In primitive cultures past and present the most frequent causes of disability and death are infections, nutritional disturbances, trauma, and obstetrical, neonatal, and early pediatric problems. In past cultures and modern ones with limited or no access to modern health care, respiratory tract problems, gas trointestinal, and urinary tract infections have formidable potential, especially for young children (50,85,102,111,215). Unstable living conditions and limited nutrition, frequently accompanied by parasitic infestations, compound the effect of infections upon the populace. Most of these diseases involve soft tissue and do not cause characteristic bone alterations.
During the twentieth century in the United States dramatic changes occurred in the causes of death (Table I.1). At the century's beginning six of the ten leading causes of death were infections; in 1968 only one was infectious. Some historical information exists concerning the health status of the Dakota Territory aborigines, but scientifically accurate data are scarce.
Table I-1. U.S. Ten Leading Causes of Death
Rate per 100,000
1900 1968
1. Tuberculosis* 194 373 Heart Disease 1.
2. Pneumonia* 175 159 Cancer 2.
3. Diarrhea and 140 106 Cerebral 3.
Enteritis* Hemorrhage
4. Heart Disease 137 58 Accidents 4.
5. Cerebral 107 37 Influenza and 5.
Hemorrhage Pneumonia*
6. Nephritis* 89 22 Certain Diseases 6.
of Early Infancy
7. Accidents 72 19 Diabetes 7.
8. Cancer 64 17 Arteriosclerosis 8.
9. Bronchitis* 45 15 Cirrhosis of the 9.
Liver
10. Diphtheria* 40 12 Emphysema 10.
* Infectious diseases.
|
Adapted from "Vital Statistics of the U.S." In: Ca- A Cancer Journal for Clinicians, 22:2-7, 1972.
The Dry Bones study began in 1962 as a project to analyze historic and prehistoric human skeletons from the Upper Missouri River Basin for evidence of disease, anomaly, or abnormality. Ultimately, the project entailed extensive travel, laboratory work, and participation in regional archeological projects. Data were compiled relating to more than 4,000 human skeletons from this region. Unfortunately, some skeletons were incomplete, limiting the information obtainable. Incomplete skeletons notwithstanding, these evaluations of isolated skeletal remnants, random samples, salvage archaeology specimens, and the residua of two massacres, have revealed commonalities and differences in diseases, abnormalities, and anomalies identifiable in bone from previous people in the area. Aided by sophisticated techniques and the expertise of specialists in anatomy, anthropology, dentistry, and medicine it was possible to identify most processes that affected the skeletons of people who lived here in the past. Through the availability of large numbers of skeletons with excellent provenience, information was forthcoming relating to previous demographic patterns. By comparison with living counterparts, longitudinal epidemiology could be investigated in the region.
Some historical reports and observations by investigators who worked with human skeletons from this region previously differ from observations during the Dry Bones study. Significant differences between others' findings and our results are presented, and interpreted. This report has five objectives: 1) To present findings in human skeletons from the Upper Missouri River region and to relate them to the people represented and their milieu. 2) To provide illustrations with explanations of common and uncommon findings and an analysis of their frequency in these skeletons. 3) To examine regional human remains humanistically. Paleopathology evaluations often emphasize the biological element at the expense of the cultural features (349). 4) To generate interest in osteopathology from the past, emphasizing that which came from this region. and, 5) To document findings relating to the health and welfare of previous inhabitants of this region that are corroborative or contrary to reports or opinions of others.
Most findings during this survey are similar within the region and, with minor variations, like those in other similar skeletal surveys. Some things discovered in this region are original and several are not duplicated in the available literature of paleopathology.
When equivocal anatomic findings were encountered, laboratory techniques were utilized and expert consultation was sought. If more than one possibility exists to explain an abnormality, our interpreta tion includes the diagnostic considerations. Some interpretations of bone abnormalities are open to question. We hope that problematic specimens stimulate appropriate constructive rebuttal.
Certain observations we made during the Dry Bones survey warrant emphasis, because they are regionally and to paleopathology generally.
1. Life span was short in this region before the twentieth century, comparable to that reported in European Bills of Mortality. Therefore, disease patterns expected generally would be those associated with a pediatric population.
2. Estimates of the effect upon the population of pregnancy, and the neonatal-pediatric interval came from statistical analyses of ancient demographic data. They indicate that some historical references to regional longevity and mortality in younger age groups are not corroborated by anatomic findings.
3. Most skeletal alterations by disease related to trauma, infections, and degenerative causes. Some represented the effects of nutritional and metabolic disorders. Occult congenital and developmental anomalies were common, but manifest anomalies were unusual.
4. Benign osseous tumors were frequent, but evidence of cancer in or upon bone was rare. In many skulls there were outer ear canal exostoses but their frequency differed from Hrdlicka's reports. Disparate results came from different archaeological techniques.
5. Contrary to recent popular press reports that scalping was introduced to The Americas from Europe, residua of scalping were in both pre and post-Columbian skeletons. Additionally, residua of "non-lethal" ante-mortem scalp avulsion were in skulls from both eras. 6. Human remnants from pre and post-Columbian eras had manifestations of severe skull and post-cranial skeletal injury with prolonged survival, suggesting that contemporary life support measures were adequate for the circumstances.
7. Changes in the form and frequency of traumatic residua between the 14th and the mid-18th centuries suggest the horse as a factor.
8. The absence of overt inborn anomalies, despite reported consanguinity and incest in the Arikara culture, and the high frequency of congenital anomalies in regional Native Americans today, suggests elimination of the obviously congenitally malformed from community cemeteries.
9. Residua of primary and secondary osteomyelitis were present, but infrequent. Periostitis from several sources was frequent.
10. Resorptive bone disease compatible with the effect of tuberculosis was present in skeletons of people who lived after 1492 A.D., but not before that date. Changes that suggested trepomatosis during life were in 14th century skeletons.
11. Radiographic studies of pre and post-Columbian temporal bones showed the effect of middle ear in fections (otitis media) during the period of mastoid air cell development, and complications of chronic otitis media. Otitis media begins in the throat as upper respiratory infections, so these findings indicate that microorganisms that behaved similar to those prevalent in the pre-antibiotic era have been active in this region during the past millennium.
12. Osseous changes secondary to metabolic problems in the past were mostly those of nutritional depletion. Evidence was found of iron deficiency and periodic stress during growth, probably of nutritional origin. In addition, mid-14th century Crow Creek skeletons had external bone surface markings, especially in the lower extremities, suggesting previous and recent subperiostial hemorrhages, probably an accompaniment of scurvy.
13. The actual health and well being of aborigines in this region in the past has been conjectural. Historically, European invaders introduced disasterous herd type diseases such as smallpox and measles. However, anatomic and statistical evidence indicates that many infections and other diseases existed in this region long before White intrusion. Although the White man undoubtedly was a large factor in the degradation of the American Indian, he is not to blame for all the problems that have been attributed to him.
By evaluating human remains it has been possible to glance into the past and to obtain some idea of the people who lived in a specific portion of the upper midwestern proto-United States during more than a millennium. Information presented here represents primarily our findings in the region, but we have included references to important material compiled by others from their investigations in the Upper Missouri River Basin. Certain findings during the Dry Bones and other studies shed new light on concepts about the health and well-being of the ancient Indians. But they also provide insight into health problems of present regional Native American inhabitants, many of which differ from those in the general population.
In about 1978 the movement for reburial of all aboriginal human remnants surfaced in this region. Since that time we are aware that more than a thousand skeletons exhumed from this region have been returned to Native Americans for disposal. To all intents and purposes these skeletons are now lost forever to anthropological or paleopathological analysis. Fortunately, most of the reburied skeletons had been evaluated during the Dry Bones survey. However, we have already encountered circumstances where doubtful conclusions by us during the original investigations might have been corrected by additional expert consultation and newer scientific techniques, had the bones still been available.
The loss of these skeletons through reburial increases the timeliness and value of the findings reported here. In addition, the frailties of the human mind that accompany increasing maturity dictate that pertinent findings be put on paper so as to be available in the future.
Markup:
Larry J. Zimmerman, 12/30/97