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the observation but record it for later comparative evaluation. No one ever regrets being too
comprehensive. Know where muscle tendons and ligaments are located, particularly those
on the shaft (diaphysis) of long bones (e.g., linea aspera of the femur, deltoid tuberosity of
the humerus, popliteal line of the tibia, and ankle ligaments). The novice scholar often misin-
terprets the exuberant bone growth of mechanical stress (called enthesopathies at tendon inser-
tions and syndesmoses at ligament insertions) for infectious reaction.
Recommended Reference Materials
Have on hand an osteology text (e.g., Steele and Bramblett, 1988; White and Folkens, 1999;
Juurlink, 2009; White et al., 2012 ) in order to help identify fragmentary material. If material is
particularly fragmentary, have reference bones available. For some identifications (e.g.,
phalanges of hands and feet), models are essential. A prudent scholar always has access to
at least one encyclopedia of bone pathology. The paleopathology “bibles” are Donald Ort-
ner's Identification of Pathological Conditions in Human Skeletal Remains (2003) and The
Cambridge Encyclopedia of Human Paleopathology by Arthur C. Aufderheide and Conrado
Rodr´guez-Mart´n (1998). There are also other available resources, including image-rich
paleopathological resource topics (e.g., Steinbock, 1976 ; Zimmerman and Kelly, 1982; Ortner
and Putschar, 1985 ; 2 Mann and Hunt, 2005; Waldron, 2007b, 2008 ), course texts (e.g., Mays,
1998 ; Cox and Mays, 2000; Roberts and Manchester, 2007; Pinhasi and Mays, 2008;
Katzenberg and Saunders, 2008; Waldron, 2008; Pinhasi and Stock, 2011 ), the Global History
of Health Project Data Collection Codebook, 3 the Guidelines to the Standards for Recording Human
Remains 4 (Brickley and McKinley, 2004) and the Standards for Data Collection from Human Skel-
etal Remains by Buikstra and Ubelaker (1994) . 5
Differential Diagnosis
Diagnostic skill also comes with experience. The scholar should be mindful that an acute
pathological process (e.g., measles, typhus, plague) does not leave a macroscopic reactive
bone signature on the skeleton; however, a chronic process disseminates to bone in later
stages. Bone also has a limited spectrum of reactive responses to disease, inflammation,
deprivation, and trauma (Aufderheide and Rodr ´ guez-Mart ´ n, 1998; Ortner, 2003 ). This
means that a particular suite of reactive changes may have one or more causes (e.g., vitamin
deficiency or parasite load), and one or more mediating factors (e.g., frailty, body size, age), or
be caused by one or another specific disease that may not or cannot be teased apart (e.g.,
2 An earlier version of this topic (Ortner and Putschar, 1981) is downloadable at http://www.sil.si.edu/
smithsoniancontributions/Anthropology/pdf_hi/SCtA-0028.pdf (all Internet links current as of
publication).
3 http://global.sbs.ohio-state.edu/new_docs/Codebook-01-24-11-em.pdf
4 http://www.babao.org.uk/HumanremainsFINAL.pdf
5 Online image catalogs are available at http://www.museumoflondon.org.uk/Collections-Research/
LAARC/Centre-for-Human-Bioarchaeology/Resources/Photographs/Default.htm and, courtesy of
Donald Ortner, at http://global.sbs.ohio-state.edu/cd-contents/Ortner-slides/Book%20001-jpg/ .
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