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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Securitizing infectious disease

Over the past decade there has been an increased awareness in the field of international relations of the potential impact of an infectious disease epidemic on national security. While states’ attempts to combat infectious disease have a long history, what is new in this area is the adoption at the international level of securitized responses regarding the containment of infectious disease. This article argues that the securitization of infectious disease by states and the World Health Organization (WHO) has led to two key developments. First, the WHO has had to assert itself as the primary actor that all states, particularly western states, can rely upon to contain the threat of infectious diseases. The WHO's apparent success in this is evidenced by the development of the Global Outbreak Alert Response Network (GOARN), which has led to arguments that the WHO has emerged as the key authority in global health governance. The second outcome that this article seeks to explore is the development of the WHO's authority in the area of infectious disease surveillance. In particular, is GOARN a representation of the WHO's consummate authority in the area of coordinating infectious disease response or is GOARN the product of the WHO's capitulation to western states’ concerns with preventing infectious disease outbreaks from reaching their borders and as a result, are arguments expressing the authority of the WHO in infectious disease response premature?     

Civilizing the “Uncivilized”: The Fight against Tuberculosis in Northern Norway at the Beginning of the Twentieth Century

Abstract

The anti-tuberculosis campaign conducted in Finnmark, north Norway, between 1914 and the Second World War was informed by shifting scientific, social and ethnic notions pertaining to the disease itself, the region of Finnmark, and its population. This article focuses on how the Sámi were represented by the medical establishment, how that image of the Sámi influenced the form and the content of the fight against the disease, and how the anti-tuberculosis campaign was connected to the state minority policy of the period. The understanding of tuberculosis and the ways of combating it underwent several changes during the period, particularly during the economic crisis of the 1920s and 1930s. The initial emphasis on the role of culture, more specifically ethnicity and language, was gradually replaced by a more medicalized focus in the fight against the disease. As the notion of tuberculosis as a disease of civilization was replaced by an understanding of the disease as an infectious one, on a par with other infectious diseases, the earlier strategy of civilizing the “uncivilized” Sámi in order to protect them from tuberculosis was replaced by a more epidemiological approach in tuberculosis prevention.     

Human biology in the Classic Maya collapse: Evidence from paleopathology and paleodiet

We review evidence from human biology—paleopathological and isotopic paleodietary studies on ancient Maya skeletons—to assess the validity of ecological models of the Classic Maya collapse, in which elevated disease and deteriorating diet are commonly assumed. To be upheld, the health arguments of ecological models require that the Maya disease burden (1) was greater than that for many other societies and (2) increased over the span of occupation. The dietary argument requires (1) consistent change in diet from Preclassic and Early Classic Periods to the Terminal Classic and (2) increasing social divergence in diet. A correlation between diet and disease is necessary to link these arguments. Neither pathology nor isotopic data consistently support these criteria. Instead, it appears that local environmental and political factors created diversity in both disease burden and diet. In view of the human biological data, we are skeptical of ecological models as generalized explanations for the abandonment of Classic Maya sites in the southern lowlands.     

Changes in the distribution of osteoarthritis over historical time

A total of 2635 skeletons recovered from different sites in England was examined for the presence of osteoarthritis (OA); 206 were from pre-medieval sites, 1453 from medieval sites and 976 from post-medieval sites. Where OA was considered to be present in a joint, the site was noted and for each time period the total number of anatomical sites with the condition was determined and the number of major sites with OA (10 in number) was expressed as a proportion of this total. There were no differences in the distribution of osteoarthritis between the pre-medieval and medieval periods but there were between the medieval and post-medieval periods. In the post-medieval period the proportion of osteoarthritis of the knee increased whereas that of the hip decreased; the proportion of osteoarthritis of the hands also increased whereas that of the wrist decreased. Other data presented indicate that patellofemoral disease is about twice as common as tibio-femoral disease in both medieval and post-medieval periods and that lateral compartment disease is almost as common as medial compartment disease.