Counting the dead: the epidemiology of skeletal populations

Palaeopathology in recent years has advanced from the mere identification and diagnosis of pathological lesions in human corporeal remains, although this is still basic in all studies. In the discipline today, diseases are not considered solely at individual level, but the aim is an understanding of diseases in archaic communities as a whole. Germane to this is a knowledge of the principles of epidemiology. It is noted however, that in practice few palaeopathologists have this and, until the present volume by Waldron, there has not been an adequate appropriate text. Thus, Counting the dead is very timely and welcome. Dr Waldron is a physician and epidemiologist, a very experienced palaeopathologist, and a university lecturer. His credentials for writing this book are probably without equal. The book is written in a pleasing and easy style. Although, of necessity, technical, it is not so complex as to be unintelligible to the newcomer to palaeopathology, or so simplistic as to be useless to the experienced practitioner. After briefly presenting the history of palaeopathology as an academic discipline, chapter 2 is devoted at length to many important factors relating to skeletal populations which are readily overlooked or not generally appreciated. Waldron points out that the discipline deals with dead archaic populations and that they differ in many respects from living contemporary peoples, not just in the fact that they are dead. The problem of age estimation of skeletal remains, and hence of palaeoepidemiological study is discussed. Even more basic in demography and epidemiology is the completeness, in community terms, of the skeletal population excavated. Waldron deals with this in a very clear and well illustrated way. The thapter on diagnosis is less useful for the experienced practitioner, but will be a good cautionary essay for the enthusiastic diagnostician. It reveals Waldron's clear interest and specialism in the palaeopathology of joint disease. Dr Waldron has always been at pains to point out the essential differences between incidence and prevalence, and the nonapplicability of the former to palaeopathology. Several other indices of morbidity and mortality are discussed and their relevance to archaic populations is considered. Clearly, there are significant limitations in palaeopathology, and Waldron has forcibly pointed these out. This is particularly valuable and must be realized before real progress can be made in palaeodemography and palaeoepidemiology. The mathematics presented are, at first, daunting, but are not as difficult as p. 63 initially appears, even to the present reviewer. Chapters 6 and 7 draw together, with examples of frequencies of skeletal anomalies, and with considerations of age and sex, the principles outlined earlier in the book. They demonstrate the way forward and the limitations and scope. Dr Waldron's admirable, well constructed, easily readable, and eminently clear book is also inexpensive. I recommend it as essential reading to students in palaeopathology and physical anthropology, and to those more experienced practitioners too. It will remain handy on my bookshelf.