Download PDF | Chryssi Bourbou - Health and Disease in Byzantine Crete (7th-12th Centuries AD) (Medicine in the Medieval Mediterranean) -Ashgate (2011).
265 Pages
Daily life and living conditions in the Byzantine world are relatively underexplored subjects, often neglected in comparison with more visible aspects of Byzantine culture, such as works of art. The book is among the few publications on Greek Byzantine populations and helps pioneer a new approach to the subject, opening a window on health status and dietary patterns through the lens of bioarchaeological research. Drawing on a diversity of disciplines (biology, chemistry, archaeology and history), the author focuses on the complex interaction between physiology, culture and the environment in Byzantine populations from Crete in the 7th to 12th centuries.
The systematic analysis and interpretation of the mortality profiles, the observed pathological conditions, and of the chemical data, all set in the cultural context of the era, brings new evidence to bear on the reconstruction of living conditions in Byzantine Crete. Individual chapters look at the demographic profiles and mortality patterns of adult and non-adult populations, and study dietary habits and breastfeeding and weaning patterns. In addition, this book provides an indispensable body of primary data for future research in these fields, and so furthers an interdisciplinary approach in tracing the health of the past populations.
Foreword
Careful excavation and research on archaeological human skeletons provide insight into important aspects of the lives of our ancestors that is not accessible through any other source. Like our older living relatives, archaeological human burials have much to teach us through the information we can gain through analysis of data from these remains. However, there are challenges in achieving this objective. Increasingly archaeologists are recognizing the value of biological data in reconstructing the culture of past human societies. Similarly biological anthropologists recognize that data from human remains are affected by the culture represented by human skeletal samples. This reality has promoted cooperation and collaboration between an archaeologist excavating a site and the biological anthropologist analyzing the human burials that may be recovered from the site — ideally with active involvement of the biological anthropologist during excavation. This emphasis on the need to integrate cultural and biological data in the interpretation of skeletal data has led to the use of the term bioarchaeology to describe a research emphasis in which archaeology provides an important context for interpreting the data extracted from archaeological human remains. Dr Chryssi Bourbou’s book provides a commendable example of this emphasis in which she provides the archaeological context for the skeletal remains which are the main focus of her book and utilizes this context in interpreting the results of her analysis.
The remarkable improvements I have witnessed during my lifetime in both the quality and quantity of data that can be obtained from comprehensive skeletal analysis highlights the fact that current scientific methods, if rigorously applied, provide the pathway to a more complete understanding of our past and our relationship to those who have lived before us. It also emphasizes the fact that new methods are likely to be developed in the future and that long-term storage and curation of archaeological skeletal samples is highly likely to provide a source of important new data in the future.
In the following pages, Bourbou has provided the reader witha careful analysis and interpretation of human remains dated to the Byzantine Period (seventh to twelfth centuries AD) and excavated from archaeological sites on the island of Crete in Greece. In her research she has demonstrated again the value of data obtained through the study of human remains. My late mentor and colleague, Dr J. Lawrence Angel, had done remarkable pioneer research on human skeletal biology in the eastern Mediterranean with an emphasis on Greece from the Neolithic Period through the Greek Classical Period. As Bourbou notes, Angel was one of the early scientists to attempt the linkage between the cultural and biological environment with the evidence of the human biological adjustment to this environment provided through analysis of the skeleton. Bourbou has applied more recent bioarchaeological methodology to highlight a phase in Greek history that has not received the attention from which earlier periods have benefited.
The analytical methods available today provide tools that I could not even imagine early in my career. Refinements in dating methods permit much greater accuracy in determining the archaeological age of human remains and radiocarbon dating using accelerator mass spectrometry requires much smaller samples than earlier dating methods. Furthermore we are much more aware of the factors that can distort dating methods. Mass spectrometry has also made possible analysis of stable isotopes that provide data for reconstructing some aspects of the diet in human archaeological skeletal samples. This research methodology is tangibly demonstrated in Bourbou’s interpretation of stable isotope data in Chapter 4 indicating a dietary emphasis on wheat, oil and wine.
Our knowledge about the skeletal disorders that one encounters in the study of human remains has increased dramatically during the 40 years I have been conducting research on human skeletal paleopathology. Ongoing research continues to improve and provide data on the health of past human populations. One of the developments has been a heightened understanding of the skeletal manifestations of two of the metabolic disorders, scurvy and rickets. My own research on scurvy provided the observations needed to identify this disorder in sub-adult skeletons. However, it also raised questions about the pathological significance of porous lesions in the skull. The porous and sometimes hypertrophic lesions apparent in the orbits and skull vault of some sub-adult skulls had been attributed by Angel to one of the genetic anemias. Since Angel’s 1966 paper in Science, in which he coined the term ‘porotic hyperostosis’ for the porous, hypertrophic lesions of the skull, the additional possibility of iron deficiency anemia was added to the list of diagnostic options associated with skull porosity. The term porotic hyperostosis, which should mean abnormal, porous bone formation, has become virtually synonymous with anemia including porous lesions not associated with new bone formation.
However, porous lesions of the skull and lesions in which there is porous hypertrophic bone formation can be caused by several disorders, including anemia, scurvy, rickets, infection and cancer. Anemia can only be identified anatomically if there is evidence of marrow hyperplasia associated with porotic hyperostosis. Angel knew this and assumed that everyone else using the term would as well. However, this has not been the case, with the result that the porous and porous hypertrophic lesions of the skull have been attributed, in most published reports, to anemia with virtually no attention being paid to the presence or absence of marrow hyperplasia. Bourbou is aware of the problem and in her research has wisely insisted on a multifactorial interpretation of these lesions. What is certainly true is that porotic and porotic hypertrophic lesions are indicative of a disorder and this has value as long as it is not attributed to a specific disorder without further evidence of pathogenesis such as the location of the lesions or the presence of marrow hyperplasia.
There are troublesome problems that remain to be dealt with in interpreting data from human skeletal samples. A vigorous scientific debate continues regarding the representativeness of archaeological skeletal samples relative to the living population from which the sample came. Clearly skeletal samples are not fully representative of the living population even in ideal situations. What is less clear is just how significant this limitation is. However, at the very least, bioarchaeologists need to be aware of the potential biases inherent in archaeological skeletal samples and avoid drawing conclusions that are not justified because of the limitations associated with the sample they are studying. For example, Bourbou notes that in Classical Greece children were not full members of society until the age of three and below that age may have been treated differently in the burial tradition. Many of the diseases that affect the skeleton can occur in infants and young children. If these are missing from the skeletal sample, disease prevalence will be distorted. Males and females may be buried in different areas of a cemetery. If the entire cemetery is not excavated this could result in a ratio between males and females that does not represent the living population.
Interpreting the significance of skeletal disease involves variables which current research has little ability to control. Although there are exceptions, the disorders one usually encounters in an archaeological burial are rarely the cause of death and may have had minimal morbidity. Skeletons with no evidence of disorder may represent very healthy people but it is also possible, for example, that they represent people with a poor immune response to infection and who die quickly before the skeleton can be involved.
Despite the limitations in interpreting the data recovered from archaeological human remains, there is much that we can learn from the analysis and Bourbou’s book provides a helpful example of the insight available from rigorous analysis of skeletal samples. As we define more carefully the biases in skeletal samples and achieve greater understanding of the disorders that affect the skeleton, the quality and the interpretation of our data will improve. With growing experience in skeletal analysis it is probable that methods will be developed that will permit researchers to control for at least some of the limitations that currently exist.
Donald J. Ortner
Smithsonian Institution
National Museum of Natural History March 2010
Acknowledgments
There are many people to thank, since without their help and support the publication of this book could never have happened. Friends and colleagues reviewed parts of the first draft, and their valuable comments and suggestions enhanced its format and content: Marie-Héléne Congourdeau (Centre d’ Histoire et Civilisation de Byzance), Benjamin Fuller (Max Planck Institute), Sandra Garvie-Lok (University of Alberta), Cecily Hennesy (Christie's Education), Mary Lewis (University of Reading), Donald Ortner (Smithsonian Institution), Mike Richards (Max Planck Institute; University of British Columbia), Charlotte Roberts (University of Durham), Dionysios Stathakopoulos (King’s College London), and Dimitris Tsougarakis (Ionian University). I am also grateful to many people who shared with me information on the various topics of my study, making substantial contributions of bibliographical references and data from their individual projects: Ilias Anagnostakis (National Institution of Research), Efrosyni Vika, Anastasia Fiolitaki (28th Ephorate of Byzantine Antiquities), Sherry Fox (Wiener Laboratory, American School of Classical Studies at Athens), Maria Kyrimi (13th Ephorate of Byzantine Antiquities), Alice-Mary Talbot (Dumbarton Oaks), Eirini Petroutsa, and Anastasia Papathanasiou (Ephorate of Speleology and Paleoanthropology). I especially thank Vassiliki Zygouri for entrusting me with data from her unpublished master’s thesis.
Permission to examine the human skeletal material in this study was provided by Michalis Andrianakis (28th Ephorate of Byzantine Antiquities), Liana Starida (13th Ephorate of Byzantine Antiquities), and Petros Themelis (University of Crete; Society of Messenian Archaeological Studies). Generous financial support for the bioarchaeological and stable isotope analysis of the collections was granted by the Wiener Laboratory of the American School of Classical Studies at Athens, the Society of Messenian Archaeological Studies, the Ioannis Costopoulos Foundation, and the British School at Athens. Images and permission for their use were kindly provided by Petros Themelis and the Society of Messenian Archaeological Studies.
Images of pathological conditions for the collection from Eleutherna were made by Katerina Painesi, and all images have been skillfully reworked by Constantinos Andronis. Special thanks go to Constantinos Trompoukis (Faculty of Medicine, University of Crete) and Ilias Kosmidis for undertaking the radiographic analysis of the pathological specimens. I also warmly thank Argyro Mamalaki and Vaso Mylona for access to the Library of the University of Crete, and Molly Richardson for her thorough and meticulous editing of the original manuscript. I am much obliged to John Smedley (Ashgate Publishing) for his guidance and for his patience in answering my questions on the format of the book.
I deeply thank Alain Touwaide (Institute for the Preservation of Medical Traditions, Smithsonian Institution) for inviting me to contribute to the series Ancient Medicine in the Mediterranean World, for which he serves as an editor, and for his continuous help and encouragement in the writing of this book. Dionysis, my family and my friends offered tremendous support, standing next to me during moments of stress and gently reminding me of the bright side of life.
Introduction
This book is about the analysis and interpretation of lifestyle and disease in Byzantine Crete through the study of human skeletal remains and the use of innovative techniques such as chemical analysis (stable isotopes) for the reconstruction of dietary, breastfeeding and weaning patterns. The interaction between humans and their environment is a millennia-long affair that has attracted increasing interest from archaeologists since the development of science-based multidisciplinary applications in the field. In the last decade, the term ‘bioarchaeology’ has been applied to the subfield that through a multidisciplinary approach focuses on the human biological component of the archaeological record and offers insights into the lifestyle, demography, disease patterns (palaeopathology) and diet of past populations.’
Major or minor, each adaptation to a continuously changing environment is potentially reflected in our bodies. Thus, without studying humans themselves we could only partially reconstruct life in the past. Bones and teeth, as well as mummified remains, serve as the primary source of evidence for anthropological and palaeopathological analysis, while iconography and documentary evidence supplement the study of diseases in the past. The methods most frequently applied to the study of human remains are macroscopic (visual) observation, radiology and computed tomography.’ More sophisticated techniques are increasingly being employed, providing more accurate information, but also leading to higher costs and technical demands. The application of biomolecular techniques such as ancient DNA (aDNA) analysis* has proven particularly useful for recognizing diseases that only affect soft tissues, such as the Black Death.‘ Research to date has concentrated mainly on tuberculosis’ and leprosy,* although DNA from the causative organisms for diseases such as venereal syphilis,’ malaria,’ Spanish influenza’ and typhoid fever’ has also been extracted and amplified from archaeological material. Microscopic applications (for example, palaeohistology) have also presented exciting possibilities, providing detailed information to make or confirm specific diagnoses.'' Also of increasing importance has been the application of chemical analysis (for example, stable isotope analysis) for looking at dietary patterns in order to better understand the quality and balance of foodstuffs and their effect on health” or migration patterns.’
Limitations (for example, not all pathological conditions produce lesions on dry bone) and pitfalls in bioarchaeology, as in every discipline, give rise to various problems inherent to the study of human remains recovered from archaeological contexts. In 1992, Wood et al. published a thought-provoking paper that brought these problems to the attention of researchers. Their observations were ~and still are — shared by the majority of specialists working in bioarchaeology, skeletal biology and related disciplines, who recognize that from the soil to the laboratory, human remains are subject to a number of extrinsic and intrinsic factors that potentially complicate any attempt to reconstruct past lifestyle and disease patterns.'* Much criticism has also stemmed from the argument that since the early 1980s, a lack of shared and combined research between archaeology and physical anthropology is noted. Goldstein pointed to the need for more science- and laboratory-oriented research on human remains, whereas today physical anthropologists ignore archaeological data, and bioarchaeology seems to be solely the study of human remains recovered from an archaeological context.!> Although some of her arguments and concerns are valid and are partially explained by the different trajectories the two disciplines have followed during the years, it must be always remembered that it is actually the educational background of the researcher that weighs most heavily upon the type of analysis applied. In other words, for an archaeologist specializing in the study of human remains the integration of archaeological, cultural and biological data is unquestionable in every attempt to reconstruct past lives, especially within historic contexts. Nevertheless, the “bioarchaeological approach’ is recognized as an important tool of investigation and, although still burdened with several complex unresolved issues, it remains our best option to understand fully the ways of life and death in the past.
During the last quarter of the nineteenth and the first half of the twentieth centuries, the educational background in medicine and biology of researchers involved in the study of human remains in Greece influenced their interests, which centered on exhaustive measurements and indices of variations between and within populations.'* The physical anthropologist J. Lawrence Angel (191586) was the first to exhibit an interest in the skeletal biology of the Eastern Mediterranean, with Greece being the major focus throughout his life.'” Angel belongs to the group of researchers who were responsible for shifting the research interests of palaeopathology from a static concern with the history of disease to questions concerning the epidemiology of diseases and their relation to other biocultural factors. Apart from his many reports on skeletal material from a variety of archaeological sites in Greece,'* Angel had a keen interest in a number of areas of physical anthropology, such as palaeodemography,” palaeopathology (with publications on thalassaemia and its relationship to malaria in the Mediterranean area),”° trauma”! and occupationally related pathology.”
In the years that followed, bioarchaeology in Greece demonstrated a shift from hesitant and sporadic case studies to population-based analysis on a wider regional and temporal level. Most of these studies initially focused on prehistoric or classical populations.” Laskaris, in his survey of Byzantine cemeteries and scattered burials throughout Greece, lists 561 sites, out of which only a very small number have received a thorough study of their recovered human skeletal remains.” This lack of skeletal studies for Byzantine populations can be explained to a great extent by the fact that very few systematic excavations have been carried out on Byzantine cemeteries and most of the material has been retrieved from rescue excavations, where it is at best viewed as a time- and money-consuming issue. Under these circumstances most Byzantine burial grounds are hastily excavated, and the material recovered is poorly stored and far less available for study and publication. In addition, human remains from Christian burials excavated within churches often end up in a communal grave after a brief ceremony by the local priest. In other European countries, such as the United Kingdom, specific guidelines are published for the treatment of human remains excavated in Christian burial grounds.** However, such protocols do not currently exist in Greece, highlighting the need for public awareness of the scientific value of human skeletal remains.
It is only in recent years that an increased interest has been expressed in the study of populations dating to Byzantine and post-Byzantine periods, or of specific segments of these populations such as non-adults.”* Besides these population studies, researchers are increasingly using stable isotope analysis for detecting dietary, breastfeeding and weaning patterns, surveying as well the abundant documentary evidence against which the biological data can be projected and compared.” The present study focuses on the reconstruction of health status and dietary patterns of early (fourth to ninth centuries AD) and middle (tenth to thirteenth centuries AD) Byzantine populations from Crete.’® Human skeletal collections from the early Byzantine period date mainly to the sixth-seventh centuries AD, and from the middle Byzantine period to the eleventh—twelfth centuries AD. Little information has been available for Byzantine Crete, making the contribution of an interdisciplinary approach essential. Documentary and archaeological evidence gives sparse and scattered information, resulting in more questions than answers for the transitional and idiosyncratic character of the period in question.” The multiple and intensive stresses (including invasions and natural disasters such as earthquakes) suffered periodically throughout the Byzantine period highlight the need for caution in order to avoid simplistic generalizations about everyday life and the socioeconomic and cultural activities of its populations. Nevertheless, in the past few years a growing interest can be noted in the rather neglected and largely unknown Byzantine Crete. The international conference Creta Romana e Protobizantina (Heraklion, 2000) represented a pioneering effort to bring together researchers from a variety of specializations in order to determine the effects of the complex phenomena observed during the gradual transformation from the ancient to the Byzantine world, and the resulting four-volume corpus of papers was published in 2004.” Added to these proceedings is the extensive publication of the results obtained from years of systematic excavation at the early Byzantine site of Eleutherna.*! Piece by piece, the picture of Byzantine Crete is being roughly shaped and, although still much work remains to be done, a solid background exists upon which science-based research can be conducted.”
Since studies published on health in past populations vary in quality, data for inclusion in this book have been mainly derived from the work conducted by the author for the sites of Eleutherna, Kastella and Stylos. For comparison, published data for other Byzantine populations from Crete have been scrutinized and modified as appropriate in order to provide a more complete picture of the era in question; the publications that have proven helpful include those on the early Byzantine sites of Gortyn, Knossos and Kefali Pediados.* For the reconstruction of dietary patterns it was thought more useful to include all available data from sites outside Crete, in order to have a better idea of the Byzantine dietary profile and attitudes towards breastfeeding and weaning patterns.
The book begins with a presentation on the general context of Byzantine Crete, in order to contextualize the biological data and the methodology used for the anthropological and palaeopathological analysis (Chapter 1). The next two chapters discuss the results obtained from the study of the adult (Chapter 2) and non-adult (Chapter 3) segments of the populations, respectively. These chapters present the demographic profile and mortality patterns of the populations, as well as the observed pathological conditions.
There are anumber of broad categories of disease that most palaeopathologists consider when studying past populations, some of which are more common than others. In this book the major disease categories (dental, joint and infectious diseases, hematopoietic and metabolic disorders, as well as traumatic incidents) are the areas focused on, but where evidence exists for rarer conditions (such as neoplastic and congenital) they are also included. Notably pathological conditions are better viewed in their biocultural context. Thus, for example, in terms of periodic crises and culturally influenced practices, it is impossible to ignore the impact of impoverished conditions on the development of specific pathological conditions.
Chapter 4 is devoted to stable isotope analysis applied to the study of dietary habits, as well as of breastfeeding and weaning patterns. The results obtained from such an analysis are viewed within the specific cultural context of the era: for example, it is essential to determine the likely 5'°C and 6°N values of some of the items mentioned in the sources and known to be included in the Byzantine diet. Furthermore, fasting rules targeting some key animal products in the diet, or restrictions applied according to gender, should be considered when reconstructing Byzantine diets. Similarly, since attitudes towards breastfeeding and weaning patterns are cited in the written sources, isotopic data can ideally be projected and compared against documentary evidence. As the effects of weaning have been associated with the development of specific pathological conditions, special attention is given to metabolic and hematopoietic disorders. Finally, a synthesis of the obtained data is presented in the last chapter (Conclusions), where the integration of biological, chemical and cultural data provides a holistic picture of Cretan populations during the Byzantine era.
The diversity of fields that bioarchaeology draws from (for example, biology, chemistry, social sciences) reflects the fact that humans more than any other living organism experience a complex interaction between physiology, culture and the environment. The interpretation of this interaction — which usually affects human remains in multiple and not always clear ways — is the bioarchaeologist’s primary task. Since the mid-1980s the changes seen in the field of bioarchaeology demonstrate an increasing sophistication, which permits us to share Larsen’s enthusiasm when noting that:**
Bioarchaeology is enjoying a period of robust growth.
The same spirit of vitality and innovation in bioarchaeology is shared among specialists working in Greece. The increasing number of publications has stimulated a series of events convened to highlight the burgeoning of bioarchaeological studies in Greece.* Currently, a number of institutions support and promote the study of human skeletal remains in Greece (university departments in Athens, Rhodes, Thessalonike, Thrace and Heraklion; the Ephorate of Speleology and Palaeoanthropology; the Wiener Laboratory of the American School of Classical Studies at Athens), offering a rich environment for fruitful work. Recognizing the significance of modern reference collections for research and teaching purposes, such a collection is currently housed at the Department of Animal and Human Physiology at the University of Athens.** The establishment of such a collection highlights the emergence of a clearly science-based discipline in Greece. It is also promising to see that archaeologists are incorporating into their research projects the study of human skeletal remains and encouraging the presence of a specialist in the field. They also understand the benefits of integrating the results of such an analysis into the general discussion of the funerary and cultural context, rather than including a separate appendix at the end of a cemetery report.
It is very important to emphasize the hope that bioarchaeological studies will further promote the interest of all related specialists in the education of the general public on the scientific value of human remains, a task that can be accomplished if bones take an actual place in museum halls.” A brief survey of how skeletal remains are displayed in museum exhibitions designed to teach people that archaeology discovers not only elaborate structures and precious artifacts but also the remains of the people who actually produced them, is limited to a handful of examples. While artifacts derived from funerary contexts are displayed and presented with much detail, the associated skeletal remains are usually absent. The Kerameikos Museum in Athens hosts only one funerary urn with cremated remains — and that is the only visual presence of human remains in a museum devoted exclusively to the finds retrieved from an extensive burial ground (Figure Intro. 1). Figure Intro.1_ A funerary urn with cremated human bones. Kerameikos Museum, Athens (photo: C. Bourbou)
In a more optimistic view, though, it must be highlighted that several temporary exhibitions have devoted a special section to the wealth of information we obtain from the study of human remains when observing pathological conditions and their treatment, diet or genetic affiliations (Minoans and Mycenaeans: Flavors of their Times, National Archaeological Museum of Athens, 1999), or have reconstructed burial environments including the skeletal remains (Eleutherna: Polis, Acropolis, Necropolis, Museum of Cycladic Art, Athens, 2005). A truly innovative way of displaying human remains has been admired by visitors at a recent exhibition (Andritsa Cave - Fateful Refuge, Byzantine and Christian Museum, 2005): bare bones were not exhibited; instead a sandy outline was carefully arranged to mimic the actual position of the skeleton as found within the burial context.
It is hoped that in the near future archaeologists and biological anthropologists will work together so that skeletons will come out of their closets, revealing secrets of their past lives. The bioarchaeological approach applied to Byzantine populations from Crete is expected to be such a stimulus for future analyses in Greece, especially for cases in which documentary and archaeological evidence is scarce and incomplete. The solid background of the discipline in Greece and the increasing interest in multidisciplinary applications to archaeological projects demonstrate a field where fruitful research is yet to be done.
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