The Bioarchaeology of Tuberculosis: A Global View on a Reemerging Disease. CHARLOTTE A. ROBERTS AND JANE E. BUIKSTRA. University Press of Florida, Gainesville, 2003. ix + 343 pp., illus., figs., tables, glossary, biblio., index. $59.95 (cloth), ISBN 0-8130-2643-1.
Reviewed by Ben M. Shields
The study of tuberculosis has received increased attention over the past decade due to the inflation of infection rates in major "third world" cities and in correctional institutions such as the Russian prison system. When these figures are coupled with the recent discovery that the tuberculosis bacillus now has the ability to resist successive waves of antibiotic treatment regimes, it becomes clear that the evolutionary story of the disease must occupy a front-line position if progress is to be made toward its eradication. The Bioarchaeology of Tuberculosis: A Global View on a Reemerging Disease, by Charlotte A. Roberts and Jane E. Buikstra takes a substantial step in this direction. The authors cover a broad spectrum of ideas, concerns, and topics related to the human experience of tuberculosis and how it has been studied. These include the pathogenesis of the disease, the living conditions and policies that have nurtured its spread, the differential diagnosis of its skeletal manifestations in past populations of the Old and New Worlds, and the methods that have been employed to treat tuberculosis patients throughout recorded history. Casting a wide net is necessary for understanding a disease that ignores social, political, and geographic boundaries, and Roberts and Buikstra traverse these borders by incorporating research published in hard-to-find sources into their discussions.
The book is comprised of six chapters and includes a glossary of definitions for terms that are commonly used in the literature of medicine and paleopathology. In chapter 1, Roberts and Buikstra define tuberculosis as an infectious disease that affects human and nonhuman animals and that is caused by numerous species of the genus Mycobacterium. The species that more commonly infect both humans and nonhuman animals are emphasized to draw attention to how the relationship between these hosts has been a major predisposing factor to acquiring the infection. Following a survey of published infection rate data derived from western nations and a discussion of the initial stages of bodily infection, the authors focus on the signs and symptoms that alert its victims and health-care practitioners to its presence. I find that the last few sections of chapter 1 are particularly sobering because it is here where the pre-disposing risk factors, treatments, and control issues regarding tuberculosis are presented and scrutinized. The authors underscore the obstacles that patients with HIV-/AIDS face in resisting tuberculosis and elaborate on the problems that may arise when drug therapy regimens (e.g., DOTS, or Directly Observed Therapy) are not followed through to completion.
The risk factors that are particularly relevant to tuberculosis infection in past populations, as well as for modern human groups, constitute the subject mater of chapter 2. Buikstra and Roberts explicitly identify overcrowding, poverty, and human relationships with nonhuman animals as the major predisposing factors to infection in modern groups. Ethnographic examples and public health studies are drawn upon to illustrate how certain living conditions, particularly poorly ventilated housing in areas of high population density, create the ideal environment for M. tuberculosis and M. bovis to thrive. As Roberts and Buikstra suggest, all of these factors are certainly amenable to archaeological research, as are issues of migration and travel of infected persons to geographically distant locales.
In chapters 3 and 4, the authors weave together discussions of the differential diagnosis of skeletal lesions produced by tuberculosis, the biomolecular approaches that may distinguish the presence of the disease when lesions are ambiguous or absent, and the evidence for prehistoric tuberculosis in the Old and New Worlds. …