Human parasites in the Roman World: health consequences of conquering an empire

The archaeological evidence for parasites in the Roman era is presented in order to demonstrate the species present at that time, and highlight the health consequences for people living under Roman rule. Despite their large multi-seat public latrines with washing facilities, sewer systems, sanitation legislation, fountains and piped drinking water from aqueducts, we see the widespread presence of whipworm (Trichuris trichiura), roundworm (Ascaris lumbricoides) and Entamoeba histolytica that causes dysentery. This would suggest that the public sanitation measures were insufficient to protect the population from parasites spread by fecal contamination. Ectoparasites such as fleas, head lice, body lice, pubic lice and bed bugs were also present, and delousing combs have been found. The evidence fails to demonstrate that the Roman culture of regular bathing in the public baths reduced the prevalence of these parasites. Fish tapeworm was noted to be widely present, and was more common than in Bronze and Iron Age Europe. It is possible that the Roman enthusiasm for fermented, uncooked fish sauce (garum) may have facilitated the spread of this helminth. Roman medical practitioners such as Galen were aware of intestinal worms, explaining their existence and planning treatment using the humoural theory of the period

Anatomy and surgery in Europe and the Middle East during the Middle Ages

My aim here is to consider the evidence for both anatomical and surgical knowledge in the Middle East and Europe during the medieval period. A large body of excellent research exists that explores medicine at that time. However, some areas are understood much better than others, and some theories from the nineteenth and twentieth centuries are still included in modern texts even though they have been disproved or significantly revised. The Middle East and Europe were distinct geographically, linguistically, and theologically, but the theory that underpinned the understanding of medieval medicine was the same since both regions followed the humoural theory of the ancient Greeks. Despite the known differences between medieval Europe and the Middle East, there was considerable movement of people, translation of medical texts, and practical interaction between medical practitioners from both regions, especially at the time of the crusades. This complex interaction allows us to consider the flow of ideas between cultures, and to compare and contrast how these differing cultures led to variation in the practice of anatomical dissection and surgery

Improving the use of historical written sources in paleopathology

The texts written by the people of past societies can provide key information that enhances our understanding of disease in the past. Written sources and art can describe cultural contexts that not only help us interpret lesions in excavated human remains, but also provide evidence for past disease events themselves. However, in recent decades many biohistorical articles have been published that claim to diagnose diseases present in past celebrities or well known individuals, often using less than scholarly methodology. This article aims to help researchers use historical written sources and artwork responsibly, thus improving our understanding of health and disease in the past. It explores a broad range of historical sources, from medical texts and histories to legal documents and tax records, and it highlights how the key to interpreting any past text is to understand who wrote it, when it was written, and why it was written. Case studies of plague epidemics, crucifixion, and the spinal deformity of King Richard III are then used to highlight how we might better integrate archaeological and historical evidence. When done well, integrating evidence from both archaeological and historical sources increases the probability of a complete and well-balanced understanding of disease in past societies

The afterlife of Laurence Sterne (1713-1768): Body snatching, dissection and the role of Cambridge anatomist Charles Collignon

This paper aims to highlight the practice of body snatching from graves in the 1700s for the purpose of providing corpses for anatomical dissection, and for stocking anatomy museums. To do this, we examine the exhumation and dissection of the famous eighteenth-century novelist Laurence Sterne and explore the involvement of Charles Collignon, Professor of Anatomy at the University of Cambridge. We also show that osteological and cut-mark analysis of a skull purported to be that of Sterne, currently housed in the Duckworth Collection at Cambridge, provides the key to solving the mystery surrounding why Sterne was resurrected

Ancient Human Parasites in Ethnic Chinese Populations

Whilst archaeological evidence for many aspects of life in ancient China is well studied, there has been much less interest in ancient infectious diseases, such as intestinal parasites in past Chinese populations. Here, we bring together evidence from mummies, ancient latrines, and pelvic soil from burials, dating from the Neolithic Period to the Qing Dynasty, in order to better understand the health of the past inhabitants of China and the diseases endemic in the region. Seven species of intestinal parasite have been identified, namely roundworm, whipworm, Chinese liver fluke, oriental schistosome, pinworm, Taenia sp. tapeworm, and the intestinal fluke Fasciolopsis buski. It was found that in the past, roundworm, whipworm, and Chinese liver fluke appear to have been much more common than the other species. While roundworm and whipworm remained common into the late 20th century, Chinese liver fluke seems to have undergone a marked decline in its prevalence over time. The iconic transport route known as the Silk Road has been shown to have acted as a vector for the transmission of ancient diseases, highlighted by the discovery of Chinese liver fluke in a 2,000 year-old relay station in northwest China, 1,500 km outside its endemic range

Human Intestinal Parasites From the Wushantou Site in Neolithic Period Taiwan (800–1 BC)

Here, we investigate the presence of parasitic infections in Neolithic peoples from Taiwan to provide insight into the health and cultural development of these populations. Analysis was conducted on 27 soil samples collected from the pelvic region of human skeletal remains, along with control samples taken from the skulls and feet excavated from the Wushantou site in southwest Taiwan. The samples were disaggregated, passed through micro-sieves, and visualized using light microscopy. Analysis revealed the presence of roundworm eggs (Ascaris lumbricoides) within the remains of one individual. The control samples were negative for parasites, suggesting a true infection in this individual and not later environmental contamination of the soil. This is the first discovery of ancient parasite eggs in prehistoric Taiwan. The low apparent prevalence of parasites in this population is discussed in the context of the environment during this time and the consequences of regional climate on preservation of parasite eggs

Intestinal parasites from public and private latrines and the harbour canal in Roman Period Ephesus, Turkey (1st c. BCE to 6th c. CE)

To improve our knowledge of the parasite species affecting the inhabitants of Roman period Asia Minor, we analysed faecal material from Ephesus, Turkey. Mineralised material from the drain from a private house latrine (3rd c. CE), sediment samples from the sewer drain of a public communal latrine (6th c. CE), and sediment from the harbour canal (ca. 1st c. BCE to ca. 6th c. CE) were studied for the presence of intestinal parasites. Samples were viewed by light microscopy for helminth eggs, and commercial enzyme-linked immunosorbent assay (ELISA) kits were used to test for protozoal parasites that cause dysentery. Eggs of roundworm were found in the public latrine, whipworm in the house latrine, and both whipworm and roundworm in the harbour canal. Sequential sampling of the harbour core suggests that whipworm was by far the most common parasite throughout the Roman period, and there was no clear evidence for change in parasite species over the centuries. Whipworm and roundworm are both spread by the contamination of food and drink by human faeces. Despite the large number of travellers to Ephesus, as the capital of its province and a major port city in the Roman Empire, there was a surprising lack of diversity in parasite species found. This is especially apparent when we consider that ten species of intestinal parasite have been found across the Roman Empire. This is the first Roman site to be directly assessed for differences between infection in individuals using private latrines, public latrines, and mixed town effluent (in the harbour) at the same site.This research was supported by a doctoral award from the Social Sciences and Humanities Research Council of Canada [752-2016-2085] and a Tidmarsh Cambridge Scholarship from the Cambridge Commonwealth, European and International Trust and Trinity Hall Colleg

Infectious disease in the ancient Aegean: Intestinal parasitic worms in the Neolithic to Roman Period inhabitants of Kea, Greece

Little is known about infectious disease and parasites in the prehistoric inhabitants of the islands of the Aegean, in contrast to later time periods. It is only with the development of Greek medical texts in the 5th and 4th centuries BC we start to find evidence for the diseases that affected the population of region. Foremost amongst these authors was the medical practitioner Hippocrates, who lived on the island of Kos. The descriptions of the many diseases he and his students encountered were recorded in their medical texts in the 4th and 3rd centuries BC, known as the Hippocratic Corpus. These important texts provided the core philosophy underpinning medical theories in Europe and the Arab world for the following 2,000 years. Past research to determine which species of intestinal parasitic worms were described in the Hippocratic Corpus has suggested they indicate roundworm, pinworm and Taenia tapeworm. However, until now, there has been no archaeological evidence for which species of helminths were present in ancient Greece. In this study, we analysed soil sediment adherent to the sacrum and iliac bones of the pelvis of 25 burials dating from the Neolithic to Byzantine period on the Greek island of Kea, not far from Kos. Four individuals (16%) were positive for the eggs of intestinal helminths, dating from the Neolithic (4th millennium BC), Late Bronze Age, and the Roman Period. The species identified were whipworm (Trichuris trichiura) and roundworm (Ascaris lumbricoides). We consider reasons as to why fewer species of parasite appear to have been present on Kea than was the case for northern Europe at the same time period. This study of ancient parasites shows how we can combine archaeology with history of medicine to better understand the discoveries of key early scientists and medical practitioners

Examining a staging model for anorexia nervosa: empirical exploration of a four stage model of severity.

Background: An illness staging model for anorexia nervosa (AN) has received increasing attention, but assessing the merits of this concept is dependent on empirically examining a model in clinical samples. Building on preliminary findings regarding the reliability and validity of the Clinician Administered Staging Instrument for Anorexia Nervosa (CASIAN), the current study explores operationalising CASIAN severity scores into stages and assesses their relationship with other clinical features. Method: In women with DSM-IV-R AN and sub-threshold AN (all met AN criteria using DSM 5), receiver operating curve (ROC) analysis (n = 67) assessed the relationship between the sensitivity and specificity of each stage of the CASIAN. Thereafter chi-square and post-hoc adjusted residual analysis provided a preliminary assessment of the validity of the stages comparing the relationship between stage and treatment intensity and AN sub-types, and explored movement between stages after six months (Time 3) in a larger cohort (n = 171). Results: The CASIAN significantly distinguished between milder stages of illness (Stage 1 and 2) versus more severe stages of illness (Stages 3 and 4), and approached statistical significance in distinguishing each of the four stages from one other. CASIAN Stages were significantly associated with treatment modality and primary diagnosis, and CASIAN Stage at Time 1 was significantly associated with Stage at 6 month follow-up. Conclusions: Provisional support is provided for a staging model in AN. Larger studies with longer follow-up of cases are now needed to replicate and extend these findings and evaluate the overall utility of staging as well as optimal staging models

Early evidence for travel with infectious diseases along the Silk Road: Intestinal parasites from 2000 year-old personal hygiene sticks in a latrine at Xuanquanzhi Relay Station in China

The Silk Road has often been blamed for the spread of infectious diseases in the past between East Asia, the Middle East and Europe. While such a hypothesis seems plausible, there is actually very little concrete evidence to prove that diseases were transmitted by early travellers moving along its various branches. The aim of this study is to look for ancient parasite eggs on personal hygiene sticks in a latrine at a large relay station on the Silk Road at Xuanquanzhi (111 BCE–CE 109), at the eastern margin of the Tarim Basin in north-western China. We isolated eggs of four species of parasitic intestinal worms: Chinese liver fluke ($\textit{Clonorchis sinensis}$), $\textit{Taenia}$ sp. tapeworm (likely $\textit{Taenia asiatica, Taenia solium}$ or $\textit{Taenia saginata}$), roundworm ($\textit{Ascaris lumbricoides}$) and whipworm ($\textit{Trichuris trichiura}$). The Chinese liver fluke requires wet marshy areas to sustain its life cycle and could not have been endemic to this arid region. The presence of this species suggests that people from well-watered areas of eastern or southern China travelled with their parasites to this relay station along the Silk Road, either for trade or on government business. This appears to be the earliest archaeological evidence for travel with infectious diseases along the Silk Road.This work is funded by the national support program for science and technology of the Ministry of Science (WS05_2016_SCX_1820) and Technology of the People's Republic of China (2013BAK08B02) and the Chinese Academy of Social Sciences innovation projects