffering which is an obvious and necessary counter- part to the history of disease representations. In the opening paper of the special issue of SHM on The Year 1000, some of the palaeopathology available to us from around that date in Europe and the Middle East was briefly reviewed. There, its limitations were given more weight than its potential. In the subsequent one-day conference on which we are here reporting, a more positive view of the evidence from burial sites was offered. Palaeopathology can tell us about the evolution and progress of human disease, about such matters as sex and age at death, nutrition, occupational stress, accidents, and particular forms of surgery such as trepanation. The evidence is gathered by microscopic inspection, CT scans, radiology, stable isotope analysis, chemical analysis and DNA testing.

Of course, the field is beset by general problems.

(1) The problem of preservation and conservation

Soft tissue is usually lacking: we are mostly confined to the observation of bones, and of course only chronic conditions leave traces on bones. The conservation of material for analysis has been sufficiently careful only in the last twenty years or so.

(2) The problem of excavation and contamination

Excavations have not been properly carried out and often bones have not been seen as very important evidence. The site has been disturbed before excavation.

(3) The problem of publication

Information is slow to reach the public domain. Very few large-scale cemeteries of the early Middle Ages have been excavated.

(4) The problem of selection

Those whose burials we find are not necessarily representative of the local population: their diseases are not necessarily a guide to what was generally wrong with that population. If the site has been disturbed the population of the cemetery may be unclear. Reports have been flawed by misdiagnosis or over-adventurous diagnosis (reading far too much into highly ambiguous remains). On the more positive side, palaeopathology offers evidence that may be at least as reliable as written sources. DNA testing promises much, although its evidence is very easily contaminated. It has already confirmed the presence of plague in southern France in the later Middle Ages (The Times, 10 Novemb er 2000).

Points arising in discussion:

The study of leprosy has been a prime example of an area of investigation in which palaeopathology has helped history of medicine progress. It offers the possibility of quantification, even of objectivity. Texts can provide statistics too, though, if a critical mass of one particular kind of report is available (for example, Razi's case books). Such texts can cover a broader range of diseases than palaeopathology, which is, as we noted, nearly always limited to those conditions that leave traces on bones. The evidence of excavated cemeteries attached to leper hospitals now embraces material from some 3,000 individuals from medieval England alone. The number of skeletons showing traces of Hansen's disease undermines the notion once common among historians, that medieval people could not tell the difference between 'true' leprosy and other skin conditions such as psoriasis. Of course, some of the people who entered leper hospitals may have been put there because they had psoriasis and they contracted leprosy subsequently through commingling with other inmates. But the weight of numbers is impressive. There were too many sufferers from Hansen's disease in the leper hospital cemeteries for that sequence to have been commonplace.

Palaeopathology is a young discipline. It is perhaps only thirty years old. The range of conditions and diseases on which it can report is increasing all the time. It can shed light on important questions such as whether or not venereal syphilis was present in Europe before the 'Columbian' exchange. It can refute the idea that bubonic plague was absent from later medieval Europe.