A pre‐Columbian case of congenital syphilis from Anatolia (Nicaea, 13th century AD)

In this study, the skeleton of an approximately 15‐year‐old child, dating back to the Late Byzantine period (13th century AD) is examined with the aim of determining where this specimen fits in the continuing arguments on the origins of syphilis. It was unearthed during an excavation at an amphitheatre in Nicaea dating to the Roman period. The Nicaea specimen displays common symptoms found in the majority of people with congenital syphilis such as Hutchinson's incisor, mulberry molar, darkened enamel, radial scar on frontal bone, sabre tibia, syphilitic dactylitis, and gummatous and non‐gummatous osteomyelitis on almost every post‐cranial bone. Because of the sub‐periosteal new bone formation, the medullary spaces in some long bones are narrowed or completely obliterated. These lesions, which were observed via macroscopic and radiological examination, reflect the late stages of congenital syphilis. The specimen, when examined together with increasing numbers of other finds from the Old World, contributes to the argument that venereal syphilis did exist in the Old World before 1493, and brings forward the need to revise the Columbian hypothesis, which maintains that syphilis is a new disease carried to the Old World from the New World by Columbus' crew. Copyright © 2005 John Wiley & Sons, Ltd.     

The population of the Amazon basin in 1492: a view from the Ecuadorian headwaters

"Recent archaeological, ethnohistorical and ecological evidence has begun to challenge the view that 'civilizations' failed to develop in the Amazon basin due to limitations of the tropical forest environment. As a result, estimates of the native population in 1492 have become an issue of debate. These estimates are evaluated in the light of the ethnohistorical research on the Ecuadorian headwaters. Estimates are considered by examining estimated habitat densities, the impact of Old World diseases and contemporary evidence for native cultures. The study is based on documents found in archives in Quito, Seville, Madrid and Rome. It is suggested that the population of the Amazon basin in 1492 probably exceeded 5 million but that expectations of substantially higher populations appear unfounded."     

Pre-Columbian congenital syphilis from the late antiquity in France

Today, exactly 500 years after the discovery of America, there is still a lot of controversy about the history of syphilis in Europe, especially about the Columbian and pre-Columbian hypotheses. This paper presents evidence for the presence of venereal treponematosis in the late Antiquity in France. The case that we examined comes from the necropolis of Costebelle (3rd-5th centuries AD; Hyères, Var, France). Grave no. 1 contained the well-preserved skeleton of a relatively old woman with the skeletal remains of an approximately 7-month-old fetus in her pelvic cavity. The osseous lesions of the fetal remains can be described in four groups: periosteal appositions on the skull vault (frontal and parietal); signs of periostitis on the long bones (bilateral cortical irregularities, predominantly on the left side, which affect first of all tibiae, femora, fibulae, radii and humeri, particularly in the metaphyseal region); some infraperiosteal detachment reminiscent of an infraperiosteal haematoma surrounding the distal extremity of the left forearm and the left hand; and finally, the irregular lesions of the humeral distal and proximal tibial metaphyses reminded us radiologically of Wimberger's signs. The most probable diagnosis of all the lesions mentioned above is that of a precocious congenital syphilis. This case consists of an argument against the epidemiological theories about the migration of Treponema pallidum from the New World back to the Old World starting at the end of the 15th century.     

A case of treponematosis from pre‐Columbian Chaco Canyon,New Mexico

Although numerous cases of treponemal infection have been identified in prehispanic New World skeletal remains, none has been reported from Chaco Canyon, New Mexico. Chaco Canyon was the epicentre of a broad culture system that spanned the Four Corners region of the pre‐Columbian Southwestern United States. A burial recovered from the central Great House of Chaco Canyon, Pueblo Bonito, exhibits lesions indicative of treponematosis. However, the pathological condition of this individual has heretofore been only tentatively diagnosed because the skeleton was collected from a commingled context and distributed across four separate catalogue numbers. Now reassociated, these remains exhibit a pattern of pathological changes strongly indicative of treponemal disease. This case not only adds to the growing body of literature on the clinical expression and geographic distribution of pre‐Columbian treponematosis, but also demonstrates the utility of painstaking reassociation of commingled human remains. Copyright © 2009 John Wiley & Sons, Ltd.     

The distribution of skeletal lesions in treponemal disease: is the lymphatic system responsible?

The differential diagnosis of bone lesions in treponemal disease is well established in palaeopathology. However, the actual mechanism responsible for the characteristic distribution of bone involvement is not as clear. Two mechanisms are proposed in the literature. Firstly, that bone lesions are the result of direct extension from the skin rash of the secondary stage of disease. Secondly, that bones situated closer to the skin are more vulnerable to local trauma and therefore more likely to elicit a subperiosteal bone response. We propose an alternative explanation for the characteristic distribution of bone lesions in treponemal disease. This explanation is based on the close association between the lymphatic and skeletal systems and the pathogenesis of treponemal disease. This paper argues that the position of the lymphatic nodes and vessels, with little soft tissue intervention between bone tissue, mirrors the characteristic pattern of skeletal involvement in treponemal disease. Copyright © 2002 John Wiley & Sons, Ltd.     

Digging deeper into the limits of ancient DNA research on syphilis

The search for the origins of syphilis has a long history in the medical and anthropological literatures. If we know more about the emergence of the pathogen that causes the disease in humans we will understand its evolution through time and space as well as shed light on its current state in living populations. Ancient DNA techniques used to isolate Treponema pallidum subsp. pallidum DNA from archaeological human specimens provide direct evidence of its existence in the past. However to date, only Kolman et al. (1999) have been successful in this endeavour, while other attempts have failed (e.g., Barnes and Thomas, 2006; Bouwman and Brown, 2005). Why has there been little success? This paper serves to compliment and add relevant information to Bouwman and Brown's and Barnes and Thomas' discussion concerning our inability to apply ancient DNA techniques to study venereal syphilis in past human populations.Our approach utilized 15 different human specimens from different geographies and different temporal periods: eight samples come from medically diagnosed individuals archived during the American Civil War period; six originate from the United Kingdom and predate 1492 with four of these samples having been previously analyzed by Bouwman and Brown and one sample comes from historic Canada. Human mitochondrial and amelogenin DNA, as well as several genes from the Treponema organism were analyzed revealing the relatively good preservation of human multi-copy and single copy DNA but not treponemal DNA. This study also incorporates a unique molecular experiment using rabbits infected with venereal syphilis to help illustrate that treponemal DNA disseminates to bone early during the first stages of infection but is not present in later stages of the disease using the techniques presented in this study.     

Subsistence and Settlement Correlates of Treponemal Disease: Temporal Patterns in Pre‐Columbian East Tennessee

After ca 1000 BC , coinciding with the transition to sedentism, tertiary stage treponemal disease apparently becomes osteologically pervasive in pre‐Columbian North America. However, varying interobserver treponemal disease diagnostic thresholds, sampling error and the possibly ecosensitive nature of the pre‐Columbian nonvenereal treponemal disease variants (i.e. yaws and treponarid) prevents subsistence‐settlement pattern from becoming a reliable predictor of treponemal disease prevalence. This is particularly true of later prehistory with the transition from horticulture to intensive, maize‐based agriculture. To address whether treponemal disease visibility does vary across this specific subsistence‐settlement threshold, subadults (4+ years of age) and adults from 11 late prehistoric sites (N = 997) from the same geographic area of East Tennessee were sampled for the presence of treponemal disease. Six sites (N = 279) primarily date to the Late Woodland period (AD 700–900) and culturally belong to what is referred to as the Hamilton mortuary complex. The sample is archaeologically characterised as horticulturalist with presumably a dispersed farmstead or hamlet settlement pattern. Six sites (N = 718) date to the Late Mississippian (AD 1300–1550, Dallas phase) and are maize‐intensive agriculturalists with a large, aggregate village settlement pattern. The sites were examined using three different levels of treponemal disease diagnostic confidence. Treponemal disease raw frequency does indeed differ across the levels of diagnostic confidence between the total Late Woodland horticulturalist sample (4.3–5.5%) and total Late Mississippian maize agriculturalist sample (5.4–6.5%). The meaning is complex as the Dallas phase sample may have a socially segregated elite; the mound‐interred (1.8%) relative to the village‐interred (6.1–7.4%) exhibited significantly fewer cases of treponemal disease. Tentatively, treponemal disease visibility does appear to co‐associate with sedentism and perhaps (if the mound‐interred Dallas individuals are elites) also aggregated settlement. Copyright © 2013 John Wiley & Sons, Ltd.     

A possible case of treponemal disease from England dating to the 11th–12th century AD

This short report describes a human skeleton from an archaeological site in England showing signs of treponemal disease. A radiocarbon determination indicates that it is firmly pre‐Columbian in date. The implications for recent debates concerning the origin of treponemal disease in Europe are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Environmental change,agricultural innovation,and the spread of cotton agriculture in the Old World

Recent excavations at the site of Kara-tepe in northwestern Uzbekistan revealed evidence for the production of cotton (Gossypium sp.) in domestic contexts dated to ca. 300–500 AD. These archaeobotanical remains help to document the spread of Old World cotton production, and predate the existing evidence for its cultivation in Central Asia. The context in which these remains were found—in temperate Eurasia at a time of intense environmental and social change—suggests that the spread of cotton agriculture to this region occurred when new plant varieties were incorporated into domestic production regimes as part of local adaptive strategies. The development and transmission of cotton as a global cultigen was initiated by these small-scale innovations aimed at the expansion of economically and environmentally sustainable subsistence practices in Central Asia. Subsequent worldwide transmission occurred when emerging empires helped to spread cotton agriculture more widely across the Old World.     

Treponematosis in Pre-Spanish Western Micronesia

There is no longer any doubt that treponemal infections existed in the pre-Columbian New World. In Europe, a few reported pre-Columbian cases seem to be rather firm both in diagnosis and dating. The possibility of treponema having been brought from the New World by Norsemen has been suggested. A New World origin hypothesis ignores the extremely high prevalence of yaws in pre-Spanish western Micronesia. On a sample of 486 individuals, we found 17–27 per cent of adults and 10 per cent of children to have skeletal yaws. It was present at least as early as the ninth centuryAD . Speculation on the origin of treponema must be global in scope, not just Euro-American.     

Reviews/comptes Rendus

Book reviewed in this article:
Disease and Empire/Maladie et Empires
The Resettlement of British Columbia: Essays on Colonialism and Geographical Change by Cole Harris
Disease and Demography in the Americas edited by John W. Verano and Douglas H. Ubelaker
Born to Die: Disease and New World Conquest, 1492–1650 by Noble David Cook
Coastal Dynamics and Landforms by A.S. Trenhaile
Liberation Ecologies: Environment, Development, Social Movements edited by RICHARD PEET and MICHAEL WATTS
Looking for Old Ontario: Two Centuries of Landscape Change by THOMAS F. MCILWRAITH
Des Romans-Géographes: Essai by Marc Brosseau, Paris, L'Harmattau     

Two cases of facial involvement in probable treponemal infection from late prehistoric coastal North Carolina

This paper describes two late prehistoric burials from coastal North Carolina with cranial and postcranial lesions characteristic of treponemal infection. Each case exhibits facial lesions consistent with clinical reports of treponemal infection, but which have not previously been documented in these populations. The suite of facial lesions in one case and a mandibular lesion in the other serve to illustrate the variability inherent in treponemal infections. © 1998 John Wiley & Sons, Ltd.     

Paget's disease in pre‐contact Florida? Revisiting the Briarwoods site in Gulf coast Florida

This report presents results of a reanalysis addressing the presence of Paget's disease (Osteitis deformans) in the pre‐contact Safety Harbour Briarwoods site (8PA66), a burial mound in Pasco County along Gulf coast Florida, dating around 1000–1500 AD. Due to the paucity of published histological and radiological analyses as well as the suspect nature of this Paget's disease report, a new study was conducted. The diagnosis was suspect for three reasons. First, the original diagnosis was based on five skeletal fragments from five different burials making the results questionable. Secondly, Paget's disease is very similar to treponemal disease and can possibly be misdiagnosed. The characteristic histological mosaic pattern found in Paget's disease provides the most definitive differential diagnosis. Thirdly, Paget's disease is found primarily in European populations and this is a pre‐contact site. Histological sections from the suspected Pagetic bones were analysed for the presence of the mosaic pattern. Macroscopic and microscopic analyses were unable to support or deny the presence of Paget's disease due to the fragmentary nature of the skeletal elements as well as extensive diagenesis resulting from exposure to the environment. The presence of Paget's disease could not be confirmed or refuted at Briarwoods due to extensive taphonomic damage. However, it is suggested that the presence of treponemal disease should be investigated because although not originally reported, the presence of saber‐shin tibiae consistent with this disease are present at this site. Copyright © 2009 John Wiley & Sons, Ltd.     

A case of healing spinal infection from classical Rome

This paper describes a spinal infection in an adult male skeleton from Ist century AD necropolis in Rome. Pathological alterations of the lower thoracic vertebrae, including bone destruction and fusion, suggest tuberculous spondylitis as the most probable diagnosis. The rarity of healing infections, as well as the non‐diagnostic appearance of the lesions, have prompted this note. Copyright © 2005 John Wiley & Sons, Ltd.     

Congenital Syphilis in the Archaeological Record: Diagnostic Insensitivity of Osseous Lesions

The paucity of convincing evidence for congenital bone lesions of syphilis in the archaeological record led to study of the human remains from the Buffalo site in West Virginia, dated at 550—650 years BP. The diagnosis of syphilis (venereal) in adults was based on previously validated population criteria for the recognition of syphilis and its distinction from among the other treponemal diseases. Among the 151 juveniles (23.3 per cent of the total series), only one had macroscopic evidence of periosteal disease. The low frequency of recognizable osseous stigmata characteristic of congenital syphilis, combined with the conspicuous absence of pathognomonic dental lesions, make such periosteal lesions insufficiently sensitive criteria for the identification of syphilis in the archaeological record. © 1997 by John Wiley & Sons, Ltd.     

Treponemal Disease,Tuberculosis and Subsistence‐settlement Pattern in the Late Woodland Period West‐central Illinois

In later pre‐Columbian prehistory (post AD 1000), the adaptation and intensification of maize agriculture and its correlate of aggregate village settlement (i.e. Mississippianization) is temporally and geographically variable. In the Midwest, consequential to the florescence of the major ceremonial centre of Cahokia (AD 1050–1300), the Mississippi River Valley alluvial plain in Illinois, known as the American Bottom, became a core area of this subsistence‐settlement change. Much archaeological research has traced aspects of this transition in the Lower and Middle Illinois River Valley, but little is known outside of these areas. A skeletal sample from the remote hinterland area of the Upper Mississippi River in west‐central Illinois was examined for arguable paleopathological correlates of sedentism (treponemal disease) and Mississippianization (tuberculosis). The Schroeder Mounds (AD 900–1100) adult skeletal sample (N = 53) exhibited a high frequency of treponemal disease (13.2–15.1%). This result is consistent with paleopathological literature linking a 9+ % pre‐Columbian North American prevalence with sedentism, challenging archaeologically based inferences that the hinterland was occupied by mobile forager‐horticulturalists. A hallmark of Mississippianization is the presence of diagnostic cases of tuberculosis. No cases were observed in the Schroeder sample, suggesting a pre‐Mississippian subsistence‐settlement pattern. Copyright © 2013 John Wiley & Sons, Ltd.     

Adapt or Die: Three Case Studies in Which the Failure to Adopt Advances from Other Fields has Compromised Paleopathology

Over the past several decades, the field of paleopathology has rapidly advanced, but a continuing delay in incorporating scientific advances and a lack of methodological rigor hinder its progress. Inconsistencies in the presentation of data, the persistent use of non‐standardized criteria and non‐specific skeletal lesions to diagnose diseases, and the misuse of or delay in adopting critical, relevant concepts and methods from other disciplines obfuscate the current state of evidence and unnecessarily prolong debates. Here, we present three major research questions that have been affected by these issues: the origin and antiquity of syphilis in the Old World; the pathogen responsible for the Black Death; and whether the incidence of cancer has risen in recent human history. Drawing on these examples, we conclude with recommendations that could facilitate a more rigorous, scientific approach to important questions in paleopathology. Copyright © 2015 John Wiley & Sons, Ltd.     

A possible case of coccidioidomycosis from the Los Muertos site,Tempe, Arizona

Coccidioidomycosis is a fungal disease endemic to southwestern North America and parts of Central and South America. Coccidioidomycosis frequently disseminates to the human skeleton and produces mostly lytic skeletal lesions. However, this disease is infrequently described within archaeological populations. As a result, it is important to report potential cases in order to improve current understanding of the appearance and distribution of lesions resulting from coccidioidomycosis in archaeological specimens. This study describes skeletal lesions in an adult male recovered from the Los Muertos site, Tempe, Arizona (AD 500–1450). These lesions are present on the inferior border of the left scapular spine, the medial portion of the left first metacarpal head, and the medial portion of the right first metatarsal. The lesions are predominantly lytic with sclerotic and, in some cases, healed cortical bone distributed around their margins. Evidence of skeletal healing is recorded within the destructive focus of one lesion. Geographical information on pathogen endemism, overall lesion distribution, and agricultural‐era Hohokom behaviour suggest that coccidioidomycosis is the most likely diagnostic option for these lesions. Mounting evidence for possible infections in the palaeopathological literature, combined with high frequencies of nutritional stress levels in endemic regions, suggests that coccidioidomycosis contributed at least moderately to morbidity in the American Southwest. Copyright © 2006 John Wiley & Sons, Ltd.     

Sclerosing Bone Dysplasia from 16th Century Sardinia (Italy): A Possible Case of Camurati–Engelmann Disease

The skeletal remains of a male aged 45–55 years displaying several bone anomalies were unearthed from the Alghero (Sardinia) plague cemetery ‘lo Quarter’, a burial site dating back to the 1582–1583 AD outbreak. The skeleton, whose stature is about 165 cm, presents a bilateral hyperostosis with increased diameter of the diaphyses of all the long bones of the upper and lower limbs; the metaphyses appear to be involved, while the epiphyses are spared. Marked thickening of the cranial vault is also evident. Radiological study showed irregular cortical thickening and massive endoperiosteal bone apposition; sclerotic changes are observed in the diaphysis of some metacarpals. Computed tomography (CT) cross sections of the long bones displayed a thickening of the cortical portion and endoperiosteal bone apposition. The individual was affected by a sclerosing bone dysplasia, a genetic disease characterized by increased bone density. In differential diagnosis, several sclerosing bone dysplasia, such as hyperostosis corticalis generalisata, craniodiaphyseal dysplasia, craniometadiaphyseal dysplasia, pachydermoperiostosis and Camurati–Engelmann disease, as well as other disorders characterized by sclerosing manifestations, such as Erdheim–Chester disease, mehloreostosis and skeletal fluorosis, need to be considered. The anomalies observed in skeleton 2179 fit with the features of Camurati–Engelmann disease, which is the most likely candidate for final diagnosis. It is highly challenging to evaluate how such a condition may have influenced the individual's lifestyle in terms of development, mobility and quality of life. This individual was probably symptomatic and must have experienced common clinical symptoms, such as pain in the limbs and fatigability. However, the strong development of the muscular insertions and the degenerative changes in the upper limbs suggest that the mobility problems should not have prevented him from reaching a mature age and from performing essential daily activities. The presented case is the unique paleopathological evidence of Camurati–Engelmann disease so far diagnosed. Copyright © 2015 John Wiley & Sons, Ltd.