By Tony Waldron (Cambridge Manuals in Archaeology). Pp. xvii + 279, figs. 38. Cambridge University Press, New York 2009. $28.99. ISBN 978-0-521-67855-1 (paper).
Written from the standpoint of a medically trained practitioner, this book is not meant to be a review of the paleopathological literature. Rather, it aims to provide enough information for those without a medical background to understand and recognize the diseases encountered when examining human skeletal remains. The central purpose of the text is to introduce the epidemiological concept of operational definitions, or diagnostic criteria, to allow for the accurate diagnosis of pathological lesions on skeletal remains. In Waldron's view, paleopathologists have too few operational definitions to work from, and "none has been universally agreed upon" (7). Waldron's goal is to open a discourse by proposing operational definitions for the various conditions covered in the book.
Today, most paleopathologists enter the discipline from an archaeological background, specializing with a master's degree or doctorate in the subject. Given this context, Waldron makes a controversial proposal that one needs medical training to study paleopathology successfully. In Waldron's view, the endgame is to provide a diagnosis for an individual disease, and he asserts that archaeologically trained paleopathologists do not usually do this well: "most . . . have no medical training, so have not been subject to the discipline of the diagnostic treadmill" (2). Waldron has a rather pessimistic view of the subject as a whole, stating that "palaeopathologists have the advantage of being able to study directly the remains of the diseased . . . and this may be the only thing in their favour" (1).
The book comprises 13 chapters, three of which are devoted to Waldron's special interest in joint disease. These chapters (chs. 3–5) provide a good overview of joint anatomy for the uninitiated. There is a useful section on the joints that are most commonly affected, a discussion of the factors that can lead to secondary changes (e.g., trauma), and a comment on the neurological problems associated with Schmorl's nodes. However, for those using the book as an introduction to paleopathological diagnosis, the discussion of recognizing osteoarthritis is not detailed enough, and the diagnostic features (e.g., pseudoarthrosis in fig. 3.3, osteophytes in fig. 3.5) are not labeled.
The lack of illustrations is a general weakness of the book, and while this may be due to publisher constraints, it means that this book cannot stand as a substitute for other texts. Also, while there are operational definitions for 11 conditions in the joint disease chapters, there are considerably fewer provided in the chapters on infections, metabolic disease, tumors, and growth disorders. In fact, Waldron omits some standard (and universally accepted) diagnostic criteria for conditions such as osteomyelitis, and there is little emphasis on the need to provide a differential diagnosis. The somber view that paleopathologists may never accept limitations in the etiology of cribra orbitalia (137) has recently proved to be unfounded (P. Walker, R.R. Bathurst, R. Richman, T. Gjerdrum, and V.A. Andrushko, "The Causes of Porotic Hyperostosis and Cribra Orbitalia: A Reappraisal of the Iron-Deficiency-Anaemia Hypothesis," American Journal of Physical Anthropology 139  109–25).
Waldron's medical perspective leads to some interesting and unique inclusions in the book. For example, in the trauma section, he provides names for different types of fractures, commonly damaged nerves, and a ranking for fractured bones in modern and archaeological populations, although he fails to provide the sources for his archaeological data. In the chapter on tumors, there is a recommendation that paleopathologists should consult skeletal radiologists and pathologists when attempting diagnosis, and this is sound advice. There is also a chapter dedicated to epidemiology and the way in which paleopathologists choose to present their data—not something seen in standard texts. Many facts and most references are provided in footnotes, which include several interesting anecdotes. These are more entertaining than they are factual (e.g., the hazards of a septal aperture to an acupuncturist ), but they serve to lighten the mood.
It is hard to grasp who the audience for this book is. If the book is meant to encourage archaeologists to move into paleopathology, it advises them to take a medical degree. It does not provide enough detail, or illustrations, to serve as a diagnostic reference for those working in archaeological units at postgraduate level or beyond. At the same time, it is not basic enough for undergraduate students new to paleopathology, nor archaeological enough to guide medics through the needs of archaeological practice—that is, to recognize pseudopathology and postmortem damage or to interpret radiographs of dry bones. Today, most paleopathologists come from an archaeological background and gain the training they need with regard to recognizing, describing, and diagnosing pathological lesions from within the discipline, which borrows heavily from clinical knowledge. The operational definitions the author provides for many conditions are commonly taught in undergraduate and postgraduate courses across the world—and debated at many conferences—so Waldron does not provide a particularly new approach here.
Modern paleopathology works within the theoretical paradigm of the biocultural approach: combining skeletal, clinical, environmental, historical, and archaeological evidence to interpret the lives of people in the past. The main aim is not to provide a clinical diagnosis of one interesting individual or specimen, although that is a necessary task; there is a broader obligation to interpret the pathology within its archaeological context. What the book lacks is the cultural context that defines paleopathology today. Instead, it comes across as the study of disease for the sake of disease and is only mildly interested in how that can inform us about the past. In that sense, it is old-fashioned and harks back to a time when paleopathology was an isolated discipline.
Paleopathology benefits from contributions from a variety of fields, and Waldron's book has merits in providing a clinical perspective. As such, it might be used as a supplementary text to more comprehensive books on skeletal diagnosis (e.g., D. Ortner, Identification of Pathological Conditions in Human Skeletal Remains [San Diego, Calif. 2003]) and paleopathology (e.g., C. Roberts and K. Manchester, The Archaeology of Disease [Gloucester 2005]).
Department of Archaeology
University of Reading
Reading RG6 6AB