Our diseased ancestors

Palaeopathology - the study of ancient disease and injury, usually from archaeological contexts - elicits widespread public interest (see any week's television listings). Yet, judging from the TV documentaries and their publications, very many palaeopathologists' horizons still seem bounded by the trench or tomb that yielded their case material.

There is a pressing need for a broader synthesis, founded on detailed knowledge of the nature and limitations of the palaeopathological evidence, but relating it to wider issues of population history and epidemiology.

This remarkable volume provides just that. It contains an exhaustive review of all diseases likely to be recognised from ancient human remains, as well as others, such as cholera, which are not, but that had major impacts on populations.

Arthur C. Aufderheide and Conrado Rodriguez-Martin take a broad view of their subject and there are sections on every major anatomical system and disease category, including a final, commendably short, sweep-up of "miscellaneous conditions".

The volume provides far more information than most others on the development of individual pathologies and the reader gains a real idea of disease progression and the factors leading to lesion formation. This not only makes the account far more biologically and medically meaningful than the arid diagnostic lists that litter some texts but also promotes awareness of the variability inherent in pathological indicators. Unusually, both skeletal and soft-tissue pathologies are extremely well covered. Occasional bog bodies apart, most European investigations necessarily focus on osteopathology, but the authors rightly insist that this cannot be understood in isolation from soft tissue changes. Between them they have extensive experience of Andean and Guanche (aboriginal Canary Islands) mummies and these provide many of the book's illustrated case studies.

In addition to the individual consequences of particular pathologies there are valuable review essays on the aetiologies, interrelationships and historical significance of major infections such as treponemal diseases (pinta, yaws, bejel and syphilis), leprosy, tuberculosis, plague, smallpox and other diseases, including those of childhood.

All in all, the approach is refreshingly and impressively multi-disciplinary, with the pathology nicely integrated into summary accounts of the relevant archaeological, anthropological and cultural evidence of the communities referred to in the case studies.

I would have liked rather more prominence accorded to early hominid palaeopathology. With other kinds of evidence effectively non-existent, factors such as dental attrition and carnivore damage in Australopithecus, and trauma, osteoarthritis and assorted other pathologies in Neanderthals (as well as probable cut marks on crania), all provide otherwise unobtainable insights on behaviour and lifestyles.

The section on pseudopathologies might also have included instances where taphonomic effects have been taken as evidence of conspecific violence. But these are trivia compared with the range of scholarship displayed in this volume and the achievement it represents.

Far more than a laboratory manual for the practising palaeopathologist, it effectively combines the subject with perspectives from archaeology, demography and historical epidemiology. It exemplifies the potential of such integration for understanding the health dynamics and ecology of past communities and it will undoubtedly be the subject's standard reference for many years to come.

Alan Bilsborough is professor of anthropology, University of Durham.