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Ortner’s Identification of Pathological Conditions
in Human Skeletal Remains
Ortner’s Identification of
Pathological Conditions in
Human Skeletal Remains

Third Edition

Edited by

Jane E. Buikstra
Arizona State University, Tempe, AZ, United States
Academic Press is an imprint of Elsevier
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List of Contributors
Amanda M. Agnew, School of Health and
Rehabilitation Sciences, The Ohio State University,
Columbus, OH, United States
Megan B. Brickley, Department of Anthropology,
McMaster University, Hamilton, ON, Canada
Jane E. Buikstra, Arizona State University, Tempe, AZ,
United States; Arizona State University, Phoenix, AZ,
United States
Morgana Camacho, Pathoecology Laboratory, School of
Natural Resources, University of Nebraska - Lincoln,
United States
Mary E. Cole, Department of Anthropology, The Ohio
State University, Columbus, OH, United States
Sharon DeWitte, University of South Carolina, SC,
United States
Bruno Frohlich, Department of Anthropology,
Smithsonian Institution, Washington, DC, United
States; Department of Anthropology, Dartmouth
College, Hanover, NH, United States
Anne L. Grauer, Loyola University Chicago, Chicago,
IL, United States
Rebecca Kinaston, Department of Anatomy, School of
Biomedical Sciences, University of Otago, Dunedin,
New Zealand
Haagen D. Klaus, Department of Sociology and
Anthropology, George Mason University, Fairfax, VA,
United States
Mary Lewis, University of Reading, Reading, United
Kingdom
Niels Lynnerup, Department of Forensic Medicine,
University of Copenhagen, Copenhagen, Denmark
Carina Marques, Research Centre for Anthropology and
Health (CIAS), Department of Life Sciences,
University of Coimbra, Coimbra, Portugal; Department
of Anthropology, William Paterson University, Wayne,
NJ, United States
Simon Mays, Historic England, Portsmouth, United
Kingdom
Justyna J. Miszkiewicz, School of Archaeology &
Anthropology, Australian National University,
Canberra, ACT, Australia
Marc F. Oxenham, School of Archaeology &
Anthropology, Australian National University,
Canberra, ACT, Australia
Andrew T. Ozga, Center for Evolution and Medicine,
Tempe, AZ, United States; Institute for Human
Origins, Tempe, AZ, United States
Rebecca Redfern, Centre for Human Bioarchaeology,
Museum of London, London, United Kingdom
Karl Reinhard, Pathoecology Laboratory, School of
Natural Resources, University of Nebraska - Lincoln,
United States
Charlotte A. Roberts, Department of Archaeology,
Durham University, Durham, United Kingdom
Anne C. Stone, School of Human Evolution and
Social Change, Tempe, AZ, United States; Center
for Evolution and Medicine, Tempe, AZ, United
States; Institute for Human Origins, Tempe, AZ,
United States
Samuel D. Stout, Department of Anthropology,
The Ohio State University, Columbus, OH, United
States
Richard Thomas, School of Archaeology and Ancient
History, University of Leicester, Leicester, United
Kingdom
Monica Tromp, Department of Anatomy, School of
Biomedical Sciences, University of Otago, Dunedin,
New Zealand; Department of Archaeology, Max
Planck Institute for the Science of Human History,
Jena, Germany
Chiara Villa, Department of Forensic Medicine,
University of Copenhagen, Copenhagen, Denmark
Tony Waldron, University College London, London,
United Kingdom
Anna Willis, College of Arts, Society & Education,
James Cook University, Townsville, QLD, Australia
xiii
Preface
One of the last times I saw Don Ortner in his office at the
Department of Anthropology of the Natural History
Museum, he gestured to the shelves and filing cabinets
where he had been beginning to accumulate sources for
the third edition of Identification of Pathological
Conditions in Human Skeletal Remains. As we who
mourn him know only too well, he died unexpectedly on
April 29, 2012, and this task remained undone. Hoping
that at least a partial manuscript existed, I asked Bruno
Frohlich, a close colleague of Don’s at the National
Museum of Natural History, about evidence of the
volume’s progress. As the person who assumed the chal-
lenging task of sorting Don’s office, Bruno indicated that
there was nothing of substance, no outline, no negotia-
tions with a press.
Thus, it was obvious that organizing a new edition
would require starting with the Ortner (2003) volume and
revising. The alternative, letting the fine second edition
become increasingly out of date, a piece of history but
not a useful teaching and research aid, seemed an
unhappy choice. New volumes by other authors would no
doubt appear, but in my opinion that energy and expertise
could be better directed toward advancing knowledge in
other ways rather than “reinventing the wheel.”
Following discussions with colleagues in paleopathol-
ogy and the Ortner family, primarily Don’s widow Joyce
and son, Don, Jr., I agreed to explore publication options
and consider how the volume might be revised to reflect
new knowledge and the further integration of the study of
health into perspectives on the past. After discussions
with several presses, it seemed prudent to choose
Elsevier, as they could readily provide the text and image
files from the second edition. I wish to thank them most
sincerely for their support and patience throughout this
protracted process.
There have been many decisions along the way.
Initially, and with sage advice from many colleagues,
such as Anne Grauer and Charlotte Roberts, I generated a
proposal for Elsevier, which included an outline of the
volume, as it appears here. Recognizing that a collabora-
tive effort would be needed to update the core chapters on
pathological conditions, specialists in the paleopathology
of specific conditions were invited to take Don’s (and
Walter Putschar’s) chapters and rework them to reflect
new knowledge. Each invited author accepted, which is a
measure of their professionalism and their respect for
Don.
In creating the current organization, I have deleted
information about basic osteological methods, such as esti-
mating age-at-death and biological sex. These are now
covered in much greater detail in a variety of basic and
advanced osteology texts. We have introduced distinctive
chapters on normal and abnormal bone development,
imaging, radiology, and ancient pathogen DNA and micro-
biomes. The chapter on dental disease now also includes
biochemical methods for estimating diet (paleodiet). In
some cases, conditions have been shuffled between chap-
ters, their realignment reflecting contemporary thought.
Faced with deciding whether to follow my vision of
paleopathology in the 21st century or to attempt to guess
what Don might have wanted 15 years after the previous
edition and 6 years after his death, I have chosen the for-
mer. In reflecting upon the many stimulating and open
discussions that Don and I have had about the field, I am
convinced that he would approve. I have therefore de-
emphasized “classification” in the diagnostic process, and
I have added a chapter that recognizes social theoretical
approaches to interpreting pathological conditions. In
addition, attempting to recognize related specialties, chap-
ters on mummy science and animal paleopathology have
also been added. It is my personal view that the 21st cen-
tury will witness remarkable new knowledge of disease
histories and disease transmission that unites the study of
zoonotic and human infections, facilitated by molecular
studies. The biomolecular “revolution,” however, will
continue to complement and augment our studies of
human remains, which will continue to be as fundamen-
tally important to the study of ancient disease as Don and
Walter recognized in their 1981 volume.
A final word should be added about authorship.
Several chapter authors asked that Don be included as a
co-author, as I also felt appropriate for the volume as a
whole. As there are prohibitions against attributing post-
humous authorship, I decided to follow the biomedical
xv
xvi Preface

model and entitle this volume Ortner’s Identification of
Pathological Conditions in Human Skeletal Remains, 3rd
edition.
So here it is! It wouldn’t have been possible without
Don’s (and Walter’s) exemplary prototype, as well as the
many colleagues who so willingly contributed revisions
and original chapters. I sincerely hope that you find it
useful in your research and teaching, as you advance the
vibrant field of paleopathology during the 21st century.
Jane E. Buikstra
Arizona State University
A Tribute to Don Ortner
It is a great honor to be asked to write this tribute for the
third edition of Don’s Identification of Pathological
Conditions in Human Skeletal Remains. Charlotte had
attended Don’s 1985 Short Course in Paleopathology at
the Smithsonian Institution, Washington, DC (the fifth
and final one there), and we both met Don at the
Paleopathology Association European Meeting in Madrid
in 1986. He indicated that he was “looking for a hook on
which to hang his hat” in Europe and do research and
teaching. We proposed the University of Bradford, and he
accepted the University’s invitation to be an Honorary
Visiting Professor. Thus began a long and enduring rela-
tionship and collaboration with the Smithsonian
Institution, and a long and close friendship between the
Ortners and the Manchesters, and Charlotte and family.
This friendship has endured to the present, long past
Don’s untimely tragic death, and is exemplified by the
endearing label applied to Don, with typical Yorkshire
bluntness, by Keith’s wife’s aunt: “the Big Bug from
America.”
Research collaborations at the University developed,
especially in tuberculosis and leprosy, and in 1988 the
first (Bradford) Short Course in Paleopathology was run.
It ran seven times, with the final one in 2008. Don’s
involvement at Bradford had continued for several years
by then, and during that time he and his wife Joyce had
explored much of the county of Yorkshire, and become
the owners of “Yorkshire passports”!
Don started his career with an undergraduate degree
(BA) in Zoology with a minor in chemistry. This is interest-
ing when compared to the late Don Brothwell, whose first
degree was a BSc in Anthropology and Archaeology
(including zoology and geology), and the fact that Don
Ortner was inspired by a primatologist to move into looking
at past disease. A Masters degree in Anthropology followed
at Syracuse University, where he also did the physical
anthropology course taught by Gordon Bowles, who had
studied under EA Hooton. He then completed a PhD in
1969 at the University of Kansas (the effects of ageing and
disease on the micromorphology of human compact bone).
He worked for some time as a Museum Technician in the
Department of Anthropology at the National Museum of
Natural History at the Smithsonian Institution, Washington,
DC (with JL Angel and TD Stewart), and then was
recruited as an Assistant Curator in 1969, becoming
Curator of Physical Anthropology in 1976.
Following a strongly influential meeting with Adolph
Schultz at the University of Zurich in Switzerland who
studied wild shot primate pathology, he was convinced
that “paleopathology could make a valuable contribution
to science if the research was founded on a thorough
knowledge of anatomy, physiology and the mechanisms
of disease processes” (Powell, 2012: 91). The rest is his-
tory. This set the stage for the rest of his career. His meet-
ing with pathologist Walter Putschar led to Ortner and
Putschar (1981) and Don’s considerable work for that first
edition benefited from his experience working with
pathology reference collections in European museums.
Highlighting these collections as beneficial to understand-
ing how disease processes affect bones has led to much
more work on documented skeletal collections in paleo-
pathological research. Don was deeply involved with
paleopathology at many levels, including service to the
field, and he headed up the Paleopathology Association
(PPA) as President from 1999 to 2001. In terms of
research, Don has contributed much to the literature
beyond his books. He was particularly proud of his
achievements in developing diagnostic criteria for scurvy
and rickets, and documenting the effect of the early stages
of leprosy on the facial bones. He was open to debates in
paleopathology, and welcomed interactions with younger
scholars where he could help. He was always willing to
talk to anybody about paleopathology, young, old, ama-
teur or highly experienced.
In particular, we would like to emphasize Don’s com-
mitment to research-led education in paleopathology, epit-
omized by many activities. Three are prominent. Firstly,
the hugely successful short courses in paleopathology
with a worldwide participation helped many “graduates”
along the road to successful careers, including one of the
authors (Ortner et al., 2012). Secondly, these courses ran
alongside the many workshops in paleopathology Don led
at the annual meetings of the PPA, starting in 1985, and
gave people the opportunity to engage with different path-
ological conditions at theoretical and practical levels.
There is no underestimating the time Don (and his compa-
triot Bruce Ragsdale, a pathologist) spent putting the
workshops together. They remain a legacy for PPA
xvii
xviii A Tribute to Don Ortner
meetings today. Thirdly, this volume has become the
mainstay for scholars working in paleopathology.
The first edition of this book had been published in
1981, well before his link with Bradford began (“Don’s
Bible”). This marked a turning point in the global evolution
and development of paleopathology. Previous publications,
whilst important in establishing paleopathology as a disci-
pline and documenting global evidence for disease in antiq-
uity, lacked the scientific and clinical rigor of Don’s book
in elucidating diagnostic and differential diagnostic paleo-
pathological criteria for different diseases. The second edi-
tion was produced in the prime years of his involvement at
Bradford (Ortner, 2003). In that edition Don wrote 20 of the
23 chapters; authoring virtually all the chapters was no
mean achievement. These two editions had focused on a
classificatory system of disease, whilst incorporating and
integrating clinical and epidemiological aspects.
His writings on the basic biology of bone, on patho-
logical processes, and on clinical and scientific methodol-
ogy create a baseline for this third edition which, whilst
maintaining a classificatory base, has diversified and
expanded into broader aspects and concepts of paleopa-
thology. This appropriately includes methodological
developments. We believe that this edition is a just and
fitting tribute to Don’s immense and unequaled contribu-
tion to the totality of paleopathology, making it an
accepted and important component of anthropology,
archeology, and clinical medicine. The chapters of the
current edition, by necessity, have been reworked by a
range of authors from both the Old and New Worlds, but
the work Don put into the chapters of the previous
volumes provided a very strong base with which the new
chapter authors could work. We are sure that Don would
have been incredibly pleased to see this new edition and
the developments the volume has taken, and happy to see
Jane head it up.
This new edition of Don’s seminal work in paleopa-
thology will clearly take us well into the 21st century and
set the stage for research and teaching in this field. In so
doing, it takes into account developments in the field over
the last 15 years, showing particularly how nonhuman
paleopathology, paleoparasitology, and biomolecular anal-
yses have an increasing part to play in the reconstruction
of the origin, evolution, and history of disease. It also
illustrates that paleopathology is rapidly progressing as a
multimethod-driven discipline fit for the future, and one
that embraces other disciplines across the arts, humanities,
social sciences, and sciences.
Charlotte Roberts and Keith Manchester
REFERENCES
Ortner, D.J., 2003. Identification of Pathological Conditions in Human
Skeletal Remains, second ed. Smithsonian Institution Press,
Washington, DC.
Ortner, D.J., Putschar, W.G.J., 1981. Identification of Pathological
Conditions in Human Skeletal Remains. Smithsonian Institution
Press, Washington, DC.
Ortner, D.J., Knüsel, C., Roberts, C.A., 2012. Special courses in human
skeletal paleopathology. In: Buikstra, J.E., Roberts, C.A. (Eds.), The
Global History of Paleopathology. Pioneers and Prospects.
University Press, Oxford, pp. 684 693.
Powell, M.L., 2012. Donald J. Ortner. In: Buikstra, J.E., Roberts, C.A.
(Eds.), The Global History of Paleopathology. Pioneers and
Prospects. University Press, Oxford, pp. 89 96.
Chapter 1
Introduction
Jane E. Buikstra
Arizona State University, Tempe, AZ, United States
This third edition of the Identification of Pathological
Conditions in Human Skeletal Remains updates and
expands upon the topical coverage of earlier works pub-
lished by Ortner and Putschar (1981) and Ortner (2003).
In this chapter, we develop a “roadmap” for the structure
and organization of this volume. First, we present the his-
tory of this landmark volume from the perspectives of
Donald J. Ortner (first and second editions) and Jane E.
Buikstra (third edition). In these sections, and elsewhere,
our goals have included retaining Don’s voice, so there
are many portions of the second edition that are retained
throughout the volume. We also acknowledge those indi-
viduals and institutions who have contributed to its devel-
opment over the past 30 1 years. We then introduce the
objectives for this third edition, outlining those chapters
that have been reorganized as well as those chapters that
have been added to this edition, which cover a new range
of related fields integral to the development of 21st cen-
tury paleopathology. Finally, we will introduce and
review the format of the volume and its organization.
HISTORY OF THE FIRST EDITION FROM
DONALD J. ORTNER
The first edition of this book was the result of a joint col-
laboration between Dr. Walter G. J. Putschar and me. Dr.
Putschar was an internationally known, consultant pathol-
ogist at Massachusetts General Hospital in Boston, MA,
who had a special interest in diseases of the human skele-
ton. We began our professional relationship in 1970 when
he accepted my invitation to be the principal lecturer in a
seminar series on human skeletal paleopathology that I
was organizing at the Smithsonian Institution. The first
Paleopathology Seminar Series was held in 1971 and
brought several leading authorities on skeletal disease,
paleopathology, and related subjects to the Smithsonian
Institution to present a series of lectures to a select group
of scholars interested in skeletal paleopathology.
Ortner’s Identification of Pathological Conditions in Human Skeletal Remains. DOI: https://doi.org/10.1016/B978-0-12-809738-0.00001-6
© 2019 Elsevier Inc. All rights reserved.
The seminar series was held yearly through 1974. By
that time the logistics of obtaining funds to offer the
series, arranging for students to come from many univer-
sities, including those outside the United States, and
assembling an outstanding faculty for the 10-week series
of lectures and laboratory sessions raised serious ques-
tions about whether this was the most cost-effective
method for enhancing the quality and direction of
research in skeletal paleopathology. It also highlighted the
need for a comprehensive reference work on diseases of
the skeleton that might be encountered in archeological
skeletal remains. I discussed this issue with Dr. Putschar
and we decided that many more scholars interested in
skeletal paleopathology would have access to the sub-
stance of the seminar series if the information in the lec-
tures and laboratory sessions was incorporated into a
well-illustrated and comprehensive reference work on
pathological conditions that affect the human skeleton.
In the summer of 1974, with the support of a grant
from the Smithsonian Research Foundation (now the
Smithsonian Scholarly Studies Program), Dr. Putschar
and I, accompanied by our wives, Florence Putschar and
Joyce E. Ortner, and my three children, traveled exten-
sively in Great Britain and several European countries for
more than three months visiting educational and research
centers that had significant collections of documented
human skeletal pathology. In selecting these centers, we
leaned heavily on the advice of the late Dr. Cecil J.
Hackett, a physician who had worked for several years in
Uganda where he had treated hundreds of patients suffer-
ing from yaws. This experience led to a research interest
in treponematosis, and Dr. Hackett wrote his doctoral dis-
sertation on the clinical, radiological, and anatomical
manifestations of yaws (Hackett, 1947). Following his
career in Uganda, Dr. Hackett settled in England where
he continued his research on treponematosis, its history
and skeletal manifestations. As part of this research he
visited many of the major European collections of ana-
tomical pathology that contained documented cases of
1
2 Ortner’s Identification of Pathological Conditions in Human Skeletal Remains
syphilis. Hackett’s research on these cases resulted in the
publication of his classic monograph (Hackett, 1976) on
the skeletal manifestations of syphilis, yaws, and trepo-
narid (bejel). His knowledge of these collections and
which ones were likely to serve the objectives Dr.
Putschar and I had set out to achieve was an invaluable
asset.
During our visit to these institutions, Dr. Putschar and
I studied and photographed hundreds of cases of skeletal
disease. In addition to the photographic record we made
of these cases, we often were able to obtain autopsy or
museum records that provided descriptive details and a
diagnosis for the cases. Radiographic films were acquired
for some of the cases. Dr. Putschar dictated his observa-
tions about each case and these observations were subse-
quently transcribed and organized by Mrs. Putschar. In
some cases, Dr. Putschar’s diagnostic opinions were at
variance with the diagnosis given in the catalog and this
difference was duly noted in his observations. Most often,
however, the diagnosis given in the catalogs was plausible
if not reasonably certain.
We began the task of writing the book shortly after
completing our European research in 1974. In 1979, we
submitted the completed manuscript to the Smithsonian
Institution Press for publication as part of the Smithsonian
Contributions to Anthropology series. The manuscript
was reviewed by the Department of Anthropology, exter-
nal reviewers, the Director’s office of the National
Museum of Natural History, and the Press. After approval
on all levels, editing and production took an additional
several months and the book was published in December
of 1981 as Smithsonian Contributions to Anthropology,
Number 28. A hard-cover edition was published in 1985
that was identical to the first edition except for the addi-
tion of an index.
Acknowledgments for the First Edition
The initial research conducted for the first edition of this
book was an extensive survey in 1974 by Dr. Putschar
and me of documented skeletal pathology in 16 European
pathology and anthropology collections in six countries.
This survey was supported by the Smithsonian Research
Foundation and Hrdlička Fund. The following list of these
institutions and the staff members who assisted our survey
of their collections is inadequate recognition of the many
courtesies extended during our work. Sadly, many collea-
gues who provided this assistance have since retired or
died. Furthermore, some of the collections have been
moved from the site where we studied them and some
probably no longer exist. However, it remains appropriate
to acknowledge the contribution they have made to both
editions of this book. Austria: Federal Pathologic-
Anatomy Museum, Vienna (Dr. Karl von Portele and Dr.
Alexander Müller); Pathology Museum of the University
of Graz (Prof. Dr. Max Ratzenhofer); Pathology Museum
of the University of Innsbruck (Prof. Dr. Albert Probst
and Prof. Dr. Josef Thurner, Salzburg, Austria).
Czechoslovakia: National Museum, Department of
Anthropology, Prague (Dr. Emanuel Vičk, Dr. Milan
Sfloukal and Dr. H. Hanākovā). England: The Natural
History Museum, London (Dr. Theya Molleson and
Rosemary Powers); Guy’s Hospital Medical School,
Gordon Pathology Museum, London; The Royal College
of Surgeons of England, Wellcome Museum, London (Dr.
Martin S. Israel); The Royal College of Surgeons of
England, Hunterian Museum, London (Elizabeth Allen);
St. George’s Hospital Medical School, Pathology
Museum, London; Westminster Hospital School of
Medicine, Pathology Museum, London. France: (Prof. Y.
Le Gal and Prof. Andrè Batzenchlager). Scotland: The
Royal College of Surgeons of Edinburgh (Prof. Eric C.
Mekie, Dr. Andrew A. Shivas, Violette Tansy, Turner,
McKenzy). Switzerland: Anthropological Institute of the
University of Zurich (Dr. Wolfgang Scheffrahn);
Historical Museum, Chur (Dr. H. Erb); Institute of
Pathological Anatomy of the University of Zurich (Prof.
Dr. Erwin Uehlinger, Prof. Dr. Christoph E. Hedinger,
and Aschwanden); Natural History Museum, Bern (Prof.
Dr. Walter Huber). Dr. Cecil J. Hackett, an associate of
the Royal Orthopaedic Hospital, did much to expedite our
work in London, England, and offered several helpful
suggestions regarding collections in other countries that
proved valuable to our study.
The product of this 1974 survey was more than 1200
photographs, both black and white and color (taken by
me) of approximately 500 pathological specimens jointly
studied. For some cases, we were able to obtain x-ray
films as well. Dr. Putschar described the specimens in
detail on tape, and included original autopsy and clinical
data where available. This collection of photographs,
radiographs, and the transcripts of case descriptions is
available for study at the Department of Anthropology,
National Museum of Natural History, Smithsonian
Institution, Washington, DC. Many of them are used as
illustrations in this book.
A number of people made significant contributions
during the preparation of the manuscript. Paula Cardwell,
Elenor Haley, and particularly Katharine Holland typed
initial drafts. Marguerite (Monihan) Guthrie and Elizabeth
Beard typed the final draft. Marcia Bakry prepared some
of the drawings. A special note of appreciation goes to
Jacqui Schulz for the many unpaid hours spent preparing
the remaining drawings and getting the photographic
illustrations ready for publication. Photographic enlarge-
ments were prepared by H.E. Daugherty and Agnes I.
Stix. Stix also assisted in editing and typing the manu-
script. David Yong, Edward Garner, and Dwight Schmidt

provided valuable technical assistance. The staff of the
library of the Smithsonian Institution, particularly Janette
Saquet, was most helpful. Dr. J. Lawrence Angel, Dr. T.
Dale Stewart, and Dr. Douglas H. Ubelaker, members of
the Department of Anthropology, Smithsonian Institution,
have made valuable suggestions, as have Dr. Saul Jarcho
(New York City) and Dr. George Armelagos (University
of Massachusetts, Amherst, MA). The staff of the
Smithsonian Institution Press, particularly Albert L.
Ruffin, Jr., managing editor, series publications, and, Joan
B. Horn, senior editor, deserve special recognition for
their assistance from the conceptualization through publi-
cation of the book. Finally, the wives of both authors
have been intimately involved with the preparation of the
book. Florence Putschar spent hundreds of volunteer
hours organizing photographs, typing, preparing the bibli-
ography, editing, and otherwise making her remarkable
abilities available to the project. Joyce Ortner has also
assisted in obtaining illustrative material and skeletal
specimens.
HISTORY OF THE SECOND EDITION
FROM DONALD J. ORTNER
Since Dr. Putschar and I completed the manuscript for the
first edition, much has changed in the study of ancient
skeletal diseases. The Paleopathology Association, estab-
lished in 1973 with fewer than two dozen members, is
now a thriving international scientific association with
more than 600 members worldwide that holds annual
meetings in the United States and biennial meetings in
Europe. There is now a scientific journal devoted to
paleopathology1 and another new journal in which this
subject is an important emphasis. A bibliography of
paleopathology (both the published edition and the sup-
plements) contains more than 26,000 citations, many of
which were published in the last 20 years (Tyson, 1997).
My own research interest and experience has devel-
oped as well. In 1984 I received a 3-year grant from the
National Institutes of Health (NIH; grant AR 34250) to
conduct a survey of pathological cases in the human skel-
etal collections at the National Museum of Natural
History (NMNH). This survey was superimposed on a
major effort by the Museum to create an electronic data
base of our catalog that required that the anthropological
collections be inventoried. Several people were involved
in this inventory, but three members of the technical staff
deserve particular mention: Marguerite (Monihan)
Guthrie, who typed much of the manuscript of the first
edition of this book, was responsible for creating, editing,
1. Refers to the Journal of Paleopathology, founded by Luigi Capasso,
which has been published by the Abruzzo Anthropological Association
since 1987.
Introduction Chapter | 1 3
and maintaining the data base. Dwight Schmidt and
Stephen Hunter were responsible for doing the actual
inventory of the human skeletal collection. This inventory
required that all human remains in the collection be com-
pared with the catalog record to ensure that the skeleton had
been cataloged and that the catalog record was accurate.
This meant opening thousands of drawers and handling
more than 36,000 partial to complete human skeletons.
While they were engaged in this task, Schmidt and
Hunter were encouraged to identify any cases of skeletal
pathology and bring them to my attention. Both Schmidt
and Hunter were enthusiastic and highly motivated. They
became skilled at identifying pathological cases and this
added immeasurably to the quality and quantity of archeo-
logical and anatomical cases of skeletal disease in the
human skeletal collection of the NMNH. One of the frus-
trating aspects of the research Dr. Putschar and I had con-
ducted on the NMNH pathological materials was the lack
of accessible and reliable information on the archeologi-
cal dating of the human remains. The grant from NIH pro-
vided funding to hire an archeologist, Dr. James Krakker,
to review the archeological field records and publications
to determine as accurately as possible the archeological
dates for much of the human skeletal collection.
After a cluster of pathological cases had been identi-
fied, Dr. Putschar would come to the Museum for several
days and the two of us would review each one, and he
would dictate his observations on the pathogenesis and
differential diagnosis. During these visits, Mrs. Putschar
would transcribe the dictation and organize the notes. The
result was the identification and documentation of many
additional cases of skeletal paleopathology that added
greatly to our knowledge of disease in antiquity and our
ability to diagnose diseases encountered in archeological
remains.
One of the interesting dimensions of this exercise was
the enthusiasm with which Dr. Putschar reviewed these
cases. Virtually every pathological specimen brought new
knowledge and insight about pathogenesis to both of us.
Because of Dr. Putschar’s vast previous experience with
skeletal disease in many countries, it surprised me that he
was still finding new insights as he studied these cases.
The lesson he repeatedly emphasized was that archeologi-
cal remains offer the potential to see the expression of
disease in an entire skeleton and usually in the untreated
state. This is rarely possible in a modern clinical context.
He also stressed that careful observation of the type and
distribution pattern of lesions within the skeletal specimen
provided insight regarding pathogenesis that complemen-
ted other sources of information about the disease process.
Since 1979, research methodology has also benefitted
from some major breakthroughs in technology. Computed
tomography has brought new understanding to our knowl-
edge of skeletal radiology and pathology. Archeological
4 Ortner’s Identification of Pathological Conditions in Human Skeletal Remains
skeletal tissue has been found to be a remarkably good
substrate for the preservation of ancient biomolecules,
including DNA. Recovery of identifiable genetic material
from pathogens has been reported (e.g., Kolman et al.,
1999) and this is only the early stage of this research. The
remarkable power of the personal computer has provided
new ways to manage data and visualize the patterns of
pathology that we encounter in archeological skeletal
remains. The first edition of this book was prepared using
an electric typewriter. I am using a computer word pro-
cessing system for this edition and I often listen to the
music of Mozart being played through my computer while
I work. I doubt that Dr. Putschar would have approved of
listening to Mozart while writing. Among many other
interests, he had a passionate enthusiasm for classical
music and especially the music of Mozart, a fellow
Austrian by birth. Mozart, in his view, must be listened to
and appreciated without distractions.
We also know much more about the skeletal manifes-
tations of disease in archeological human remains and
this has led to greater diagnostic certainty for many patho-
logical conditions. Medical knowledge has continued to
grow, with new insight about the causes of and relation-
ships between skeletal diseases. Not surprisingly the ter-
minology in medicine and paleopathology has continued
to change to reflect the new knowledge acquired about
skeletal diseases.
All of these changes argue for a revision of the first
edition that will address the new knowledge about both
skeletal pathology and paleopathology that has developed
in the last 20 years. Regrettably, Dr. Putschar did not live
to see the development of many of these innovations or to
participate in this revision. While attending professional
meetings in Scotland in early October 1985 he and Mrs.
Putschar visited a medieval castle site near Edinburgh.
During the visit he fell and hit his head on the stone ruins.
He developed a hematoma on the brain that subsequently
required surgery. On their return to the United States he
and Mrs. Putschar received more bad news when she was
diagnosed with terminal cancer. Despite these health pro-
blems they both insisted that before Dr. Putschar’s sur-
gery he go ahead with the lectures he had promised to
deliver on skeletal disease for the last seminar series on
skeletal paleopathology held at the Smithsonian
Institution from October 21 through November 8, 1985.
Although his balance was affected by his injury, and he
was deeply troubled by Mrs. Putschar’s illness, his lec-
tures were models of clarity and provided a remarkable
learning experience for all who heard him. Mrs. Putschar
died on December 31, 1985. The Putschars had a wonder-
ful marriage and her death was a devastating loss for him.
Dr. Putschar’s health declined following two surgeries to
control the bleeding in his brain and he died on April 5,
1987 at the age of 83.
Inevitably the progress made in both medical knowl-
edge and paleopathology during the past 20 years means
that the revisions for this edition are substantial. However,
much of the insight and understanding of pathology that
Dr. Putschar brought to the first edition remains relevant
and wherever possible I have retained his language and
perspectives on skeletal disease. This second edition owes
much to his knowledge and experience.
Acknowledgments for the Second Edition
In the first edition of this book, I acknowledged the assis-
tance of those who contributed so substantially to its prep-
aration. Some of these people have since died, but the
kindness of all who gave of their time and expertise
remains a wonderful memory. Since the publication of the
first edition many additional people have shared their
knowledge and made collections and many additional
cases of pathology available for my research. These
include the following institutions and people. Australia:
The Shellshear Museum, Sydney (Prof. Jonathan Stone
and Kenneth Parsons); The Australian Museum, Sydney
(Phillip Gordon and Dr. Ronald Lampert); The South
Australian Museum, Adelaide (Dr. Graeme Pretty).
Denmark: The Danish National Museum, Cophenhagen
(Prof. Vilhelm Møller-Christensen). England: The
Department of Archaeological Sciences, The University
of Bradford, Bradford (Arnold Aspinall, Dr. Keith
Manchester, Dr. Charlotte Roberts, Anthea Boylston,
Jason Maher, Prof. Mark Pollard, and Dr. Carl Heron);
The Rheumatology Unit, Bristol University, Bristol (Dr.
Juliet Rogers and Prof. Paul Dieppe); The Canterbury
Archaeological Trust, Canterbury (Paul Bennett and
Trevor Anderson); English Heritage, Ancient Monuments
Laboratory, London (Dr. Simon Mays). Norway: The
Department of Anatomy, University of Oslo (Prof. Dr.
Per Holck and Inger Saelebakke); The Leprosy Museum
of Bergen (Prof. Lorentz M. Irgens). Scotland: The Royal
College of Surgeons of Edinburgh (Dr. I. S. Kirkland).
Switzerland: The Institute of Pathological Anatomy,
University of Zurich (Prof. Dr. Ph. U. Heitz and Prof. A.
R. von Hochstetter). United States: The Bishop Museum,
Honolulu, Hawaii (Dr. Donald Duckworth, Dr. Yosiniko
H. Sinoto, and Toni Han); The Peabody Museum,
Harvard University (Dr. David Pilbeam and Dr. Lane
Beck); The San Diego Museum of Man (Rose Tyson);
The Lowie Museum (now the Phoebe Apperson Hearst
Museum of Anthropology), University of California,
Berkeley, California.
In 1987 I was appointed Visiting Professor of
Paleopathology at the University of Bradford, Bradford,
England. Since 1988, I have been in residence in the
Department of Archaeological Sciences at the University
for varying lengths of time almost every year. This has

been a remarkably valuable experience and I am very
grateful for the wonderful collegial relationships that have
developed over the years and the generous hospitality
extended to me and my family. These colleagues include
Arnold Aspinall, the Chairman of the Department when I
was first appointed, Dr. Keith Manchester, Dr. Charlotte
Roberts (now at the University of Durham), Prof. Mark
Pollard, who followed Mr. Aspinall as Department
Chairman, and Dr. Carl Heron, the current Department
Chairman. The skeletal collection in the department, par-
ticularly the remarkable collection of human remains
from the medieval cemetery in Chichester, England, asso-
ciated with the Hospital of St. James and St. Mary
Magdalene have been of great help in furthering my
knowledge of human skeletal paleopathology. Many of
the people buried in this cemetery were lepers and their
skeletons provide crucial insight regarding the skeletal
manifestations of this dreaded disease.
In 1992 I had a casual conversation about my research
with a friend of many years, David Malin, a sales repre-
sentative for Siemens Medical Systems, Inc. He offered to
try and arrange access to CT equipment at a Siemens
facility. His efforts put me in contact with Matthew
Riemann (now retired), the director of the Training and
Development Center for Siemens Medical Systems, Inc.
in Iselin, NJ. Riemann was supportive and asked two
members of his staff, Valere Choumitsky and Blaise
Falkowski, to do what they could to assist my research.
At that time Mr. Falkowski was the senior instructor for
technical training of engineers and service technicians
who service Siemens CT scanners in North America.
When the facility was not being used for training we were
able to use the equipment to scan paleopathological cases.
Eventually the Training and Development Center moved
to Cary, North Carolina, and I and my Smithsonian col-
league, Dr. Bruno Frohlich, continued to use the equip-
ment at no cost during windows in the training schedule.
Access to this equipment proved to be a powerful
research tool and most of the CT images included in this
edition were generated on Siemens equipment.
CT scanning equipment at the Siemens training facility
is upgraded periodically to the newest models manufac-
tured by Siemens. On one occasion Dr. Frohlich learned
that a Siemens Somatom AR-T scanner was to be replaced
with a new model. He suggested that Siemens donate the
older model to the Smithsonian. After approval on all rele-
vant levels the equipment was given to the Museum and is
now used in support of the research endeavors of the
museum staff. The expertise and the many hours of assis-
tance provided by Mr. Falkowski and his colleagues at
Siemens continues to be of major value to my research.
Agnes Stix, Museum Specialist, and Janet Beck,
Volunteer Research Assistant, Department of
Anthropology, National Museum of Natural History,
Introduction Chapter | 1 5
Smithsonian Institution, have invested countless hours in
organizing bibliographic source materials and illustrations
for this book. They have created computer data bases for
the references and photographs that greatly facilitated my
work. Stix in particular has had the responsibility of orga-
nizing the various electronic files of figures, tables, text,
figure legends and references and keeping changes in one
file congruent with the other. Their contributions to this
edition are substantial and I am in their debt. Marcia
Bakry, Scientific Illustrator, Department of Anthropology,
National Museum of Natural History, Smithsonian
Institution, is responsible for preparing the digitized
figures for the book. Using the powerful software avail-
able today for manipulating digitized photographic
images, she has been able to improve significantly the
quality of the figures used in this edition and deserves my
deepest thanks and that of the reader who will benefit
from her skilled work. Dr. Margaret R. Dittemore, Branch
Librarian, Anthropology Branch Library, Smithsonian
Institution Libraries, and her colleagues in the library
were crucial in identifying and obtaining source materials
used in the book. I am also indebted to Roxie Walker and
the Institute of Bioarchaeology (formerly the
Bioanthropology Foundation) for grants that partially sup-
ported the preparation of this edition.
OBJECTIVES OF THE FIRST AND SECOND
EDITIONS
There are many sources of information on the history of
disease, including ancient medical documents, historical
records, art, and the physical remains of ancient people
including both soft tissues and skeletons. Undoubtedly,
human skeletons represent the most ubiquitous source of
information on ancient diseases. This fact must be tem-
pered with the knowledge that relatively few morbid con-
ditions affect the skeleton in a way that leaves visible
changes in dry bones. In spite of this limitation, the study
of skeletal pathology in archeological materials can pro-
vide time depth to our understanding of disease and con-
tribute to our knowledge regarding the role of disease in
human adaptation. In addition, skeletal paleopathology
may also broaden our understanding of disease as it
affects bone tissue. The paleopathologist often has access
to all portions of the skeleton, a situation rarely realized
in modern pathology or radiology. This means that the
gross pattern and distribution of the morbid condition in
all areas of the skeleton can be studied in detail.
To provide reliable standard specimens for dry bone
diagnosis, the reference cases used as a basis for the first
two editions of this book were primarily from the period
between AD 1750 and 1930. Ortner felt that earlier than
this range the medical data were too ambiguous and later,
6 Ortner’s Identification of Pathological Conditions in Human Skeletal Remains
the pathologic manifestations were too altered by surgery,
chemotherapy, radiation therapy, and, above all, by the
use of antibiotics. For this reason, the first two editions
turned to the great medical and anatomical collections of
Great Britain and of continental Europe. The British col-
lections proved in many ways to be the most useful,
because they were made by physicians and surgeons, who
were at all times interested in documenting clinical and
historical data. Yet even this material is not necessarily
identical to manifestations seen in archeological specimens.
As Ortner noted, his compiling these editions highlighted
the fact that even the great pathological anatomists of ear-
lier times made mistakes in differential diagnosis.
This book was intended mainly to serve as a text and
atlas of dry bone pathology, regardless of whether or not
each entity had been identified in paleopathology. For
that reason, as many aspects as possible of documented,
dry bone pathology were illustrated, especially because
the original skeletal collections can never be duplicated
and may ultimately disappear. In the paleopathological
discussions in these earlier editions, emphasis was laid on
careful and critical study of published reports and of
actual specimens, bringing a variety of types of evidence
to bear on arriving at a reasonable diagnostic assumption.
Even so, multiple possibilities and uncertainties often
remained. Not the least of these problems was the ambig-
uous and confusing terminology about the nature of path-
ological conditions and the chronology of archeological
specimens in published reports.
This book was written primarily with the needs of the
biological anthropologist and archeologist in mind, with
the hope that they would be able to recognize the abnor-
malities seen in archeological human skeletal material
they excavate or study. This book was also meant to high-
light the importance of recovering all mineralized tissues,
including the small bones of the hands and feet, during
excavation of a burial. Ortner also was interested in gen-
erating a broader readership with different backgrounds,
though, and emphasized the importance of including his-
torians of medicine and disease, orthopedic surgeons,
radiologists, pathologists, and physicians, who may be
called upon to interpret skeletal lesions in dry specimens
or who are interested in extending their understanding to
the more detailed gross expressions of skeletal disease.
HISTORY OF THE THIRD EDITION FROM
JANE E. BUIKSTRA
Don Ortner was just embarking upon the third edition of
this important volume at the time of his unanticipated
death on April 29, 2012, following a brief illness. For
those of us who had been close to Don professionally
and/or personally, our grief was profound. For example,
I—who had enjoyed so many pleasant lunches with Don
when I could sneak away from meetings of the National
Museum of Natural History’s Repatriation Committee or
other Washington responsibilities—could not bear to walk
by his office door for nearly a year, finding other circui-
tous routes to reach the Rose Seminar room of the
NMNH’s Anthropology Department. Don’s achievements
were celebrated both at the Smithsonian, during an event
held during the autumn of 2012, and at the annual meet-
ing of the Paleopathology Association, held during the
2013 annual meeting, April 9 and 10. Fortunately, Powell
(2012) had been able to convince Don to be interviewed
for a chapter in the Global History of Paleopathology
(Buikstra and Roberts, 2012), wherein details of his life
and scholarly contributions may be found. I can add only
that he was an enthusiastic supporter of the fledgling
International Journal of Paleopathology, ably contribut-
ing one of the Inaugural Essays and serving as an
Associate Editor. He rolled up his sleeves upon many
occasions to review articles and offer sage advice to
junior colleagues.
In discussions with Don’s family, especially his part-
ner Joyce and Don Jr., who sounds remarkably like his
father, it became clear that they would be supportive of a
third edition of Identification of Pathological Conditions
in Human Skeletal Remains, under my editorship.
Discussions with Bruno Frohlich, who was helping the
Department of Anthropology in archiving the materials
from Don’s office, made it clear that Don had only just
embarked on the project. No publisher had been identi-
fied, nor was there a proposal. Given this situation, I
began plans for the project. In creating the proposal, first
discussed with the Smithsonian Press, who were not
enthusiastic about the project due to concerns with copy-
right issues, I reflected upon the many productive discus-
sions in which I had engaged with Don. These convinced
me that he would have wanted the volume revision not to
second guess “what Don might have wanted,” but rather
to reflect the status of paleopathology at the time the revi-
sion appeared. This meant continuing to emphasize the
basic empirical evidence upon which paleopathological
identifications are based, but also to reflect the dynamic
nature of paleopathology today. Given the mentorship and
encouragement that Don had so freely provided to so
many of us, I also believe that he would have wanted our
generation(s) to leave our imprint upon the work—giving
it our best effort. It is with this spirit that we have
approached the volume.
When I approached Elizabeth Brown, Senior
Acquisitions Editor at Elsevier, about the project, she was
enthusiastic in support. We have tried to maintain the many
strengths of the earlier editions, while also adding new
methodological advances (molecular and parasitology),
mentioning closely related and increasingly convergent

research topics (animal paleopathology; mummy science)
and emphasizing the interdisciplinarity of paleopathology
in exploring themes based in the social sciences and human-
ities. When approached, colleagues in paleopathology and
related disciplines signed on enthusiastically, bringing their
special expertise to this important initiative.
Don and I agreed about most aspects of paleopathol-
ogy, especially the need for detailed descriptions of path-
ological changes, for standard terminology, to appreciate
limitations of early clinical accounts as well as those of
the antibiotic era, and for rigorous applications of differ-
ential diagnostic methods. I am less concerned than he
about classification, and therefore this topic will be less
visible in this third edition. I sincerely hope that we have
done justice to Don’s fundamental contributions to the
discipline of paleopathology, while recognizing key
developments since his seminal 2003 publications.
Acknowledgments for the Third Edition
First and foremost, I would like to acknowledge the
Ortner family in their support of this initiative. The
Department of Anthropology, especially its Chair during
the period of project development, Torben Rick, along
with Don’s long-term collaborator, Bruno Frohlich have
been immensely reassuring. The editor is extremely
appreciative of the enthusiasm and expertise of the colla-
borators, whose wisdom is represented here. The editorial
and content editorial assistance of Katelyn Bolhofner has
improved clarity and accuracy throughout the develop-
ment of the volume. Additional polish has been added by
the skills of Sylvia Cheever in final stages of the process.
Anne Grauer’s careful proof-reading and apt suggestions
have improved the final production, which is deeply
appreciated. Many of the authors wish to express their
gratitude to Don Brothwell for his scholarship and per-
sonal encouragement of our research, both in human and
in animal paleopathology. Finally, the assistance and
encouragement from Elsevier, including Elizabeth Brown,
Pat Gonzalez, and the production team have been essen-
tial to the success of the project.
OBJECTIVES OF THE THIRD EDITION
More than 30 years have passed since the landmark
Identification of Pathological Conditions in Human
Skeletal Remains (Ortner and Putschar, 1981) was pub-
lished, followed by the second edition (Ortner, 2003) over
a decade ago. The field and the profession of paleopathol-
ogy have changed markedly over this period, in no small
part due to the influence of these volumes. Ortner had
planned but not begun writing a third edition at the time
of his sudden death, and this volume represents the com-
pletion of this project, reflecting his (and Walter
Introduction Chapter | 1 7
Putschar’s) core contributions in bone disease through
revised and new chapters that manifest the contemporary
breadth and depth of the discipline of paleopathology.
This third edition updates the previous volumes
through the addition of recent medical information on
skeletal disorders and the latest relevant literature on
human skeletal paleopathology. This work also adds chap-
ters on current methods being used in research on skeletal
paleopathology. These include increased reliance on
imaging, including CT methods, histology, and analysis
of ancient DNA. In addition, chapters covering closely
related subjects, such as diet (including isotopes, micro-
wear, colon contents, (macro/micro fossils; pollen), dental
calculus, dental caries), mummy science, animal paleopa-
thology, and paleoparasitology have been added. Given
the contemporary availability of numerous texts covering
basic osteology, in this edition chapters on biological pro-
filing and osteobiographical methods have been deleted.
These topics are now introduced briefly in Chapter 3, and
Chapter 2 now offers an extended history of paleopathol-
ogy, current issues in the field, and the importance of rig-
orous differential diagnosis. The volume is further framed
by an expanded discussion of important themes for con-
sideration in this paleopathological research (Chapter 3).
As was the case for the first two editions of this vol-
ume, the most fundamental objective of this third edition
is to provide an integrated, detailed discussion of the
gross pathology of the human skeleton to facilitate rigor-
ous differential diagnosis of these pathologies in human
skeletal remains from archaeological contexts. In addition
to this foundation, the objectives of this third edition
include: emphasizing careful consideration of contempo-
rary clinical literature in diagnosis, encouraging knowl-
edge in epidemiology, animal paleopathology,
parasitology, and molecular and chemical advances in
contextualizing skeletal analyses, and presenting advances
in imaging, data collection, and diagnostic approaches
arising from such related fields as forensic science, dental
anthropology, biogeochemistry, and molecular science.
FORMAT OF THE VOLUME
While texts in paleopathology all agree that classification
is an important aspect of disease diagnosis, there is no gen-
eral agreement upon the number of classes of disease. As
Ortner (2012) notes, Reznick’s orthopedic radiology text
recognizes 17 categories. Aufderheide and Rodrı́guez-
Martı́n (1998)’s paleopathology text recognizes 13, while
both editions of the Ortner volumes focus upon 12.
Influenced by Lent Johnson, Ragsdale and various cowor-
kers (Ragsdale and Miller, 1996; Ragsdale and Lehmer,
2012) have asserted the utility of seven basic disease cate-
gories, readily recalled through the use of the acronym
VITAMIN (see Table 1.1, adapted from Ragsdale and
8 Ortner’s Identification of Pathological Conditions in Human Skeletal Remains
TABLE 1.1 Ragsdale’s Seven Basic Disease Categories
1 V Vascular
2 I Innervation/mechanical
3 T Trauma/repair
4 A Anomaly
5 M Metabolic
6 I Inflammatory/immune
7 N Neoplasms
Lehmer, 2012: 230). Roberts and Manchester (third
edition, 2010) also organize their discussion in The
Archaeology of Disease into seven categories.
After emphasizing the need for histology and recogni-
tion of disease processes, Ragsdale and Lehmer (2012:
247) close with the assertion, “that only through detailed
descriptions and diagnoses to general disease categories,
will a stronger methodological basis for comparative
research in paleopathology be reached.” They argue, based
upon evidence from four workshops held at the paleopa-
thology meetings (Miller et al., 1996) that assignments to
disease categories are more accurate than specific diagno-
ses. While these conclusions do reflect the empirical data
from the Workshops, questions about the relative experi-
ence of the participants remains. In addition, the degree to
which comparisons across 7, 12, 13, or 1 categories are
meaningful in interpreting the past must, of course, depend
upon the research question addressed or the hypothesis
posed. Further, the issue of contexts—environmental, tem-
poral, cultural—must be considered.
As Ortner (2012) emphasizes, disease classifications
emphasize cause or pathogenesis of a disease. In that,
e.g., bacterial pathogenesis can be a cause, pathogenesis
would seem to be the overarching category. Many dis-
eases have multiple causes, and classifications become
complex. Metabolic diseases, due to disturbances in oste-
oid formation and mineralization, are often associated
with nutritional deficiencies. Similarly, erosive arthropa-
thies are typically classified as joint disorders, even
though an infection may trigger the response.
This volume will follow the previous editions in its
classification of disease conditions: trauma, infectious dis-
eases, circulatory disorders, reticuloendothelial and
hematopoietic disorders, metabolic disorders, endocrine
disorders, congenital and neuromechanical disorders, dys-
plasias, tumor and tumor-like disorders, joint disorders,
dental and jaw disorders, and miscellaneous disorders. A
few specific disorders have been moved to more
completely reflect contemporary knowledge of pathogene-
sis. In reference to the process of classification, Ortner
(2012: 263) emphasized that the important point “is the
need to understand the pathogenesis and, where possible,
the cause of the disorder and not let the assignment to a
specific category of disease obscure our understanding of
the basic bone biology of disease.”
ABBREVIATIONS
The illustrations in this book are of specimens from many
institutions. The following abbreviations are used in the
legends to avoid repetition of lengthy institutional names
and locations. This list includes institutions that had path-
ological cases used in both the first and second editions.
AFIP Armed Forces Institute of Pathology, Washington,
DC, United States
AIUZ Anthropological Institute, University of Zurich,
Zurich, Switzerland
ANM National Museum of Anthropology, Prague, Czech
Republic
BMNH British Museum, The Natural History Museum,
London, England
CGH Department of Pathology, Charleston General
Hospital, Charleston, WV, United States
CISC Coimbra Identified Skeletal Collection,
Departamento de Ciências da Vida, Universidade de
Coimbra, Portugal
DPUS Department of Pathology, University of Strasbourg,
Strasbourg, France
FM Field Museum of Natural History, Chicago, IL,
United States
FPAM Federal Pathologic-Anatomy Museum, Vienna, Austria
HM Hunterian Museum, The Royal College of Surgeons
of England, London, England
IEC International Exchange Collection, Departamento
de Ciências da Vida, Universidade de Coimbra,
Coimbra, Portugal
IPAZ Institute of Pathological Anatomy, University of
Zurich, Zurich, Switzerland
LLAC- Luı́s Lopes Anthropological Collection, Museu Bocage,
MUHNAC Museu Nacional de História Natural e da Ciência,
Lisbon, Portugal
MGH Department of Pathology, Massachusetts General
Hospital, Boston, MA, United States
NHMB Natural History Museum, Bern, Switzerland
NMNH National Museum of Natural History, Smithsonian
Institution, Washington, DC, United States
PMES Pathology Museum, The Royal College of Surgeons
of Edinburgh, Edinburgh, Scotland
WM Wellcome Museum, The Royal College of Surgeons
of England, London, England
REFERENCES
Aufderheide, A.C., Rodrı́guez-Martı́n, C., 1998. The Cambridge
Encyclopedia of Human Paleopathology. Cambridge University
Press, Cambridge.

Buikstra, J.E., Roberts, C.A. (Eds.), 2012. The Global History of
Paleopathology: Pioneers and Prospects. Oxford University Press,
New York.
Hackett, C., 1947. The Bone Lesions of Yaws in Uganda. Thesis.
University of London, London.
Hackett, C., 1976. Diagnostic criteria of syphilis, yaws and treponarid
(treponematoses) and of some other diseases in dry bones.
Sitzungsberichte der Heidelberger Akademie der Wissenschaften
Mathematisch-naturwissenschaftliche Klasse, Abhandlung 4.
Springer-Verlag, Berlin.
Kolman, C., Centurion-Lara, A., Lukehart, S., Owsley, D., Tuross, N.,
1999. Identification of Treponema pallidum subspecies pallidum in a
100-year-old skeletal specimen. J. Infect. Diseases 180, 2060 2063.
Miller, E., Ragsdale, B.D., Ortner, D.J., 1996. Accuracy in dry bone
diagnosis: a comment on palaeopathological methods. Int. J.
Osteoarchaeol. 6 (3), 221 229.
Ortner, D.J., 2003. Identification of Pathological Conditions in Human
Skeletal Remains. Academic Press, New York.
Ortner, D.J., 2012. Differential diagnosis and issues in disease classifica-
tion. In: Grauer, A. (Ed.), A Companion to Paleopathology. Wiley-
Blackwell, New York, pp. 250 267.
Introduction Chapter | 1 9
Ortner, D.J., Putschar, W.J.P., 1981. Identification of Pathological
Conditions in Human Skeletal Remains. Smithsonian Institution
Press, Washington, DC.
Powell, M.L., 2012. Donald J. Ortner (1938 ). In: Buikstra, J.E.,
Roberts, C.A. (Eds.), The Global History of Paleopathology:
Pioneers and Prospects. Oxford University Press, New York,
pp. 89 96.
Ragsdale, B.D., Lehmer, L.M., 2012. A knowledge of bone at the cellu-
lar (histological) level is essential to paleopathology. In: Grauer, A.
(Ed.), A Companion to Paleopathology. Wiley-Blackwell, New
York, pp. 227 259.
Ragsdale, B.D., Miller, E., 1996. Workshop A. Skeletal Disease
Workshop VIII: several of the seven basic categories of disease.
In: Cockburn, E. (Ed.), Papers on Paleopathology Presented at the
23rd Annual Meeting of the Paleopathology Association, Durham,
North Carolina. Paleopathology Association, Detroit, p. 1.
Roberts, C.A., Manchester, K., 2010. The Archaeology of Disease.
Cornell University Press, New York.
Tyson, R. (Ed.), 1997. Human Paleopathology and Related Subjects.
An International Bibliography. San Diego Museum of Man,
San Diego.
Chapter 2
A Brief History and 21st Century
Challenges
Jane E. Buikstra1 and Sharon DeWitte2
1
Arizona State University, Tempe, AZ, United States, 2University of South Carolina, SC, United States
In this chapter, we consider the history of paleopathology
and a few of the fundamental issues faced by practitioners
in the development of this field. We then turn to a discus-
sion of the current state of paleopathology, reviewing
methodological and theoretical issues encountered in 21st
century paleopathology. In this regard, we discuss the dif-
ferential diagnosis of pathological conditions in archeolo-
gical skeletal remains, suggesting avenues by which
paleopathologists may pursue more rigorous diagnosis.
Finally, we discuss the important contribution of paleoe-
pidemiology in the advancement of this field, as well as
considering the ramifications of the osteological paradox
in such work.
A BRIEF HISTORY OF PALEOPATHOLOGY
Paleopathology has been defined in recent decades as the
study of disease, both human and nonhuman, in antiquity
using a variety of different sources, including human
mummified and skeletal remains, ancient documents,
illustrations from early books, painting and sculpture
from the past, and analysis of coprolites (Ortner, 2003: 8)
More recently, this definition has been reevaluated and
expanded to reflect the crucial interplay of biomedical
and social sciences and the humanities in the development
and future of the field (Buikstra et al., 2017). A compre-
hensive history of paleopathology has recently been writ-
ten (Buikstra and Roberts, 2012), and there are several
other older summaries of this history that readers who
have a specific interest in the subject may wish to consult
(e.g., Jarcho, 1966; Angel, 1981; Ubelaker, 1982;
Armelagos, 1997; Aufderheide and Rodriguez-Martin,
1998). Thus, a detailed history of paleopathology that
includes research using all the varied sources of potential
information is beyond the scope of this book. Here, we
offer a brief summary of the history of paleopathology,
Ortner’s Identification of Pathological Conditions in Human Skeletal Remains. DOI: https://doi.org/10.1016/B978-0-12-809738-0.00002-8
© 2019 Elsevier Inc. All rights reserved.
highlighting some of the issues and major developments
in the field over the past 200 years.
The history of paleopathology in many ways parallels
the development of most other scientific disciplines. The
early publications consist of a body of descriptive litera-
ture in which abnormalities encountered by an observer
are described against the background of what is normal.
Much of this early research was no more than an anatomi-
cal account of these abnormal conditions with little if any
attempt to explore the biological or pathological signifi-
cance of what was being described. The earliest work
focused on nonhuman paleontological specimens (e.g.,
Esper, 1774; Cuvier, 1820). Warren (1822) included a dis-
cussion of artificial cranial deformation in human skulls
of indigenous North Americans in his book titled, A
Comparative View of the Sensorial and Nervous Systems
in Man and Animals. In 1861 in Paris, Gosse published
another study of artificial cranial deformation. In the fol-
lowing decades, the question of the origin of syphilis
began to be debated with intensity (e.g., Jones, 1876;
Virchow, 1898). This debate marks one of the earliest
attempts to use archeological human remains to resolve
an important biomedical problem. And toward the end of
the 19th century, R.W. Shufeldt proposed that the term
“paleopathology” be used to describe “all diseased or
pathological conditions found fossilized in the remains of
extinct or fossil animals” (Shufeldt, 1892: 679).
As the term “paleopathology” began to be used in the
early 20th century, this period witnessed a marked expan-
sion of published reports on ancient disease. Particularly
notable is the work of Sir Marc Armand Ruffer (1910) on
Egyptian mummies, and the studies on Nubian skeletal
material by Wood-Jones (1908, 1910) and Elliot-Smith
and Wood-Jones (1910). In the United States, Aleš
Hrdlička (1914) published some observations on the
pathology of ancient Peruvian skulls. In 1923, Moodie’s
11
12 Ortner’s Identification of Pathological Conditions in Human Skeletal Remains
introduction to the study of ancient disease, which empha-
sized nonhuman paleontological specimens, appeared. A
brief, general review of human paleopathology was pub-
lished by Williams in 1929. This review included obser-
vations on bones and teeth as well as on mummy tissue
and ancient art. Pales (1930) followed with his book on
paleopathology and comparative pathology. Most of his
cases and discussions concerned European human speci-
mens. In the same year, Hooton (1930) published his clas-
sic study of North American Indian skeletal material from
Pecos in which he included an extensive description of
pathological specimens. Hooton’s study is notable in its
descriptive detail, in the statistical treatment of different
types of disease in the skeletal population, and in his
efforts to show trends in disease frequency through the
time period of human occupation at the site.
In the 1960s, Wells (1964) published a review of evi-
dence of human paleopathology from skeletal material,
mummies, and art that brought paleopathology to the
attention of a more general audience. But in the preced-
ing decades, paleopathological studies had fallen into a
pattern of inclusion in archeological research as descrip-
tive addenda or appendices. Thus, calls for further
advances in the field of paleopathology were made
(Jarcho, 1966; Brothwell and Sandison, 1967; see also
Grmek, 1983/1989), resulting in the establishment of
professional organization, international journals, and pro-
fessional meetings and training seminars (Buikstra and
Roberts, 2012).
Throughout the development of human skeletal paleo-
pathology as a scholarly discipline there have been recur-
ring problems in both theory and methodology. In the
early stages of paleopathology, most of the research was
conducted by physicians who had little knowledge of
archeology, thus context often was overlooked. As studies
of pathological skeletal specimens began to be conducted
primarily by biological anthropologists, whose formal
training and experience in skeletal pathology and radiol-
ogy may be deficient, pathological conditions were at risk
of being attributed incorrectly to the wrong time period
by those unfamiliar with the complexities of archeological
dating. Further, bone lesions were incorrectly diagnosed
through ignorance of anatomy and the total range of dis-
eases that affect bone (see Stewart’s comments on this
problem in Jarcho, 1966: 43). These problems were com-
plicated further due to the slow formulation of a theoreti-
cal context for interpreting the meaning of
paleopathological data. [See, e.g., the debate (Wood et al.,
1992; Goodman, 1993) about what can and cannot be said
about prevalence data and the inferences made about the
health of past human populations.]
In 1988, Ortner and Aufderheide (1991) organized a
symposium held as part of the International Congress of
Anthropological and Ethnological Sciences in Zagreb,
Yugoslavia (now Croatia) that attempted to assess (1)
how far paleopathology had developed as a scientific dis-
cipline, (2) some of the theoretical and methodological
problems that needed to be resolved, and (3) directions
that research might take in the future. Methodological
issues included an inconsistent descriptive terminology
that precluded comparison between published reports, and
the lack of diagnostic criteria that fully utilized the infor-
mation available in archeological human skeletons
(Ortner, 1991). Theoretical issues included the need for
greater understanding of what skeletal disease meant in
terms of the general morbidity that existed within the liv-
ing population in which the person with skeletal disease
lived (Ortner, 1991).
Much of the emphasis in paleopathology until fairly
recently has been on descriptions of pathological speci-
mens, and there had been little effort to relate the evi-
dence of disease to the broader problems of human
adaptation. Early hints of such an emphasis exist in
Hooton’s Pecos Pueblo monograph (1930), in the consid-
eration of epidemiological factors in evaluating the data
on pre-Columbian tuberculosis in the New World (Morse,
1969), and in discussions on the origin of treponemal dis-
eases (Hackett, 1963; Hudson, 1965). But not until
recently has the trend toward population studies of ancient
disease become a significant part of the literature on
paleopathology as these methodological and theoretical
problems are resolved (e.g., Larsen, 1997).
Much of the descriptive literature in skeletal paleopa-
thology depended upon the scholar’s knowledge of gross
bone pathology. Unfortunately, where this knowledge was
inadequate there were few reference sources that could be
of assistance. Jarcho (1966) organized a symposium on
human paleopathology that addressed this problem,
among others. The participants called for the establish-
ment of a paleopathology registry and improved diagnos-
tic methodology to partially correct these problems.
Steinbock’s reference book (1976) on diagnosis of ancient
bone disease represented the first integrated attempt to
establish diagnostic criteria for the paleopathologist that
addressed the broad range of diseases that affect the
human skeleton. The first two editions of this volume
(Ortner and Putschar, 1981 and slightly revised in 1985;
Ortner, 2003) provided a complimentary treatment of
skeletal disease. Both these reference works represented
important steps in improving the knowledge regarding the
types of diseases that affect bone and the morphological
features associated with the disease.
Since the publication of the first two editions of this
book, there has been a substantial increase in research on
broader scientific problems, particularly those related to
paleoepidemiology, as we will review later in this chapter.
There has also been significant progress made on several
crucial methodological problems. One of the most
 A Brief History and 21st Century Challenges Chapter | 2
important of these has been the improvement in our appli-
cation of differential diagnosis, which we will discuss in
detail in the following section. As we face a new suite of
issues and advances in the 21st century, we argue that
paleopathology should be an interdisciplinary endeavor,
incorporating expertise from the humanities, the social
sciences, and the biomedical sciences (Buikstra et al.,
2017).
21ST CENTURY PALEOPATHOLOGY
Our vision of 21st century paleopathology is of a pro-
foundly interdisciplinary endeavor, drawing knowledge
and professionals from the biomedical and social
sciences, as well as the humanities. We use knowledge
about past health to address the coevolution of humans
and pathogens, and we anticipate much more knowledge
about both human and animal disease will soon be
reviewed through molecular study. This volume therefore
is meant to be an entry point for knowledge that necessar-
ily extends well beyond these pages.
First of all, we must recognize that paleopathology
proceeds primarily through scientific methods. Our obser-
vations of ancient remains should be drawn carefully, fol-
low standard descriptive terminology, and be designed to
minimize both intra- and interobserver error. A general
overview of terminology appears on the Paleopathology
Association’s website (https://paleopathology-association.
wildapricot.org/Nomenclature-in-Paleopathology). While
this overview generally follows medical terms, methodo-
logical and application issues arise due to the fact that
most of our observations are made upon materials that
emerged from a burial environment. Taphonomic changes
are frequently described in terms also used for vital pro-
cesses, “abraded” and “eroded” being two apt examples.
Therefore, when using such terms, the observer should be
careful to indicate whether the process occurred ante- or
postmortem.
We continue to follow Ragsdale and colleague’s
(1981) descriptions of periosteal bone reactions (see also
Weston, 2012), familiar to those of us who have been
humbled during Ortner/Ragsdale and Ragsdale workshops
at the annual meetings of the Paleopathology Association.
It is crucial not only to describe, but also to understand,
the processes that have led to the observed change. As we
consider our observations, we should report whether or
not the process was active at the time of death, or
quiescent.
There are published standards (Buikstra and Ubelaker,
1994) and freely available databases (Osteoware) for
recording pathological changes in human bones.
Whatever system is used, an explicit key that explains the
coding system is crucial. While this issue may not seem
so important to those starting their research careers, its
13
significance will become apparent as the need for consis-
tency across years of data collection and comparative
approaches emerge.
Observing pathological changes and distinguishing
these from postmortem alterations is one crucial step in
assessing ancient disease (see Chapter 5: Abnormal Bone:
Considerations for Documentation, Disease Process
Identification, and Differential Diagnosis). Once these
have been coded by individual, and then across a skeletal
sample, the identification of a condition assumes signifi-
cance. Remembering that observations may be compli-
cated by comorbidities, i.e., that two or more diseases
may affect a given individual, the survey of possible con-
ditions should begin. In most cases, this assessment can
begin with this volume, but it should not necessarily end
here. To fully appreciate the manner in which bones (and
other tissues) may react to a given insult requires an
appreciation of the variable manner in which a person
may be affected and the fact that the person may have
died prior to the most extreme manifestation of the dis-
ease, as recorded here or in the clinical literature.
Certainly medical interventions, especially antibiotics and
chemotherapy, have changed the course of disease over
the past century profoundly. Earlier medical procedures,
such as treating venereal syphilis with mercury or malaria
with high-temperature baths, may or may not have altered
the course of disease. Such treatments, however, may
have introduced their own diagnostic sequelae.
Earlier editions of this volume have recommended
clinical diagnoses found in books and medical museums
between 1750 and 1930. We are inclined to a more con-
servative perspective, particularly in reference to infec-
tious diseases. The most reliable sources, in our
experience, have been clinical reports from the period fol-
lowing the identification of the pathogen causing the con-
dition and prior to the development of effective
interventions. In the absence of documented collections,
of course, autopsies and radiographic records are seldom
sufficiently complete to provide the desirable, complete
skeletal record. Even those practitioners using documen-
ted collections should be careful to read all the supporting
documentation to discern the degree to which the “diag-
nosis” was based upon clinical observations rather than
posthoc skeletal observations.
Again, we emphasize that, in most cases, this book
should be considered a secondary source. Anyone wishing
to develop a definite differential diagnosis should consult
the primary literature, which engages the clinical litera-
ture. Web-based searches are important, especially in dis-
covering primary source documents from an earlier era.
Identifying a disease process in archeologically recov-
ered human remains is only part of the process of inter-
preting past lives. A practitioner of paleopathology needs
to appreciate concepts drawn from the social sciences
Another random document with
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on his hands and knees. He paused and listened. Certain nasal
sounds seemed to indicate that the Count was sleeping very
soundly. Roko carried a tiny little lantern, and he flashed a ray across
the sleeper’s face. Having satisfied himself that the Count was
asleep, he drew from his pocket a phial containing a colourless
liquid, and, approaching a night-table, on which stood a jug of barley-
tea, which the Count had in his room every night, as he said it had
been his custom for years always to drink barley-tea in the night-
time, the Creole poured the contents of the phial into the jug, and
having done that, he withdrew as stealthily as he had entered. Soon
afterwards the Count rose, procured a light, and took from his
portmanteau a large flask, into which he emptied the barley-tea.
Then he addressed himself to sleep again, and slept the sleep of the
just.
At the usual morning meal he did not put in an appearance; but he
sent a request to madame, asking her to be good enough to come
and see him. The request was speedily complied with. When she
appeared she looked as charming and as radiant as ever. He was
profuse in his apologies for having troubled her to come to his room,
but pleaded as an excuse a feeling of extreme illness. She displayed
great anxiety and concern, and wanted to send for a doctor; but he
told her it was nothing. He thought something had disagreed with
him; that was all. It would pass off. A doctor was not needed. She
declared, however, that if he felt no better in an hour’s time she
would insist on his seeing a doctor. An hour slipped by, and he was
still in the same condition, so a messenger was despatched for a
doctor, who speedily put in an appearance.
To the doctor’s inquiries, the patient said he believed he had eaten
or drunk something which had upset him. The doctor was of the
same opinion, and prescribed accordingly. In the course of the
afternoon the Count said he felt somewhat better, and though the
hostess tried to dissuade him from doing so, he announced his
intention of going out to get a breath of fresh air. He wanted her to
accompany him. That she stoutly refused to do; and when she saw
he was determined to go she withdrew her opposition, and
expressed a hope that he would speedily return. He assured her that
he would do so. He said he was going to have a drive in a sledge on
the Neva for two or three hours. Having put on his Shuba, his fur
gloves, fur-lined boots, and fur cap, he took his departure.
After an absence of about three hours, he returned, and declared
that he felt much better. He spent about an hour with the lady in her
boudoir, then retired. She was very anxious that Roko should sit up
with him, but he resolutely set his face against that, saying that there
was not the least necessity for it. He was an exceedingly sound
sleeper, and he was sure he would sleep as soundly as usual. About
midnight his door was opened silently, as on the previous night, and
once again Roko crept stealthily to the bed-table, and emptied the
contents of a phial into the barley-tea. Soon after he had withdrawn
the Count jumped up, poured the tea into another flask, which he
produced from his portmanteau, and then lay down in the bed again
until a neighbouring church clock solemnly and slowly tolled out two
o’clock. Almost immediately the Count rose, and dressed himself.
That done, he took from his portmanteau a revolver, and having
examined it to ascertain if it was properly loaded, he lighted a lantern
provided with a shutter, to shut off the light when required. Going to
the door, he opened it gently, and listened. All was silent. There
wasn’t a sound, save that made by the wind, which whistled
mournfully through the corridor. Having satisfied himself that nothing
human was stirring, the Count proceeded cautiously along the
corridor, descended a short flight of stairs to another corridor, along
which he passed, and gained the main door that gave access to the
street. He opened this door, though not without some difficulty, as
there were bolts and chains to be undone, and he worked cautiously
for fear of making a noise.
At last all obstacles were removed, and the heavy door swung on its
hinges, letting in a blast of icy air, and revealing the brilliant stars that
burned like jewels in the cloudless black sky. In a few minutes eight
men filed into the house noiselessly, and the door was closed, but
chains and bolts were left undone. The men exchanged a few
sentences in whispers. Then, following the Count, they proceeded to
the sleeping apartment of Madame Julie St. Joseph. In an anteroom,
through which it was necessary to pass to reach her room, Roko,
enveloped in furs, lay on a couch, locked in sleep. A shaded lamp
stood on a bracket against the wall.
Four men remained in this room; the other four and the Count
entered the lady’s chamber. Here, again, a shaded lamp burned on a
bracket, and close to it an ikon—or sacred picture—hung. The pretty
widow was also sleeping. By this time the Count had undergone a
strange transformation. His beard and moustache had disappeared,
revealing the smooth-shaved, mobile face of Michael Danevitch, the
detective. He shook the lady. With a start she awoke. The four
policemen had concealed themselves; Danevitch alone was visible.
It was some moments before madame realized the situation; then,
seeing a strange man by her bedside, she uttered a cry, and called
for Roko. He sprang up, and instantly found himself in the grip of two
stalwart men, while the revolver under his pillow, which he tried to
get, was seized.
‘Madame Julie St. Joseph,’ said Danevitch, ‘get up and dress
yourself.’
‘What does this mean?’ she asked, with a look of alarm on her pretty
face, as she thrust her hand under the pillow, where she likewise had
a revolver concealed. But in an instant Danevitch had seized her
wrist in his powerful grasp, and one of his colleagues removed the
weapon.
‘It means,’ he answered, ‘that your career of infamy has come to an
end. You are under arrest.’
A look of terror and horror swept across her face as she asked in a
choked sort of voice:
‘On what grounds am I arrested?’
‘That you will learn later on. Sufficient for you to know that you are a
prisoner. Come, rise and dress yourself.’
She recognised the hopelessness of resistance, and, of course, she
understood that her faithful watch-hound Roko had been rendered
powerless. She was trapped; that she knew. But it did not dawn upon
her then that the Count and Danevitch were one and the same.
Consequently she was puzzled to understand how her downfall had
been brought about.
With a despairing sigh she rose and put on her clothes. Half an hour
later she was being conveyed to the gaol with Roko, accompanied
by Danevitch and three of his colleagues. The other five had been
left in charge of the house. When madame had somewhat recovered
her presence of mind, she assumed a bravado which she was far
from feeling, and asked Danevitch airily if he knew how her guest the
Count was.
‘Oh yes,’ answered Danevitch. ‘He is perfectly well, as you may
judge for yourself; for I it was who played the part of the Count so
effectively.’
With an absolute scream madame bit her lip with passion, until the
blood flowed, and dug her nails into the palms of her hands.
‘What a fool, a dolt, an idiot I’ve been! But tell me, how was it Peter
Trepoff asked me to invite you to the ball?’
‘Peter Trepoff is my agent, madame.’
With a suppressed cry of maddening rage, the wretched woman
covered her face with her hands and groaned, as she realized how
thoroughly she had been outwitted.
That same night, or, rather, some hours before the widow and Roko
were swept into the net which had been so cleverly prepared for
them, Alexander Vlassovsky was arrested in Moscow. Danevitch
learned that fact by telegraph when he went out in the afternoon. He
had first begun to suspect Vlassovsky after that interview when he
was making inquiries about the death of Captain Baranoff. The result
was that he intercepted letters from Madame Julie St. Joseph, who
had returned to St. Petersburg. She had a small house in Moscow,
which she occasionally visited in order to secure victims. In Moscow,
where he was well known, the wily Vlassovsky did not go near her,
but he helped her as far as he could in her fiendish work. He had
been very cleverly trapped by the notes which he relieved the
supposed Count of. Those notes were not genuine, and when he
attempted to pass them he was arrested, for Danevitch had notified
the Moscow police.
Subsequent revelations brought to light that the wretched woman
had been in the habit of luring men to their doom by means of her
fatal beauty. She bled them of their money, her plan being to cajole
them into giving her a lien on any property they might possess. This
was most artfully worked by the aid of Vlassovsky, and when the
victim had been securely caught, he was poisoned. The poisons
were concocted by Madame St. Joseph herself, and when she could
not do it herself, Roko administered the fatal dose or doses. She had
picked up this man in Spanish America, where she had been for
some time, and, weaving her spell about him, had made him
absolutely her slave.
Vlassovsky, who, up to the time that he made her acquaintance, had
been an honest, industrious man, fell under the magic of her
influence, as most men did, and became her all-too-willing tool. His
nature once corrupted, all scruples were thrown to the winds, and he
hastened to try and enrich himself. It seemed that the miserable
woman really loved him, and though he was fatally fascinated with
her, he was afraid of her; and, as he confessed, his aim was to
accumulate money as quickly as possible, and then flee from her
and the country for ever. But unfortunately for himself, during that
memorable interview following Captain Baranoff’s death, he had
aroused the suspicions of Danevitch, whose marvellous perceptive
faculties had enabled him to detect something or another in
Vlassovsky’s manner, or answers to the questions put to him, which
made him suspicious. For Danevitch to become suspicious meant
that he would never rest until he had proved his suspicions justified
or unfounded.
It need scarcely be said that with her arrest in St. Petersburg
Madame St. Joseph’s career came to an end. From the moment that
Danevitch entered her house her doom was sealed. Believing him to
be the person he represented himself to be, she begged of him to
help her financially; and, seeming to yield to her entreaties, he drew
up a document which purported to make over to her at his death
certain estates in Poland. Of course, these estates had no existence.
Having secured him, as she thought, her next step was to poison
him by small doses of black hellebore, so that he might gradually
sicken and die. Her devilish cunning was evidenced in every step
she took. She would not appear in public with him, nor did she allow
any of the visitors to her house to see him. Consequently it would not
be generally known that she had associated with him. As his illness
developed by means of repeated doses, she would have had him
removed to a hotel, and she knew pretty well that, as in Colonel
Ignatof’s case, he would shrink from letting it be known that he had
been intimate with her. Her cunning, however, overreached itself;
she was defeated with her own weapons; Danevitch had been too
much for her. The poisoned barley-tea he submitted to analysis, and
the evidence against her was overwhelming. But when she found
that there was no hope, she was determined to defeat justice, and
one morning she was found dead in her cell: she had poisoned
herself with prussic acid. The acid was conveyed to her by a warder,
who was heavily bribed by one of her friends to do it. It cost him his
liberty, however, for he was sent to Northern Siberia for the term of
his natural life.
Roko died very soon afterwards from typhoid fever contracted in the
prison, but he was faithful to the last, for never a word could be
wrung from his lips calculated to incriminate the strange woman who
had thrown such a spell around him. Vlassovsky was deported to
Northern Siberia in company with the treacherous warder. He very
soon succumbed, however, to the awful hardships he was called
upon to endure and the rigours of the Arctic climate.
The number of Madame St. Joseph’s victims was never determined.
That they were numerous there was not the slightest doubt; and had
it not been for the cleverness of Danevitch she would probably have
continued to pursue her infamous career for years longer, and
ultimately have passed away in the odour of sanctity. Her downfall, it
need scarcely be said, caused great satisfaction in St. Petersburg
and Moscow, where she had destroyed so many of her victims.
 THE STRANGE STORY OF AN ATTACHÉ.
It can readily be understood that Danevitch led not only an active
life, but a varied one; and the cases he was called upon to deal with
revealed many remarkable phases of human nature. He never
attempted to pose as a moralist, but he frequently deplored the fact
that wickedness and evil should so largely predominate over
goodness. He was also apt to wax indignant against the vogue to
decry anything in the nature of sensation. He was in the habit of
saying that life from the cradle to the grave is full of sensations, and
that the inventions of the fictionist are poor, flat, and stale, when
compared with the realities of existence. But this is undoubtedly the
experience of everyone who knows the world and his kind. It is only
the cheap critic, the bigot, or the fool, who has the boldness to deny
the existence of sensation in real life, and to sneer at what he is
pleased to term melodramatic improbabilities. There is no such thing
as a melodramatic improbability. The only charge that can
legitimately be levelled at the so-called sensational writer is his
tendency to grotesque treatment of subjects which should simply be
faithful reproductions from life. The curious story of young Count
Dashkoff, the Russian attaché, with whom this narrative is
concerned, illustrates in a very forcible way the views advanced in
the foregoing lines. Indeed, as Danevitch himself says, if anyone had
invented the story and put it into print, he would have raised the ire
of the army of critics—the self-constituted high-priests of purity, who,
being unable to improve or even equal that which they condemn, are
all the more violent in their condemnation.
Count Dashkoff was a young man, a member of a very old Russian
family, who had in their day wielded great power, and before the
abolition of serfdom took place, had held sway over more serfs than
any other family in the whole of the empire. The Count had
distinguished himself in many ways. His career, up to the time of the
extraordinary events about to be recorded, had been marked by
brilliancy and shade. As a student and a scholar he had attracted the
attention of many notable men, more particularly by his well-known
and remarkable work, entitled ‘The Theory of Creation,’ which is
conspicuous for its erudition, its deep research, and its wide grasp
and clever treatment of a tremendous subject. The book is, and will
ever remain, a standard, and consequently an enduring monument
to the Count’s ability and industry. On the other hand, he had made
himself notorious by certain excesses, and a recklessness of
conduct which had shocked the proprieties and outraged the feelings
of those who were interested in him and hoped that he would
ultimately rise to power and position. Of course, excuses were
forthcoming on the grounds of his youth, and, as if trying to establish
a right by two wrongs, it was urged that he had simply done what
most Russian youths do who are born to high estate and have
control of wealth. As a stepping-stone to the future greatness
predicted for him by his friends, the Count, after a probationary
course in the diplomatic service at home, was sent as an attaché to
the Russian Embassy in Paris. As might be supposed, he took kindly
to Parisian life. He was what is usually termed an elegant young
man, with æsthetic tastes. When he first went to Paris he was about
eight-and-twenty, and, apart from the advantages of youth, he had
wealth, good looks, sound health, and a cheerful disposition. He
enjoyed life, and showed no disposition to mortify the flesh by an
austere or monastic régime. His private residence in the Champs
Élysées was conspicuous for the magnificence of its appointments,
and was the rendezvous of the élite of Paris society—that frivolous
section which lives for no higher purpose than to live, and is
attracted to wealth and luxury as bees are attracted to sugar. It
seemed that this apparently fortunate young man, who could be
serious enough when occasion required, was fond of attention and
homage. He loved to be surrounded with a crowd of admirers, who
flattered him, praised his bric-à-brac, and gorged themselves with
the good things he invariably set before them. He knew, no doubt,
that they were all fawners and sycophants, but, still, they made up a
little world over which he ruled, and wherever he led the noodles
would follow.
Two years of this sort of life passed, and then Danevitch was
instructed to proceed with all haste from Russia to try and discover
what had become of the Count, for he had suddenly and
mysteriously disappeared, and all efforts of the Paris police and the
boasted skill of the Parisian detectives had failed to reveal a trace of
him. The facts of the case were as follows: In the course of the
month of January the Count gave a grand ball and reception at his
elegant hotel, and the event drew together the gilded youth of both
sexes. These functions at the Count’s residence were always
marked by a magnificence of splendour and a lavish expenditure
which seemed hardly consonant with his position as a mere attaché.
But it must not be forgotten that he was the heir to great wealth, and
represented a noble family who had ever been distinguished for the
almost regal style in which they lived.
About two o’clock in the morning the Count drew an intimate friend of
his—a Monsieur Eugène Peon—on one side, and told him he
wanted to slip away for an hour, but he did not wish it to be known
that he had gone out. He would be sure to be back in about an hour,
he added. A few minutes later the concierge saw him leave the hall.
He was attired in a very handsome and costly fur coat, with a cap to
match; and though the weather was bitterly cold and the ground
covered with snow, he wore patent-leather shoes. The concierge,
who was much surprised at the fact of his master leaving the house
in the midst of the revels, asked him if he wanted a carriage. To this
question the Count answered curtly, and, according to the porter,
angrily, ‘No.’ The night wore itself out. The dancers danced
themselves into limpness and prostration, and began to depart.
Some surprise had been expressed at the Count’s absence, and
various inquiries had been made about him; but it was suggested
that the seductive influences of the wine-cup had proved too much
for him, and he had retired. This hint or suggestion appeared to
satisfy the light-headed revellers, who gave no further thought to the
matter. His friend, Eugène Peon, considered it very strange that the
Count should go away and remain away in such a manner, to the
neglect of his guests, for he was the most punctilious host. But Peon
set it down to an assignation, and thought that he had found the
society of some fair one more attractive than the glitter and glare of
the ballroom. The day had very well advanced before there was
anything like real surprise felt at the Count’s prolonged absence.
It appeared that Eugène Peon called at his friend’s hotel soon after
three o’clock in the afternoon, and, ascertaining that he was not at
home, went down to the Embassy to inquire for him there, but to his
astonishment was informed that the Count had not been there for
two days. Although astonished, Peon was not uneasy. He stated that
he saw no cause to be uneasy, although he had never known his
friend do such a thing before, and was aware that he was most
attentive to his duties. When he called again on the following
morning, however, and was informed that the Count was still absent,
he began then to fear that something was wrong, and he at once
communicated his fears to some of the Count’s close personal
friends; he had no relations in Paris at all. A consultation was held,
but there seem to have been divided counsels, and no steps were
taken to ascertain the Count’s whereabouts, though some inquiries
were made of the members of the household, but all that could be
elicited was that the concierge saw his master go out about two
o’clock, and that he was dressed in patent-leather boots, a heavy fur
coat, and a fur cap. From the tone in which he said ‘No,’ when asked
if he wanted a carriage, he appeared to be angry; but there was no
indication in his gait or speech that he was under the influence of
wine. It was not until another whole day had passed that anything
like real alarm had set in. The alarm by this time had reached the
Embassy, and it was decided that the police should be
communicated with. Strangely enough, the police did not at first
attach any serious importance to the matter. They made certain
inquiries in a perfunctory manner, and for some inscrutable reason—
unless it was sheer, downright pig-headedness, a quality often
enough conspicuous in the French police—they came to the
conclusion that ‘Monsieur le Comte’ had been guilty of some little
escapade, and would turn up very shortly. As this prediction had not
been fulfilled when another twenty-four hours had elapsed, a much
more serious view was taken of the young man’s absence, and dark
hints were let drop that he had been inveigled into one of the haunts
of vice which abound in the gay city, and had been murdered. The
murder theory was at once taken up; detectives were communicated
with, and the theory of murder found general acceptance.
As may be imagined, a gentleman, who by reason of his position and
his riches had cut a conspicuous figure in society, disappearing
suddenly in this way was bound to cause a sensation, and as the
Parisians dearly love a sensation and a scandal, the matter was a
fruitful topic of conversation for several days, while much ink was
expended over it by the journalists. But notwithstanding the publicity
given to the matter, and the efforts of police and detectives, another
week passed, and not a trace or sign of the missing man had been
obtained.
Up to this point the Count’s relatives in Russia had not been
communicated with, from a desire to avoid alarm, for there were
those who still hoped he would turn up again all right; but now his
Russian friends in Paris regarded the affair as too serious to be
longer withheld. As a preliminary, a message was at once sent
asking if the Count had returned home, and almost simultaneously
with the despatch of that message a courier set out for Russia with
the tidings and details.
As the Count—as far as was known—had not returned to Russia,
great consternation was caused amongst his friends by the report
that reached them, and no time was lost in securing the services of
Danevitch, who was instructed to leave for Paris without a moment’s
delay, and institute independent inquiries.
‘I found, on arriving in the French capital,’ says Danevitch, ‘that by
order of the Russian Ambassador all the Count’s things had been
sealed up and his house temporarily closed. My preliminary
investigations were directed to trying to discover if there were any
grounds for believing that the missing man had committed suicide.
This inquiry was necessarily forced upon one—at any rate upon me,
although I learnt that the possibilities of suicide had never entered
the heads of the French police. And though at first they had
suggested murder, they soon abandoned that idea, for no other
reason, as it appeared, than that they had not been able to find his
body. And in consequence of this they insisted that he had taken
himself off to some other country in order to avoid the results of
conduct unbecoming a gentleman and a member of the Embassy.
When they were asked to give a name to his conduct, they declined,
but darkly hinted at something very dreadful. I myself could find no
grounds for the theory of suicide, while everyone at the Embassy, as
well as all who knew him, indignantly repudiated the slur which was
sought to be cast upon the young gentleman’s character. I could find
no one who had a word to say against his honour. That he might
have had affaires d’amour, as the French call them, was readily
admitted; but as all is considered fair in love, as in war, these matters
were not supposed to reflect on the honour of a man.
‘As Monsieur Eugène Peon had been very intimate with the Count, I
questioned that gentleman very closely concerning his friend’s
movements, and elicited that he had been a pretty general lover, but,
so far as he knew, the Count had formed no serious attachment to
anybody. Peon could suggest no reason why the Count should have
left his guests so abruptly, unless it was to keep an assignation.
‘Now, it must be remembered that when he left his house it was
about two o’clock on a winter morning, and, according to the
concierge, he seemed angry when he went out. This seemed to me
to point to two things as absolutely certain. Firstly, the Count’s going
out at such an hour was not premeditated. Secondly, whatever
appointment he went to keep, it was not an agreeable one to him,
and, being annoyed, he displayed his irritation in the sharp answer
he gave the concierge. These points seemed to me of great
importance, and naturally led me to an inquiry directed to finding out
if one of his servants had delivered any message to him, or
conveyed any letter during the evening.
‘The servants had been dismissed, and it was not an easy matter to
reach them all; but by persevering I succeeded in doing so, and
found at last that the Count’s body-servant, a Frenchman, named
Auguste Chauzy, had been out all the evening, after having dressed
his master, and knowing that he would not be wanted again until the
morning. He returned, however, soon after midnight, and just as he
was about to enter the house, a man stepped up to him hurriedly,
and, putting a sealed envelope into his hand, said, “Give that
immediately to your master, Count Dashkoff. Fail not to do so, as it is
a matter of life and death.”
‘When Chauzy got into the hall, he glanced at the envelope, and saw
that it simply bore the Count’s name—no address; but in the left-
hand corner was the French word Pressant (Urgent) underlined. The
valet could not get near his master for some time after this, but as
soon as an opportunity occurred to do so, he handed him the note.
The moment the Count’s eye caught the superscription, a frown
settled on his face, and, with a gesture of annoyance, he thrust the
letter unopened in his pocket. About half an hour later, however, the
valet was informed by another servant that the Count required his fur
coat and cap. They were to be placed in his dressing-room ready for
him.
‘I questioned Chauzy about the man who had handed him the letter
in the street; but the only description he could give of him was that
he seemed to be well dressed, was of medium height, and had a
dark beard and moustache.’
Having brought to light the fact about the letter, Danevitch struck a
keynote, as it were—and one which had not been touched upon by
the French police. If that letter could have been found, it might have
revealed much; but it was almost certain that if the Count did not
destroy it before leaving the house he had it in his pocket when he
went out. Danevitch’s deduction from the letter incident was this: The
Count went out owing to some communication made to him in that
letter. He did not go willingly; consequently his errand was a
disagreeable one, and could hardly have been to keep a love tryst.
Whoever the writer of the letter was, he or she must have had some
powerful hold on the Count to induce him to leave his friends and
guests, and go out at two o’clock on a bitter winter morning. This line
of reasoning was one which Danevitch could not avoid, for it was his
wont to argue his subject from a given set of premises, and a strict
regard for probabilities. He was led—and it was but natural he
should be—to the conclusion that the Count’s disappearance was
due to conduct which had brought him in contact with unscrupulous
people, into whose power he had fallen. It was clear that if he was
still living he was forcibly detained somewhere or other, and was in
such a position that he could not communicate with those who were
so anxious about him. If this was not the case, it was hard to
understand why he should have remained silent, knowing well
enough the anxiety and distress his prolonged absence would
cause. The other hypothesis was—the idea of suicide not being
entertained—that he had been murdered. If that was the case, the
motive for the murder was either revenge or robbery. It seemed
almost absurd to think of robbery, for this reason: it was hardly likely
that anyone would have chosen such an inopportune moment; for, at
two o’clock in the morning, and entertaining a house full of guests,
he would scarcely have much valuable property on his person. If he
had been murdered, the crime had been prompted by feelings of
revenge, and committed by someone who believed he had a deadly
grievance against the young man—a grievance that could only be
compensated for by the shedding of the Count’s blood.
It was impossible to ignore what, on the face of it, seemed to be a
fact—that the writer of the letter was personally acquainted with the
Count, and possessed knowledge which placed a weapon in his
hand. Of course, the Count’s friends wouldn’t listen for a moment to
any suggestion that he had been guilty of conduct unbecoming a
gentleman, and, having discovered that, Danevitch kept his views to
himself; though he closely questioned Eugène Peon, who, while
admitting that he had had numerous little adventures with the Count,
declared that these adventures were only those which a young,
handsome, and rich man would engage in, and while they might be
described as foolish and reckless, they were never of a nature to
reflect upon his honour. They were, in short, simply the follies and
venial sins of youth, such as were common, in a greater or lesser
degree, to all young men. Nothing further than this could be elicited
from Peon, who appeared to be a reserved and reticent person,
giving Danevitch the impression that he always had something in
reserve—that he had an arrière pensée, and would not tell more
than it suited him to tell. At any rate, he declined to suggest any
theory that would account for his friend’s sudden and mysterious
disappearance.
‘Do you not know if he had any serious love affair?’ asked Danevitch
with some sharpness, as he came to the conclusion that Peon was
not as candid as he ought to be.
‘I don’t,’ answered Peon emphatically.
‘But surely, intimate as you were with him, you must know something
of your friend’s little gallantries?’
‘I do not, beyond what I have told you.’
Peon gave this answer with a sharpness and decisiveness which
made it clear that he would not submit to pumping, and would not be
drawn on the subject of his friend’s amours.
During the time that Danevitch was searching for a clue—without
avail up to this stage—the Count’s friends did not remain inactive.
Necessarily, they were impatient, and grew more restless as the
weeks sped by without bringing any tidings of the missing man. The
police confessed themselves baffled, and seemed to be at a loss to
suggest a feasible theory, and they urged the friends to offer a
substantial reward for information that would lead to the discovery of
the Count if living, and a lesser reward for his body if dead. The
friends yielded, and intimated that they would pay ten thousand
francs for the Count’s recovery living, or five thousand for his body.
The police quite believed this reward would have the desired effect,
and that they would be relieved from an embarrassing situation. Of
course, the human water-rats who haunt the Seine kept a very sharp
look-out indeed, and every corpse that they dragged from the foul
and reeking waters of the sluggish river was eagerly scrutinized in
the hope that it would turn out to be the body of the missing Count.
But though it was reported several times that the dead Count had
been fished out of the river, the report, on investigation, proved to be
false. Nor did the offer of the ten thousand francs prove more potent.
Not a trace of the missing man was discovered.
This failure of the substantial reward to bring forth any tidings
confirmed Danevitch in the opinion he had formed that the Count’s
disappearance was the result of some plot, and those engaged in it
were in a position which rendered them indifferent to the reward.
This did not imply that the detective considered it a certainty that the
Count was living. On the contrary, he inclined to the belief that he
had been murdered, but, necessarily, the murderers could not
produce his body for fear of betraying themselves. In his own way,
Danevitch worked away quietly and unostentatiously. He was
perfectly convinced that the clue to the mystery would be found in
the habits of the Count, or among some of his possessions. But the
friends in Paris opposed strong objections to any exhaustive search
of his effects being made, influenced thereby, no doubt, by a fear of
anything being made public calculated to reflect on the missing
man’s honour. This supersensitiveness was annoying, and at last
Danevitch applied to the relatives in Russia, and asked them to give
a peremptory order for him to be allowed to go through the Count’s
papers. In response to this application, the Count’s father came at
once to Paris, and took possession of everything belonging to his
son, and he and Danevitch went through the papers together. There
was a mass of official correspondence and business letters, but very
few private letters, except those from his parents and his near
relatives, and love letters from a young lady residing in Russia. She
was of high family, and well known to the Count’s people, who hoped
that he would ultimately make her his wife, as in every way the
match was a desirable one. The letters evinced a very strong
attachment on the lady’s part, and were in many instances couched
in warm, even extravagant, phrases of love. But there was nothing in
them calculated to throw light on the mystery. She knew of her
lover’s disappearance, and was prostrated with grief and anxiety, so
the Count’s father asserted.
The result of the examination of the papers so far was very
disappointing, but a small diary was found in which were some rather
remarkable passages. It was not a diary of doings and events from
day to day, but seemed to be the outpourings of the writer’s feelings
and emotions, written in a fitful and irregular manner. Those which
struck Danevitch the most were as follows:

‘I often wonder whether we are really free and responsible beings;

whether the evil we do is the result of deliberate sinning, or whether
it is due to some inward promptings which we are absolutely
powerless to resist. If the latter, to what extent can we be held liable
for our sins? I am sorely troubled at times with this thought, and
yearn for someone to whom I could appeal with a hope of receiving
such an answer as would seem to me satisfactory. The teachings of
my Church do not satisfy me. The Church says that to do evil is to
incur the wrath of Heaven; but if I cannot resist doing evil, is it right
that I should be held responsible? Of course, the world would say
that this is sophistry, but when I find myself on the one hand trying
with all my might to avoid doing anything which, according to the
laws of ethics and the canons of the Church, could be construed into
wrong-doing, and, on the other, being drawn by some vaguely
defined power, which I am too weak to resist, into doing that which I
am conscious it is not right to do, I ask myself if I can really be held
responsible. It seems to me that I have two distinct characters,
clearly separated, and entirely antagonistic to each other. The one
leads me into paths that I would fain avoid; the other causes me to
weep for my frailty. I wonder if all men are constituted like this?
Perhaps they are, but are less sensitive than I am.

‘If a man entangles himself in a net, he may exhaust himself in his

struggles to get free again, and it may even be that the more he
struggles the more tightly he may enmesh himself, until he realizes
the horror that he is doomed to remain powerless until death itself
releases him. This is figurative language, but it is by such language
that we can best convey our true meaning. It is but speaking in
parables, and parables better than anything else often enable us to
understand and grasp what would otherwise be obscure. Unhappily,
I am entangled in a net, and I have struggled in vain to free myself. If
I could undo the past, I might know true happiness once more; but
that which is done is done, and though we weep tears of blood, we
can never obliterate the record which is written on the tablets of
memory. I wonder what the pure being in Russia, to whom I gave my
heart, would say if she knew how I had wronged her. Can I ever look
into her clear honest eyes again with the frank, unflinching gaze of
the happy days past and gone? I fear not. Indeed, I feel that I dare
not meet her again. I have dug a gulf between us, and that gulf can
never be bridged. But I suffer agony of mind when I think how she
will suffer when she knows my baseness, as know she must, sooner
or later. It is hard to have to live two lives, as I am doing. To my
friends I appear all they would believe me to be; but in the solitude of
my chamber my heart bleeds as I realize how false I am.

‘I have been weak, but am growing strong again. Desperation is

lending me strength, in fact; and I shall burst these accursed bonds
asunder. I have still youth and energy, and must make an effort to
climb to higher heights. I have been walking blindly hitherto, and
have missed my way, but I see it clear enough now; and a resolute
and determined man, who finds himself surrounded by obstacles,
should sweep them away. He who hesitates is lost; I have hesitated,
but will do so no longer. Great things are expected from me, and I
must not disappoint those who have placed their hopes upon me.
Marie must not be allowed to keep me bound down in the gutter. It is
not my place. I was destined to walk on higher heights; and since it
is impossible for me to raise her, she must be cut adrift. It may seem
cowardly; it may be cruel for me to do this; but it must be done, for I
cannot endure the double life any longer. Is a man to suffer all his life
for one false step? Am I justified in breaking the hearts of parents
and betrothed? No. It must not be—shall not be. In a few weeks I
shall send in my resignation, and quit Paris for ever. It will cause a
nine days’ wonder, but what of that? People will say I am a fool, but it
won’t affect me. I shall plead that I know my own affairs best, and
that circumstances of a private and pressing nature necessitate my
hasty return to Russia. This I am determined to do, cost what it may.
I have taken Eugène Peon into my confidence. He will help me, and
satisfy the curious when I am gone.’
There was a significance in the foregoing passages which was not
lost upon Danevitch. The Count gave himself away, though, of
course, he never expected that any eyes but his own would read
what he had written. It will be said, of course, that it was foolish for
him to have committed his thoughts to paper; though it must be
remembered that there are some men who seem to derive a strange
pleasure in recording their evil deeds. It is a well-known fact that
some of the greatest criminals have kept diaries, in which they have
written the most damning evidence of their guilt. The Count’s diary
proved conclusively that there were certain ugly passages in his life,
and two points were made clear—there was a woman in the case,
and Eugène Peon knew more of the Count’s affairs than he cared to
own to, and confirmed Danevitch in his belief that Peon was a crafty
man, and by no means carried his heart upon his sleeve.
As may be imagined, the Count’s father was much cut up, as he
realized that his son had been guilty of evil which was calculated to
reflect upon the honour of the family, that honour of which the old
man was so proud, and which he would gladly have died to shield.
Of course it became necessary now to find out who the ‘Marie’
referred to in the diary was; for it was obvious that she was directly
or indirectly responsible for the Count’s disappearance. No letters
could be discovered which were calculated to throw any light on the
subject, but in a small drawer of the Count’s desk there was found
the photograph of a young woman, and on the back, in a scrawling
hand, was the following:
‘For ever and ever thine.
Marie.’
The likeness was that of a singularly handsome girl of about two-
and-twenty; but the handwriting was so bad it suggested that the
writer was not educated.
Danevitch felt now that he was in possession of a clue—a vague
one, it was true, but it was possible it might lead to very important
results. Marie must be found, though he did not know at the moment
how he was going to find her. Paris was a big place; Marie was a
very common name. Danevitch, however, having once got on the
scent, was not likely to go very far astray, and he generally found
some means of bringing down his quarry at last. He was not
indifferent to the self-evident fact that in this case there were no
ordinary difficulties to contend against; this was proved by the large
reward having failed to bring forth any information. It showed that
those who were responsible for the Count’s disappearance had very
powerful motives for keeping their secret; and whether few or many
were interested in that secret, ten thousand francs was not strong
enough to tempt one of them; and it seemed as if it was not the
Count’s money that was responsible for his disappearance. He kept
a banking account in Paris, but this had not been drawn upon since
the week before he went away, when he cashed a cheque for three
thousand francs. But at this stage a curious incident was brought to
light, which put a new complexion on the matter altogether.
The incident was this: It appeared that the Count also kept a
considerable account at the Moscow branch of the Bank of Russia.
He owned a good deal of property in and about Moscow, part of it
being a flourishing flax-mill, which turned over a princely revenue.
His Moscow affairs were managed by an agent who had been
connected with the family for nearly half a century. It was his duty to
pay all money that he received into the bank without delay.
Consequently, there was generally a large balance standing to the
Count’s credit. One day a three months’ bill of exchange, purporting
to be drawn on the Count by Paul Pavlovitch and Co., flax
merchants, at Riga, for one hundred thousand francs, and accepted
by the Count and payable at the bank in Moscow, was duly
presented by an individual, who stated that he was a member of the
firm. As all seemed right, the bill was paid, and a receipt given in the
name of Peter Pavlovitch, who represented himself as the son of
Paul. A week later the cancelled bill passed into the hands of the
Count’s agent, and he at once declared it to be a forgery. Pavlovitch
and Co., of Riga, were immediately communicated with, and they
denied all knowledge of the Count, had never had any business
transactions with him, had never drawn a bill upon him, and knew
nothing of Peter Pavlovitch. This was a revelation indeed, and
pointed conclusively to a conspiracy. It seemed to Danevitch pretty
evident that the person who forged the bill knew a good deal about