Importance of Paleopathology: Disease and Health
In disease and health, Paleopathology plays a unique position of bridging the gap between science and art. Paleopathology offers an integration of clinical data with anthropological theoretical viewpoints in a bid to provide solutions with broad contemporary relevance to the body of medicine and anthropology ( Roberts, 2015) . Data collected from the remains of animals whether in skeletal or preserved bodies enables gaining of insights into the lives as well as deaths of human ancestors. The remains of humans are critical evidence of how people lived in the past and, thus, useful in finding out how individual’s lives impacted on their health ( Gowland, 2015) . Paleopathology offers insights into how the human health has changed over time since the existence of human species. Paleopathology enables the understanding of the epidemiological transition that has occurred in the human species over the past years ( Roberts, 2015) . The transition has changed how people live and die since the existence of human species. Therefore, the interaction of humans with the environment has changed over the past affecting their health ( Zuckerman, Harper, & Armelagos2016) . Three case studies are critical to comprehending the role of paleopathology in understanding the evolution of the disease. They include tuberculosis as a respiratory health problem, leprosy, and syphilis. Reasons for such illnesses still existing in numerous countries today also forms a fundamental point discussion.
Discussion
Palaeopathology deals in the documentation of disease origin and provides primary evidence of disease evolution across generations ( Roberts, 2016) . Such details offer useful information for health and wellbeing of humans. They can be found from human remains such as bones and preserved eggs. Therefore a bio-cultural approach is undertaken to integrate such data from the biological remains with the context under which the remains were derived. For a proper understanding of the health of people in the ancient days, it is imperative to keenly interrogate how they lived in the environment ( Roberts, 2016) . Such would include their feeding habit, culture, how they interacted with one another and overall lifestyle and, although extrinsic affect disease occurrence and biological inheritance of diseases. Others may include biological sex and age. The common analogy that genes load the bullet to the gun while the environment serves to pull the trigger well describes the situation that environment plays in the evolution of diseases ( Zuckerman, Harper, & Armelagos, 2016) .
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According to Roberts, (2016), first reports of ancient DNA was reported in a mummy in 1989 and was found in bones. Similarly, in 1993, the first pathogen DNA to be was published was that of Tuberculosis. Therefore, the paleopathology as an area of study has seen incredible development in addition to the sequencing of genomes of ancient and modern times. As such, the comparison has been possible to advance treatment in the health industry. Paleopathology has thus enabled confirmation of disease diagnosis in skeletons without bone exchanges. It has further allowed the exploration of organisms' strains and detection of disease carriers ( Gowland, 2015) . Paleopathology documents soft tissue disease that may exist in skeletons looks at the susceptibility and gene resistance as well as the frequency rates of infections. A case study of three diseases, tuberculosis, syphilis and leprosy offers insight into the role of paleopathology in health and medicine.
Tuberculosis and paleopathology
In paleopathology, Tuberculosis has become a considerable focus of research. Roberts, (2016) describes TB as a bacterial infection caused by the Mycobacterium tuberculosis complex bacterium. The disease is contracted through the lungs during inhalations as well as through gastrointestinal tract from infected foods such as milk or meat. Certain lifestyle, socio-economic or cultural predisposing condition include poverty, individual’s lack of vitamin D as well as migration s and constant sharing of space with animals ( Roberts, 2016) . Tuberculosis affects the skeletal. In this regard, the spine, knee, and joints are the places most affected by Tb. However, a small percentage of individual's with untreated TB would experience it in their joints and spines, approximately 5% ( Roberts, 2016) .
Paleopathology enables Tuberculosis to be well understood from a paleopathological history that dates back to thousands of years in the old world although it has been reemerging in recent years. Paleopathology thus proves an imperative in understanding the phenomenon. A lot has been done in Paleopathology since 1993 to understand the history of TB. The Paleopathological research has been instrumental in understanding why the strains of TB have become resistant to the medication particularly antibiotics ( Dutour, 2016) . With the development of Paleopathology, the critical question about the history of the disease have become pushier. Paleopathology has begun to reveal more about human interaction with the environment and how it makes it conducive for TB to develop.
Through Paleopathology, there has been DNA analysis successful in the identification of species that have affected humans. Majority of the studies conducted have shown that TB is the human form of the bacteria. Recently, the advancement of technology in Palaeopathology has been able to show the strands of TB people that were affected. Additionally, the availability of genomics data on bacteria has enabled the comparison with the ancient data furthering the Palaeopathology success.
The modern TB strains are isolated in Iron Age England while those of 18th/19th century are in Hungary. According to Bos et al. (2014), about 1000-year-old Peruvians with tuberculosis strains were found to be closely linked to strains adapted sea lions. In a study seeking to detect strains of TB in skeletons from archaeological sites in England across different periods, it was realized that there existed different strains of TB at different times. For instance, in a Roman site around the 2nd–3rd century, AD two separate strands of TB were found while others were found at post-medieval places during the 19th century AD ( Doughty, Sergeant, Adetifa, Antonio, & Pallen, 2014) . It was also found out that a woman in a specific post-medieval site had contracted a TB strain not common in England but primarily found in North America. (Bouwman et al. 2012). Owing to the above, an inference could be drawn that there was a relationship between human mobility and TB transmission. The difference in TB strains across people over time is also a clear indicator that environmental factors affect TB ( Doughty et al., 2014) . However, the ecological issue remains the significant factor of research in understanding the challenges of TB in the recent days in terms of its reoccurrence.
Syphilis and Paleopathology
Karem and Pillay, (2014) explain that Paleopathology has enabled the syphilitic lesions to be investigated to understand their association with differing timelines. Similarly, the difference in the presence of the infection in the old and new worlds have been examined. However, it is needful to recognize that the methods used for assessment of the disease had a few limitations. For instance, documentation of bone lesions shows evidence of the existence of syphilis in anthropologic samples. Nevertheless, it is not limited to syphilis. Recent studies have provided evidence of the origin of syphilis geographically as well as chronologically. The data obtained from such studies indicate closest genetic relatives of the disease to be yaws-causing T. pallidum subsp. pertenue strains. Such strains originate from South America. Such case would also support the Columbian theory that explains the origin of syphilis to be Columbia. The debate over the origins of such infectious disease like syphilis is of importance to paleopathologists. It informs them on the history of the environmental interactions of humans and the evolutionary paths of both humans and bacterium.
Further, the use of both phylogenetic and paleopathological data has enabled the understanding of syphilis and the environment it originated from. According to Karem, and Pillay (2014), Paleopathological analysis combined with molecular analysis as well as the Columbian evidence of yaws, it is easier to make predictions on the evolution of the disease. In fact, based on the genomic rates, it is estimated that syphilis emerged about 5000 ybp. Through such analysis, the introduction of syphilis to Europe and other parts of the world can thus be analyzed to understand how to approach the disease. Paleopathology of syphilis also suggests that the disease is evolutionary over an estimated period of 500ybp while the etiological agents are showing to be much older than those years. Such studies are prudent in highlighting the power of paleopathology combined with genomic studies in understanding the disease's evolution to inform on better ways of managing them today. From the studies above, it is also clear that treponemes can give more insight into the evolution and origin of syphilis.
Paleopathology has enabled various disease to be studied using the same combination to define their origin and evolution. The environmental characteristics that played a role in genetic mutation to allow for the evolution of the disease can thus be understood. Therefore, combining paleopathology with epidemiology and disease ecology provides a reasonable approach towards understanding the disease from its ancient times. It enables one to gain insights into the attributes of convergent as well as divergent evolution. Likewise the role of natural selection on ancient human pathogens as a way that a disease may be extinct or disappear over some time.
Through Paleopathology, research can benefit from knowledge on how syphilis has undergone various changes that are very dynamic. Zuckerman, Harper, and Armelagos, (2016) note that s uch changes are both therapeutic and behaviorally adaptive to remain a problem for the world up to the 21st century. Evolution of disease needs more paleopathological studies. For instance, controlling syphilis became viable during the mid-20th century. Medication available then was penicillin and proved very effective in fighting the disease. The world health organization even published a monograph that certain detailed states that had succeeded in fighting syphilis with penicillin. The use of penicillin made the control of treponemal possible over a very short period. Its elimination was just in the offing. However, the disease would later become an issue in other areas and is present today albeit not a pandemic.
Paleopathology has indeed been helpful in the study of syphilis. In fact, biological, research on the disease suffers limitations owing to the nonexistence of an in vitro growth system that will enable the propagation of treponemes ( Dutour, 2016) . As a result, basic research on syphilis has become quite expensive since there is a need for the in vivo growths. Paleopathology is also helpful in the analysis of syphilis because the laboratory research lab strains often may not well epitomize the pathogenic strains in human beings. After all, the clinical isolation done for syphilis bacterium for research has largely been as a result of the need for animal facilities thereby limiting the studies of pathogenic strains.
Paleopathology has revealed how the ecology of syphilis as a disease exclusively depends on human behaviors ( Lockau, 2017) . Consequently, the control efforts largely depend on the disease surveillance, appropriate diagnosis and intervention programs in pace. Lockau, (2017) notes that t he transmission of syphilis is evidently reliant on the human conduct. Therefore, the behavior patterns are a good study point in the paleopathology of the disease especially in the understanding of why it would be pandemic in certain periods. The advances in the diagnostics of the disease in addition to the effectiveness of such diagnostic techniques may offer an improved public health impact. However, Lockau, (2017) adds that a combination of paleopathology with genomics and gene sequencing offers more insight into the evolution and pattern of treponemes. Noteworthy is that the capacity for the control of treponemes that cause syphilis is largely depended on the advancement of knowledge in paleopathology and genomics and best practices in the disease diagnostics.
Leprosy and paleopathology
M. leprae bacteria cause leprosy. Paleopathology has provided tremendous developments in the treatment of leprosy as well as its management. According to Suzuki, Saso, Hoshino, Sakurai, Tanigawa, Luo, and Ishii (2014), M. leprae DNA has been detected in archaeological skeletal remains of humans. In Japan, there have been published reports of M. leprae DNA found on exhumed human skeletal. Such remains were observed owing to the Suzuki et al. (2014) points out that poor preservations that occurred as a result of acidity of the soil. Combining whole PCR analysis and genome amplification with DNA sequencing was able to reveal the presence of M. leprae DNA in such human remains. Paleopathology provides insightful information about infectious diseases like leprosy ( Donoghue, Taylor, Marcsik, Molnár, Pálfi, Pap, and Likovsky, 2015) . Paleogenomics approaches have thus had very significant contribution toward understanding infectious disease management. Similarly, they have enabled enhanced understanding of the evolution of the linkage between humans and pathogens. Therefore, an integrative approach that is multidisciplinary enables the combination of data from ancient bones and molecules to construct the human past and subsequently the infections ( Donoghue et al., 2015) . As such, predictions of the past leprosy human relationship can be reached to inform how it could be approached in the present. The infectious diseases like leprosy have continued to exist in the 21st century, an indicator of disease evolution. Knowing the past would be instrumental in predicting their future.
Paleopathology has enabled the identification of osteological lesions that are Leprosy specific among excavated remains of humans in Japan. Owing to the discovery, an inference about the culture of the Japanese people could be drawn in terms of how they reacted to the disease and treated the victims as could be seen in Nabe-kaburi burials ( Suzuki et al., 2014) . Although paleopathology has given more insights into the ancient details of the disease, the molecular evidence about it still lacks. The Nabe-kaburi burials have played an essential role in the paleopathology process of leprosy. They have enabled the detection of M. leprae which is the Mycobacterium responsible for the disease.
Paleopathology enabled an evaluation to be conducted from the M. eprae bacterium from Nabe-kaburi burials involving small samples drawn from both control and affected areas to show evidence of the disease ( Suzuki et al., 2014) . Using whole genome amplification, the DNA was extracted targeting M. leprae. It, therefore, gives evidence that there were Nabe-kaburi burials perfumed for individuals with leprosy in the Japanese community. Both archeological and anthropological examinations could explain the reasons for the performance of Nabe-kaburi burials in Japan during the ancient times though.
Owing to the paleopathology studies on the skeletal, leprosy could be observed in human skull around the nasal region. The edge of the human nasal aperture indicated the presence of leprosy while the inner surface of the nasal cavity showed bone absorption in addition to remodeled maxilla palatine process a condition likely to be caused by periostitis ( Suzuki Ishii, (et al., 2014) .
The use of paleopathology has been a boon to health and medicine through progressing disease analysis in the field of palaeomicrobiology ( Dutour, 2016) . As such, from an excavated human skeletal, DNA from pathogenic microorganisms can be identified through the utilization of the polymerase chain reaction. As a robust molecular tool PCR enables diagnosis of infectious diseases on the skeletal which allows for the demonstration of the distribution of the disease, its spread as well as the genetic evolution. Therefore, it offers an opportunity for conducting a genome-wide comparison bacteria in the old world and current times provided the DNA is well preserved.
Paleopathology will thus be an important tools useful in future efforts to validate existence of M. tuberculosis or Treponema pallidum in skeletal of human remnants. Such will be possible provided the obtained DNA if samples have osteological lesions of tuberculosis or syphilis. Therefore, the findings of paleopathology combined with molecular analysis will be a boon to medicine and health through providing definitive evidence on disease patterns and evolutionary trends.
Paleopathology studies have enabled the tracing of diseases on human as well as animal remains from the ancient times. It has enabled the deeper understanding of the infectious disease evolutionary patterns giving insights on how the diseases like TB, Syphilis and Leprosy could be better managed. Through the application of paleogenetics on the DNA of microbes integrated with genome sequencing techniques, the process of paleopathology has renewed how infections of such diseases occurred in the past ( Dutour, 2016) . Such advances have served to open up the new challenges that have hindered the understanding of human-pathogen relations in the health concept. The process had further informed reasons for the optimistic prediction into the eradication of tuberculosis and syphilis in the 20th century and why the diseases are still in existence to date. Therefore, paleopathology enables a better understanding of the disease history and evolution to predict its future.
References
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