The Medieval Transylvanian Oral Condition: a Case Study in Interpretation and Standardization

77 The Medieval Transylvanian Oral Condition: A Case Study in Interpretation and Standardization Katie Zejdlik1*, Jonathan D. Bethard2, Zsolt Nyárádi3, and Andre Gonciar4 1 Anthropology and Sociology Department, Western Carolina University 2 Department of Anthropology, University of South Florida 3 Haáz Rezső Museum, Odorheiu Secuiesc, Romania 4 ArchaeoTek-Canada LLC., Ontario, Canada Keywords: medieval; dental; health; Székely; Transylvania; archaeology ABSTRACT Interpretation of dental ‘health’ in archaeologically derived skeletal assemblages is challenging due to the lack of patient histories, clearly understood pathological processes, broad etiologies, and cultural perceptions of health. Furthermore, the language used in description of pathological conditions of the oral cavity condition is not consistent across researchers thereby resulting in challenging cross-site comparison. Standardization of terms and description is necessary as proposed by Pilloud and Fancher (2018). This paper demonstrates the challenges associated with cross-site comparisons through an attempt to place medieval Transylvanian Székely peoples’ oral condition within a larger medieval cultural and biological framework. To do this, first, a review of medieval perceptions of dental health and treatment is provided. Next, a total of 90 individuals recovered from two medieval Székely ceme- teries were analyzed for pathological conditions of the oral cavity. The results of the analysis were then compared to other medieval skeletal assemblages reporting on dental ‘health’. Results show that conditions of the medieval oral cavity cannot be generalized and comparisons are further complicated by a lack of standardization in description and reporting thus supporting this volume’s call for standardization. Results also show that conditions of the oral cavity are specific to time and place even between the two Transylvania sites discussed. Health, as a descriptive term, is commonly used in faceted approach that pieces together cultural and the bioarchaeological literature to indicate evi- biological information. Combined with the use of dence of pathological modification on the skeleton. standardized language, communication between However, the World Health Organization includes researchers can be improved and interpretations mental and social factors, in addition to bodily dis- more accurately compared across sites. This paper ease states, as important to an assessment of health examines pathological conditions of the oral cavity (WHO, 1999). Reitsema and McIlvaine (2014) have among medieval Transylvanian Székely communi- added that a majority of pathological modifications ties as a case study to apply the vocabulary and observable in skeletal and dental tissues could definitions discussed by Pilloud and Fancher have been caused by a myriad of conditions. With- (2019) and to demonstrate the challenges of com- in the more focused parameters of oral health, the parison between sites. Furthermore, it contributes lack of patient histories, clinical records, and envi- to the paucity of information available on archaeo- ronmental living conditions has resulted in incon- logically derived skeletal collections from Eastern sistent application of terminology, understanding Europe. of disease etiologies, and recording of observations in bioarchaeological contexts (Pilloud & Fancher 2019, this volume). What this means is that to un- *Correspondence to: derstand the ‘health’ of a population, one must Katie Zejdlik consider physical, mental, and social factors with- Western Carolina University out access to patient histories, clearly understood Cullowhee, NC 28723 etiologies, or standardized definitions among re- [email protected] searchers. Bioarchaeologists are suited to address this challenge through the application of a multi- Dental Anthropology 2019 │ Volume 32 │ Issue 02 78 Condition of the oral cavity: Medieval cultural archaeological record include general tooth decay, perspective dental caries, periapical lesions, and tooth loss. Human skeletal remains hold important infor- Toothache, which could have several etiologies, the mation about the social and biological context in most treated problem in medieval dental medicine, which a specific person navigated. Interpretation was managed with everything from fumigations to of that individual’s lived experience begins with oaths (Anderson, 2004; Bifulco et al. 2016). J. understanding the cultural context of the time. For Platearius, a doctor in the Salerno school, wrote the medieval individuals discussed here, an under- that dental pain was specifically a result of imbal- standing of medieval medical practices is useful. anced warm and cold humours from the brain or Healthcare in the middle ages was predomi- stomach (cited in Bilfulco et al., 2016). Additional- nately influenced by Hippocrates’s 5th century B.C. ly, some of the doctors at Salerno believed tooth humoural theory. In his treatise, The Nature of Man, decay was caused by odontalgic worms that Hippocrates stated that the body was composed of caused pain with their movements, an idea that humours, or body fluids, specifically, blood, yel- dates to Sumerian texts from 5,000 B.C. Gilbertus low and black bile, and phlegm. These humours Anglicus (c.AD 1240) also agreed that tooth worms corresponded with different conditions and sea- caused dental pain and required balancing the hu- sons: blood, hot and wet, predominates in spring; mours (cited in Anderson, 2004). Dental caries and yellow bile, hot and dry, in summer; black bile, fistulae were treated with herbal concoctions cold and dry, in autumn; and phlegm, cold and placed as a paste within the cavity of the tooth wet, in winter (Jouanna, 2012). It was thought that (Anderson, 2004) or by cauterizing the rotten den- every person had a different make-up of humours; tal pulp and sealing it with wax, which essentially even organ systems within people had different destroyed the pulp chamber nerve supply (Bifulco humoural constructions and poor health resulted et al., 2016). when the humours were out of balance. The noted Dental care was limited to non-invasive treat- Greek physician, Galen, later supported and ex- ment (Anderson, 2004). Dental extraction was rare- panded Hippocrates’ work, which gave it the sus- ly cited in the Salerno documents because it was tainable success that carried it into the Enlighten- not a practice of physicians but rather “charlatans ment (Jouanna, 2012; King, 2013). Multiple other who practiced their profession in the streets and in interpretations branched off Hippocrates’ original open-air markets, and replacing the tooth with a idea but the vocabulary and general understanding tiny piece of wood or an iron bolt” (Bifulco et al., of the humours remained prevalent in medieval 2016:2). The ‘charlatans’ were barber surgeons and understandings of health and medicine (Jouanna, willing to do surgery, unlike doctors. They often 2012; King, 2013). learned their skill through performing surgery on The broadly applied humoral theory extended the war wounded or as an apprentice; though, into dentistry (Anderson, 2004; Bifulco et al., 2016). many had no formal education, and most were The Medical School of Salerno, Italy was one of the illiterate. Eventually surgery became a formalized most influential medical resources of the medieval profession and barbers were not allowed to pro- period. In addition to general medicine, they paid vide surgical intervention except in cases of tooth attention to dentistry and domestic oral hygiene. extraction and blood-letting (Pelling, 1998). Access Trotula De Ruggiero, a person of somewhat mythic to barber surgeons was regulated by the Catholic status associated with the Salerno school, is credit- Church and not accessible to females (Lopez et al., ed with writing the first treatise on oral hygiene 2012). Those who could not access or afford a bar- (Bifulco et al., 2016). She advocated deep dental ber surgeon depended on prayer or pilgrimage as a cleaning and brushing, mouthwash, chewing of means for a cure (Anderson, 2004). Medieval peo- herbs for daily cleaning and pleasant breath, as ples understood that small infections of any type well as remedies for gingivitis, halitosis, and tooth could become fatal if not attended to and took all whitening. Many of the ingredients she suggested available treatment precautions (Pelling, 1998). are still used today in cosmetic and hygiene prod- In terms of actual oral heath, it is unknown ucts (Bifulco et al., 2016). Though these practices what medieval peoples perceived as unhealthy. are largely unobservable in skeletal remains, they Literature related to oral ‘health’ during the medie- indicate that medieval people were interested in val period is often derived from skeletal assem- oral care in addition to more visible and serious blages and the interpretations of modern research- modifications. ers. That is the problem with the casual use of the Conditions of the oral cavity observable in the word ‘health’. It is temporally and socially compli- Dental Anthropology 2019 │ Volume 32 │ Issue 02 79 cated to define. At best, researchers must anecdo- creased dental caries was thought to be due to the tally pull information from various types of know- increased level of wear resulting from a harder and ing (images, educational documents, song, and more fibrous diet, which required longer and folklore) to try to understand an ancient perspec- stronger mastication. As the complicated morphol- tive. In the case

Load more