ANTHR 2245 Final

WHO: “a state of complete physical, mental and social well-being, not merely the absence of disease”

• Abnormal condition caused by physical, emotional, or psychological disruption.
• The description of disease is culturally constructed.

Morbidity is the condition of being diseased.

• “Bourgeois empiricist” models of disease causality are composed of epidemiological agent, host and environment
• The triad model is inadequate because it fails to consider the ultimate causes of disease, which are economic, social and political.
• The triad fails to elucidate why epidemics occur at certain historical moments or why eradication of a specific infection does not ensure prevention of illness.

The study of human skeletons from archaeological sites in order to provide information about the biological, cultural and environmental dimensions of human life in the past.

• Pathogens (macroparasites vs. microparasites)
• Mode of transmission (direct contact vs. respiratory, zoonotic (reservoir) or chronic)
• Other epidemiological variables such as incubation period, infectivity, population size

• Historical: how disease shapes the course of history.
• Epidemiological: Focused on broader population patterns related to disease spread and distribution.
• Cultural: How cultural beliefs affect how disease is diagnosed and subjectively experienced.

• The study of ancient diseases
• Focus on abnormal variation in human remains
• Lesion = individual tissue manifestation in a specific disease
• We generally study diseases that leave markers on bone: Syphilis, Dental disease, Joint disease, Metabolic disease (vitamin c, d, b12 deficiency)
• But importantly, placing skeletal evidence in context tells us about biological, sociocultural and ecological stressors

• Understanding distribution of disease patterns across a population.
• How and why disease spreads and who is affected.
• One could adopt epidemiological approaches to studying drug addiction, violence, spread of fear and stigmatization, terrorism etc.

• Biological / evolutionary
• Ecological / environmental (example is the Yangtze river)
• Sociocultural / behavioral (deliberate vs. non-deliberate, health maintaining, health demoting)

• Strict separation of “intangible” mind and “physical” body.
• The division between the rational and the emotional is not representative of other cultures.
• Scheper-Hughes and Lock challenge Cartesian dualism by drawing on examples which focus on the idea of a whole, equilibrium or harmony, rather than division.

Discomfort is either physical or mental, and often medicalized to reassert the perception of human control and intelligence.

• The body-self: the phenomenological body (the sensation of being in the world)
• The social body: body as a natural symbol, Healthy body is a microcosm of the healthy state
• The body politic: body as a site of power, How bodies are disciplined by society to ensure normative behavior or Body of the monarch or ruler (Thomas Hobbes, Leviathan)

• Traditional form of community in the Andes prior to the Incan conquest.
• Essentially extended family or kin groups based on self-sustenance, reciprocity, kinship and territory establishment.
• Example for social body.

The interactions between sociocultural, biological, ecological variables relating to the etiology and prevalence of infectious diseases.

• Diseases we share with extant primates, presumably inherited from a common ancestor
• Head and body lice
• Bacteria (staphylococcus)
• Herpes (HSV-1)

From vertebrate animals, then become endogenous to human (transmitted person to person)

• Physical disruption resulting from unhealthy environmental conditions.
• Bioarchaeologists often take a “general stress perspective,” analyzing the health consequences of various types of stressors, such as environmental, cultural and biological.

• Environmental: Nutritional deficiency
• Cultural: Health conditions associated with social standing (example, lead poisoning of the elite in Rome)
• Biological: Pathogen infection

• Major technological shift and the rise of agricultural practices and tools. Agriculture emerges as a part of a complex subsistence web, including hunting, fishing & farming.
• Shift from hunter gatherer lifestyle to sedentary farming societies.
• Not one “Aha!” moment, moreso several small moments that took place over centuries, if not millenia. The shift is not uniform.
• Management and sedentism predates systematic cultivation by millenia

• Happens in different places at different times.
• Beginning around 10,000 BC, sedentism and cultivation begin to complement hunting and foraging societies
• Agriculture is not the dominant mode of subsistence until 6,000 BCE.

• It is the first epidemiological transition in human history.
• Major shifts in patterns of mortality, disease and fertility in human history.
• Generally speaking, health quality declines with the shift to agriculture.
• Example: In agricultural societies, weaning occurs earlier (innovations in food processing, domesticated grains and tubers are relatively soft), leading to increased fertility and maternal mortality rates.
• Example: High starch pasty foods facilitate its adherence to teeth, leading to higher caries. Agricultural societies have higher caries rates than mixed foraging/agriculture and foraging.

• Depends. Generally speaking, health quality declines with the shift to agriculture. However, we need to ask the following questions:
• More or less variety? Monocropping in restricted geographic range vs. cultivation of diverse crops.
• More or less animal foods? Pastoralism vs. shift toward plant goods.
• More or less nutrients? Greater potential for abundance, storage, selection, specific method of food processing may lead to increased nutrients.

• Schistosomes are blood flukes (infectious worms) that are carried by freshwater snails.
• The disease can affect liver, urinary bladder, other organs
• It is a macroparasite, direct contact, zoonotic

Households with water connections (sewage, running water) have less occurrence of schistosomiasis. However, even in houses with water connections, disease persists and there is sex-based differences (males more).

• Two major forms of irrigation
• Saqiya irrigation systems: very effective for agriculture, but also favorable for snails
• Annual flooding: no continuous source of water, but would expect lower prevalence of schistosomiasis
• Two sites along the Nile in modern-day Sudan, Kulubnarti (550-750 AD) which relies on annual flooding, Wadi Halfa (350-550 AD) which relies on Saqiya irrigation systems.
• Population size is much lower in Wadi Halfa, which could either be due to conservation conditions or demographic differences.
• Schistosoma mansoni prevalence is higher in Wadi Halfa (Saqiya irrigation systems).
• Peaks at earlier age in Kulubnarti and mature adult at Wadi Halfa.
• Inferred from soft tissue sampling.

• The sample found might be biased, not representative of the population as a whole
• Non-specific, lesions that can be caused by any number of infectious agents or nutritional deficiencies.
• Lesions we can see are limited, most diseases can’t be inferred.

• Enamel hypoplasias: interruption of enamel deposition brought on by physiological stress. Non-specific: disease, nutritional stress from weaning
• Harris lines: Lines of arrested growth visible on x-rays of long bones. Non-specific: disease, nutritional stress from weaning

• Reduced mobility and increased food supply lead to positive energy gain, which leads to earlier menstruation and higher fertility.
• The softer foods produced lead to earlier age-of-weaning, which also increases fertility.
• Increase in disease is offset by increase in fertility.

• Slash-and-burn agriculture results in pools of water which are great mosquito habitats and malaria.
• Malaria originates in the Paleolithic, but flourishes in settled societies.

• Permanent settlement covering a large area
• Has several thousand people
• Who live quite closely together and are socially diverse

• Waste accumulation,
• violence and crime (what kinds are legitimized, what are pathologized),
• water contamination,
• fire
• These risks are not distributed uniformly. They are distributed along political, social and geographic lines.

• Built environment includes all physical parts of where we live and work.
• Affords and/or restricts political, social and ideological activity.

• Attest only to the treatments administered by “professional healers,” resulting in a gap of knowledge relating to simpler home remedies and traditional treatments in Ancient Mesopotamia.
• Aspects of medical practice that would require observation and practice as opposed to written instructions are not included in the preserved medical texts

• Strengths:
• Bioarchaeological evidence is often non-specific. Historical sources provide direct first-hand and specific evidence for the experience, diagnosis, treatment and prognosis of disease.
• They provide evidence for pathologies not represented in skeletal evidence.
• Weaknesses:
• The texts are often not historical and are not written for the purpose of providing historical evidence. (no evidence for surgical practice in ancient mesopotamian texts)
• They don’t say anything about prevalence. (edwin smith’s papyrus)
• They are often specified for certain societal sections. (edwin smith’s papyrus, adult male soldiers and laborers)

• Ostraca (administrative texts in Egypt) give insight into daily life and allow us to see disease prevalence throughout more granular time periods.
• However, Ostraca are non-specific.
• Ostraca mainly represent adult males.

• Porous lesions on eye socket generally interpreted as indicators of anemia.
• Can be caused by
• Plant based diet deficient of vitamin B
• Infection by pathogen and nutrient losses from diarrheal disease and intestinal parasites

• Assuming that there will be a one-to-one relationship between a disease in the past and disease today. It could be a related disease, or an isolated disease.
• Thucydides might not be listing all symptoms, and a diagnostic approach from symptoms alone might not even be possible today.
• Issues with translation of non-medical terms.
• The terms used to describe the plague are imprecise, in short, because the ancient humoral approach does not coincide with a modern patho-physiological approach. To focus endlessly on what currently recognized disease caused the epidemic is futile and divers us from Thucydides’ overarching purpose.

• aDNA culprit for plague of athens.
• Typhoid fever is spread through contaminated water or close contact.
• It is not zoonotic.
• No lesions.

• Pulse-taking: increasing specificity
• Bloodletting: Prescribed throughout time, formalized in the time of Galen.
• Despite some key shifts, “Hippocrates” and Galen similarly advocate a clinical, rational approach to medicine.

Four distinct fluids coursing through the body (blood, phlegm, black bile, yellow bile). Distinct properties of these fluids, rooted in environmental factors. An imbalance of these humors causes illness.

Are not structurally equivalent to veins and arteries.

Greek anxieties of excess manifested themselves in plethora, a condition of excess and corrupt blood that led to fever and inflammation.

• Shi: excess of foreign invasion
• Xu: pathological emptiness (lack of strength) that allows for Shi, is a precondition for Shi.

• The mo wasn’t the pulse or the circulatory system.
• Mo coursed through the thread of affliction and relief.

Pulse diagnosis, feels the palpating Mo.

• Sphygmoi is referenced in Hippocratic writing and refers to spasms, tremors and palpitations. Phlebes are not just blood vessels, so palpitations exist in the head and the womb in Hippocratic writing. The idea of the pulse had yet to crytallize.
• Galen refers to specific types of pulses with the term Sphygmos, distinguishing between tremors and spasms and what we now know as pulse.

• Medical traditions preserved and elaborated under caliphate state sponsorship, beginning in the latter centuries of the 1st millennium.
• Islamic medicine includes non-Arab scholars, Persians, Jews, Indians and Europeans.
• Textual sources include Hadiths, translation of Greek treatises. Not the Qur’an.

• His life illustrates many key aspects of “Islamic medicine” by synthesizing Greek medicine
• Philosopher, physician, political counselor
• Writes “The Canon of Medicine”, contains chapters on surgical techniques.
• Translated into Latin

• Theoretical medicine (tibb nazari): Anatomical knowledge based on Galen and Humoral theory.
• Practical medicine (tibb ‘amali): Pharmacology and prescriptions largely derived from Greek sources.
• Folk medicine (from Mesopotamia etc.) is included alongside “rational” medicine

• Relied on knowledge acquired from Greek medicine
• Did not conduct dissections
• Earliest anatomical illustrations from Islamic world are associated with Mansur’s Anatomy (Late 14th century).
• However, there are some surgical innovations. Catheters, forceps, stitching are invented and developed.

• Split into two:
• Philosopher-physicians (hakim):
• State sponsored.
• Practices Galenic-Islamic medicine
• Formed by elite class, male
• Emphasis on theoretical knowledge, but also clinical practice in hospitals. However, it’s unclear whether hakims practiced surgeries
• 2. Lay healer (multitabbib)
• Folk medicine
• Lower status
• Unclear if generalists or specialized
• Included female physicians

• Based on hadiths, include naturalistic treatments with an emphasis on healing effects of prayers and incantations.
• Broader corpus on the other hand is rooted in Galenic tradition and humoral theory. Includes Theoretical medicine (tibb nazari): Anatomical knowledge based on Galen and Humoral theory. And Practical medicine (tibb ‘amali): Pharmacology and prescriptions largely derived from Greek sources.

• Hadiths: collection of accounts of wisdom of the Prophet Mohammed on various medical issues
• Include naturalistic treatments
• Emphasis on healing effects of prayers and incantations
• Disease causation is God
• There is thus a denial of contagion. But, of course, there are contradictions. For example, according to the Prophet, one should not water healthy animals with sick animals.
• Two causes of epidemics (vaba)
• the distant/heavenly causes either the will of God or Destiny, should seek healing in sadaqa and prayer
• accessible/earthly causes, like the putrefaction of air, prayer and measures like diet or evacuation.

• Include naturalistic treatments. Fresh bread and lamb produce healthy blood, focus on diet
• Emphasis on healing effects of prayers and incantations

• Both traditions depend on Hippocratic/Galenic medicine, and thus believed that the immediate cause of the disease was a pestilent miasma or corruption of the air.
• Treatment of plague was prayer and flight in Europe.
• Muslim response was to ban flight from plague-stricken land.
• Muslim understanding denied contagion, as disease only came directly from God. Though some flight is observed.
• Nuance from Stearns (2011): Some scholars in the Islamic context argued for contagion.

• European Christian viewed plague as overwhelming punishment from God. Propagated by the church and seen in European art and literature. Plague as divine retribution for the wickedness of European society.
• In Islam, plague was a mercy from God and a martrydom for the faithful Muslim and a punshiment for the infidel - NOT a punishment. The believer that died from the plague is assured of reaching paradise. Hence, no breakdown of governmental or religious power seen.
• Nuance from Stearns (2011): There were still public gatherings in the Christian context. Plague was also associated with martyrdom in the Christian context, true believers were thought to have God’s protection.

• European Christian response was the flagellant movement, the persecution of alien groups and a pessimistic preoccupation with imminent death. Lepers, gravediggers, other social outcasts and Muslims in Spain were also subject to persecution.
• No persecution in Islam, mass communal responses involved prayer, fasting, food provision and journeys to cemetearies. In addition, magical practices were popularized, including incantations and amulets.
• Western man took the plague epidemic as an individual trial more than a collective, social calamity. This reflects the difference in the cosmic settings of the two religions, where Christianity is focused on personal salvation/redemption and Islam focused on correcting the behavior of the total community.

• Explicit comparison reveals the basic insights of both cultures.
• Wide array of communal reactions revealed by comparative analysis may guard against a simplistic interpretation of human behavior.
• May facilitate false equivalence or loss of nuance.
• May promote a monolithic understanding of both factions to facilitate comparison. In reality, there is a great degree of variation within Christian/Muslim scholarship.

• Waste accumulation: Food and water contamination by fecal material, open latrines in the kitchen and defecation and urination in the streets.
• Malaria: Peaks in late summer, which a hypothesis suggests is peak malaria season (from August-October). Seasonal mortality variation can be attributed to Malaria. Literary sources suggest the impact of Malaria in late summer and early fall. High seasonal death rates imply sustained immigration from malaria-free zones.
• water contamination, slums, overcrowding, social stratification, poor sanitation

• Peaks in late summer, which a hypothesis suggests is peak malaria season (from August-October).
• Seasonal mortality variation can be attributed to Malaria. Literary sources suggest the impact of Malaria in late summer and early fall.
• High seasonal death rates imply sustained immigration from malaria-free zones

• Cribra orbitalia is porous lesions in eye socket.
• Porotic hyperostosis is porous lesions on cranial vault.
• Both are Multi-factorial, nutritional stress such as b12 deficiency synergistically interacts with parasitic infection.

• Mid 14th century
• Killed 30-60% of affected populations
• Major economic and social changes
• By clarifying the context of the emergence of black death as an emerging disease, there is the potential to gain a deeper understanding of current and future emerging diseases.
• In England, emerged in the context of increasing population density, increasing socioeconomic inequality, increasing urbanization, little ice age and climate change which led to famines.

• Patterns of mortality relating to sex, pre-existing health conditions and age investigated.
• Written records exclude information regarding women and children, but bioarchaeological evidence (burial ground) allow us to capture these mortality patterns.
• Dewitte compares black death burial vs. normal mortality

• Osteological analysis
• Determine age and sex
• Look at skeletal stress markers (enamel hypoplasia, cribra orbitalia)
• Black death itself doesn’t have skeletal markers (kills in 3-5 days)
• Used hazard models

• Black Death mortality
• Elevated risk for older adults
• Elevated risk for frail people of all ages
• No significant difference in sex, but more recent evidence from the Netherlands suggests higher mortality for females
• Black death burial and normal burial have similar mortality patterns
• No evidence regarding socioeconomic differences in burial in London, but more recent evidence suggests that lower socioeconomic status led to higher mortality rates.

• No evidence of functionally unique traits of 14th century Yersinia pestis. But - epidemiology of plague 14th century-19th century is very different. Why?
• Were trends prior to the Black Death responsible (intergenerational epigenetic changes?)

• Dewitte looks at survivorship over time to reflect the general health of the population:
• Survivorship decreased from the 13th century to the 14th century, then increased after the Black Death from the 14th century to the 15th century.
• Decline in survivorship prior to Black Death due to repeated famines (End of the Medieval Warm Period and Little Ice Age), increasing social inequalities, disease.
• Increase in survivorship after Black Death due to increased real wages and improvements in diet, increased migration (influx of young healthy people into London). Women as laborers, allowing them to get more freedom and the adoption of the European Marriage Pattern (negative effect of fertility, women getting married later)
• Demonstrating deep histories can counter a view of disease as something due to personal decisions. This idea is often used to place blame on people and excuse us from fixing the structural reasons for disease transmission.

• Infection caused by mycobacterium leprae
• Prolonged person-to-person contact. Transmitted through droplets in the air. Infectivity is low and depends on the extent of sickness in the diseased individual.
• Very long incubation period. Hence, it’s difficult to pinpoint the point of transmission. (up to 20 years of incubation)
• Affects nerves, skin, eyes, nose. Nerve damage can lead to paralysis.
• Pus filled granulomas on skin.
• Disease spectrum depends on immune response and resistance. More mild form is tuberculoid leprosy (mild lesions, nerve damage), Lepromatous leprosy (severe lesions and nerve damage).
• The considerable inter-individual variation in how leprosy manifests makes it very difficult for medical/cultural diagnosis to pinpoint the nature of this disease.
• Loss of extremities.

• Icon of a leprous individual.
• The bell signals that there is an individual with leprosy in the area.
• A way of communicating in the absence of an ability to speak.

• The wretched leper:
• Leper compared to corpse
• Physically and morally corrupt
• Ground for ostracism
• Most dominant stereotype in the historical corpus
• 2. The noble leper:
• Elected by God
• Suffering as a pathway to salvation

• God: punishment of the individual
• Personal behavior: Overindulgence, unclean food, sexual appetite
• Natural causes: Corrupt air, humoral theory

• Modern biological differs from social diagnosis.
• Lepra (scaly disease) may have been applied to a wide variety of skin diseases
• Recognize that there is no one-to-one translation between historical terms or social diagnoses.
• Sara’ath (Hebrew Old Testament)
• Typically translated as leprosy, but descriptions are not always consistent.
• Nonspecific condition of ritual uncleanliness
• Judham refers to lepromatous leprosy

• Diet
• Bathing of the skin
• Theriacs: various concoctions of herbs, spices, opium, mixed with wine and honey, maybe small amounts of poison
• Bloodletting

• Ministry to lepers
• Leprosaria (form of christian charity, bathing in medicinal waters, public health or segregation?)

• Increase could be due to increased population density and increased conductivity.
• Increase could also be due to paranoia and social stigma. Individuals admitted into leper hospitals do not always have leprosy.
• Decrease is likely due to demographic or epidemiological shifts due to the Black Death

• No theory of contagion, disease comes from God. However, sick should still be avoided.
• There is segregation, as leprosy is not seen as divine punishment.
• Leprosy is seen as hereditary, but is not linked to sexual intercourse.

• The underlying notion is that Excess blood leads to contamination
• Stigmatization of menstrual blood
• Tied to notions of pure/impure
• It was believed that a man who had sexual intercourse with a menstruating woman or their child could contract leprosy.
• Anti-Semitism
• Jewish communities were accused of kidnapping children and using their blood to purify their own.
• Notions of bestiality or cannibalistic tendencies are represented both in the context of Jewish community and female genitalia.
• Leprosy, Anti-Semitism, Misogony are united through this idea of blood and social stigmatization. Collapse of stigma.
• Disease is a very powerful context to crystallize stigmas and stereotypes.

• Ancient DNA evidence points to Yersinia pestis.
• Comparison of medieval and modern genomes of Y. pestis do not show signs of genome evolution associated with increased virulence.

• Bubonic plague: most common type, large swellings
• Pneumonic plague:

• Incubation period of leprosy from infection to expression is 5 years
• Differential diagnosis of tuberculoid and lepromatous leprosy is difficult.
• Osteological paradox: 5% show evidence for leprosy

Documented in India (2000 BC)

• Rhinomaxillary syndrome
• Resorption of extremities - finger, nasal and oral cavities, and toe bones. Bacteria are not eating away at the bone, they lead to paralysis. If you’re not moving your bones, bone atrophy occurs.

• Young adult male (25-35)
• Enamel defects: early life stress, nutritional deficiencies or infection. May be indicative of being immunocompromised or having lower quality nutrition, which could cause frailty leading to lepromatous leprosy.
• Antemortem tooth loss (3 occurrences), multiple carious lesions: High starch diet, infection leading to loss in teeth
• Calculus on all teeth: buildup of plaque around gums
• Overall: Poor oral health. Leprosy: difficulty swallowing, dry mouth due to mouth breathing, poor oral health could be due to leprosy.
• Resorption of metatarsal: Porosity and atrophy due to nerve damage and infection. This means low mobility, everyday help required for walking, resting, bed rest, which may have led to bed sores. Severely limited in labor. Every day help required for washing clothes, cutting nails etc.
• Clinical interpretation:
• Incubation period of leprosy is ~5 years.
• Stress history (enamel defects) can lead to susceptibility to infection later on in life.
• It is noted that people with leprosy have poorer dental health than those without.
• Thinking about leprosy in a broader social contextL stress, suffering, stigmatization - but also support and survival

• Causative agent: Yersinia pestis
• Earliest impact on humans: Plague of Justinian (6th century)
• Transmission: Common interpretation is zoonotic transmission (rats and fleas)
• Skeletal evidence: There isn’t, it kills too quickly.

• Caused by Mycobacterium tuberculosis complex (MTBC)
• Bacterial infection that attacks the lungs
• Transmitted through droplets
• Remains latent in the body until immunocompromised
• Evidence suggests that bovis strain (cow) evolved from human adapted strains. Zoonotic-anthroponotic transmission is a two-way street. Can still be transmitted from cattle.

• Periostitis of Vertebrae, ribs, sternum
• 3-5% of active cases present skeletal lesions
• Spinal involvement: Destruction of bone tissue, especially vertebral bodies. Bony response to spread of infection into the bone may lead to collapse of vertebral bodies, called kyphosis.

Skeletal lesions develop only in 3-5% of active cases However, clinical data postdating the use of antibiotics may underestimate these rates

• Clusters may reflect epicenters
• A long tradition of archaeological research in certain areas.
• Underlying preservation conditions and sampling biases may also play a role.

• No possible cases of tuberculosis in Maya archaeological sites.
• Depiction of kyphosis-like vertebral curvature on Maya vases and iconography, but this is non-specific. Is this an absence of evidence or an evidence of absence?
• Possible explanations:
• Populations might be resistant to Tb infection
• Sampling biases and/or poor preservations. Infected individuals may not be included in traditional burial sites.
• Specific Tb variant may not have spread to the lungs
• Diet may have influenced the host response. Heavy reliance on iron-deficient maize. Body’s sequestration of iron deprives mycobacterium of iron.

• 12% Tb affected
• Higher overall mortality in children less than 10 and individuals 50+, bathtub distribution
• More individuals who died at 10-20 disproportionately show mortality from Tb.

• Not brain surgery, but cranial surgery.
• Cutting away part of the cranial vault.
• Treatment of seizure disorders (such as epilepsy)
• Medical intervention to relieve intracranial pressure from traumatic brain swelling and hydrocephaly
• Magico-religious purposes

• The cure for madness or folly in medieval tradition: Medieval islamic medicine and Hippocratic-galenic tradition
• Not mentioned in Edwin Smith papyrus, but could be in Egyptian medicine
• Also practiced today (congresswoman shot, large segment of skull removed to allow brain to swell)

• Practiced over long period of time and geographic area. Earlies evidence goes back to ~400 BC.
• Cranial trauma increases in the Late Intermediate AD 1000-1450, before Inca state formation. Resources decrease due to ecological condition. Intense and pervasive violence, 30% of samples have evidence of healed/causal cranial trauma.
• Techniques include scraping, circular grooving, boring, and linear cutting.
• There’s also evidence of experimentation in some skulls, with different size drill bits and bore holes of increasing depth (93 total)

• Cuzco is the heartland of the Inca empire
• 411 individuals studies, 66 individuals with trepanation
• 108 out of 109 trepanations result from scraping or circular grooving, most are in the midline front and back, and on the left side (right handed attacker).
• Males are disproportionately represented.
• 29 of the 66 individuals showed evidence of cranial trauma. This suggests trepanation as a response to violent conflict.
• There is much higher healing rates in other regions of the Andes and low frequency of infection.
• Going from LIP to Inca period, healing rates increase.
• The increasing survival rates suggests a standardization of practice over time. Suggests Inca surgeons were highly skilled.

• False dichotomy between magico-religious healing and medical expertise.
• Given ritual and symbolic significance of the head in Andean body.mountain metaphors, likely the case here is well.
• Dichotomy between ancient and modern medicine often obscures parallels in medical treatment. We need to understand how ancient peoples coped with violence and social strife, rather than portraying them as passive victims.

• The second voyage (1493-1496)
• Disease compounded by malnutrition and starvation.
• Mix of dysentery, influenza, measles, chickenpox etc. Not an epidemic in the form of the spread of one disease.
• Period of massive death, particularly among the native people of Hispaniola (Dominican Republic). From around 500,000 to less than 2000 native individuals in 1542. Within 50 years, the population is drastically reduced due to virgin soil epidemics.
• However, there are difficulties in making precise estimates, due to 1) exaggeration 2) Imperfect analogy, using analogies that refer to Muslim contexts 3) Incomplete census taking.
• In this initial period, there is no aim to decimate the native population, as the Spaniards depend on Native labor.

• Florentine Codex (AD 1540-1576):
• Bernardino de Sahagun
• Franciscan friar and ethnographer.
• Goes way beyond a politically instrumental view of Aztec culture.
• 2,500+ illustrations by native artists.
• Reads like a pictorial history of native people’s suffering in their own words, though through the editorial filter of Sahagun.
• Anales
• Chronological histories
• Anonymous Aztec authors
• Sometimes involved supervision by Spanish friars.

• Mummified ancestor in Incas.
• Transportation of Wayna Qapaq’s mummy bundle to Cuzco may have facilitated the spread of smallpox to the heartland the Inca empire.

• Superhuman person, shrine, holy and powerful object. Locus of energy or force. Animating essence. Mallqui is an example of this.
• For Spaniards, Waka is a disease itself. A hereditary illness of idolatry. Idolatry must be destroyed. So, Incan mummies are all destroyed.

• The dead as living, houses for the dead.
• Ancestors confer political legitimacy to the living
• Ensure social and agricultural regeneration.
• Waka: superhuman person, shrine, holy and powerful object. Locus of energy or force. Animating essence. Important role in this system of regeneration. Mummy-centered, but mummies only play a role in this system. Traverses boundaries between animate and inanimate as we see it.

• For Spaniards, Waka is a disease itself. A hereditary illness of idolatry. Idolatry must be destroyed. So, Incan mummies are all destroyed.
• Also destroyed indigenous records of history (Codixes and khipus)

• Reliance on native lords to rule by proxy and indigenous forms of resource management
• Mummified ancestors are guarantors of agricultural regeneration. Destruction of the legitimate basis of social, economic and religious life.

• Taqui Oncoy (Dancing Sickness) 1564-1571
• Millenarian religious and political movement
• Rejection of Spanish foods, clothing, Christian names etc. As they’re seen as an embodiment of illness.
• Involved oracular possession by displaced wakas.
• Response to disease, calling for a return to ancestral deities in effort to restore relationship of prosperity and wealth

• Punishment and suppression of Taki Onqoy
• Execution of Tupac Amaru, the last Inca king
• Forced resettlement of indigenous peoples into Christian township: Reduccion program of village resettlement (1570s)
• Reduces dispersed villages from mountaintops into towns that follow Spanish/Mediterranean grid system. This makes surveillance easier.
• From an epidemiological standpoint, this allows for easy transmission of disease. Closer proximity to waste and animals. Water contamination. Sure enough, several epidemics occur.

• Political and economic conditions that are the product of history and human decision-making not only impact the spread of disease but also the distribution of resources, shaping who is most susceptible to negative health outcomes.
• Preventable stressors and injuries resulting from structural forces are normalized as unfortunate part of everyday life.

• Synergistic effects of diet and infection
• Degenerative joint disease (intense physical activity, labor, extractive economy)
• Growth depression (femur length)
• Depressed birth rate (Estimated from the relative proportion of skeletal individuals older than 30 years over the number of individuals older than 5 years)

• One of the first reducciones, founded in June 1536. We aim to study systemic stress post-contact
• 870 individuals from colonial church (AD 1536-1750)
• PH increases, Periostitis increases, Degenerative joint disease, Trauma is low,
• LEH (linear enamel hypoplasia) decreases. Related to high mortality, children don’t survive period of metabolic insult. There was no survival, therefore we have no LEH.
• Political and economic inequalities penetrate to the bone
• Increase in nonspecific chronic infection is greater for women
• It is useful to look at specific sites, but seeing patterns across reducciones can drive home the idea of structural violence.

• (Larsen, 2005)
• Late 16th century, establishment of missions in northern Florida, coastal Georgia
• Important case study due to
• Time depth of material found (400 BC to 1400 AD)
• Many native american groups with diverse subsistence strategies, allows us to understand the variety in response.

• European written evidence
• Paleoethnobotanical evidence (specific)
• Dental caries (non-specific)
• CO + PH
• LEH
• Osteoarthritis
• Periostitis

• Carbon and nitrogen isotope values vary along the food chain and between different kinds of plants. They can be measured in bone and teeth to interpret dietary composition and variation.
• Carbon pathway is related to photosynthetic pathway of plant. The only C4 plant in the Americas is maize.
• Nitrogen values indicate position in the food chain. More steps in the food chain leads to higher nitrogen. Seafood has higher steps in the food chain, so seafood leads to higher nitrogen values.
• Early pre-contact groups: Higher nitrogen values in Georgia coastal. Mix of maize and meat. High variation within the groups.
• Mission-period: Dramatic shift, low variation within groups. More maize consumption. Really strong clustering in the more maize group. More homogenization.

• Increases from Early Prehistoric to Late Prehistoric. Females have higher than males in both. This could be due to the agricultural revolution, foraging to farming. This also fits with past case studies, where biological or labor differences lead to higher caries in females.
• Generally Increases from early mission and late mission. Males have higher caries rates than females during mission.
• Late mission sees similar caries rates in males and females, which shows a trend towards homogenization.

• CO decreases from Early Prehistoric to Late Prehistoric. This could be explained by increased access to nutrition following the agricultural revolution.
• CO increases from Late prehistoric to Early mission and then to Late mission.
• Osteoarthritis:
• Similar distribution of joint osteoarthritis among males and females in terms of where it was.
• Pre-contact foraging and farming sees a lower osteoarthritis for both genders.
• Early mission and late mission sees a dramatic increase in osteoarthritis.

Biomechanical responses to draft labor. Shows adaptive increase in bone strength in response to labor. Bone remodeling (adaptation in the biomechanical sense).

• Political control over territory
• Economic exploitation
• ‘Civilizing’ mission: Religious conversion, Project of cultural conversion
• Control over bodies: Normativity

• New World Conquest and the reduccion approach leads to
• Draft labor, leading to joint disease
• Eating more corn, which leads to caries and anemia
• Drinking well water, which leads to infectious disease
• Living in crowded missions, which leads to infectious disease

• English
• Profit motive
• Diverse economic activities
• Less government involvement, “entrepreneurial”
• Spanish
• Extraction of natural resources (gold, silver)
• State directed, role of the Spanish Crown
• Emphasis on religious conversion, civilizing mission and subject making processes are more in the forefront

• Estimating genetic relatedness: Dental morphology is very heritable and has a strong genetic component. (as opposed to height). This gets into ideas of group division and isolation.
• Expectation that decimation and aggregation of Indigenous communities would reduce genetic variation. Genetic bottleneck effect.
• Early mission period shows genetic isolation between populations.
• Late mission period shows less genetic isolation and increased gene flow. This indicates new forms of coming together that previously may not have existed.
• This points to a reformulation of social and ethnic identities (ethnogenesis)

Reformulation of social and ethnic identities

Vital force centered at the head. Root Tona means heat. Losing tonalli is an underlying cause of different diseases.

• Widespread belief in Mesoamerica that “hot” and “cold” balance is necessary to maintain health. How did humoral theories develop in Mexico?
• Foster argues that this ideological system of hot/cold dichotomy is inherited from colonialism.
• However, Aztec cosmos is system of balancing opposites. And similarities between Indigenous and Spanish deities facilitated syncretism
• Hippocratic concepts were compatible with pre-existing concepts in Mesoamerica. Compatibility of beliefs logically extended to health and medicine.
• Counter-argument to Foster (argument that hot-cold came from humoral theory)
• Hot-Cold system extends to cosmos
• Hot-cold system mentioned in early sources
• Some concepts in Aztec medicine contradict classic humoral theory. Example: Wet and dry do not exist. Memeyas are almost all of a hot and dry nature in humoral theory, but cold and useful against fever in Aztec medicine.

• Emphasized cleanliness
• Advised on dietary and sexual behavior
• Removed stillborn if necessary

• Earliest treatise on Mexican medicinal plants and native remedies
• Written in Nahuatl and translated into Latin
• “Remedy for black blood” found in Codex.
• This points to syncretism but also highlights the purpose and audience of this book (mostly European) and may reflect this more than inclusion of syncretism in Aztec medicine.

• Bioactive components from Aztec medicinal plants (cihuapatli) show that they stimulate uterine contractions. Empirical basis of Aztec medicine has been tested and hypothesized.
• 16 of the 24 plants surveyed in one study produced the desired effect.
• Although magic and religion were quite important in the Aztec treatment of disease, there was a strong empirical underpinnings which has not received the attention it merits.
• Herbal medicine reflects a wide and varied range of therapeutic resources, including homeopathy, acupuncture and various forms of psychotherapy, as well as the therapeutic agents derived from plants.

• Enslaved peoples included priests, magicians, herbalists
• Source areas for enslaved people change over time, thus shifting source traditions for ethnomedical knowledge.
• Despite multiple origins, Yoruba and Dehomeyan influences are most predominant.

• Disease causation linked to spiritual realm. Healing takes place in communal places, such as the leprosarium in Cartagena.
• Cures must reestablish spiritual equilibrium. Include prescription of medicinal plants (leaves, roots, bark)
• Specific deities tied to healing and well-being.
• Similarities between African deities and Roman catholic deities facilitated religious syncretism.

• Gods are associated with different medicinal and healing domains.
• Osanyin / St. Joseph God of healing herbs
• Obatala / Jesus

• Experimentation with new plants
• Substitution and similarity between Africa/Caribbean, bottle gourds
• Introduction of African cultivars. (Okra, cola nuts) in the New World

• Perform rituals.
• Main medical provider in the countryside and the majority of the population, such as Diego Lopez. While traveling, Lopez’s inventory adopts a wide region of medicinal wisdom of all origins, including across Europe (German and Italian), as well as Africa and Indigenous wisdom.
• Prepare medicines in pharmacies, some are in hospitals, some are unlicensed but have major social influence, such as Francisco.

• Health practices were not framed around strategies to resist or react to slavery, capitalism or the Enlightenment, Instead, they were shaped by impreatives of social, cultural and economic adaptation. Black Caribbean were more interested in producing competitive healing techniques, explanations and rituals than they were in transmitting West or West Central African cultural tropes or resisting European social and cultural norms and structure.
• Unlike the lives of African ritual practitioners living in the main centers of the Spanish colonial project in the New World, Africans arriving in the Caribbean did not necessarily conform or adapt to Spanish cultural norms.
• Healing and treatment performances happened in public, showcasing the competitive marketplace of medicinal wisdom.
• A heterogenous group of ritual practitioners of African descent, arriving from Europe, Africa and the New World formed “Early modern Caribbean” medicine. There was no integrative identity of “Black” physicians. There is no definable or unique “black Atlantic culture,” there is diversity and richness in the emerging early modern Caribbean.
• The circulation of knowledge in the Atlantic was multidirectional and rooted in pragmatic and immediate concerns. The use of medical treatments in the Caribbean trumped not only imagined racial boundaries, but also constraints of scholarly doctrine.
• This all shows that black healing practices and culture were normative and mainstream, as opposed to ancillary, adaptive or responsive to European institutionalized medical practice.

Spanish inquisition records

• Meant to link religious and medical caretaking
• Black surgeons become a stable presence in Caribbean hospitals
• Surgeon barbers reiterate the divide between elite and non-elite physicians (elite scholars)

• 102 Afro-Caribbean healers attested to in colonial documents
• Most black healers simply fall outside of historical records
• Includes women of comparable authority and skill
• Places of birth vary

• Not just form of resilience and resistance, but part of a more complex picture involving experimentation, incorporation and competition. Non-Europeans represented as peripheral to the production of Enlightenment knowledge.
• However, the project of discovering, experimenting with and using medical substances and new medical practices in the Caribbean was not exclusively a product of European-sponsored scientific enterprise. Afro-Caribbean ritual practitioners were at the forefront of the production of empirical knowledge related to corporeality in the region.
• Columbian exchange also involves extraction and appropriation of Indigenous/African knowledge. Draws on Indigenous and African expertise, but excludes any aspect of African/Indigenous culture.
• Plant knowledge is a source of power within Afro-American communities, (Enables Kwasi (Surinamese healer, botanist former slave) to move between black and white colonial spaces), However, secret knowledge - especially of plant-derived poisons - is viewed as a threat.

• Establishment relies on traditional knowledge
• Barber surgeons mixed popular and erudite knowledge
• Formerly enslaved peoples were also healers, shamans and doctors.

Smallpox, Measles, Influenza, Typhus, Plague

• Plasmodium falciparum
• Earliest date in Americas is 1503
• Transmission is through mosquitos
• DNA evidence and non-specific lesions

• Valoria virus
• Earliest impact ever in Neolithic times, egypt soft tissue preservation
• Earliest date in Americas is 1518 epidemic.
• Transmitted through contact and respiratory droplets
• No skeletal lesions

• Yersinia perstis
• Earliest impact ever 6th century
• Earliest date is 1530 epidemic
• Respiratory transmission
• No skeletal lesions

• Mycobacterium leprae
• Earliest date ever at least 2000 BCE (India)
• Earliest date in Americas is unknown, but likely during slave trade
• Transmitted through prolonged contact
• Rhinomaxillary changes, resorption in 5% of cases

• Mycobacterium tuberculosis
• Earliest instance ever 4000 BCE
• Earliest instance in Americas AD 300 (Pre-columbian)
• Droplet transmission
• Vertebral destruction, periostitis on ribs in 5% of cases, which may be underestimated due to current antibiotic use.

• Treponema pallidum
• Earliest impact in the Americas 2500 BCE (Pre-Columbian)
• Venereal, skin-to-skin contact
• Caries sicca, erosive lesions, dental defects

• Bacterial infection caused by Treponema pallidum, this is a spirochete.
• Transmitted via sexual contact, in utero, or by contact with infected blood, sore
• Best treatment is penicillin
• Venereal syphilis, congenital syphilis (neurological symptoms, death)
• Non-venereal (affect youth), Yaws (skin-skin contact) and Bejel (mouth-mouth contact, affects mucus membranes on the face)

• 1495: Epidemic during Invasion of Naples by French troops and mercenaries during the Italian War of 1494-1498.
• Many names for syphilis, proliferation of names indicates that it is a virgin-soil epidemic.

• There is rapid spread and virulence, indicating that it is a new disease in Europe
• Recognized as a distinct disease by contemporaries
• Early understanding of disease included its venereal character and progression (incubation, primary, secondary stages)
• The main question here is whether this is a virgin soil epidemic or an evolution of an existing bacterium.

• Caries sicca (pathognomic, specific), destruction and proliferation of bone on the front of the skull
• Saber shin, swollen tibia (not pathognomonic)
• No reliable method for distinguishing manifestation of three treponemal subspecies in skeletal remains. However, Yaws typically doesn’t involve cranium
• Skeletal involvement in only 1-20% of cases

• Passed to fetus in utero
• Has hypoplastic defects
• Hutchinson’s incisors are highly suggestive of syphilis, but not strictly specific

• Columbian hypothesis: Syphilis not epidemic in Europe until late 15th century. Lack of syphilitic skeletons in Europe
• Pre-Columbian hypothesis: Mild and not recognized as a distinct disease. There is an increase in virulence at the end of the 15th century. Places emphasis on skeletal evidence that appears to predate the Columbian Exchange.

• Argues for pre-columbian hypothesis
• Dating based on stratigraphy, radiocarbon dating and dendrochronology of coffins.
• Multiple individuals with lesions highly suggestive or pathognomonic for syphilis, such as Caries sicca. There is no question that there was syphilis, the question is the date.
• Recent meta-analysis results in 95% confidence interval for radiocarbon date, adjusted for “marine reservoir effect.” Radiocarbon dates are inherently not very precise due to changes in atmospheric carbon throughout time. Eating marine foods may also result in the incorporation of old carbon into the bone. We can adjust for this through nitrogen.
• Dendrochronology is also tricky, as people may be using old wood.

• Over Reliance on non-specific indicators in published literature
• There would be a wider distribution of radiocarbon dates for Old World if treponemal disease had a separate origin there, but there is instead a cluster around 1450 dates.
• Pre-1492 dates are called into question by marine reservoir and old wood effect.
• No undisputed cases of Pre-Columbian syphilis/treponemal disease in the Old World
• Still lack skeletal evidence from Sub-Saharan Africa and Asia.
• Genetic evidence also in support of Columbian hypothesis (though not uncontested). The closest relative of modern syphilis from South American strains that cause yaws.

• Major shifts in mortality, disease and fertility.
• First epidemiological transitions: rise of infectious diseases. Disease frequency increases because of disease exposure and stress related to sedentarization, urbanization, animal domestication etc.
• Second epidemiological transition: Industrial revolution. Infectious disease decreases due to vaccination and medicine. Increase in chronic diseases and degenerative conditions.
• Third epidemiological transition: Reemergence of infectious diseases due to antibiotic-resistant pathogens. Speaking specifically about new pathogens identified: HIV-AIDS, Ebola, COVID. Malaria and tuberculosis persist as major killers, in part due to resistance to antimalarial and antibiotic drugs.

• Link between malaria and deforestation, extreme climatic events
• Effects of warming: Widen mosquito range, increase seasonal duration, alter growth cycle of parasite
• Transmission will be mediated by economic, public health factors: example: Hills of Rome as refuge from malaria.
• Encroachment into and destruction of natural habitats facilitates vector-borne disease (malaria, Lyme disease) and zoonotic disease (like COVID-19)

• What are Asu and Asipu?
• Asû:
• Physician
• Therapeutic medicine
• Set bones, treat wounds, external & internal symptoms
• Ašipu:
• Magician
• Divinatory medicine
• Treatment of mental illness
• Exorcisms
• Considerable fluidity and overlap between both professions.

• What is swnw?
• Trained doctors (swnw), man of pain or healing. Mostly a male profession
• From head down, editorial authorship, and systematized.
• As opposed to texts from Ancient Mesopotamia, cases are physically based, no reference to magical treatment or incantation.
• Patients are able-bodied males, either laborers or soldiers.

• Leprosy only manifests in the skeletal remains of affected individuals 5% of the time. This indicates that frequencies of leprosy in the bioarchaeological record do not necessarily represent frequencies of the disease in the living population.
• In addition to manifesting in diverse ways based on the specific immune response of each affected individual, diagnostic criteria for identifying leprosy in the skeletal record are non-specific. For example, tibial and fibular bone formation as a result of infection in the foot as an indicator of leprosy can also be attributed to tuberculosis, trauma or scurvy.

• Surgeries in the South Pacific are carried out with chipped stone, shark teeth, seashell, coconut shell and bamboo to treat traumatic cranial injuries such as skull fractures caused by slingshots, stones or clubs.
• In North/East Africa, surgeries are similarly carried out in response to skull fractures or headaches or convulsions caused by cranial injuries. The tools used are generally made from scrap metals, ranging from pocket knives and metal probes to saws and hand drills. Done to treat cranial trauma and resulting headaches.
• Though the tools used differ, trepanation seems to have independently arisen as a practical medical procedure with a high success rate in both cultural/historical contexts.
• Despite being medical procedures, trepanation practices are also marked with cultural traditions in both contexts. For instance, cranial sutures, which have religious significance, are avoided in North African trepanation practices. Similarly, magical procedures in the form of healing mixtures are used in the South Pacific to promote recovery after a trepanation.

• Descriptions of the smallpox epidemic are subject to subsequent reworking, revision and recopying, with the original manuscripts often going missing.
• McCaa discusses the Memoriales, which was written by Motolinia in 1524, was published only in 1858 in Spain as the Historia by a copyeditor not specialized in Nahuatl and with less of a concern for the accuracy of its descriptions. In Historia, accounts of the smallpox epidemic are exaggerated and an emphasis is placed on divine punishment. Brooks argues it is a biblical allegory instead of a strict historical account.
• He posits that the number one half is exaggerated in Historia, but disagrees with Brooks’ description of the epidemic as “mild” like in Europe. He argues that the effect is greater than in Europe, but not as high as explained in Historia.

• American Indians have suffered disproportionately from prevailing diseases for the last 500 years, with health disparities ranging from smallpox and tuberculosis outcome to alcoholism and suicide.
• Explanations for health disparities range from socioeconomic factors, diet, living conditions, and climate to racial differences and religion.
• Although the explanations have persisted for the last 500 years, their meanings and the emphasis placed upon them has shifted throughout history. Evidently, ideology has influenced the explanations offered, and, in turn, healthcare spending, policies and research.
• Example: 18th century reservation system brought a severe tuberculosis epidemic. Observers emphasized the synergy between the poor living conditions on the tribes and the unhealthy behavior of the natives. Despite increased participation in the government by the IHS and increased government spending, reservations continue to be underfunded, still contributing to this disparity.
• Jones points out that the fact that health disparities have persisted no matter the prevailing disease is a powerful argument against explanations based on inherent susceptibility. He argues that disparities in health are manifestations of disparities in wealth and power.

• Definitely not introduced by European contact, as Norris Farms site Oneota culture (1300 AD) show 12% tuberculosis.
• Second hypothesis was that it accompanied the ‘First Americans’, which means that the origin of MTBC dates to >=35kya.
• However, final hypothesis is that Tb was brought to the Americas by seals. Pre-Columbian mycobacterial genomes (extracted directly from bone with vertebral regions) were most closely related to Mycobacterium pinnipedii found in sea lions.
• It could be that Tb came from sea lions, or we spread to sea lions.
• Age of the last common ancestor of MTBC strains across the globe was placed 5000-6000 years ago, which is very recent.
• Tb existed in the New World in Pre-Columbian period, but European strains dominate after contact.
• The question remains about how Tb could have established distinct genetic lineages in such a short evolutionary history.