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The prevailing view regarding the evolution of medicine is that the emergence of settled agricultural societies around 10,000 years ago (the Neolithic Revolution) gave rise to a host of health problems that had previously been unknown among non-sedentary foraging populations, stimulating the first major innovations in prehistoric medical practices1,2. Such changes included the development of more advanced surgical procedures, with the oldest known indication of an ‘operation’ formerly thought to have consisted of the skeletal remains of a European Neolithic farmer (found in Buthiers-Boulancourt, France) whose left forearm had been surgically removed and then partially healed3. Dating to around 7,000 years ago, this accepted case of amputation would have required comprehensive knowledge of human anatomy and considerable technical skill, and has thus been viewed as the earliest evidence of a complex medical act3. Here, however, we report the discovery of skeletal remains of a young individual from Borneo who had the distal third of their left lower leg surgically amputated, probably as a child, at least 31,000 years ago. The individual survived the procedure and lived for another 6–9 years, before their remains were intentionally buried in Liang Tebo cave, which is located in East Kalimantan, Indonesian Borneo, in a limestone karst area that contains some of the world’s earliest dated rock art4. This unexpectedly early evidence of a successful limb amputation suggests that at least some modern human foraging groups in tropical Asia had developed sophisticated medical knowledge and skills long before the Neolithic farming transition.

OBJECTIVES: We test the hypothesis that the condition(s) leading to the development of cribra orbitalia at Con Co Ngua, an early seventh millennium sedentary foraging community in Vietnam, effectively reduced the resilience of the population to subsequent health/disease impacts. An assessment of both the implications and potential etiology of cribra orbitalia in this specific population is carried out. METHODS: The effective sample included 141 adults aged ≥15 years (53 females, 71 males, and 17 unknown sex) and 15 pre-adults aged ≤14 years. Cribra orbitalia was identified by way of cortical bone porosity of the orbital roof initiated within the diplöic space, rather than initiated subperiosteally. The approach is also robust to the misidentification of various pseudo-lesions. Resultant data was analyzed using Kaplan-Meier survival analysis. RESULTS: Median survival is higher in adults aged ≥15 years without cribra orbitalia than those with this lesion. For the pre-adult cohort, the opposite pattern is seen where median survival is higher in those with cribra orbitalia than those without. CONCLUSION: Adults displayed increased frailty and pre-adults increased resilience with respect to cribra orbitalia. The differential diagnosis for a survival analysis of adults and pre-adults with and without cribra orbitalia included iron deficiency anemia and B12/folate deficiency, parasitism (including hydatid disease and malaria) in addition to thalassemia. The most parsimonious explanation for observed results is for both thalassemia and malaria being the chief etiological agents, while appreciating these conditions interact with, and can cause, other forms such as hematinic deficiency anemias.

Climate change is an indisputable threat to human health, especially for societies already confronted with rising social inequality, political and economic uncertainty, and a cascade of concurrent environmental challenges. Archaeological data about past climate and environment provide an important source of evidence about the potential challenges humans face and the long-term outcomes of alternative short-term adaptive strategies. Evidence from well-dated archaeological human skeletons and mummified remains speaks directly to patterns of human health over time through changing circumstances. Here, we describe variation in human epidemiological patterns in the context of past rapid climate change (RCC) events and other periods of past environmental change. Case studies confirm that human communities responded to environmental changes in diverse ways depending on historical, sociocultural, and biological contingencies. Certain factors, such as social inequality and disproportionate access to resources in large, complex societies may influence the probability of major sociopolitical disruptions and reorganizations—commonly known as “collapse.” This survey of Holocene human–environmental relations demonstrates how flexibility, variation, and maintenance of Indigenous knowledge can be mitigating factors in the face of environmental challenges. Although contemporary climate change is more rapid and of greater magnitude than the RCC events and other environmental changes we discuss here, these lessons from the past provide clarity about potential priorities for equitable, sustainable development and the constraints of modernity we must address.

For more than two centuries, lack of sunlight has been understood to cause vitamin D deficiency and documented as a primary cause of rickets. As such, evidence of rickets in the archeological record has been used as a proxy for vitamin D status in past individuals and populations. In the last decade, a clinical global consensus has emerged wherein it is recognized that dietary calcium deficiency also plays a role in the manifestation of rickets and classic skeletal deformities may not form if dietary calcium is normal even if vitamin D is deficient. This disease is now clinically called "nutritional rickets" to reflect the fact that rickets can take calcium deficiency-predominant or vitamin D deficiency-predominant forms. However, there are currently no paleopathological studies wherein dietary calcium deficiency is critically considered a primary etiology of the disease. We review here the interplay of calcium, vitamin D, and phosphorous in bone homeostasis, examine the role of dietary calcium in human health, and critically explore the clinical literature on calcium deficiency-predominant rickets. Finally, we report a case of rickets from the late Formative Period (~2500-1500 years ago) of the Atacama Desert and argue the disease in this infant is likely an example of calcium deficiency-predominant rickets. We conclude that most archeological cases of rickets are the result of multiple micronutrient deficiencies that compound to manifest in macroscopic skeletal lesions. For clinicians, these factors are important for implementing best treatment practice, and for paleopathologists they are necessary for appropriate interpretation of health in past communities.

We describe a case of Pott’s disease from the Liao Dynasty of the Khitan Empire (947–1125 A.D.) in Mongolia.A young adult male (AT-840) from the site of Ulaan Kherem, a fortified settlement in Central Mongolia, was assessed for evidence of skeletal pathology. Radiographs were taken of lytic lesions of the thorax to assist with diagnosing the etiology. A differential diagnosis was completed using standard and new threshold criteria. AT-840 presented with multiple lytic foci of the thoracic spine, complete destruction of the T9 vertebral body, and consequent ventral collapse. Multiple lytic foci of the rib heads were associated with new bone on the visceral surfaces of the rib shafts. A single lytic lesion was also observed on the inferior right pterygoid plate of the sphenoid bone. Differential diagnosis included mycosis, brucellosis, echinococcosis, and tuberculosis. The presence of tuberculosis at Ulaan Kherem may have been influenced by mobility within the empire, including trade, conflict, and nomadic pastoralism. This is the first documented evidence of tuberculosis in Mongolia and for the Liao Dynasty in East Asia. The case provides a unique opportunity to consider the impact of tuberculosis on the individual, the community, and its presence in the empire. No previous systematic paleopathological research on Khitan skeletal assemblages has been conducted prior. Therefore, population health data are unavailable to fully contextualize this individual’s disease. However, historical references exist. Pathogen DNA analysis will enable identification of the causative tuberculosis pathogen. Монгол нутаг дахь эртний төрт улсуудын нэг Киданы (947–1125) үеийн бэхлэлт суурингийн дурсгал Булган аймгийн Баяннуур сумын нутагт орших Улаан Хэрэмийн малтлагаас илэрсэн идэр насны эрэгтэй хүний ясны олдвор (АТ-840)-т ажиглагдсан Поттийн (Сүрьеэ) өвчний тохиолдлын талаар энэхүү өгүүлэлд танилцуулж байна. Өвчнийг оношлоход цээжний хөндийн ясны эд хайлсан эмгэгийн рентген зураг, өвчлөлийн шинжүүдийг уламжлалт болон шинэ шалгуурын тусламжтай жиших аргыг ашиглав. АТ-840 олдворт сээрний нугалмууд болон хавиргануудын толгойд ясны эд хайлсан олон голомттой, сээрний 9-р нугалмын бие бүрэн хайлж, урд хэсэг нь үгүй болсон, хавиргануудын биеийн дотно гадаргуу дээр нэмэлт яс ургасан, суурь ясны баруун талын жигүүр сэртэнгийн дор ясны хайлалт явагдсан зэрэг шинжүүд ажиглагдаж байна. Энэ хүний өвчний оношийг бруцеллёз, мөгөөнцөртөх өвчин, туузан хорхойтох өвчин, сүрьеэ зэрэг өвчний шинжүүдийг харьцуулан жиших аргаар тодруулав. Улаан Хэрэмийн хүн амд сүрьеэ өвчин тохиолдоход нүүдлийн мал аж ахуйн хэв маяг, худалдаа арилжаа, дайн тулаан зэрэг эзэнт гүрний доторх шилжилт хөдөлгөөн зохих нөлөө үзүүлсэн байх магадлалтай. Энэхүү тохиолдол нь Монголын эртний хүн амын төдийгүй Зүүн Азийн Киданы үеийн сүрьеэ өвчний анхны бүртгэгдсэн баримт болох юм. Уг баримт нь Киданы эзэнт гүрэнд сүрьеэ өвчин байсан гэдгийг нотлон харуулахаас гадна энэ өвчин хувь хүн, тухайн цаг үеийн нийт хүн амд хэрхэн нөлөөлж байсныг судлах боломжийг олгож байна. Хэдийгээр түүхийн сурвалж мэдээ байдаг ч Киданы үед холбогдох хүний яснуудад палеопатологийн системтэй судалгаа өнөөг хүртэл хийгдээгүй байгаа учраас түүхэн тухайн үеийн нийт хүн амын эрүүл мэндийн байдлыг ганц тохиолдолд тулгуурлан тайлбарлах нь хангалтгүй билээ. Цаашид уг хүний эмгэг төрөгчийн ДНХ-г судалснаар түүний сүрьеэгийн үүсгэгчийг тодорхойлох боломжтой юм.

Skeletal evidence of two probable cases of treponematosis, caused by infection with the bacterium Treponema pallidum, from the northern Vietnamese early Neolithic site of Man Bac (1906–1523 cal B.C.) is described. The presence of nodes of subperiosteal new bone directly associated with superficial focal cavitations in a young adult male and a seven-year- old child are strongly diagnostic for treponemal disease. Climatic and epidemiological contexts suggest yaws (Treponema pallidum pertenue) as the most likely causative treponeme. This evidence is the oldest discovered in the Asia-Pacific region and is the first well-established pre-Columbian example in this region in terms of diagnosis and secure dating. The coastal ecology, sedentary settlement, and high fertility at the site of Man Bac all provided a biosocial context conducive to the spread of treponemal disease among inhabitants of the site. Co-morbidity with scurvy in both individuals demonstrates that malnutrition during the agricultural transition may have exacerbated the expression of treponematosis in this community. Man Bac is a site of great regional importance owing to its role during the Neolithic transition of Mainland Southeast Asia. During this transition, approximately 4,000 years ago, farmers migrating from southern China into Southeast Asia influenced a number of changes in subsistence and demography and potentially introduced new infectious diseases such as treponematosis to indigenous forager communities. The findings presented here may encourage reevaluation of existing Southeast Asian skeletal samples and demonstrate the importance of using weighted diagnostic criteria for future reporting of treponematosis cases. Hai trường hợp nhiều khả năng mắc bệnh ghẻ cóc do nhiễm vi khuẩn Treponema pallidum, thuộc di chỉ Mán Bạc sơ kì đá mới Việt Nam (cal 1906–1523 B.C.) được mô tả trên bằng chứng di cốt. Sự có mặt của các hạt xương mới dưới màng xương trực tiếp liên quan đến các lỗ ổ bề mặt ở một nam trẻ tuổi trưởng thành và một trẻ em 7 tuổi là chẩn đoán nhiều khả năng cho bệnh này. Bối cảnh khí hậu và dịch tễ học cho thấy bệnh ghẻ cóc do nhiễm xoắn khuẩn Treponema pallidum pertenue là nguyên nhân phổ biến nhất. Bằng chứng trên được phát hiện muộn nhất ở khu vực Châu Á-Thái Bình Dương và là một ví dụ điển hình đầu tiên giai đoạn tiền Columbia trong khu vực này dựa vào chẩn đoán và định niên đại chính xác. Sinh thái biển, lối sống ít di động, và tỷ lệ sinh sản cao ở di chỉ Mán Bạc, tất cả đã tạo ra sự tương tác giữa các yếu tố sinh học và xã hội thuận lợi cho việc lây lan bệnh ghẻ cóc giữa các cư dân thuộc di chỉ này. Cùng với đó là sự mắc bệnh thiếu vitamin C (scurvy) ở cả hai cá thể trên chỉ ra rằng sự suy dinh dưỡng trong suốt quá trình chuyển tiếp nông nghiệp có thể trầm trọng hơn và biểu hiện bệnh ghẻ cóc ở cộng đồng này. Mán Bạc là một di chỉ vùng quan trọng bởi vì nó nằm trong ranh giới giai đoạn chuyển tiếp Đá Mới của Đông Nam Á lục địa. Trong suốt bước chuyển này, khoảng 4000 năm cách đây, các cư dân nông nghiệp di cư từ miền nam Trung Quốc vào Đông Nam Á đã ảnh hưởng nhiều thay đổi trong phương thức sinh kế, dân số, và mang theo bệnh nhiễm trùng mới tiềm ẩn như là bệnh ghẻ cóc vào các cộng đồng nông nghiệp bản địa . Các phát hiện trình bày trên đây hi vọng sẽ là khởi đầu đánh giá lại về sự tồn tại các di cốt Đông Nam Á và minh họa tầm quan trọng của việc sử dụng tiêu chí chẩn đoán tin cậy về các trường hợp bệnh ghẻ cóc cho nghiên cứu tiếp theo.

Objectives In this brief communication we discuss issues concerning scientific rigour in palaeopathological publications, particularly studies published in clinical or general science journals, that employ skeletal analysis to elucidate the lives and deaths of historical figures or interpret “mysterious” assemblages or burials. We highlight the relationship between poor methodological rigour and lack of interdisciplinary communication, and discuss how this can result in scientifically weak, sensational narratives being presented to the public. Conclusions Although most high profile publications involving analysis of archaeological human remains are methodologically sound and well interpreted, others have suffered from poor scientific rigour stemming from an apparent lack of awareness of anthropological methods and ethics. When these publications are highlighted by the press, sensationalistic narratives are perpetuated which may reflect poorly on our discipline and give the public unrealistic expectations about our work. Suggestions for future research We suggest that best practice in high-profile paleopathological research include recruitment of a range of authors and reviewers from clinical sciences, anthropology, and the humanities, consideration of the ethical issues surrounding retrospective diagnosis, and transparency with the press in regards to the limitations inherent in this kind of work.

The prevailing view regarding the evolution of medicine is that the emergence of agricultural societies around 10,000 years ago (the ‘Neolithic Revolution’) gave rise to a host of health problems that were previously unknown among non-sedentary foraging populations, stimulating the first major innovations in prehistoric medico-socio-cultural practices1,2. Such changes included the development of more advanced surgical procedures, with the oldest known indication of an ‘operation’ formerly held to consist of a farmer with a surgically amputated arm from a Neolithic site in France, dating to around 7,000 years ago3. This accepted case of amputation would have required comprehensive knowledge of human anatomy and considerable technical skill and has thus been viewed as the earliest evidence in world history for a complex medical act3. Here, however, we report the discovery of skeletal remains from Borneo of a young individual who had their lower left leg surgically amputated, probably as a child, at least 31,000 years ago. The individual survived the surgical procedure, living for at least another six to nine years before intentional burial within Liang Tebo cave—located in East Kalimantan, in a limestone karst area that hosts some of the world’s earliest dated rock art4. This unexpectedly early evidence for successful limb amputation implies that modern human foraging groups had developed sophisticated medical knowledge and skills long before the Neolithic farming transition.

The processes of human mobility have been well demonstrated to influence the spread of infectious disease globally in the present and the past. However, to date, paleoepidemiological research has focused more on factors of residential mobility and population density as drivers for epidemiological shifts in prehistoric infectious disease patterns. A strong body of epidemiological literature exists for the dynamics of infectious disease spread through networks of mobility and interaction. We review the epidemiological theory of infectious disease spread and propose frameworks for application of this theory to bioarchaeology. We outline problems with current definitions of prehistoric mobility and propose a framework shift with focus on population interactions as nodes for disease transmission. To conceptualize this new framework, we produced a theoretical model that considers the interplay between climate suitability, population density, residential mobility, and human interaction levels to influence infectious disease patterns in prehistoric assemblages. We then tested observable effects of this model in paleoepidemiological data from Asia (n = 343). Relative risk ratio analysis and correlations were used to test the impact of population interaction, residential mobility, population density, climate, and subsistence on the prevalence and diversity of infectious diseases. Our statistical results showed higher levels of population interaction led to significantly higher prevalence of infectious disease in sedentary populations and a significant increase in pathogen diversity in mobile populations. We recommend that population interaction be included as an important component of infectious disease analysis of prehistoric population health alongside other biosocial factors, such as sedentism and population density. Daar is goed gedemonstreer dat die prosesse van menslike mobiliteit die verspreiding van aansteeklike siektes wêreldwyd in die hede en in die verlede beïnvloed. Maar tot op hede het paleo-epidemiologiese navorsing egter meer gefokus op faktore van residensiële mobiliteit en bevolkingsdigtheid as dryfvere vir epidemiologiese verskuiwings in die prehistoriese infeksiesiektepatrone. Sterk epidemiologiese literatuur bestaan vir die dinamika van aansteeklike siektes wat versprei word deur netwerke van mobiliteit en interaksie. Ons ondersoek die epidemiologiese teorie van die verspreiding van aansteeklike siektes en stel raamwerke voor vir die toepassing van hierdie teorie op die bioargeologie. Ons skets probleme met huidige definisies van prehistoriese mobiliteit en stel ‘n raamwerk verskuiwing voor met die fokus op bevolkings-interaksies as nodusse vir oordrag van siektes. Om hierdie nuwe raamwerk te konseptualiseer, het ons ‘n teoretiese model vervaardig wat die wisselwerking tussen klimaatsgeskiktheid, bevolkingsdigtheid, residensiële mobiliteit en menslike interaksievlakke oorweeg om die infeksiesiektepatrone in prehistoriese samestellings te beïnvloed. Daarna het ons die waarneembare effekte van hierdie model getoets in paleo-epidemiologiese data uit Asië (n = 343). Relatiewe risiko-verhoudingsanalise en korrelasies is gebruik om die impak van bevolkings-interaksie, residensiële mobiliteit, bevolkingsdigtheid, klimaat en bestaan op die voorkoms en diversiteit van aansteeklike siektes te toets. Ons statistiese resultate het gedemonstreer dat hoër vlakke van bevolkings-interaksie gelei het tot aansienlik hoër voorkoms van aansteeklike siektes in sittende bevolkings en ‘n beduidende toename in patogeen diversiteit in mobiele bevolkings. Ons beveel aan dat bevolkings-interaksie ingesluit word as ‘n belangrike komponent van die aantstekingsiekte-ontleding van die prehistoriese bevolkingsgesondheid, tesame met ander biososiale faktore soos sedentisme en bevolkingsdigtheid.

The processes of human mobility have been well demonstrated to influence the spread of infectious disease globally in the present and the past. However, to date, paleoepidemiological research has focused more on factors of residential mobility and population density as drivers for epidemiological shifts in prehistoric infectious disease patterns. A strong body of epidemiological literature exists for the dynamics of infectious disease spread through networks of mobility and interaction. We review the epidemiological theory of infectious disease spread and propose frameworks for application of this theory to bioarchaeology. We outline problems with current definitions of prehistoric mobility and propose a framework shift with focus on population interactions as nodes for disease transmission. To conceptualize this new framework, we produced a theoretical model that considers the interplay between climate suitability, population density, residential mobility, and human interaction levels to influence infectious disease patterns in prehistoric assemblages. We then tested observable effects of this model in paleoepidemiological data from Asia (n = 343). Relative risk ratio analysis and correlations were used to test the impact of population interaction, residential mobility, population density, climate, and subsistence on the prevalence and diversity of infectious diseases. Our statistical results showed higher levels of population interaction led to significantly higher prevalence of infectious disease in sedentary populations and a significant increase in pathogen diversity in mobile populations. We recommend that population interaction be included as an important component of infectious disease analysis of prehistoric population health alongside other biosocial factors, such as sedentism and population density. Daar is goed gedemonstreer dat die prosesse van menslike mobiliteit die verspreiding van aansteeklike siektes wêreldwyd in die hede en in die verlede beïnvloed. Maar tot op hede het paleo-epidemiologiese navorsing egter meer gefokus op faktore van residensiële mobiliteit en bevolkingsdigtheid as dryfvere vir epidemiologiese verskuiwings in die prehistoriese infeksiesiektepatrone. Sterk epidemiologiese literatuur bestaan vir die dinamika van aansteeklike siektes wat versprei word deur netwerke van mobiliteit en interaksie. Ons ondersoek die epidemiologiese teorie van die verspreiding van aansteeklike siektes en stel raamwerke voor vir die toepassing van hierdie teorie op die bio-argeologie. Ons skets probleme met huidige definisies van prehistoriese mobiliteit en stel ‘n raamwerk verskuiwing voor met die fokus op bevolkings-interaksies as nodusse vir oordrag van siektes. Om hierdie nuwe raamwerk te konseptualiseer, het ons ‘n teoretiese model vervaardig wat die wisselwerking tussen klimaatsgeskiktheid, bevolkingsdigtheid, residensiële mobiliteit en menslike interaksievlakke oorweeg om die infeksiesiektepatrone in prehistoriese samestellings te beïnvloed. Daarna het ons die waarneembare effekte van hierdie model getoets in paleo-epidemiologiese data uit Asië (n = 343). Relatiewe risiko-verhoudingsanalise en korrelasies is gebruik om die impak van bevolkings-interaksie, residensiële mobiliteit, bevolkingsdigtheid, klimaat en bestaan op die voorkoms en diversiteit van aansteeklike siektes te toets. Ons statistiese resultate het gedemonstreer dat hoër vlakke van bevolkings-interaksie gelei het tot aansienlik hoër voorkoms van aansteeklike siektes in sittende bevolkings en ‘n beduidende toename in patogeen diversiteit in mobiele bevolkings. Ons beveel aan dat bevolkings-interaksie ingesluit word as ‘n belangrike komponent van die aantstekingsiekte-ontleding van die prehistoriese bevolkingsgesondheid, tesame met ander biososiale faktore soos sedentisme en bevolkingsdigtheid.

The human skeleton reflects an individual’s biocultural life-course, recording information on diet, health, and stress. Using new methods for inferring phys-iological stress during the foetal, infant, and childhood periods, this chapter investigates the early lives of two subadult individuals through the lens of the maternal-infant nexus from the Neolithic site of Man Bac in Vietnam. We apply a novel approach that incorporates stable isotopic evidence for weaning and diet, with a quantitative method of identifying and measuring linear enamel hypoplasia to assess physiological stress during development. These case studies are interpreted within a bioarchaeology of infant- and child-care theoretical model approach that focuses on the maternal-infant nexus, and incorporates information on fertility, palaeopathological data, archaeological data on the natural and social environment, and social organisation.

Thalassemias are inherited blood disorders that are found in high prevalences in the Mediterranean, Southeast Asia and the Pacific. These diseases provide varying levels of resistance to malaria and are proposed to have emerged as an adaptive response to malaria in these regions. The transition to agriculture in the Holocene has been suggested to have influenced the selection for thalassemia in the Mediterranean as land clearance for farming encouraged interaction between Anopheles mosquitos, the vectors for malaria, and human groups. Here we document macroscopic and microscopic skeletal evidence for the presence of thalassemia in both hunter-gatherer (Con Co Ngua) and early agricultural (Man Bac) populations in northern Vietnam. Firstly, our findings demonstrate that thalassemia emerged prior to the transition to agriculture in Mainland Southeast Asia, from at least the early seventh millennium BP, contradicting a long-held assumption that agriculture was the main driver for an increase in malaria in Southeast Asia. Secondly, we describe evidence for significant malarial burden in the region during early agriculture. We argue that the introduction of farming into the region was not the initial driver of the selection for thalassemia, as it may have been in other regions of the world.

A case of disability in the Metal Period of the Philippines, likely requiring healthcare from others, is presented to explore aspects of group dynamics in this period of antiquity. B243, a middle-aged man excavated from the Napa site in the central Philippines, suffered severe trauma to the right leg resulting in considerable restrictions to mobility and self-maintenance of survival-related behaviours such as food provision and hygiene. It is likely that B243 required assistance from others to survive for some period of time prior to eventual death. The bioarchaeology of care method was applied to assess the types of healthcare that B243 likely required and to consider potential social and biological impacts to both B243 and his community. Provision of healthcare practice in this case suggests that B243's community had access to health-related resources, knowledge on the treatment of his injuries and underlying values in the group for sustaining human life in the case of injury and disability. Copyright © 2017 John Wiley & Sons, Ltd.