Multiple Cases with Probable Treponemal Infection from 16th to 19th Centuries Romania

In this paper, we describe pathological lesions identified in seven skeletons discovered in the Saint Sava necropolis in Bucharest, Romania, dating to the Late Medieval/Early Modern period. The pathological changes observed in the skeletons were analysed using macroscopic examination. Additionally, computed tomography scanning was performed on two individuals displaying advanced lesions on the cranial surface. For the differential diagnosis, we took into consideration treponemal infection, tuberculosis, osteomyelitis, leprosy, fluorosis, melorheostosis, hypertrophic pulmonary osteoarthropathy, Paget's disease and mycotic infection, along with the possibility of multiple afflictions occurring simultaneously. The morphology and distribution of the lesions are suggestive of treponematosis, which, to our knowledge, makes this the first case of this disease on the Romanian territory in archaeological populations. Copyright © 2015 John Wiley & Sons, Ltd.     

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.     

Pre-Columbian treponematosis in medieval Britain

There has been much debate regarding the origins of treponemal disease and, in particular, acquired syphilis. Greater numbers of skeletons with apparently diagnostic bone lesions in the New World than in the Old have given rise to the postulate, particularly advanced by American workers, that the disease originated there prior to AD 1492 and was carried back to the Old World by Columbus's sailors. This paper presents evidence for the presence of treponemal disease in medieval Norwich prior to AD 1492, however. The dating of the site is good and the skeleton concerned comes from a well-sealed context. Others in the group have similar lesions and there are four individuals with evidence of leprosy. All were buried in a communal cemetery. The individual has widespread, bilateral, florid periostitis, especially of the tibiae and fibulae, and the radiographic changes support the diagnosis of treponemal disease. Differential diagnosis and geographical situation suggest that this skeleton displays evidence of syphillis.     

The limits of biomolecular palaeopathology: ancient DNA cannot be used to study venereal syphilis

To determine whether ancient DNA (aDNA) can be used to study the palaeopathology of venereal syphilis, we carried out a comprehensive analysis of the preservation of human and pathogen DNA in a set of 46 bones of various ages, most of which displayed osteological indications of the disease. Bones came from seven English cemetery sites that were in use during the 9th–19th centuries. Twelve of the 46 bones consistently yielded mitochondrial DNA (mtDNA) sequences after replicate polymerase chain reactions (PCRs), and a further 13 bones yielded mtDNA sequences with less reproducibility. The sequence data enabled tentative mitochondrial haplogroups to be assigned to nine of the bones, and the identities and frequencies of these haplogroups were compatible with the geographical origins of the bones. Twenty-one bones consistently gave negative results with all mtDNA PCRs, indicating that at least these bones were not contaminated with modern human DNA, and those bones that gave positive results only yielded one sequence each, again suggesting that widespread modern contamination had not occurred. Mycobacterium tuberculosis sequences were obtained from seven bones, including three of five bones with tuberculous lesions. The cloned and direct sequences obtained from both the mtDNA and M. tuberculosis PCR products showed features typical of degraded aDNA. All of these results suggest that at least some of the 46 bones that we studied were suitable for aDNA analysis. All 46 bones were tested with nine different treponemal PCRs, each optimised to give a detection limit of ≤5 genomes. Although various bones gave PCR products of the expected size with one or more of these PCRs, sequencing showed that none of these products were authentic treponemal amplicons. Our failure to detect treponemal DNA in bones that were suitable for aDNA analysis, using highly sensitive PCRs, suggests that treponemal DNA is not preserved in human bone and that it is therefore not possible to use aDNA analysis to study venereal syphilis. Any past or future paper claiming detection of treponemal aDNA should therefore be accompanied by a detailed justification of the results.     

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.     

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.     

Adding insult to injury: opportunistic treponemal disease in a scalping survivor

Although the taking of scalps is arguably a perimortem trophy‐taking behaviour, cases of scalping survival are occasionally reported in the historical documents of the American Colonial Period and the 19^th century westward expansion. Survival cases are also detected in pre‐Columbian bioarchaeological contexts. Although scalp avulsion injuries can heal without complication, often the process is compromised by secondary osteomyelitis, usually attributable to environmentally ever‐present Staphylococcal or Streptococcal bacteria. A scalping survivor case from the late prehistoric (AD 1200–1600) Hampton site (40RH41) of East Tennessee unusually displays infectious sequelae in the area denuded by scalp avulsion which are pathognomonic for treponemal disease (caries sicca, stellate scarring). This infection is probably a reflection of the easy opportunity afforded by the large size of the wound bed, poor post‐trauma hygiene, and direct inoculation of the diploë by a ubiquitous Treponema. Copyright © 2008 John Wiley & Sons, Ltd.     

Temporal and Spatial Distribution of Treponemal Infection in South Florida: An Epidemiological Approach

Bioarchaeological analysis of the MDM site (8DA11) in Miami, Florida (ad 400–1200) has identified human skeletal remains with lesions suggestive of and consistent with treponematosis. A population and epidemiological approach was utilised to compare the MDM site to geographically neighbouring skeletal samples from the Highland Beach mound (8PB11) (ad 600–1200) and Fort Center (8GL12) (ad 1–500/1000). These samples were then integrated with data from previous research on proliferative skeletal lesion prevalence on the Gulf Coast of Florida. Population comparisons suggest a higher prevalence of proliferative skeletal lesions in Atlantic coastal populations as opposed to the nearest sampled site from the interior (p < 0.00001), a trend seemingly different from Gulf Coast populations. This investigation details the presence of treponemal disease in the Everglades archaeological region likely as early as ad 400, and the southern terminus in the contiguous United States that treponematosis has been reported. Copyright © 2013 John Wiley & Sons, Ltd.     

Osteological and Biomolecular Study of Two Possible Cases of Hypertrophic Osteoarthropathy from Mediaeval England

Two skeletons from Mediaeval Wharram Percy, England, show osteological lesions consistent with hypertrophic osteoarthropathy. The primary cause of hypertrophic osteoarthropathy is generally chronic pulmonary disease, usually either cancer or infection; in the pre-antibiotic era it was predominantly the latter. Biomolecular analyses indicate the presence of Mycobacterium tuberculosis DNA in one of the specimens, strongly indicating that pulmonary tuberculosis was the eliciting factor in this case. This is the first time that a primary cause for hypertrophic osteoarthropathy has been firmly identified in an ancient skeleton and illustrates the potential of a dual approach using both osteological and biomolecular techniques for enhancing our understanding of early disease. The other specimen proved negative for M. tuberculosis complex DNA, however the presence of infectious rib lesions allowed us to suggest that some non-tuberculous pulmonary infection was likely the primary cause of hypertrophic osteoarthropathy in this case.     

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.     

A possible case of ‘poll‐evil’ in an early Scythian horse skull from Arzhan 1, Tuva Republic,Central Asia

Occipital bone lesions on an Iron Age horse cranium from the burial mound of Arzhan 1, Tuva, Central Asia, are described and interpreted. Cavitations around the nuchal ligament attachment site on the skull are interpreted as foci of inflammation and necrosis following local infection. It is suggested that the pathology represents a case of ‘poll‐evil’, most likely due to a bacterial infection. The significance of such an interpretation is discussed, including its implications for disease ecology and the possible infection risks to contiguous animal and human communities of the first millennium BC in Central Asia. Copyright © 2009 John Wiley & Sons, Ltd.     

Leprosy in a skeleton from the 7th century necropolis of Vicenne‐Campochiaro (Molise,Italy)

Analysis of the skeleton from tomb 144 of the early medieval necropolis of Vicenne‐Campochiaro in Central Italy revealed several features indicative of leprosy. The skeleton belongs to a male estimated to be between 20 and 25 years of age at death. The distal halves of the 1st and 2nd left metatarsals present acro‐osteolysis and both legs show severe subperiosteal bone reaction. The facial skeleton shows changes compatible with a chronic inflammatory process, possibly due to an infectious disease. The anatomical distribution of the lesions and their association with other skeletal lesions seems to be compatible with a near‐lepromatous form of leprosy. A differential diagnosis is made, and the skeletal traits pathognomonic of leprosy are discussed. Copyright © 2005 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.     

Craniofacial trauma in the Prehispanic Canary Islands

The current project is a study of craniofacial trauma in a large sample (n = 896) of Prehispanic Canary Islanders (PCIs). The possible causes and social implications of the trauma found are considered, with reference to archaeological and historical data. Variables include the island, period and ecology, the sex and age of the individuals, the distribution of lesions across the skull (by side and by individual bone) and ante‐mortem tooth loss. The results show a fairly high trauma rate (16%), a low prevalence of peri‐mortem trauma (3.8% of all lesions), higher prevalence of trauma in males than in females (25% vs. 13% of all individuals), more cranial than facial lesions (8.9% vs. 3.5% of all elements) and more lesions on the left side of the skull (6.7% vs. 4.5% of all elements) which suggests that the lesions were sustained through intentional rather than accidental agency. There was no correspondence between trauma prevalence and ecology. The archaeological and historical data support the assertion that the lesions may be the result of skirmishing between groups, using weapons such as slingshots, stones and staves. The presence of edged‐weapon lesions on some individuals suggests that these may have been the victims of contact‐period European groups. Copyright © 2007 John Wiley & Sons, Ltd.     

Neurocranial Trauma in the Late Archaic Human Remains from Xujiayao,Northern China

The early Late Pleistocene late archaic human remains from Xujiayao, northern China, reveal several abnormalities of the neurocranial vault. The Xujiayao site is located on the northwestern boundary of the Nihewan Basin, and on the basis of various indicators, it dates to the early Late Pleistocene. Among the 15 human neurocranial elements found at Xujiayao in the 1970s, three elements show minor traumatic lesions of the external table: the largely complete Xujiayao 5a immature parietal bone, the Xujiayao 8 small piece of anterior right parietal bone and the Xujiayao 12 partial occipital bone. The lesions are all superior to the temporal or nuchal lines and hence were subcutaneous, covered only by the pericranium, the galea aponeurotica and the overlying skin. The external tables are variably concave with irregular bone within the bony depressions, and the diploë show varying degrees of involvement. The Xujiayao abnormalities join a series of minor neurocranial healed lesions among Pleistocene humans, as well as more pronounced healed neurocranial and facial trauma. Copyright © 2012 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.     

Periapical lesions and dental wear in the early Maori

Dental wear and intrabony lesions were evaluated in a sample of 225 skulls (136 male) of pre‐contact New Zealand Maoris. The degree and direction of surface wear was scored according to the method of Molnar ( Molnar 1971 . Human tooth wear, tooth function and cultural variability. American Journal of Physical Anthropology34: 175–190) and revealed severe surface loss in both males and females with horizontal wear being the dominant pattern (62.4% male, 57.5% female). The width of coronal tissue above the pulp chamber, as well as the maximum depth and width of periapical lesions, was measured from both standard radiographs and digital images. The high prevalence of periapical pathology in the Maori underlined the extreme nature of dental wear in these people. It is postulated that this degree of tooth loss may be attributable to a change in diet from large birds to marine‐dependence, the introduction of the kumara to New Zealand, dental erosion and finally, to the excessive masticatory forces exerted by a robust facial complex on normally sized teeth. Fenestrated lesions were highly prevalent (83% of skulls) and were centered mostly on the maxilla, with an even distribution among tooth classes. The finding of periapical lesions in teeth with minimal observable wear was attributed to traumatic occlusion. Copyright © 2001 John Wiley & Sons, Ltd.