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A Personal Anthropology of Driving

12 Mar

As I shift the gear stick I can feel the muscles tensing and releasing in my left arm; I can also imagine the tendons moving smoothly under the flesh, like steel lift cables, as the contracting muscles react to the electric jolts shooting down the nervous pathways spread across the body.  Both of my legs work in tandem with my left arm to leverage the accelerator and clutch pedals in a fluid series of movements to change the engines gear, whilst the right arm keeps the steering wheel stable.  My eyes keep a steady lookout at the road ahead, alert to the changes around me and the weather before me as the grey clouds break and heavy raindrops start to splatter the windscreen.  A quick flick of my index finger switches the front wipers on.  My ears are primed to the sounds of passing engines or the screaming sirens of emergency vehicles.  Perceptibly, but just, I can feel my heart beat that much faster as my right foot presses down on the accelerator.  At a stretch I’d say it was beating in time to the song playing, but that may be poetic licence and an exaggeration…


Broken Bones: Convoluted as a Medical History

It has been just over  a year since I first started driving in a daily capacity after passing my driving test a few years ago.  It has been a long and somewhat patient journey to get to this stage.  I had passed the theory and practical tests almost two years beforehand, but a well-timed pathological fracture to the right tibia and fibula bones of the lower leg (as, when a tibia breaks, the fibula, acting as a supporting lateral strut to the larger and more robust tibia bone and connected to it by a tough fibrous tissue, also often fractures) kept me off the road for a good while after having just ordered a car for the first time.  After healing from this fracture, the third such transverse fracture for these two bones, I was again ready to hop in the car and onto the road but this time as a fully legit legal driver no longer in his training vehicle.  My body, however, had different ideas as I went on instead to fracture the right humerus bone of the upper arm in an accident shortly before receiving the said car, delaying once again my time to drive and the time on the tarmac.

As a direct result of these two separate fracture incidents I gained two new titanium plates as permanent (and palpable) bodily additions and welcomed, though somewhat initially delayed, doses of entinox and morphine to subdue the immediate pain from the fractures themselves.  After the initial throbbing pain of a fractured bone, which is enhanced by the muscle spasms and contractions that often accompany a break of a major limb bone, the pain starts to wear off to a gentle ache once the limb has been stabilized, protected and padded from any further movement or injury.  Where necessary the bone is reduced to the correct alignment.  The reduction of the bone can, without anesthetic, be as painful as initially fracturing the bone itself.  As indicated above my fractures were treated surgically to correct long-standing problems using metallic alloys fashioned into a sturdy plate screwed onto the bone, which help prevent stress shielding and allow the natural responsive dynamics of bone modelling to continue.  It should be stated here that fractures can also be treated conservatively with limb immobilization and pain relief given whilst the bone heals itself, if a good enough reduction and union can be carried out without the need for surgical intervention.

right humerus fracture 2014 july

Humerous triptych. Pre-surgical and post-surgical fixation with the use of a permanent titanium plate on the right humerus (upper arm) following the pathological fracture I sustained in an accident in July 2014. As a result of having McCune Albright Syndrome, and the associated Polyostotic Fibrous Dysplasia (PFD) disorder where bone tissue is replaced with a fibrous tissues, my skeletal system is weaker than normal with a higher bone cell turnover rate. Pathological lesions in the bone, which can already be naturally deformed in size and shape, can lead to fractures (so-called ‘ground glass’ visual which can be found on x-rays of PFD bone). If reproduced elsewhere please credit as appropriate and inform the author of this blog.

I said it was a long and patient journey because the majority of the time spent waiting to drive was spent silently healing, my head often buried in an article or a book whilst devouring coffee.  It took a long time for the two pieces of the bone shafts to become one again as the callus formed and bridged the fracture site, the woven bone that is initially laid down changing over time to lamellar, or mature, bone.  So much so that in some cases bone fracture sites can be completely remodeled with little noticeable sign of a historic break ever having taken place.  During this time I was shuttled from appointment to appointment as a passenger in my assigned vehicle, wondering what it was like to dictate the journey and the destination, what it was like to take control.

On Starting

You may think that I would be wary of driving due to the above described frailties that my body imposed on my life, but I was ready to go and ready to face the roads of my country.  I was, and remain, eager to explore the freedom of the road alongside the exploration of the idea that that freedom represents in itself .  Many of my friends had started driving at 17 or 18 years old, had passed their tests and then drove aimlessly to gain experience on the roads around the regional towns, only to abandon their cars as they themselves started undergraduate courses at universities in other towns and other cities across the country.  Running a car, and having the money to fund the fuel bill, insurance, road tax and other associated costs, was an expense that many didn’t have and didn’t need at that time in their lives.

I too had started to learn to drive at that age but I soon gave it up, frustrated at the confusing methods used by the teacher and wary of the upcoming femoral fixation surgeries that I faced at that time to limit what appeared to be regular interruptions of forced stillness in my life.  I was happy to ignore the need to drive for another decade or so, not needing to do it for my undergraduate and postgraduate university courses and happy to use the trains and other methods of public transport for work and pleasure.  Indeed I came to love the numerous hours spent commuting to volunteer placements, work, and journeys to see friends and old companions.  It was time to relax, to speak to other passengers, to sit and to read or simply to sit and to stare at the countyside unfolding before me.

As every driver informs every non-driver, the convenience of the car is the epitome of freedom over the strict timetable of public transport.  As an ardent user and lover of the train (the misery of the delay is trumped by the friends made in the carriage and by the regulars who recognize you in turn), I remained somewhat skeptical of this claim.  What I had not counted on, however, was how it actually felt to have that freedom when I drove myself, both for my own pleasure and as a matter of commuting to and from my workplace.  There have been times when I am driving down an empty flyover at 1am with the twinkle of the industrial north to my right and the disappearance of the work office behind me and, as the song I’m listening to reaches its crescendo, I feel somewhat at peace with the world around me.  This is of course the thrill of riding an empty road listening to your favorite music and soaking in every last note sounded and vocal moaned.  But driving with a crowd is different, but it is different for me in particular.

To Drive, To Think

The car, for me, and the act of driving the car, means that I can merge in with the public body at large in a seemingly innocuous manner.  When I walk I use crutches for short distances and, for longer distances, I need and use a manual wheelchair.  As such it is an obvious difference that is noticed immediately on sight, one which signifies that I am different in some significant way from the majority.  I have had, and continue to have, people treat me differently in ways that they would not my friends or family, say by speaking to someone other than to me even when it is I who have raised the question or query, or by treating me in such a way which invokes past experiences of relatives or loved ones in states of profound impairment, despite the fact that my experiences and needs are different; that is in such cases my personal agency as an actor, or individual, with my own views, worries and questions, is abated.  I am viewed as a representative, therefore I am not an individual.  There is no such differentiation between specialized, or adapted, vehicles for the physically impaired, or disabled, individuals on the road compared with ‘normal’ cars – we all flow into the same lane or road.  (The caveat here is, of course, parking bays where disabled bays, alongside mother and child bays, are given proximity priority but I am strictly talking of when the car is in motion).

As such I am intrigued by the possibility of me in the car being treated in a similar manner as to everyone else who is present on the road.  That our actions speak for themselves, rather than the prejudices present on seeing the physical self as a first judgement.

I’ve briefly touched on my own experiences here and a few ideas above, but I want to move forward to acknowledge a few thoughts that have swirled around my mind over the past year or so on the open road.  I have become somewhat intrigued by the notion of driving, and the path of the road, as a cultural symbol and as a personal experience.  As such the following are thoughts, somewhat vague in nature, of driving.

A Marker By The Side

During the first six months of my experience as a driver I passed a personal marker on the road to work, a curve in the dual carriageway where a silent, single fluttering jersey indicated a geographical spot where a young life had been cut short, the car skidding from the road late at night killing one of its two occupants.  The jersey by the side of the road aptly demonstrated both the family’s singular pain and the danger of driving without due regard for the road conditions, a memento of the often tumult path of life.  It acted as a constant reminder for me then, when I saw it throughout the different seasons of the year, and I remember it clearly now in my mind’s eye.  It is easy to be self-contained in a car if you are driving alone, thinking only of yourself and not of the actions that you yourself have on others and those around you.  That the road is open and easy to see.  Yet drivers, especially of cars, can be subdued too easily by the sheltering in the cage of metal and glass.  Too easy it is to shut out both the weather and the sound of the road, too easy to become disconnected from what is in front, to the side, and behind.  Death is the ultimate outcome of driving dangerously or incorrectly, each person who drives should understand that they are both responsible for themselves, any passengers, and for the safety of those of who the car comes near, be it other vehicle drivers or pedestrians.

A friend who rides a motorcycle near year-round has spoken of their wish that each person who learns to drive does so first on a motorbike, where every second must be concerned, and concentrated with, the movement of your bike and your body, where the dangers in the driving blind spot become that much more pronounced as there is no clear boundary or distinction between the body and the tarmac.  It is an interesting idea, I think, and it shows that although the majority of the road users in most countries are car and truck drivers there are different experiences of using the road out there.  That even though we may be all drivers, we do not each experience the same sense of driving or the same sense of security from the vehicles we choose to use to get from A to B.  It is my suggestion that this is the experience of the other in this environment, the one that car and truck drivers must take extra special care for motorcyclists (as well as cyclists) due to the physical differences in the size of the vehicle and the position of the body on top of the vehicle, rather than the notion of what it feels like to be on the inside of it.

Thoughts on Interior vs Exterior

However, within the confines of my personal anthropology of driving, there is also a need to define the personal space within the interior of the car and the exterior public face of the vehicle, i.e. the personalization of the interior as a representation of the identity versus the need to drive responsibly and react accordingly to the changes in weather, traffic density and normal, or exceptional, road hazards.

We have all, for instance, seen the personalized number plates or stickers attached to the exterior surface of cars, or the use of rosary beads dangling from the rear view mirror, possibly signifying a religious connection to Catholicism or perhaps simply a physical item in which to grab and to hold, to reassure and to connect.  These are markers of expressed individual and group identity through the modified material culture of the car, which could be symbolic of the beliefs of the individual and, possibly, an indicator of the nature of their personality, although there must also be a distinction between these leaps and not infer beyond the unreasonable.  These do of course differ dependent on the circumstances.  The cliché of a boy impressing a girl by driving fast is indicative of the use of the vehicle to express dominance or perceived masculinity and not the expression of the material culture of the individual within the car.  There are, as such, different signifiers at work when we consider the expression of identity with regards to vehicle ownership and use (see photograph below).


‘Warning: if you value your life as much as I value this truck don’t mess with it!’. Seen in San Francisco in April 2015. Photograph, taken with a digital camera, by the author. If used elsewhere please credit as appropriate.

So what is in my car?  You can expect to find the odd physio stretching band, placed in the car from before I started to drive so I could exercise the muscles of the right arm on the way to and from work, to regain the majority of the extension of the antebrachium back.  (I have permanently lost the ability to fully extend my arm due to the somewhat intimidating and unnerving bend of the right humerus – it isn’t immediately noticeable, the bend, but when I point it out in person you may be surprised and somewhat horrified at what once was and now what is).  Look into the main storage box and you’ll find a whole heap of CD’s covering a fairly wide range of genres and musical styles, from the cut and thrust of Fugazi‘s 13 Songs to the emotional tape loops of Steve Reich‘s Different Trains and Guitar Counterpoint.  You could probably tell that the CD medium is the one in which I invest the most in for music listening just via the car haul of discs themselves.  I’m forever rotating my classic selection of favoured CD’s with new albums I’ve purchased more recently, such as Joanna Newsom‘s Divers, Godspeed You! Black Emperor‘s Asunder, Sweet and Other Distress, or Sufjan Steven‘s hauntingly beautiful Carrie and Lowell album.  The car, now, has become one of my prime personal music venues, enhanced by the visuals on the road and the acuity of speaker-to-body distance.  The drive to and from work allows for the almost total immersion of sound to radiate around me, to envelope the body and invigorate the mind as I drive.

The expression of music is carried on in the material contents of the car by three or four worn drumsticks perched precariously in the front chair’s backseat pocket.  The drum sticks head and necks are pretty worn away, indicative of their active life beating the various tom toms, snares, and high hats of drum kits across the rehearsal and practice rooms of my home town.  If you dig a bit deeper it is quite possible you may find a roll of film (now I’m really harking back to pre-digital technology!), indicative of the ownership of my beloved cheap Pentax camera, which sometimes finds a temporary home in the car for when I am out and about; it is sometimes paired with my cheaper-still digital camera.  Nestled in the front passenger seat is a battered copy of Will Self’s experimental novel Shark, a copy of which I convince myself I will finish one day.  (Regardless of the growing stack of novels and non-fiction books that mount beside my bed.  Karl Ove Knausgård’s Min Kamp circle of books has taken my recent fancy as well as Janine Di Giovanni‘s more somber documentation of Syria’s ongoing destruction in her book The Morning They Came For Us: Dispatches from Syria).  It is, I think, also an expression of the need to read in down times, where I find myself waiting for one reason or another.

So these are the two big things you may notice in my car – music and books, but what does the car and the road say about us from a non-individual status?  What laws do we follow and why, what are the roads laid out before us and why do we subscribe to a set of nationally, and internationally, prescribed laws?

State Expression

As such it could be highlighted here that the need to observe the rules of the road are, essentially, laid in law by whichever, or whoever, is in control of the land itself.  That is, the road, and the population who drive on that road, are obeying the rules in a manner prescribed by the ruling power and as such act in that way.  This could be a potentially reductionist approach to understanding how countries or cultures approach driving and the road network, however it is also an intriguing area of interest.  Allow me to expound briefly on the above point.  The expression of the state is manifested by the obligation of the driver to obey the rule of the law on the road, whilst the interior environment of the car allows for a personal reflection of the identity via its material culture.  Aligned to this are group identities expressed in this way – they can be cultural, religious, personal, or idiosyncratic in nature.  We’ll take a very quick global tour to explore some of this expressions of individuality within group expression.  I’ll also highlight some of the cultural restrictions placed on car drivers in different countries as it can be easy to think that each country’s laws are similar to one another, but cultural restrictions play an important part in this as a projection of the country’s laws and beliefs.

Road Changes & Cultural Restrictions

Road space rationing is the term used to describe the strategy to limit road users using particular methods of restriction.  These can include methods such as no-drive days, alternate day travel, and general restrictions on road access.  The strategies are used globally as temporary or permanent measures to decrease vehicle use and environmental impact, largely in major cities but also with increasing use in major industrial countries such as China and India.  A similar method to this is the use of car-sharing lanes where privileged road, or lane, access is given to cars containing more than one person as an incentive to cut single person travelling.

In London, England, the permanent Congestion Charge Zone was introduced in 2003 to combat the growing number of vehicles entering the center of the capital city, as a means of cutting down environmental damage and of limiting the sheer volume of traffic.  Bikes, and notorious Boris Bikes, have been particularly targeted as the green and safe way to travel within the city center alongside the extensive public transportation routes.  Transport for London (TfL) have stated that there has been a 10% reduction in vehicle traffic in the decade since the introduction of the congestion charge, which has found favor with a number of residents of the city.  In the capital of France, Paris, a temporary scheme whereby owners of cars with odd or even number plates were not allowed into the city on that particular day or days was in place during a particularly polluted period in 2014.  Temporary measures such as this are largely aimed at immediately cutting smog that threatens, or has, blanketed the city in question.

Other methods include closing down particular routes or roads during particular days.  In São Paulo, Brasil’s biggest city, a normally packed 3.5 km section of the Minhocão highway (nicknamed ‘the Big Worm’) is returned for the use of pedestrians and cyclists only each weekday evening, Saturday afternoons and full Sundays during the summer period.  Whilst Minhocão has been partially closed to vehicles for 26 years, there has been a new movement to close down Avenida Paulista in the city on Sundays as well.  The schemes in São Paulo is used as an urban reclamation of roads, or transportation routes, as a matter to regain urban walkways and increase the use of public transportation and finds similarities with a number of schemes across the globe.  For instance in New York City, USA, the reclamation of the 1.45 km long High Line, an old railroad renovated as an elevated walkway festooned with shrubbery, has seen it become a major attraction within the city itself in its own right.


The car can become symbolic as in this case where it is the icon of a city forever on the move. The New York taxi is one such symbol and if encountered on its home turf is often accompanied by an incessant honking of the horn and the permanent background noise of a thousand ticking engines running over, forever stopping and starting. Photograph, on a digital camera, by the author. If used elsewhere please credit the author as appropriate.

New York City is both famous and infamous for its classic yellow cabs that litter the city.  To any driver from Europe, the roads of American cities can present a challenge as American cities are often built on the grid pattern, much like the ‘new city’ of Milton Keynes in the United Kingdom.  In such a busy and compacted city as New York this invariably means that the traffic never truly gets a chance to flow due to the traffic lights at each and every corner dictating who goes where when.  On a visit to the city that I was lucky enough to have last year I couldn’t help but notice the truly gigantic sounding board that the multi-storied buildings of Manhattan presented as the taxi drivers and drivers throughout the city incessantly honked their horn.  It surprised me, but also moved me in a way I had not expected – I was in the city of the movies, arguably the heart of the country itself in all of its architectural splendor and Freudian intimidation alongside the metaphorical American Dream representations.

As I come to the conclusion of this post I have presented a quick introduction to some of my thoughts, rounding down to international approaches to do with the increase in the number of the drivers and the damage wrought by diesel and petrol hungry engines in city centers, not to mention the natural environment.  Yet there is much more that I feel I ought to write, I haven’t touched on the interesting subculture of young male drivers in the kingdom of Saudi Arabia in which steam is let off by drifting (or Tafheet) and other associated vehicular activities, not the mention the incredibly strict restrictions placed on females in the country (females are forbidden from driving, although this is not illegal per se, it is heavily policed with punishments handed out for females caught driving).  Nor have I mentioned the fascinating subculture of bōsōzoku in Japan, which centers around the customization of cars and motorcycles.

The post describing these subcultures can perhaps wait for another day as this post has reached a fairly substantial length already.

Disengaging the Engine

So those are my brief thoughts on a personal anthropology of driving with a few nods to international views and explorations.  Nothing substantial, just a brief overlay of ideas that percolate through my brain as I slip on my seat belt, engage the engine and accelerate away onto the tarmac before me and into the night ahead of me.

Influences & Further Reading

BBC & British Library Sound Archive. 2015. Noise: A Human History. An Ever Noisier World. Episode 29 of 30. BBC Radio 4.

Martin, D. L., Harrod, R. P. & Pérez, V. R. 2014. Bioarchaeology: An Integrated Approach to Working with Human Remains. New York: Springer.

Robb, P. 2005. A Death In Brazil: A Book of Omissions. London: Bloomsbury Publishing.

Four of A Kind: Body Focused Books

7 Dec

There has been a recent spate of publications that will interest the wide variety of professions that study and work with the human body, and a few that will be of major interest to those in the bioarchaeological and anthropological fields who study both the physical remains of the body and the cultural context that these bodies lived, or live, in.  With the annual Christmas celebrations a matter of weeks away, I’d thought I’d highlight a few publications that could potentially be perfect presents for friends and family members who are interested in the human body, from anatomical inspection to the personal introspection of what my body, and yours, can inform us of ourselves and the world around us…


Cover shots of the four books discussed below.

Adventures in Human Being: A Grand Tour from the Cranium to the Calcaneum by Gavin Francis. London: Profile Books (in association with the Wellcome Collection). 

Having previously read Francis’s book on being a doctor in Antarctica and knowing that he has accrued a wealth of knowledge and experience of treating the body from a medical viewpoint in a wide variety of countries, I was intrigued to see this new publication by him, which focuses on different sections of the body as a jumping off point for the essays in this collection.  I’d recently read Tiffany Watt Smith’s The Book of Human Emotions: An Encyclopedia from Anger to Wanderlust (which, coincidentally, is also published by Profile Books and the Wellcome Collection), which introduces over 150 different human emotions in an exciting combination of psychological, anthropological, historical and etymological mini essays on the human condition.  It was a thoughtful book and made me wonder about how we approach the body in bioarchaeology, whether our lexical terminology isolates and intimidates, frustrates and alienates those who we seek to engage and educate.  The Book of Human Emotions succinctly highlighted what we think is the universal, the standard charge sheet of emotions (anger, fear, joy, love, etc.) that can be found in cultures across the world, is actually not quite the case or clear-cut, and that they can be expressed and felt in different ways.  Francis’s book, I think, will also offer something as equally as thought-provoking.  Known not just for his medical expertise but also for the humanity of his writing, Francis’s exploration of the body, as a story we can each call our own, delves into the medical, philosophical and literature worlds to uncover the inner workings of the human body, in good health, in illness and in death.

Crucial Interventions: An Illustrated Treatise on the Principles and Practices of Nineteenth-Century Surgery by Richard Barnett. London: Thames & Hudson (in association with the Wellcome Collection).

I came across the above book purely by chance whilst out browsing bookstores in York recently and I have to say it is now on my festive wish list.  The medical historian Richard Barnett introduces a publication detailing the knowledge and variety of surgical practices available to the 19th century surgeon, focused largely on the presentation of the technical drawings produced in the era as a precise method for communicating the advancements made in a variety of treatments.  The publication introduces some of the earliest effective surgical techniques for dealing with devastating facial and limb injuries, either from disease processes, traumatic incidents or the outcomes of warfare, and documents the procedures used in re-configuring the body to alleviate the pain and the disfigurement suffered from such injuries and traumas.  It may not be for the faint of heart, but I could see that some modern-day surgeons may be interested to learn of past techniques, the tools and resources that they had, and the importance of always improving and building upon the innovations of the past.

Bioarchaeology: An integrated Approach to Working with Human Remains by Debra L. Martin, Ryan P. Harrod & Ventura R. Pérez. New York: Springer.

For any undergraduate or postgraduate student of archaeology that has a burgeoning interest in biarchaeology as a profession, I’d heavily encourage them (and the department) to get a copy of Bioarchaeology: An Integrated Approach to Working with Human Remains by Martin, et al.  The volume concisely introduces the discipline and outlines the background to it, the theories and methodologies that have informed the theoretical and practical application of bioarchaeology, the current state of play with regards to legal and ethical frameworks, and, finally, the impact and the importance of bioarchaeology as a whole.  The volume also uses invigorating case studies to elucidate the methods of best practice and the impact of the points made throughout the volume.  It is an excellent guide to the discipline and well worth purchasing as a reference book.  Furthermore the volume is now out in paperback and it is very handy to have in your backpack, partly as a one stop reference for any theories or methodologies currently used in bioarchaeology but also as a pertinent remainder of the value of what we do as bioarchaeologists and why we do it.

Theory and Practice in the Bioarchaeology of Care by Lorna Tilley. New York: Springer (Hardback only at the moment).

The post before this one has already detailed the aim and scope of this publication but I feel it is worth highlighting here again.  The bioarchaeology of care, and the associated online Index of Care application, aims to provide the bioarchaeologists with the tools for a case study framework for identifying the likelihood of care provision in the archaeological record by providing four stages of analysis in any individual skeleton exhibiting severe physical impairment, as a result of a disease process or acquired trauma.  The methodology takes in the importance of palaeopathology (the identification and diagnosis, where possible, of pathological disease processes in skeletal remains which has a firm basis in modern clinical data) but also the archaeological, cultural, geographic and economic contexts, to examine whether receipt of care is evidenced.  In the publication Tilley documents and investigates a number of prehistoric case studies, ranging from the Upper Palaeolithic to the Neolithic, and determines the likelihood of care and the type of care that was needed for the individuals under study to survive to their age at death.  The theoretical background and implications, alongside the ethical grounding of the methodology and the concerns in terminology, are also documented at length.  Perhaps most importantly, this is a methodology that is open to improvement and to the use within current and future research projects.  It is also a method that can be used first hand when examining skeletal remains or from the literature itself (where available to a good enough standard).


The above publications are, to me, some of the most interesting that I have seen recently, but I am always on the look out for more.  Please note that the average costs of the books above are within the £10.00-£20.00 range, but prices will vary significantly.  The hardback academic publications can be quite expensive (+ £70), however once the volume is out in paperback the price tends to fall steeply.  If you can recommend anything please let me know in the comments below.

And Finally a Stocking Filler…

The University of Durham is playing host to a one day conference entitled Little Lives, focusing on new perspectives on the bioarchaeology of children, both their life course and their health, for the very fair price of £10.00 on the 30th of January 2016.  The Facebook group for the conference can be found here.  Alternatively contact the conference organizers via the Durham University webpage here to secure a place (something I must do soon!).


Please note that the call for papers date has now passed and that the conference program has now been finalized.

Further Information

  • The Wellcome Trust, which helps operate the Wellcome Collection, is an independent global charity foundation dedicated to improving health by funding biomedical research and medical education.  The charity also has a keen focus on the medical humanities and social sciences, and it recognizes the importance of running educational workshops, programs and outreach events.  Find out more information on the charity here.

aRNA: A Helpful Friend In Palaeopathology?

20 Dec

It is another quick post from me highlighting another researcher’s work but it is one well worth reading!  Over at So Much Science, So Little Time researcher Dr Kristin Harper has highlighted an intriguing possibility on the direction for the future of palaeopathology.

What is aRNA?

Harper’s post highlights the possible value of aRNA ( ancient Ribonucleic acid) in the investigation of viruses (think influenza and coronaviruses such as SARS) in past human populations in her post on the ability of researchers being able to obtain aRNA samples from 700 year old maize samples.  RNA performs a variety of important functions in the coding, decoding, regulation and expression of genes; essentially RNA acts as the messenger which carries instructions from DNA (Deoxyribonucleic Acid) for controlling the synthesis of proteins in living cells.  DNA itself is the molecule that encodes the genetic instructions that are used in the development and functioning of all known living organisms (including many viruses) however, unlike DNA, RNA is composed of shorter single strands of nucleic acids.  This has made it particularly vulnerable to degradation in archaeological contexts.

The best place to search for evidence of aRNA strands in the human skeleton in an archaeological context would be in the dental pulp cavity, specially the molar teeth.  This seems to be the place where diagenesis  has the least effect on the human skeleton due to both the tough enamel coating found in human teeth and the tooth sockets themselves being fairly protected inside the mandible and maxilla, which is where cortical bone is often dense due to the biomechanics of mastication (Larsen 1997).

I should point out here that the area of genetics is not my specialty but it is an area of inherent interest for me, especially in its applications to palaeoanthropology and palaeopathology.

Why Could This Be Important?

The foundations of palaeopathology are built on the observed changes in human skeletal material and palaeopathology itself often specifically focuses on markers of stress or trauma that can be found in the macro or micro skeletal anatomy.  As a consequence of this many diseases (and indeed traumas) are ‘invisible’ in the archaeological record as they leave no marker of note on the skeleton itself.  The diseases and syndromes that do leave a lesion (which can include blastic and/or lytic lesions) are often said to leave pathognomonic lesions that are, at a basic level, an indicator of the disease or infection processes behind the bone change.

So, as you can imagine, quite often in human osteology we have a ‘healthy’ skeleton of an individual that has died at such and such an age but with no obvious cause of death.  In essence we have the osteological paradox, where those who do contract a disease and die shortly afterwards leave no evidence of bone lesions (or trace of the cause of death) in comparison to individuals who do have severe pathological bone changes but have evidently lived long enough for the disease itself to alter the skeletal architecture; it is, in short, the question of discerning the health of a past population (Larsen 1997: 336).  This is a simplified version of the osteological paradox, a discussion outlining the paradox and it’s full implications and discussion points can be found in Woods et al.’s (1992) article (available online here).

This can have serious effects on our estimates of disease prevalence in history and prehistory, especially in the cases of viruses as they can often kill quickly and leave no skeletal marker.  However because they are cells that were once alive they do leave behind evidence of traces of aRNA.  So any new methodology of being able to extrapolate aRNA of past infections from human skeletal material is welcome as this could potentially open up new insights into past populations and population dynamics.

Further Information


Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour From The Human Skeleton. Cambridge: Cambridge University Press.

Woods, J. W., Milner, G. R., Harpending, H, C. & Weiss, K. M. 1992. The Osteological Paradox: Problems of Inferring Prehistoric Health from Skeletal Samples. Current Anthropology. 33 (4): 343-370. (Open Access).

Dental Delights and Disability in Archaeology

26 Mar

I’ve recently had the joy of a dealing with a dental abscess affecting the left hand side of my mandible, and whilst I’m thankful for modern medicine I can only imagine the pain and frustration for pre-modern populations suffering with such an infection, especially those who didn’t have access to antibiotics and strong painkillers.  As such I haven’t posted properly for a while, and it might be a bit longer before I do.  Having had surgery to relieve the effect of the swelling and to drain the infection and remove two pesky teeth (with added complications courtesy of Fibrous Dysplasia), I’m once again learning how to chew (farewell 1st and 3rd left mandibular molars!).  It has also given me the time to think about the role of disability in the archaeological record and how it is approached by modern-day researchers.  What follows below is a very quick and brief overview of the main points of how disability has been approached in the archaeological sector and the changes therein.  Articles of interest are noted in the bibliography.

Dettwyler famously wrote a paper entitled ‘Can paleopathology provide evidence for compassion‘ (1991: 375-384, PDF embedded) that rightly questioned the interpretations of archaeologists and osteologists on the inferred aspects of care and compassion that disabled individuals from the archaeological record may or may not have received during their lifetimes.  The author cautioned that archaeologists and researchers are not ‘justified in drawing conclusions either about quality of life for disabled individuals in the past or attitudes of the rest of the community from skeletal impairment of physical impairment’ (Dettwyler 1991: 375).  This was a much-needed wake up call, and rightly raised questions in the realms of archaeology and palaopathology regarding how we viewed individuals, and how we analysed them.

The majority of disability studies before the Dettwyler (1991) article focused on disabled individuals as case studies, reported in journals and rarely integrated or investigated as part of the society or cemetery population they may belonged to.  Mays (2012) rightly investigated the impact of the relative value of individual case studies compared to quantitative and problem orientated population studies, and found that although the publishing gap had lessened between the two types, singular case studies still predominated.  Mays (2012) main contention is that individual case studies do little to further the advance of palaeopathology, something which Larsen (1997) effectively demonstrates throughout his book and review (2002), in the consideration of how palaeopathology can indicate society or cultural wide rituals, actions or lifestyles.

Since the publication of the Dettwyler paper there has been a slew of articles, journals and books dedicated to researching disability as evidenced from the skeletal and archaeological record, both from a bioarchaeological perspective and from a theory perspective (Battles 2011, Brothwell 2010, Hawkey 1998, Kleinman 1972, Vilos 2011, Wood et al. 1992).  Indeed the study of disability and the implications for affected individuals, their communities and societies, has moved on considerably since the descriptive days of Calvin Wells, especially in the consideration of the theory of ‘compassion’ as an evolutionary force in the primate family (Hublin 2009, Stewart et al. 2012), or as evidenced in other mammals (Fashing & Nyuyen 2011).

This is in accordance with the rise and debate of disability theory and studies in numerous other disciplines.  This has had real life applications in many areas of modern-day life, where multi-agented approaches to understanding,  recognising and implementing programs that are designed to raise awareness or life quality for disabled individuals.  Two prominent examples from the UK are the 2005 Disability Discrimination Act and the 2010 Equality Law where disability itself is given a legal definition, and here we come to a prominent problem in the archaeological and palaeopathological record itself.

Disability, as we would recognise it today, can mean both a physical and/or a mental impairment that can be substantial and lifelong, and it is worth noting some problems inherent in the archaeological record.  Firstly, in the archaeological record, we can only recognise physical disability when it has affected the skeletal remains of individuals, normally at a late and severe stage in the disease progression (Aufderheide & Rodriquez 1998, Waldron 2009, Wood et al. 1992).  As such, a large number of individuals with diseases or traumatic injuries that only affected the flesh will go unknown, and as such are unstudied.  Secondly, there is no universal or standard definition of disability that archaeologists and researchers use, it is solely up to the person/persons to define clearly and openly which definition they are using at the outset of their research (and there are a lot of definitions and models depending on which source you base your definition on).  Thirdly, the usage of terminology itself, such as the very word disability, can have vastly different connotations or implications for different populations and cultures (Battles 2011).

There may have been distinct differences as to who was considered disabled or not in historic and prehistoric cultures, and we should, as researchers, always be aware of observer bias ourselves (Dettwyler 1991).  As such researchers should always be clear who they are addressing, and the possible differences highlighted, where evidence is available, as to how a disabled person was treated within their culture when archaeological or cultural evidence is available.

To complicate the matter further is the ‘osteological paradox‘, as highlighted by Larsen (1997), Woods et al. (1992) and Wright & Yoder (2003) amongst others, which heavily influences the health status of skeletal remains that survive and that are then studied.  Therefore it should always be understood that no skeletal sample is entirely representative of their population, that there are many caveats (Hahn 1995, Roberts 2000).

Battles (2011) highlighted the need to move towards a more holistic approach to disability, to take advantage of different fields (including physical anthropology, sociocultural anthropology, experimental studies and archaeology itself) to understand disability at archaeological sites and affected individuals, to a model that integrates the data and insight of the various fields.  In particular Battles (2011) makes the salient point of noting the individuals  (largely females and sub-adults) that historically have been under-studied in archaeological and population analyses.

An important methodological update has been the advancement of a ‘Bioarchaeology of Care‘, as espoused by Tilley & Oxenham (2011), where a four stage assessment of an individual produces an assessment of the care needed for the disabled individual found in a Neolithic Vietnam community.  The stages are: (1) describing,  diagnosing and documenting the individual and site, (2) identify the clinical/functional impacts of disease or trauma, and determine if care was needed, (3) produce a model of care, and finally (4) interpret the implications for the individual and society, as well as possible indications for the identity and nature of both (Tilly & Oxenham 2011: 36).  It could be argued that other researchers have espoused the same sentiments (Roberts & Manchester 2010, Vilos 2011), but it is the clear initiation of the applying the model to individuals who fit the criteria that will hopefully produce further studies and elicit meaningful result which highlight this recent study as one to watch.  The Tilley & Oxenham (2011) model is particularly useful for prehistoric cases where there are no written or documentary sources.

Hawkey’s (1998) study of musculoskeletal markers (MSM’s) of a disabled individual from a New Mexico Pueblo culture highlighted the worth of applying existing osteological techniques to disabled individuals in order to assess the quality of bodily movement.  The modelling of the movement capable for this individual suggested that bodily manipulation, feeding, and the cleaning of this person was likely carried out by members of his culture (possibly family relatives, although this is conjecture) due to the severity of his disability (Hawkey 1998: 330).  Craig & Craig (2011) make extensive use of modern medical imaging to diagnosis a specific disease (fibrous dysplasia) in the case of a sub-adult from an English Anglo-Saxon site.  The striking bone expansion in the mandible is discussed within the social sphere of the community that the individual belonged.  The implications, via the the inference of position of the body within the grave, grave goods and grave location, and studies into Anglo-Saxon culture and social stratification give rise to the theory that the individual was not treated any differently due to his disability, although it is unknown if the disease led to the early demise of the individual (Craig & Craig 2011: 3).

Craig & Craig’s (2011) case study, and the above studies, highlight the use of modern medical literature and imaging technology in establishing a likely disease diagnosis, yet Brothwell (2010) rightly highlights the dangers of the differential diagnosis of diseases in skeletal remains at a macroscopic level.  Waldron’s (2009) palaeopathology handbook presents an ideal source on how to identify diseases that can lead to disability, but highlights the value of the differential diagnosis when the osteologist cannot be exactly sure of the disease.

The battery of scientific techniques used in archaeological investigations, including aDNA analysis, trace chemical analysis, and isotopic analysis amongst others, have become significantly refined within the past two decades, and are now allowing for a more nuanced understanding of individual and population dynamics (Brown & Brown 2011).  This includes the ability to analysis the movement of a person in a landscape within their lifetime (Marstellar et al. 2011), and to understand the changes in diet and the effects of diet on the body (Larsen 1997, Roberts 2000, Roberts & Manchester 2010). It also includes the ability to indicate the likely exposure of populations to various chemicals and diseases (Barnes et al. 2011), and exploration of how social structure (Bentley et al. 2012), and hence the role of the population or of the individual, changed through time.

Perhaps what the above studies cannot show, especially in prehistoric societies, are the actions of the disabled individuals themselves.  It is most likely that we will never know if they took an active interest in their society, if they took part, or how they felt as disabled individuals, or even if they saw themselves as disabled (Battles 2011, Hahn 1995).  Compassion  itself cannot be excavated (Dettwyler 1991), but with careful examination of the available evidence results can be produced that suggest that severely disabled individuals did survive past natural limitations.

The progress continually being made in the hard sciences and in the humanities continues to advance our knowledge of past populations via their skeletal remains and their cultural context.  The understanding of disability within an archaeological and osteological context provides the opportunity to investigate of how individual’s survived, and whether care was a key component (Hawkey 1998, Kleinman 1978, Tilley & Oxenham 2011).  This is a burgeoning area of bioarchological research, and when combined with a multidisciplinary approach, it opens up a wide range of interesting and diverse approaches and avenues.

Case Studies, Theories and Further Information:

Full articles are linked where possible, although a number hide behind Journal pay walls.

Aufderheide, A. C. & Roderiquez-Martin, C. 1998. The Cambridge Encyclopedia of Human Palaeopathology. Cambridge: Cambridge University Press.

Barnes, I., Duda, A., Pybus, O. G. & Thomas, M. G. 2011. Ancient Urbanization Predicts Genetic Resistance to Tuberculosis. Evolution. 65 (3): 842-848.

Battles, H. 2011. Toward Engagement: Exploring the Prospects for an Integrated Anthropology of Disability. Explorations in Anthropology. 11 (1): 107-124.

Bentley, R. A., Bickle, P., Fibiger, L., Nowell, G. M., Dale C. W., Hedges, R. E. M., Hamiliton,. J., Wahl, J., Francken, M., Grupe, G., Lenneis, E., Teschler-Nicola, M., Arbogast, R-M., Hofmann, D. & Whittle, A. 2012. Community Differentiation and Kinship Among Europe’s First Farmers. Proceedings of the National Academy of Sciences Early Edition. 1-5. (Early View).

Brothwell, D. 2010. On problems of Differential Diagnosis in Palaeopathology, as Illustrated by a Case from Prehistoric Indiana. International Journal of Osteoarchaeology. 20: 621-622.

Brown, T. & Brown, K. 2011. Biomolecular Archaeology: An Introduction. Chichester: Blackwell Publishing.

Churchill, S. E., Franciscus. R. G., McKean-Peraza, H. A., Daniel, J, A. & Warren, B. R. 2009. Shanidar 3 Neandertal Rib Puncture Wound and Palaeolithic Weaponry. Journal of Human Evolution. 57: 163-178.

Craig, E. & Craig, G. 2011. The Diagnosis and Context of a Facial Deformity from an Anglo-Saxon Cemetery at Spofforth, North Yorkshire. International Journal of Osteoarchaeology. (Early View doi: 10.1002/oa.1288).

Dettwyler, K. A. 1991. Can Palaeopathology Provide Evidence for “Compassion”? American Journal of Physical Anthropology. 84: 375-384.

Fashing, P. J. & Nguyen, N. 2011. Behaviour Towards the Dying, Diseased, or Disabled Among Animal and its Relevance to Palaeopathology.  International Journal of Palaeopathology. 1: 128-129. 

Hahn, R. A. 1995. Sickness and Healing: An Anthropological Perspective. New Haven: Yale University.

Hawkey, D. E. 1998. Disability, Compassion and the Skeletal Record: Using Musculoskeletal Stress Markers (MSM) to Construct an Osteobiography from Early New Mexico. International Journal of Osteoarchaeology. 8: 326-340.

Hublin, J. J. 2009. The Prehistory of Compassion. Proceedings of the National Academy of Sciences. 106 (16): 6429-6430.

Kleinman A. 1978. Concepts and a Model for the Compassion of Medical Systems as Cultural Systems. Soc Sci Med. 12: 85-93.

Knusel, C. J. 1999.  Orthopaedic Disability: Some Hard Evidence. Archaeological Review Cambridge. 15: 31-53.

Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour from the Human Skeleton. Cambridge: Cambridge University Press.

Larsen, C. S. 2002. Bioarchaeology: The Lives and Lifestyles of Past Peoples. Journal of Archaeological Research. 10 (2): 119-166.

Marstellar, S. J., Torres-Rouff, C. & Knudson, K. J. 2011. Pre-Columbian Andean Sickness Ideology and the Social Experience of Leishmaniasis: A Contextualised Analysis of Bioarchaeological and Palaeopathological Data from San Pedro de Atacama, Chile. International Journal of Palaeopathology. 1 (1): 23-34.

Mays, S. 2012. The Impact of Case Reports Relative to Other Types of Publication in Palaeopathology. International Journal of Osteoarchaeology. 22: 81-85.

Roberts, C. A. 2000. ‘Did They Take Sugar? The Use of Skeletal Evidence in the Study of Disability in Past Populations’. In Hubert, J. (ed) Madness, Disability and Social Exclusion: The Archaeology and Anthropology of Difference. London: Routledge. 46-59.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease. Stroud: The History Press.

Stewart, F.A., Piel, A.K., O’Malley, R.C., 2012. Responses of Chimpanzees to a Recently Dead Community Member at Gombe National Park, Tanzania. American Journal of Primatology. 74: 1–7.

Tilley, L. & Oxenham, M. F. 2011. Survival Against the Odds: Modelling the Social Implications of Care Provision to the Seriously Disabled. International Journal of Palaeopathology. 1 (1): 35-42.

Vilos, J. D. 2011.  Bioarchaeology of Compassion: Exploring Extreme Cases of Pathology in a Bronze Age Skeletal Population from Tell Abraq, U. A. E. Master’s Dissertation. Las Vegas: University of Nevada.

Waldron, T. 2009. Palaeopathology. Cambridge: Cambridge University Press.

Wood, J. W., Milner, G.R., Harpending H. C., & Weiss, K. M. 1992.  The Osteological Paradox: Problems of Inferring Prehistoric Health from Skeletal SamplesCurrent Anthropology 33:  343-370.

Wright, L. E. & Yoder, C. J. 2003.  Recent Progress in Bioarchaeology: Approaches to the Osteological ParadoxJournal of Archaeological Research 11 (1): 43-70. (**An extensive bibliography of articles can be found in the bibliography of this article**).

Infectious Disease Part 2: Malaria and Associated Anaemic Conditions

5 Oct

This second post, and the first part, deal with biomolecular approaches and research studies in detecting  the presence of infectious diseases in human bone from archaeological material.  The recent coming of age of biomolecular techniques, as applied to archaeological material, has provided a rich and complex source of information in helping to uncover how infectious diseases spread in the historic and prehistoric past.  The second post, here, describes recent research focused on Malaria and associated anaemic conditions, including Sickle Cell Anaemia and Thalassaemia.  The first post can be found here.


It has long been realised that malaria can only be recognised in skeletal remains via indirect evidence of presentation of the following pathological lesions- porotic hyperostosis, cribra orbitalia and marrow hypertrophy- which are taken as evidence of the presence of anaemia, the main contributor of mortality in malarial victims (Roberts & Manchester 2010).  However there is no pathognomonic bone lesion for either Plasmodium vivax or P. falciparum, the main human species of malaria causing Plasmodium genus  (Gowland & Western 2012: 303, Roberts & Manchester 2010: 233), and the above skeletal lesions have varying aetiologies including anaemia, osteitis, parasitic infection, and other interrelated deficiency diseases which are still not clearly understood (Gowland & Western 2012: 302).  To securely diagnose malaria in skeletal material, DNA identification of the Plasmodium genus must take place, and even then current Polymerase Chain Reaction (PRC) tests ‘do not appear to be able to amplify routinely the DNA of malaria pathogens from ancient bones’ (Gowland & Western 2012: 302).

Recent immunological techniques to identify antigens have also been used to isolate and identify P. falciparum, although false positives can occur as a result of contamination or diagenetic factors(Gowland & Western 2012: 302).  Gowland & Western (2012) have recently proposed a spatial epidemiological model for malarial spread in Anglo-Saxon England, which highlights the re-surging interest in malaria in the modern context as well as one affecting a past population.  This holistic approach used GIS data with diagnosed porotic hyperostosis in skeletal remains, mosquito (Anopheles atroparvus) habitat information and historical data in presenting a locality data set for malaria infected individuals (Gowland & Western 2010: 304-305).  The modelling of palaeopathological, climatic, and historical data, provides new information on disease range, mechanism of transmission, and infection localities.  However, there are also complicating factors in assessing and diagnosing malaria from other diseases, as noted below (Roberts & Manchester 2010: 234).

Particularly important are two inherited haemolytic anaemia’s, thalassaemia and sickle-cell anaemia, who are characterised by abnormal haemoglobin and increased destruction of red blood cells (Jurmain et al. 2011: 312, Roberts & Manchester 2010: 232).  Thalassaemia is a genetically determined disorder which is caused by a ‘problem of haemoglobin synthesis’ (Roberts & Manchester 2010: 233).  This results in failure or depression of synthesis of the chain, this leads to pale cells with low hemoglobin content which are then rapidly destroyed once formed.  There are three grades of the disease, minor, intermediate and major, the last of which includes severe anemia and possible bone changes; the range of the disease is typically centered in the Mediterranean, Middle East and Far East (Roberts & Manchester 2010: 233).  The importance is that it is seen as an adaptive response to malaria infection through the development of this heritable disease; that the high red blood cell turnover stalls and negates any effect of malarial infection.  Archaeological evidences comes from Greek, Turkish and Cypriot populations deriving from marshy contexts, which are ideal breeding grounds for mosquitoes, the prime vector for malaria (Roberts & Manchester 2010: 233).

Sickle-cell anaemia occurs as a result of the deformation and destruction of red blood cells which leads to over enlargement of bony centres (centered on the skull, pelvis, vertebrae) and over-activity of marrow production as the body produces more red blood cells (Waldron 2009).  This inheritable disease range is mainly located in Central and Eastern African populations who have high rates of the disease, but also affects Indian, Middle Eastern, and Southern European populations (Roberts & Manchester 2010: 234).  Jurmain et al. (2011: 312) remark that the sickle-cell allele hasn’t always been effective in malarial negation in human populations, and primarily came to prominence during the advent of agriculture, and in particular during the last 2000 years in Africa.  The origin of the mutation of the allele responsible, HB5 in haemoglobin, has been dated to 2100 to 1250 years ago in African populations (Jurmain et al. 2011: 312).  Although malaria infection has only relatively recently affected human populations, it has become a powerful selective force that still affects large portions of the world’s population today.

In conclusion, biomolecular approaches to archaeological and osteological remains are vital in unraveling past populations and the natural world (Jurmain et al. 2011).  The interactions between wild and domesticated animals, humans, insects and the environment are a prerequisite for understanding the mode of transmission and virulence of infectious diseases (Barnes et al. 2011, Gowland & Western 2012, Jurmain et. al 2011).  Yet, we must take into consideration the difficulties in understanding infectious disease; examples of the osteological paradox are ever present, understanding the aetiology of bone changes, and the context of genetic differences between populations must be noted whilst PCR amplification, aDNA detection and genome explorations methods must be continually improved for clearer results (Li et al. 2011, Schurch et al. 2011, Spigelman et al. 2012, Tran et al. 2011); this approach must be multidisciplinary in understanding past and present populations (Jurmain et al. 2011, Roberts & Manchester 2010, Waldron 2009).

The modern world has changed, and the boundaries that once protected various human populations has changed dramatically with cheap air travel and vast population movement; this is unprecedented in both history and prehistory, and in population density and scale, but also at the genetic level in human genetic variation (Hawks et al. 2007, Jurmain et al. 2011: 311).  The eradication of smallpox, the Bill and Melinda Gates foundation in fighting malaria, and the ongoing WHO (World Health Organisation) case against polio (Branswell 2012: 50) are strong examples of what can be achieved worldwide.  By building a past population profile of the effects of infectious disease, we are better prepared for the fight tomorrow.


Barnes, I., Duda, A., Pybus, O. G. & Thomas, M. G. 2011. Ancient Urbanization Predicts Genetic Resistance to Tuberculosis. Evolution. 65 (3): 842-848.

Branswell, H. 2012. Polio’s Last Act. Scientific American. 306 (4): 50-55.

Gowland, R. L., & Western, A. G. 2012. Morbidity in the Marshes: Using Spatial Epidemiology to Investigate Skeletal Evidence for Malaria in Anglo-Saxon England (AD 410- 1050). American Journal of Physical Anthropology. 147: 301-311.

Hawks, J., Wang, E. T., Cochran, G. M., Harpending, H. C. & Moyzis, R. K. 2007. Recent Acceleration of Human Adaptive Evolution. Proceedings of the National Academy of Sciences. 104 (52): 20753-20758.

Jurmain, R., Kilgore, L. & Trevathan, W. 2011. The Essentials of Physical Anthropology, International Edition. Belmont: Wadsworth.

Li, Y., Carroll, D. S., Gardner, S. N., Walsh, M. C., Vitalis, E. A. & Damon, I. K. 2007. On the Origin of Smallpox: Correlating Variola Phylogenics with Historical Smallpox Record. Proceedings of the National Academy of Science. 104 (40): 15787-15792.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease. Stroud: The History Press.

Schurch, A. C., Kremer, K., Kiers, A., Daviena, O., Boeree, M. J., Siezen, R. J., Smith, N. H., & Soolingen, D. V. 2010. The Tempo and Mode of Molecular Evolution of Mycobacterium Tuberculosis at Patient-to-Patient Scale. Infection, Genetics and Evolution. 10 (1): 108-114.

Spigelman, M., Shin, D. H., & Gal, G. K. B. 2012. The Promise, the Problems and the Future of DNA Analysis in Palaeopathology Studies. In Grauer, A. L. (ed). A Companion to Palaeopathology. Chichester: Blackwell Publishing Ltd.  pp.133-151.

Tran, T., Aboudharam, G., Raoult, D., & Drancourt, M. 2011. Beyond Ancient Microbial DNA: Nonnucleotidic Biomolecules for Palaeomicrobiology. BioTechniques. 50: 370-380.

Waldron, T. 2009. Palaeopathology. Cambridge: Cambridge University Press.

Infectious Disease Part 1: Treponemal Disease & Smallpox

5 Oct

The following two posts deal with biomolecular approaches and research studies in detecting the presence of infectious diseases in human bone from archaeological material.  The recent coming of age of biomolecular techniques, as applied to archaeological material, has provided a rich and complex source of information in helping to uncover how infectious diseases spread in the historic and prehistoric past.  Whilst it has help clear some mysteries up, it has unleashed others.  The first post, here, describes recent research focused on Treponemal diseases (including Yaws, Syphilis and Pinta) and Smallpox.  The second post can be found here.


Treponemal Diseases

Roberts & Manchester (2010: 216) note that infectious diseases are ‘not solely microbiological entities but are a composite reflection of individual immunity, social, environmental, and biological interaction’.  The study of treponemal disease, in particular, is fraught with controversy and stigma, both in the modern and historical contexts (Lucas de Melo et al. 2010: 1, Roberts 2000), and in the nature of its spread and transmission.  However the combination of molecular pathology, phylogenetics, and palaeopathological studies, are helping to produce a clearer genetic origin of the disease and the impacts that this disease had, and continues to have, on the world at large (Hunnius et al. 2007: 2092).  Typically the bacterial diseases of the genus Treponema are split into different forms; pinta (T. carateum), yaws (T. pallidum subspecies pertenue), endemic syphilis (T. pallidum subspecies edemicum) and venereal/congenital syphilis (T. pallidum subspecies pallidum) (Table 1; Lucas de Melo et al. 2010: 2).  The four forms were, until recently, indistinguishable in physical and laboratory characteristics (Roberts & Manchester 2010: 207), whilst the pinta strand does not affect bone (Waldron 2009: 103).  DNA analysis of the bacteria of venereal syphilis has shown a difference between it and the non-venereal types; although it is noted that there is no change in the clinical presentation of the disease (Roberts & Manchester 2010: 207).

Table 1. Geographic location, transmission and whether bone is affected for treponemal disease (after Waldron 2009: 103).

Yaws was likely the first disease to emerge, probably from an ape relative in Central Africa, whilst the endemic form of syphilis derived from an ancestral form in the Middle East and the Balkans at a later date, whilst T. pallidum was the last to emerge, probably from a New World progenitor, although the issue is still highly contentious (Roberts & Manchester 2010: 212, Waldron 2009: 105).  Gaining virulence at a dramatic rate in the 15th and 16th centuries AD in Europe, venereal syphilis affected a large section of the population due to its mode of transmission.  It should be noted, however, that bone changes in syphilis are rare in the early stages but common in the tertiary stage of the disease (Roberts & Manchester 2010).  It has also been noted that there could be a back and forth transmission, from one treponemal disease to another, within intra-population groups changing from one environment to another; that ultimately it’s possible that each social group, or population, has its own treponemal disease suited to its ‘geographic and climatic home and its stage of cultural development’ (Roberts & Manchester 2010: 213).

However, this infectious disease, in its venereal form, is particularly hard to locate and identify in archaeological populations; the limitations of biomolecular palaeopathology have become clear (Bouwman & Brown 2005: 711, Hunnius et al. 2007, Lucas de Melo et al. 2010: 10).  Bouwman & Brown’s (2005) experiment, and Hunnius et al. (2007) subsequent paper, have highlighted the difficulties in amplifying T. pallidum subspecies T. pallidum, even in highly suspected bone samples.  Bouwman & Brown (2005: 711) tested 9 treponemal samples using the Polymerase Chain Reaction (PCR) tests, optimized to highlight ancient treponemal DNA.  This resulted in poor amplification of  treponemal ancient DNA (aDNA) from human bone, even with bone of varying origins (geographic, social and climatic samples).  3 outcomes where postulated; the bones were either not suitable for aDNA retrieval, treponemal aDNA was present but the PCR was not sensitive enough to be pick it up, or there was no treponemal DNA in the bones (Bouwman & Brown 2005: 711-712).  Subsequent investigations and phylogenetic approaches have highlighted that the disease invades different parts of the body at impressive rates, but in the later stages of the disease, the organism’s DNA is not present in the actual bone itself, just at the stage when an osteologist can identify it macroscopically (Hunnius et al 2007: 2098).  Phylogenetic evidence supports evidence of variations in the virulence of syphilis, and the support of a more distant origin, possibly around 16,500 to 5000 years ago, but where exactly remains unsolved (Lucas de Melo et al. 2010: 2).  Interestingly, in the early 20th century P. Vivax (the main causer of malaria) was used as a treatment for patients with neurosyphilis in a procedure by the physician Julius Wagner-Jauregg; it was injected as a form of pyrotherapy to introduce high fevers to combat the late stage syphilitic disease by killing the causative bacteria (Wagner-Jauregg 1931).


The Smallpox virus is particularly devastating and disfiguring disease, but thankfully no longer an active infection in the modern world (Manchester & Roberts 2010: 180).  Although kept only in laboratory samples now, there is an ongoing concern regarding whether it could be a danger to modern archaeologists dealing with infected material (Waldron 2009: 110).  The disease, once contracted, either leads to recovery with lifelong immunity or death.  The severe form is called variola major and is documented in the Old World with a 30% death rate once contracted, whilst its less virulent form, named variola or alastrim minor, is found in Central America and has a mortality rate of 1% (Hogan & Harchelroad 2005, Li et al. 2007: 15788).  Smallpox, the strictly human variola virus pathogen, is found in literature and documentary records during the last 2000 years (Larsen 1997), yet an osteological signature is not present or identifiable in infected individuals (Waldron 2009: 110).  Therefore to find out the origins of the disease, Li et al. (2007) used correlated variola phylogenetics with historical smallpox records to map the evolution, origin and transportation of smallpox between human populations.

Li et al. (2007: 15787) state that no credible descriptions of the variola virus have been found on the American continent or sub-Saharan Africa before the advent of westward European exploration in the 15th century AD; suggesting that with European exploration and expansion came the virulent waves of smallpox that helped to decimate the existing Native American populations, who previously had no contact or natural immunization with such a highly virulent disease.  It is worth noting here the disease has been used in warfare as a chemical weapon surprisingly early.  During the 18th century American colonial wars between the French, British and the Native Americans, the British forces stationed in America actively infected items of clothing that were given to the Native population to help aid the spread of the disease among the Native Americans , who at that time were largely allied to the French.  This weakened the Native American population dramatically during the various colonial wars and subsequent colonial expansion westward; it’s estimated nearly half of the American Native population died from smallpox alone and its naturally rapid commutable spread of smallpox through human populations (Hogan & Harchelroad 2005).

Li et al. (2007: 15787) note that there are ambiguous gaps in the evolution of smallpox disease itself however.  Li et al. (2007) initiated a systematic analysis of the concatenated Single Nucleotide Polymorphisms (SNP’s) from the genome sequences of 47 variola major isolates from a broad geographic distribution to investigate its origins.  Variola major has a slowly evolving DNA genome, which means a robust phylogeny of the disease is possible (Hogan & Harchelroad 2005).

Firstly, the results showed that the origin of variola was likely to have diverged from an ancestral African rodent–borne variola like virus, either around 16,000 or 68,000 thousand years ago dependent on which historical records are used to calibrate the molecular clock (East Asian or African) (Li et al. 2007: 15791).  Taterapox virus is associated with terrestrial rodents in West Africa, and provides a close relationship with the variola virus.  It is entirely possible that variola derived from an enzootic pathogen of African rodents, and subsequently spread from Africa outwards (Li et al. 2007: 15792).  Secondly, evidence points towards two primary clades of the variola virus, both from the same source as above, but each represent a different severity and virulence of the variola virus.

The first primary clade is represented by the Asian variola major strains, which are the more clinically severe form of smallpox;  the molecular study of its natural ‘clock’ suggests it spread from Asia either 400 or 1600 years ago (Li et al. 2007: 15788).  Included in this first primary clade is the subclade of the African minor variation of the main Asian variola major disease.  The second primary clade compromises two subclades, of which are the South American alastrim minor and the West African isolates (Li et al. 2007: 15788).  This clade had a remarkably lower fatality rate in comparison to the above clade.  The importance of phylogeny analysis is that it highlights areas of disease prevalence and virulence that can be missed, or indeed entirely absent, from the osteological and archaeological record (Brown & Brown 2011).


Bouwman, A. S. & Brown, T. A. 2005. The Limits of Biomolecular Palaeopathology: Ancient DNA cannot be used to Study Venereal Syphilis. Journal of Archaeological Science. 32: 703-713.

Brown, T. & Brown, K. 2011. Biomolecular Archaeology: An Introduction. Chichester: Blackwell Publishing.

Hogan, C. J. & Harchelroad, F. 2005. Smallpox. Emedicinehealth. Accessed at on the 29th of April 2012.

Hunnius, T. E., Yang, D., Eng, B., Waye, J. S. & Saunders, S. R. 2007. Digging Deeper into the Limits of Ancient DNA Research on Syphilis. Journal of Archaeological Science 34: 2091-2100.

Larsen, C. S. 1997. Bioarchaeology: Interpreting Behaviour from the Human Skeleton. Cambridge: CambridgeUniversity Press.

Li, Y., Carroll, D. S., Gardner, S. N., Walsh, M. C., Vitalis, E. A. & Damon, I. K. 2007. On the Origin of Smallpox: Correlating Variola Phylogenics with Historical Smallpox Record. Proceedings of the National Academy of Science. 104 (40): 15787-15792.

Lucas de Melo, F., Moreira de Mello, J. C., Fraga, A. M., Nunes, K. & Eggers, S. 2010 Syphilis at the Crossroad of Phylogenetics and Palaeopathology. PLoS Neglected Tropical Diseases.4 (1): 1-11.

Mitchell, P. 2003. The Archaeological Study of Epidemic and Infectious Disease. World Archaeology. 35 (2): 171-179.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease. Stroud: The History Press.

Wagner-Jouregg, J. 1931. Verhutung und Behandlung der Progressiven Paralyse durch Impfmalaria.  Handbuch der Experimentellen Therapie, Erganzungsband Munchen.

Waldron, T. 2009. Palaeopathology. Cambridge: Cambridge University Press.

‘The Bioarchaeology of Care’: A Case Study From Neolithic Vietnam (Tilley & Oxenham 2011)

29 Jan

A recent article in the International Journal of Palaeopathology, ‘survival against the odds: modelling the social implications of care provision to seriously disabled individuals’ by Tilley & Oxenham (2011), has proposed a new methodology (the ‘bioarchaeology of care’) highlighting the functional impacts of pathologies, possible and probable health challenges encountered, and the nature of support required to sustain life for disabled individuals in the archaeological record.  Make no mistake- this is a bold, interesting and arresting improvement in the field of palaeopathological studies.

Man Bac Burial 9 (Tilley & Oxenham 2011: 37)

The focus of the investigation is the individual called Man Bac burial 9 (hereafter referred to as M9), from a Neolithic cemetery site (1700-2000BC) located in Ninh Binh province of northern Vietnam, 100km north of Hanoi (Tilley & Oxenham 2011: 36).  Excavations between 1999 & 2007 uncovered 95 individuals, with the site occupying a mouth of an estuary of the Red River Delta.  The archaeological evidence suggests a ‘hunter gather economy’, with a focus on aquatic and terrestrial vertebrate fauna (Tilley & Oxenham 2011: 36).

The individual under study was a  male between 20-30 years old, buried in a north to south flexed position on his right side, in contrast to the normal mortuary practice of extended supine east-west orientation.  The skeleton of M9 exhibits extreme disuse atrophy of the lower and upper limbs (as evidenced by the gracile bones), alongside full ankylosis of all cervical and first three thoracic vertebrae, permanent torticollis, and bilateral temporomandibular joint degeneration; a ‘diagnosis of Klippel Feil Syndrome type III has been proposed’ (Tilley & Oxenham 2011: 36).   It is thought that M9 survived for approximately 10 years with disabilities (minimally paraplegia/maximally quadriplegia) so severe that he relied on assistance for nearly ever aspect of his life.

The methodology identified the context of care for M9, (as above), included reviewing the socio-cultural context, general health, and the Man Bac physical environment.  Next, Tilley & Oxenham (2011: 37) reviewed current clinical literature and split the care needed by M9 into a) basic and b) advanced care.  Basic care consists of the daily necessities of life- dressing, food, water, transport & dressing, whilst advanced care includes maintenance of personal hygiene, managing long term environmental and physical concerns, general health maintenance, dedicated nursing, medical intervention as needed and continued well-being.

Tilley & Oxenham (2011: 40) are right in assessing that it can never be known how the Man Bac society identified and understood illness, but assume that the same basic  physiological responses were the same.  The methodology is still under development, and I look forward to it being applied to further archaeological individuals and cultures (Larsen 1997, Roberts & Manchester 2010).

Ninh Binh (Wikipedia 2012)

My only reservation regarding the methodology and approach of the researchers & archaeologists are the dangers inherent in applying a care scheme (or ‘retrospective attribution of motive’) onto a culture from which we are substantially removed from, both in space and time.  Regarding what is, and what can be classed as a disability, together with differing cultural and world views, means that disability can never be classed easily (Roberts & Manchester 2010).  The ever resourceful IFA have produced a recent paper on employing disabled people, and it helps to  highlight how Britain’s own views on disabilities have, and continue, to change (see this post for the social, medical and charitable models of disability).

Regardless, this is an interesting and much-needed review of how disabled individuals are examined in a cultural context.  The use of modern clinical data alongside the environmental, archaeological and palaeopathological evidence is well presented, and produces interesting results whilst making the best use out of available evidence.  On the last note, it is noted that the cultural values exhibited & recorded are key in giving a partial insight into the life and care of M9; hopefully this methodology will be developed further and used again, however it should not be used carte blanche without the full context of evidence available.


Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour From The Human Skeleton. Cambridge: Cambridge University Press.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease Third Edition. Stroud: The History Press.

Tilley, L. & Oxenham, M. F. 2011. Survival Against the Odds: Modelling the Social Implications of Care Provision to Seriously Disabled Individuals. International Journal of Palaeopathology. Vol 1 (2) pp.35-42. (Access required).

Waldron, T. 2009. Palaeopathology: Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.

Whittington, K. 2011. Employing People with Disabilities- IFA Practise Paper. Reading: IFA.

An Introduction to Fibrous Dysplasia & McCune-Albright Syndrome

28 Oct

Definition of Fibrous Dysplasia: ‘Fibrous dysplasia is a non-inherited metabolic bone disease in which abnormal differentiation of osteoblast maturation (which) leads to replacement of normal marrow and cancellous bone by immature bone and fibrous stroma’ (Fitzpatrick et al 2004: 1389).  Fibrous Dsyplasia (FD) can be described as either monostotic (one) or polyostotic (many), depending on how many bones are affected by the disease.  Fibrous Dysplasia lesions are often displayed as having a ‘ground glass‘ appearance on x-rays and are a distinctive radiographic feature of the disease, although it is not pathognomonic of it (Waldron 2009).  It is also noted that pathological fractures are a key defining feature of polyostotic Fibrous Dysplasia (Marsland & Kapoor 2008).  FD is described as a rare disease, with the monostotic form being more prevalent than the polyostotic form.

Definition of McCune-Albright Syndrome:  McCune-Albright Syndrome (MAS) was originally typically diagnosed and recognised when a person had any of the two of the triad of the following symptoms: polyostotic Fibrous Dysplasia, Cafe-au-lait marks and/or precocious puberty.  However it was later recognised that ‘endocrinopathies, including hyperthyroidism, growth hormone excess, renal phosphate wasting with or without rickets/osteomalacia, and Cushing Syndrome’  could be found in association with the original triad (Dumitrescu & Collins 2008: 1).  In all three systems (skin, skeletal & endocrine), the presentation and abnormality can be highly variable from person to person depending on the tissues involved and the extent of the involvement (OMIM-see below).  Estimated prevalence is 1/100,000 to 1/1,000,000, it is such a wide margin because no thorough prevalence study has been carried out in recent times (Dumitrescu & Collins 2008: 1).


As a person who happens to have McCune Albright syndrome, to have known to have it from the first years of life, I have become somewhat forgetful of its origin: that somewhere in the early postzygotic  divisions of my life, the disease appeared and became a part of me.  Although I am aware each day of the ramifications that the mutation of the GNAS1 gene has caused I often consider myself lucky.  Lucky in the fact that in my case it has only led to broken bones and various surgeries rather than the full expression of the endocrinopathies that can occur.  I use a wheelchair for everyday mobility with limited use of crutches, mostly used for aiding inside mobility (and sometimes excavations!).

In my personal case, the disease has most affected the main weight-bearing bones of the lower limbs (fairly typical as they are the stress bearing bones, prone to fracture from weakened bone architecture).  Generally speaking,the long bones of the appendicular skeleton tend to be bowed naturally with a pathological weakness due to the lack of normal bone density and high bone cell turnover, with the aforementioned bone lesions occurring spontaneously which sometimes lead to fracture.  This includes the bilateral deformity of the femora with which I’ve had numerous pathological fractures (Five natural transverse fractures, five elective surgery initiated) on both the left and right sides, alongside a number of fractures of the right tibia and fibula (including both transverse and hairline fractures), two on the right humerus and the 5th metatarsal in the right foot.  The shepherd’s crook deformity is the common bowing deformity with varus angulation of the proximal femur (Fitzpatrick et al 2004: online).

As stated the primary bones affected by the MAS pathological fractures are typically located in the appendicular skeleton and include the following bones in order of prevalence first:  a) femur, b) tibia, c) fibula, d) humerus and e) the ribs.  It can also affect the craniofacial skeleton with distinct abnormalities in the amount of bone growth and deformity; however this tends to lessen with age after the primary and secondary growth periods (adolescence and sexual maturity), or ‘burn out’ as it is often called by medical specialists (Dumitrescu & Collins 2008: 8).

‘An example of the shepherds crook’ deformity of the femoral neck (coxa vara) with internal fixation.

My experiences of living with McCune Albright syndrome has included numerous hospitalizations due to fractured bones and planned corrective surgeries.  This has also included large amounts of time stuck in my old friend the Thomas Splint in bed bound traction, alongside enduring a host of various corrective surgical procedures to improve the angulation of both femoral necks.  Although the initial idea following a number of fractures was to treat the femoral deformities with an Ilizarov apparatus by manipulating the bone growth every day, it was quickly decided that an intramedullary rod (nicknamed the Sheffield Rod), carried out in conjunction with osteotomies to correct the femoral neck angle during surgery, would be a much safer and further reaching goal in stabilising both femoral necks in the long term.  (A rather wonderful digital video of a rod being inserted/hammered in can be viewed here).  Five major elective intramedullary rod surgeries later (3 for the left femur and 2 for the right femur!), and it seems as if they have thus far stabilised each femoral shaft/neck enough for them not to fracture again.  However this is also due to using the wheelchair much more extensively than before!

I also have had surgery to stabilise the right tibia and fibula.  This was decided after having undergone three accidental fractures of the right tibia and fibula with a space of 5 years (when the tibia breaks the fibula often follows because of their connection via the interosseous membrane), with each fracture requiring many months in plaster in order for the bone to heal.  Again this surgery included osteotomies of the tibia and fibula to improve the angle of the bone (and thus improve the bio-mechanical loading of the lower leg) and included the fixation of the tibia by means of a titanium plate.  It was hoped that an intramedullary rod could be inserted into the tibia after the tibial osteotomy but the risk of massive blood loss (an outcome of the porous bone and increased heartbeat/blood flow) and the presence of porous cortical bone meant that the tibia was probably unlikely to be able to ‘hold’ the rod in place.

I have also fractured the right humerus twice, with the second transverse fracture resulting in the fixation of the humerus with a permanent titanium plate and associated screws.  This is similar to my right tibia which has a permanent titanium plate and screws to fixate the bone and alleviate some of the pressure of walking.

I have undertaken treatment using biphosphonphates (in my case the drug pamidronate) to increase the bone density itself over a number of years in the past when I was a teenager, but the resultant bone density scans (taken at intervals before, during and after the treatment) showed little improvement and treatment was subsequently stopped.  Upon further reading into this it seems there are possible problems for long term users of biphosphonates.   This can include the higher risk of fracture after long term use due to the bodies inability to metabolize the drug and the natural effect of the biphosphonate inhibition on the bone cell turnover rate (Ott 2005: 31897).  There are many cases though where drug treatment has proved beneficial; however each case should be merited individually and each person monitored as appropriate.  I will stress here that there are many different types of biphosphonates available and that McCune Albright Syndrome varies in its intensity.

X ray of my left femur and hip with a locking intramedullary rod and screws.  Although please note that two of the femoral neck screws have now been taken out.

Although this is just a short post on the introduction to the disease that is sharing life with me it can also be found in the archaeological record.  Waldron (2009: 214) points out that Fibrous Dysplasia is often best diagnosed in an archaeological skeleton by the noting of either a shepherd’s crook deformity, healed fractures and findings of expansile swellings on one or more bones.  Subjecting the suspected sample to X-ray should show ‘lucent areas with endosteal scalloping and sometimes a thick sclerotic border’  (Waldron 2009: 215).  Unlike today’s vast array of modern medical treatment and surgical procedures, people in the past largely had to make do and mend.

As Roberts & Manchester (2010) discuss in their book, fracture treatment in the medieval age and before was fairly adept at helping in supporting and stabilising the fracture site.  However with repeated breaks in the main weight supporting bones, it is doubtful whether one could have led a normal life if the fractures were not reduced properly or repeatedly after continual breaks (Oakley 2007).  It also should be noted here that due to the nature of McCune Albright Syndrome it is unlikely to be described in the archaeology record as human skin rarely preserves.  It is far more likely that Fibrous Dysplasia is diagnosed based on the skeletal remains.

In the archaeological record Fibrous Dysplasia remains a rare and elusive disease to diagnose, whilst is has actively been described and documented in more recent human remains (Nerlich et al. 1991).  The following two case studies highlight individual cases of where Fibrous Dysplasia has been documented in archaeological material.

A recent case study presented by Craig & Craig (2011) discusses a juvenile skeleton with evidence of polyostotic Fibrous Dysplasia.  The skeletal remains of a child aged 7 years presents with Fibrous Dysplasia with evidence of involvement most noticeable with large bone expansion on the left mandible alongside involvement of the temporal, maxilla, parietal and frontal craniofacial bones.  A review of the burial context of the skeleton and of the Anglo-Saxon cemetery population that the child comes from shows no differentiation between this and other burials, indicating no differentiation in the disposition of this child’s body or associated grave goods.  Craig & Craig (2011) also cite further Ango-Saxon literature to suggest that it is highly unlikely that the child was stigmatized due to his disability, although we can never know for sure.

Recent evidence in a 120,000 year old Neandertal individual from the Upper Pleistocene site of Krapina in present day Croatia highlights the likely evidence for Fibrous Dysplasia presence in a small rib fragment (Monge et al. 2013).  This is extremely rare to find a bone lesion or tumour  in skeletal material from such a period and it is extremely exciting.  The rib was allocated original as a faunal remain when the site was initially excavated, but the rib was recognised for being of Neandertal origin by sharp eyed human osteology legend Tim D. White (Monge et al. 2013).

X ray of the transverse fracture of my right tibia and fibula in the summer of 2009.  This was the first of three transverse fractures of the right tibia and fibula that followed in quick succession over a short number of years, and resulted in the fixation of the tibia with a permanent titanium plate.

Below are some medical and non-medical sources of information on the various aspects of both Fibrous Dysplasia & McCune Albright Syndrome (FD and MAS). This includes a few recent palaeopathology articles that are freely available, medical articles discussing both FD and MAS, core palaeopathology textbooks and support groups in the US and UK for sufferers of the bone disease.  Although the disease is not headline grabbing news, the lack of research into the socio-economic aspects of the disease is distinctly lacking, as is the number of foundations or adult support services for sufferers with the disease.

I am thankful for the support of my friends, family & my consultant in the treatment of this syndrome and for continued support given.

N.B. The origin of the Ilizarov frame is particularly interesting.  It was first used in the 1950s in the USSR, with Dr Gavril Ilizarov originally using bicycle wheel spokes to fixate, support and lengthen badly fractured bones.  It was only introduced to the West in the 1980’s as a direct result of Ilizarov’s corrective surgery on a patient in Italy when all other options had failed in healing the patient’s fractures.  So far I have managed to avoid having the frame but it is still a standard procedure for badly fragmented fractures, in particular it is often used after motorbike accidents or reconstructing limb angulation/length.

Bibliography and Further Sources:

Fibrous Dysplasia:

Medical Articles:

  • Lee, J. S. FItzgibbon, E. J., Chen, Y. R., Kim, H. J., Lustig, L. R., Akintoye, S. O., Collins, M. T. & Kaban, L. B. 2012. Clinical Guidelines for the Management of Craniofacial Fibrous Dysplasia. Orphanet Journal of Rare Disease. 7 (1): 1-19..
  • Marsland, D. & Kapoor, S. 2008. Rheumatology and Orthopaedics. London: Mosby Elsevier.

McCune-Albright Syndrome:

Medical Articles:

  • Aufderheide, A. C. & Rodríguez-Martín. C. 1998. Cambridge: Cambridge University Press. (pg.420-421).
  • Roberts, C. & Manchester, K. 2010. The Archaeology of Disease Third Edition. Stroud: The History Press.
  • Waldron, T. 2009. Palaeopathology: Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.
General Medical
  • Pub Med, a US National Library of Medicine website.

The Origins of Tuberculosis & Smallpox

3 Jun

The following articles cited were brought to my attention by the good work of Confusedious: A Science Blog, and his entries on TB and its  possible origin.

Surprising Origins of Tuberculosis & Smallpox

Recent genetic investigations into the origin of the above diseases, of the chromosomes in TB and the study of smallpox’s ‘biological clock’, has revealed interesting information regarding their origin.   TB and Smallpox were previously thought caused or at least had its early origins during the domestication of animals, and by the dense urbanisation of human populations, first seen during the Mesolithic to Neolithic transition (Tuberculosis- Barnes et al 2011, Larsen 1997, Roberts & Manchester 2010, Smith et al 2009, Smallpox- Li et al 2007, Waldron 2009).

Compression Of Vertebrae As An Effect Of TB

Tuberculosis was originally thought to be spread from bovine at the period of domestication, with the strains M. Tuberculosis and M. Bovis to be considered the main organisms for TB infection in humans.  New genetic research has led to distinguish that M. Tuberculosis did not evolve from M. Bovis at the time of domestication of animals as a direct zoonosis; however it must be remembered that ‘it is probable that a necessary condition for its transference from animal to human is the close association between the two’ (Roberts & Manchester 2010: 184, Smith et al 2009).  I’d imagine the intensification of the Neolithic domestication undoubtedly led to higher rates of cross-species infection.  Research has also shown that the Mycobacterial Tuberculosis strain appeared some 15,300-20,400 years ago, well before the domestication of the earliest animals (Roberts & Manchester 2010: 185).  However there is no doubting the record that during the Neolithic, and up to the present day, that TB has damaged numerous lives.  The effects of TB on the human body can produce results found in osteological remains (Waldron 2009).  This will be discussed in a later blog entry on diseases found in human bones.

The threat of smallpox, a unique infectious disease to humans, was wiped out in AD 1980, but its origins are mysterious.  As Roberts & Manchester (2010: 181) note smallpox (Variola major or minor) ‘would obviously need highly populated urban areas for its success…and it is unlikely it was a problem until urbanization occurred’.  Recent genetic investigations into the origin of the Variola major/minor have discovered that it likely diverged from an ancestral African rodent-borne Variola-like virus either 68,000 to 16,000 BP (Li et al 2007).  However, it is well known that in its most virulent form in humans as smallpox, it has ravaged human urbanised populations for at least 2000 years, and is definitely dated to 10,000 BP.  Curiously, from documentary data and archaeological data, it seems there is a particular lacking of recorded smallpox cases in ancient Greece and ancient Rome (Roberts & Manchester 2010).

The Effects of Smallpox Decimated The Americas When The Europeans Helped Spread the Disease in the 16th Century, As Depicted In This, The Florentine Codex.

New genetic data is providing the backdrop for how infectious diseases spread, and more about their origin.  It is also helping scientists develop past population pathways for infection routes and rates (Jurmain et al 2011).It is apparent that new genetic data has opened up a whole raft of new research potentials into the origins and evolution of tuberculosis, and the relationship before, during and after the domestication of animals.


Barnes, I.Duda, A. Pybus, O. G. Thomas, M. G. 2011. ‘Ancient Urbanization Predicts Genetic Resistance To Tuberculosis’. In Evolution. 65 (3): 842-848. Blackwell Publishing: London.

Jurmain, R. Kilgore, L. & Trevathan, W.  2011. Essentials of Physical Anthropology International Edition. London: Wadworth.

Li, Y. Carroll, D. S. Gardner, S. N. Walsh, M C. Vitalis, E. A. & Damon, I. K. 2007. ‘On The Origin of Smallpox: Correlating Variola Phylogenics with Historical Smallpox Record’. In PNAS. 104 (40). October 2nd.  15,787-15,792.National Academy of Sciences: Wisconsin.

Roberts, C. & Manchester, K. 2010. The Archaeology of Disease Third Edition. The History Press: Stroud.

Smith, N. H. Hewinson, R. G. Kremer, K. Brosch, R. & Gordon, S. V. 2009. ‘Myths and Misconceptions: The Origin and Evolution of Mycobacterium tuberculosis’. In Nature Reviews: Microbiology. Vol 7. 537-544. Macmilan Publishers Limited: London.

Waldron, T. 2009. Palaeopathology: Cambridge Manuals in Archaeology. Cambridge:Cambridge University Press.