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Group Title: Florida anthropologist
Title: The Florida anthropologist
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Title: The Florida anthropologist
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Physical Description: v. : ill. ; 24 cm.
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Table of Contents
    Copyright
        Copyright
    Front Cover
        Front Cover
    Table of Contents
        Table of Contents
    Paleoepidemiology and distribution of prehistoric treponemiasis (syphilis) in Florida - Adelaide K. Bullen
        Page 133
        Page 134
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    Treponematosis - Lyman O. Warren
        Page 175
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FLORIDA
ANTHROPOLOGIST






iiNov 19i







PUBLISHED BY THE
FLORIDA ANTHROPOLOGICAL SOCIETY, INC.


VOLUME 25 DECEMBER 1972 NUMBER 4



















THE FLORIDA ANTHROPOLOGIST

: Vo, 'tm: .- XXV, V. N o. 4 December 197 2



CONTENTS


-L .:spi:;.emhiology and distribution of prehistoric treponemiasis
(.i.: :,:-i:,: ...syphilii) in Florida by Adelaide K. Bullen . . 133

.:':'Trenpone.ma.tosis by Lyman O. Warren . ... . 175




OFFICERS OF THE SOCIETY

President George Magruder
.lay alilms" Apts. No. 235B
". iaf.la bour Beach. FL. 32937 Executive Committeemen

i;' Vice Peident John W. Griffin Three years: Yulee Lazarus..
s^':t. Gorg St., St. Augustine, FL. 32084 Ft. Walton Beach, Florid.
Vi.': ci President Adelaide K. Bullen Two years: Wilra B. Williai.
fl."tid*State Museum, University of Florida Hollywood, Florida
-Gaine;svile, Florida 32601
One year: Thomas Gouchnour
Secretary Cliff E. Mattox Jacksonville, Florida
P0iPix 521, .eCooa Beach, FL. 32931 .. :
..;: .:.. .'" At large, for one year;: !:
*;-Treasiurer Leon Reyniers, P.O. Box 8451
,Ft.. :Lauderdale, Florida 33310 Charles A. Hoffmann, Jr.,.
Gainesville, Florida
7 Xitol.Rkesident Agent Ripley P. Bullen
j:ilbrida State. Mseum, University of Florida Benjamin I. Waller,
-":;i.:'Gi ville, Florida 32601 Ocala, Florida
;:::: :,:, :; ,:.; !o, ;: : : : .. ,
,"": "~ .... A::,i .":.iL';









PALEOEPIDEMIOLOGY AND DISTRIBUTION OF PREHISTORIC
TREPONEMIASIS (SYPHILIS) IN FLORIDA*


Adelaide K. Bullen


One early researcher of prehistoric disease in Florida (Ales Hrdlicka,
M.D., physical anthropologist of the Smithsonian Institution, 1922:87-88)
wrote, "Next to massiveness the Florida bones from some localities impress
one with the commonness of disease. This consists essentially of inflamma-
tory processes, periostitis and osteoperiostitis, particularly on the tibia and
other long bones. These lesions suggest strongly a syphilitic origin and it would
seem that here if anywhere the problem of pre-Columbian syphilis in America
could be settled. "

We are tempted to inquire whether at the present time we can produce
some data--old or new--which will elucidate Hrdlickas early impressions and
provide some of the answers which he felt should be forthcoming. He was sur-
prised that there was no mention of venereal disease in early accounts of Flor-
ida. However, Le Moyne's comment with his illustration of "How They Treat
Their Sick" ends with the statement: "Venereal disease is common among
them, and they have several natural remedies for it" (Lorant 1946:75).

Syphilis is a timely topic today. However, we must look to earlier med-
ical researchers --before penicillin--for copious clinical data on late-stage
syphilis. Bone syphilis is usually a tertiary manifestation. In tracing the dis-
ease from prehistoric times to the present, can we recognize a late-stage case
with osseous involvement whenever and wherever it may occur? There has been
great debate on this subject. Treponemal "drift" and developed resistance to the
disease--as well as possible variations in virulence and in other factors--may
well effect some aspects of its symptomatology over time and space.

What we are now looking for in the archaeological record is incontestable
evidence of the presence of syphilis in Florida in pre-Columbian times. As
Aiden Cockburn, M.D. (1967:51) explains in Infectious Diseases--Their Evo-
lution and Eradication: "Of supreme importance are the evidences of infections
that are so clearcut that specific diagnoses can be made, especially so when the
circumstances are so favorable that precise estimates can be made of the times
and places where they occurred. Such evidences form the foundations on which
theories can be erected. The more imprecise data are usually of more dubious

*Based on two scientific papers delivered by the author at the Annual Meeting
of the Florida Anthropological Society, 1966, and at the Annual Meeting of the
Eastern States Archaeological Federation, 1971.
133
Florida Anthropologist, vol. 25, no. 4, December 1972







PALEOEPIDEMIOLOGY


value and often lead to lengthy and fruitless controversy, but unfortunately
only too often there is nothing else to be found. "

Problems of diagnosis and problems of reliability in dating finds (See
Hrdlicka 1922:87-88) has plagued the interpretation of available data from
archaeological sites. As to dating, archaeology now has radiocarbon dates.
Also, more exact techniques of excavation and consequent clarity of associa-
tion have produced more reliable chronology.

As to diagnosis, medical texts emphasize two cardinal points to be re-
membered in diagnosis of closely similar diseases. One is the distribution
over the body that is characteristic of the given pathology being considered.
Another is the environmental context in which this disease occurs--both as to
climatic and social environments. We shall keep these two cardinal points in
mind: first, by using the case study approach and secondly, by paying atten-
tion to socio-geographical factors.

For present purposes, we shall use the familiar term "syphilis" rather
than "treponemiasis"--a term equated with syphilis in some medical and other
dictionaries. Treponemiasis, however, reminds us that syphilis is a trepone-
mal infection (Treponema pallidum). Theoretical questions about relationships
of the treponemal infections--still being debated among experts--will not be
dealt with in this paper.

Before considering Florida prehistoric finds, let us look at what have
been considered diagnostic criteria of bone syphilis from known cases.

Bone Pathology of Known Cases of Syphilis

Bone pathology of known cases of syphilis is, of course, valuable for
comparison with archaeological finds. Before Herbert U. Williams, M. D.,
wrote his review article on prehistoric syphilis (1932:779-814, 931-983), he
examined and made notes on more than 500 known syphilitic skulls of modern
times as well as seeing museum specimens of skulls labeled syphilitic "in
London, Paris, Amsterdam, Leyden, Berlin, Leipsic, Munich, Prague,
Vienna, Zurich, Boston, Philadelphia, and Washington, to mention only mu-
seums having fifteen or more skulls labeled syphilitic.... The list of cities is
not without significance, for it enables one to say that there seems to be no
difference of opinion as to what constitutes a typical syphilitic skull. He
points out that less than half the skulls labeled syphilitic were perfectly typical.
"... but, he continues, "I should think the perfectly typical syphilitic skull...
[would be] a more certain criterion for diagnosis than a Wassermann reaction
of four plus or an aneurysm of the aorta" (Williams, 1932:784).

"The type of skull that is most characteristic of syphilis [Williams writes,


134







BULLPEN


1932, pp. 784-85] is that produced by widespread gummatous inflammation of
the periosteum, frequently with localized gummatous nodules. The gummatous
periostitis is accompanied by a certain amount of osteitis. It leads to destruc-
tion of bone and simultaneously or later there is new formation of the bone at the
edges of the parts affected. An unevenness or irregularity of the surface of the
skull results that is peculiar and distinctive. English books sometimes speak of
it as appearing 'worm eaten. Erosions bordered by new bone may be present
where there were gummas, partly healed. As Virchow stated it, the scars re-
maining after a gummatous peripheral osteitis are most characteristic; there
is deficiency of new formation in the middle with excess at the outer parts.
Such scars produce jagged, linear, not rarely stellate depressions ["Stellate
scars" is a term sometimes used in a general sense including "jagged, linear
depressions" even if not exactly star-shaped.], with the most marked defect in
the middle, and with smooth, rounded and elevated edges. Virchow revived the
term 'caries sicca, used by an earlier author, Bertrandi, for this process....

"The alterations produced by syphilis frequently affect a large part of the
outer surface of the calvaria; the inner surface is rarely involved. They often
begin on the frontal bone, but not always. The skull may be abnormally heavy,
but is not necessarily so. Gummas may erode so deeply as to cause perfora-
tion. Large sequestrums are sometimes [not frequently] formed...."

Figure 1 shows skull and long bones (femur and humerus) of a prostitute
with known syphilis (Army Medical Museum, Washington, D. C. No. 6414,
Williams 1932:788-89). Figure 2 shows another skull of a known case pictured
in a recent medical text Orthopedic Diseases by Aegerter and Kirkpatrick 1963:
267). Diagnosis is referred to as "acquired syphilis. It will be noted the old
label on the skull reads "Luetic Periostitis. "Lues" is another word for
syphilis.

The skull in Figure 2, though perhaps a more extreme case than that of
the prostitute, is very similar. The text reads, "... The subperiosteal new
bone formation is quite irregular so that the cortical surface becomes rough-
ened by numerous irregular craters and jagged linear depressions. The inter-
stices are filled with syphilitic granulation. I have underlined "jagged linear
depressions"--the same descriptive words used in the earlier literature.

As to long bones, Williams (1932:787) writes, "In the case of long bones,
few observers lay much stress on the stellate scars described by Virchow as
characteristic of syphilis, although such scars are of great importance in the
skull. He also reminds us, "... .the diagnosis of... syphilis in a single dried
bone without its clinical history would be dubious; the involvement of several
bones would make a diagnosis of syphilis more plausible. ".... bones that
are exposed to injury, such as...the tibia and the clavicle, are likely to be
affected. ..."


135







PALE EPIDEMIOLOGY


Fig. la. "The skull and bones of a prostitute,
Army Medical Museum, Washington, D. C. ,
no. 6414.... The long bones appear to show
both gummatous and diffuse syphilis of bone"
(Williams 1932:788).


Fig. lb. "A roentgenogram
of the long bones shown in
Figure" la (Williams 1932:
789).


136







BULLPEN


Fig. 2. "Acquired syphilis" (Aegerter and Kirkpatrick 1963:267).

Williams (1932) discusses many diagnostics of bone syphilis from re-
cent known cases. Anyone interested in more details of diagnostics should see
the original publication which has many illustrations--gross, histologic, and
radiographic. Space does not permit profuse quotation or illustration here. A
few comments pertinent to this paper will, however, be mentioned.

Williams summarizes diagnostics of bone syphilis as follows: "The skull
(1932:800) is most important: Extensive involvement of its upper surface, the
so-called 'caries sicca, new formation of bone, irregular and stellate scars
and the 'worm-eaten' appearance justify the diagnosis of syphilis in all reason-
able probability. Involvement of the nasal region, with new growth of bone is
frequent, but caution must be used in these cases, as there are several other
infections that may affect the nasal region, usually without much formation of
bone, however.

In discussing long bones, he writes: "In syphilis, the new-formed bone is
largely periosteal in origin and often dense; encroachment on the medullary
canal is characteristic. Sinuses and sequestrums are uncommon. Involvement
of two or more bones of the extremities is in favor of this diagnosis (1932:801)
.... Large areas of necrosis, leading to the formation of sequestrums, may
occur; they may be due to secondary infection. Such sequestrums are less fre-
quent in syphilis than in osteomyelitis and tuberculosis (1932:787).







PALE OE EPIDEMIOLOGY


"Acute osteomyelitis (1932:793) with periostitis may also lead to new
growth of periosteal bone, though less frequently than does syphilis. It is more
likely, than syphilis, to affect single bones and to lead to the formation of si-
nuses and sequestrums....In nonsyphilitic periostitis (1932:801), the new
formed bone is usually periosteal. It is unlikely to encroach on the medullary
canal.

As to Paget's disease, Williams (1932:801) writes: "In Paget's osteitis
deformans,... The new bone is usually not dense.... the marrow cavity (p. 798)
is usually large or is filled with spongy bone.... The mosaic structures describ-
ed by Schmorl may eventually be of assistance in making the diagnosis (1932:801)
.... The formation of new irregularly disposed lamellar bone (1932:799) pro-
duces in its final stages what Schmorl called 'mosaic structures ...Sections
of the new bone, under moderately high power, show that it is traversed by nu-
merous short, irregularly running lines of cement substance, giving the impres-
sion that the tissue is made of many small pieces put together like a mosaic....
Schmorl said that they appeared in other bone diseases also, but that these were
not comparable to the mosaic structures of osteitis deformans. "

Williams also comments (1932:794): "Tuberculosis commonly causes
destruction, but not regeneration, of bone. As to yaws, he says: "Yaws
frambesiaa) is said to show tertiary lesions of bone similar to those found in
syphilis and giving a roentgenogram like that of syphilis. Some roentgenograms
from cases of tropical frambesia sent me by Professor Schiffner, of Amsterdam,
show proliferation of bone different from any I have seen in syphilis or other con-
ditions. The bone lesions of yaws... I should think...were much less frequent...
than those of syphilis. "

In the light of past knowledge of diagnostic criteria of bone syphilis and
of other closely similar diseases, study of a documented find in a modern lab-
oratory should yield results which can be viewed with confidence. The detailed
study of the Palmer find which follows is of interest.

Palmer Case Study

The Palmer case study of a documented skeleton is of particular impor-
tance because all major bones are present and were in good state of preserva-
tion at time of excavation. Post-mortem mineralization from local conditions
in the ground account for the unusually good preservation.

The skeleton--a female of middle age range--came from the Palmer bur-
ial mound, Osprey, Florida. According to ceramic typology, this is a Weeden
Island site dated by radiocarbon to around A. D. 850 (1100 BP 105, Sample
G-602; Bullen and Bullen n. d.). No historical items were found in the site
except for remnants of a very recent chicken coop on top of the mound.


138







BULLPEN


The author was present as physical anthropologist at time of excavation
and was impressed with the pathology of the bones as they came out of the
ground. Diagnosis of syphilis seemed indicated but as this subject has been
so controversial in the literature, I wished to have detailed analysis done by
experts in pathological diagnosis from dry bone. Most practising physicians--
even orthopedists--have very few occasions to diagnose disease from dry bones
alone.

I took the bones to the Armed Forces Institute of Pathology, Washington,
D. C. Ellis R. Kerley, Ph. D., then Physical Anthropologist in the Orthopedic
Pathology Section of AFIP, in consultation with Lent C. Johnson, M.D., Pa-
thologist, AFIP, and T. Dale Stewart, M. D., Physical Anthropologist of the
Smithsonian Institution, with the laboratory and technical assistance of mem-
bers of the Institute, studied the skeleton. Kerley sent the author a report
dated November 27, 1963 with photographs and radiographs.

Illustrations of the Palmer skeleton in this report (Figs. 3-8) are from
these originals. Unfortunately, due to faulty packing when it was returned from
the Armed Forces Institute of Pathology, the skull had the facial area seriously
broken and also damage occurred in other parts of the skeleton. Therefore we
are particularly grateful for the AFIP illustrations of the undamaged bones.
However, bones can be seen at the Florida State Museum, and, except for some
damage to the nasal area, diagnostic parts of the skeleton are clearly present.

Kerley discusses diagnostics of syphilis below and then describes the
Palmer skeleton (FSM 97527). He is in agreement with and includes many of
Williams' diagnostic criteria noted above.

"Diagnostics"

"The gross anatomic effects of syphilis on bone are becoming less im-
portant in the diagnosis of the disease as more reliance is placed on the sero-
logic data and fewer specimens of skeletal lues are encountered in medical
practice. Furthermore, such syphilitic lesions of bone as do occur are usually
mitigated or otherwise altered by the use of antibiotics. It is necessary, there-
fore, to turn to the older, rather than the most modern methods of diagnosis in
dealing with ancient, untreated lesions of bone that may have been caused by
syphilis -- or at least the disease that was known as syphilis prior to our cur-
rent emphasis on the not infallible examination and testing of blood. All of this
is not to belittle the overwhelming benefits of serologic tests, but to suggest
that in the absence of any good serologic evidence, there are other diagnostic
methods available to determine with reasonable accuracy whether or not certain
bone lesions were the result of syphilis.

"Virchow (1896) was of the opinion that the stellate scars left by small


139







PALE EPIDEMIOLOGY


resorptive gummas in the center of sclerotic areas were virtually pathognomic
of syphilis. Knaggs (1926) and Williams (1932) both placed great emphasis on
these stellate scars as well -- particularly those of the frontal bone of the skull.
Other luetic marks include a diffuse osteitis that tends to encroach upon the
marrow cavity rather than enlarge it and a combination of diffuse, dense new
bone with small areas of focal resorption. Typically, the more superficial areas
of bone with their minimal circulation and greater exposure to trauma are the
most often involved (Bennett, 1953). These include the skull, where involve-
ment usually begins in the frontal bone, the tibiae, distal fibulae, distal humeri,
proximal ulnae, distal radii, and the clavicles. Other bones, of course, may be
affected as well in severe cases.

"Since these skeletal lesions are fairly distinctive, any problems in di-
agnosing syphilis from the skeleton must arise from similarities to bone le-
sions resulting from other diseases. There are relatively few conditions that
should normally be mistaken for syphilis from their effects on bone.

1. Osteomyelitis usually affects a single bone or area of injury, such
as the knee or ankle. It produces sequestrae surrounded by a rather
distinctive involucrum bone, in which smoothwalled sinuses are
formed. Old chronic osteomyelitis may leave a good deal of sclerotic
bone, but it does not contain widespread foci of active resorption.

2. Paget' s disease often affects multiple bones including the skull and
tibiae most commonly. The outer table of the skull is usually thick-
ened and the new bone is porous in appearance without resorptive
foci. In the long bones the marrow cavity is enlarged as the cortex
expands. Microscopically, there is a mosaic pattern resulting from
rapid and erratic remodeling (Paget, 1877).

3. Pulmonary osteoarthropathy is the formation of often massive perios-
teal new bone along the long bones of the extremities where there is
not sufficient oxygenated blood supplied. It tends to be symmetric
and affect distal areas more than proximal ones. It is bilateral in
the extremities.

4. Tuberculosis is a chronic, low-grade inflammation that may affect
various bones throughout the body. It is essentially destructive with
very little new bone formed in the area of lesions. The spine is most
commonly affected. The epiphyseal areas of long bones are where
the destructive lesions of tuberculosis are found.

5. Yaws frambesiaa) produces lesions that are similar to those of
syphilis by X-ray. Grossly, the gummatous lesions of yaws can be
distinguished from those of syphilis -- or at least from some of the


140







BULLPEN


lesions most typical of lues. The gummatous lesions of yaws are
larger and more localized in a bone than those of syphilis usually
are. The diffuse, sclerotic periostitis of syphilis is not as wide-
spread in yaws, and the stellate scars are missing. The palate and
nasal areas are almost inevitably involved in yaws. Geographically,
yaws is limited to the tropics. Although common in the West Indies
and Central America, yaws has never been an epidemiologic problem
in the United States.

"In view of these distinctions, it should be possible to determine with confi-
dence that a skeleton of a given specimen had syphilitic lesions if they (1) fit
the description of known syphilitic lesions grossly and radiographically,
(2) fit the skeletal distribution of syphilitic lesions, (3) do not fit the descrip-
tions of other skeletal diseases that might resemble syphilis, and (4) occur
outside the tropic areas where yaws is prevalent. Also, they should resemble
gross specimens and X-rays of known syphilis.

Florida Specimens

"FSM 97527 consists of the remains of Burial 352 from the Palmer Burial
Mound in Osprey, Florida. The bones are heavily mineralized and are dark
gray in color as a result of ground water staining. Most of the skeleton is pre-
sent. Some bones have been broken post-mortem. The shafts of some long
bones are filled with sand. Pathologic lesions are present in various bones.
The skeleton appears to be that of a middle-aged female American Indian, who
has had at least one pregnancy.

Skull: The frontal bone, left orbit, left zygoma, and left mandibular ramus
have areas of inflammatory destruction combined with the formation of
periosteal new bone [Fig. 4]. The frontal bone in particular shows new
resorptive foci and old stellate scars surrounded by dense, sclerotic
repair bone [Fig. 5]. The nasal area and palate are not involved as they
usually are in yaws. The cranial sutures are open, except for the basal
suture, which is obliterated. The teeth are worn down to the dentine.
Direct comparison of this skull with those of known syphilis disclosed
complete similarity with some specimens of known syphilis. [See Figs.
3-5]
Vertebrae: The vertebrae appear normal. There is a little periarticular
lipping that is normal with advancing age. All epiphyses are completely
fused. The first sacral segment is transitional, apparently incompletely
lumbarized. Since five normal lumbar vertebrae precede it, and the ribs
and cervical vertebrae all appear normal, it would appear to represent
an incompletely lumbarized first sacral segment (Lanier, 1954).

Scapulae: Both scapulae are broken post-mortem. There is some inflamma-







PALE OE PI DEMI OLOGY


Fig. 3. Right lateral radiograph of the Palmer skull (FSM 97527).

(Facing page) Fig. 4. Left lateral photograph of the Palmer skull
(FSM 97527). Both courtesy of the Armed Forces Institute of Pa-
thology, Washington, D.C.


142







BULLPEN


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PALE OE PIDE MIOLOGY


tory resorption of the left acromial articular surface.

Clavicles: The sternal epiphyses are completely fused. There is some
inflammatory resorption of the acromial articular surface of the
left clavicle.

Sternum: The manubrium is missing. The segments of the gladiolus are
united with the lines of fusion barely discernible by X-ray. The xiphoid
is missing. There is some evidence of inflammation on the superior
surface of the gladiolus, where it articulated with the manubrium.

Ribs: The ribs present multiple post-mortem fractures. All epiphyses are
completely fused. The right number 9 rib has an inflammatory lesion
that has destroyed bone. There is some loosely woven new bone sur-
rounding the lesion. X-rays show multiple lytic areas surrounded by
sclerotic bone. This lesion is compatible with syphilis, but could have
been caused by a pyogenic osteomyelitis as well.

Humeri: The right humerus has a low-grade inflammatory lesion involving
the distal third of the bone and expanding the cortex. Focal areas of
destruction are surrounded by diffuse osteitis and dense reparative
bone. On X-ray, these areas show as extremes of lysis and sclerosis.
The left humerus appears to be normal. [See Fig. 8]

Radii: The radii are normal except for a slight thickening with patches of
periosteal new bone formation on the anterior aspect of the distal
fourth of the diaphysis. X-rays show slight irregular radiolucence in
these areas.

Ulnae: Both ulnae appear normal. There are marked periarticular ridges
around the proximal articular surfaces. This is normal with advancing
age.

Hands: The carpals and some of the phalanges are missing. There is an old,
healed and remodeled fracture of the right fourth metacarpal. The
other bones of the hands that are present appear to be normal.

Innominates: All epiphyses and apophyses are completely fused. The sym-
physis has a strong dorsal plateau and marked ventral rampart. The
symphyseal surface is quite flat and gives the impression of advanced
age. The face appears to have been disturbed, as though by pregnancy,
and there is a parturition pit on the dorsal surface (Putschar, 1931).
Stewart (1957) has pointed out that these dorsal pits of pregnancy tend
to be associated with disturbances of the symphyseal face that makethe
age appear older than it is in some cases and may certainly affect the


144




















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d
r


f ;"


A.- .


Fig. 5. Four views of irregular and stellate scars on the frontal bone of the Palmer skull
(FSM 97527). Courtesy of the Armed Forces Institute of Pathology, Washington, D. C.


r:
I'







PALEOEPIDEMIOLOGY


Fig. 6. Palmer tibiae: a (anterior view) d (posterior view) normal
right tibia; b (anterior view) c (posterior view) pathological left tibia.


146







BULLPEN


reliability of any age estimate. In this pelvis, however, there are addi-
tional indications of advanced age. The auricular articular surfaces are
smooth and there are periarticular ridges around them. The pelvis ap-
pears to be female. This is substantiated by the pitting and irregularity
of the pubic symphysis and the pelvic indices. The sub-pubic angle is
about 90 degrees, and the ischio-pubic index is about 92. These are
both within the female range, and all morphologic characteristics appear
female.

Femora: Both femora appear to be essentially normal. There are periarticular
ridges around the articular surfaces and the fovea of the femoral heads.
All epiphyses are completely united. The maximum diameter of the fem-
oral heads is 41 millimeters.

Tibiae: The right tibia appears to be normal (Fig. 6a, d). There are peri-
articular ridges around the articular surfaces of both tibiae, and there
are squatting facets on the anterior surface of the distal ends. The ridges
for the attachment of the iliotibial bands appear particularly well devel-
oped. They are unusually elevated and present a broad surface for the
attachment. Since other attachments of muscle or tendon in that area
are not particularly pronounced, it would appear that the ilio-tibial
bands might have been under more stress or constant use than the sur-
rounding muscles. This coupled with the evidence of strong muscle at-
tachment along the superior surface of the femoral greater trochanters,
might reflect some difficulty in balance when walking. At least it would
appear that more stress has been placed on the lateral muscles that
play a major role in walking balance.
The left tibia shows evidence of a chronic inflammatory response
involving the entire shaft [ Figs. 6, b-c; 7] There are widely dispersed
punched out foci of resorption in the middle of larger areas of smooth,
dense periosteal bone [Fig. 7]. The cortex is expanded and irregular.
X-rays show multiple lytic foci surrounded by sclerotic bone. This type
of chronic, low-grade osteitis with focal areas of resorption is typical
of syphilis. Yaws leaves larger, more localized resorptive areas than
the small, diffuse ones underlying the small, low-grade gummas of
syphilis. [See also Fig. 8.]

Patellae: Both patellae are present and normal.

Fibulae: There is some post-mortem erosion of the proximal ends of both
fibulae. The right fibula appears to be normal. The left fibula has an
inflammatory response involving the distal two-thirds of the shaft and
being more severe toward the distal end. There is quite a bit of re-
active periosteal new bone along the interosseous ridge, but no evidence
of destructive lesions.


147







148


PALE OE EPIDEMIOLOGY


Fig. 7. Close-up views of the distal end of the Palmer pathological tibia:
a, lateral view; b, postero-medial view; c, medial view. Courtesy of the
Armed Forces Institute of Pathology, Washington, D. C.


Feet: The bones of the feet and ankles that are present appear to be normal.

Discussion

"The bones of 97527 (Burial 352) are of particular interest with regard
to the problem of pre-Columbian syphilis since all of the major bones are pre-
sent in this skeleton. The distribution of the lesions throughout the skeleton is
almost as important in the determination of syphilis as the nature of the lesions
themselves. A single tibia might resemble Paget's disease or pyogenic osteo-
myelitis, but a skeleton presenting the lesions that are typical of syphilis in the
areas typical of syphilitic involvement is overwhelming evidence -- particularly
in the absence of any other known disease that might produce such lesions in a
geographic area where yaws is uncommon. Burial 352 is such a skeleton.

"With the exception of the old, healed fracture of the right fourth meta-







BULLPEN


Fig. 8. Radiographs of some Palmer long bones: (left to right) left pathological tibia,
right and left (pathological) fibulae, right and left (pathological) humeri.


149







PALEOEPIDEMIOLOGY


carpal, all skeletal lesions appear to be part of the same inflammatory pro-
cess. These lesions are located in areas where the bone is close to the over-
lying skin, as is typical of syphilitic bone lesions, and are more widely sep-
arated than might be expected in osteomyelitis. Direct comparison of these
bones with those of known osteomyelitis from the Civil War showed distinct
differences between the two. X-ray comparisons showed additional differences
between the two types of lesions. Also, osteomyelitis of the skull looked entirely
different than the lesions of 97527. Paget's disease produces skull lesions that
are entirely different than the cranial lesions of this specimen, and direct com-
parison between these bones and X-rays and those of known Paget' s disease
showed marked dissimilarity. Pulmonary osteoarthropathy affects distal bones
of the extremities and is bilateral. It would not affect one humerus or tibia with-
out involving the more distal hands and feet. The skull is not usually involved,
either. Tuberculosis is primarily a destructive process that affects the spine
and ends of long bones. The sclerotic nature of the lesions and their distribution
in the skeleton exclude tuberculosis as an explanation. This narrows the choice
of pathology to either syphilis or yaws. While the lesions produced by syphilis
may be identical with those of yaws, syphilis can also produce skeletal effects
that are distinguishable from yaws. The osteitis is quite diffuse along the tibial
shaft with small scattered foci of more acute inflammatory resorption, while in
yaws the osteitis is more localized and the gummatous foci are large and less
widely disseminated. The skull of this specimen shows several of the distinctive
stellate scars of syphilis that result from small, active foci of resorption in
large areas of sclerotic osteitis. These scars are the hallmark of syphilis.

"Since 97527 exhibits lesions that are typical of syphilis in parts of the
skeleton that syphilis typically affects, and since no other disease is known
to produce similar lesions in that same pattern, one is led to conclude that
this individual did, indeed, have syphilis. This is strong evidence that syphilis
was present in the New World before the arrival of Columbus. This conclusion
is supported by the fact that yaws -- although common in the West Indies -- is
not and has not been historically a disease that is prevalent in Florida. Also,
yaws tends to affect the palate and nose much more frequently than syphilis.
The palate and nasal area are not affected in this specimen. All available ev-
idence indicates that this specimen represents syphilis of bone, and there are
no indications that it might be anything else. "

Other bones of the Palmer series were also diagnosed as syphilitic by
Kerley. These will be included in the final report on the Palmer site. It is
pertinent here to point out that 97527--while the most striking case in this
series--was not the only person with pathology diagnosed as syphilis.

Report on Bayshore Homes Pathology

Another skeleton (FSM 94387) with several foci of infection has been re-


150







BULLPEN


corded by Charles E. Snow (1962) for the Bayshore Homes site, St. Peters-
burg (Burial 14). This site is also Weeden Island time period (A. D. 850-1350)
but a little later than the Palmer Burial Mound. For the purposes of this paper,
we shall not subdivide the Weeden Island period into "Weeden Island I" and
Weeden Island II. Both sites are unquestionably pre-Columbian in date with
characteristic Weeden Island period ceramics. No contact material or demon-
strably late pre-Columbian pottery was found.

Snow selected the most noticeably pathological bones for further study.
He writes (1962:20-21):

"Suspecting the possibility of syphilis, a bloated femur, tibia, and pha-
lanx [metacarpal] from Burial 14 (FSM Cat. No. 94387) were taken by the Bul-
lens to the College of Medicine, University of Florida, for examination. Nich-
olas R. Greville, M. D. of the division of Orthopedics reported:

'After inspecting...the bones (Figs. 9-10) and having them X-rayed I
believe that the lesions presented in these bones are most likely those of syph-
ilis osteitis. The appearance of the phalanx [metacarpal]... is particularly
characteristic. The appearance of the other bones is quite compatible both
grossly and radiologically with this disease. Dr. Reeves the Radiologist con-
curred with this opinion. '

"These same bones.. .were then taken to the Armed Forces Institute of
Pathology in Washington by the Bullens for analysis. The report by Ellis R.
Kerley follows:

....These observations and their interpretations were arrived at after
consultation with Dr. Lent C. Johnson (pathologist), Dr. Walter Putschar
(pathologist) and Dr. T. Dale Stewart (physical anthropologist), ...

'94387: Femur, tibia and metacarpal [Figs. 9-10]. The metacarpal appears
to represent a simple osteomyelitis. The portions of tibia and femur present
multiple, low grade inflammatory lesions. Syphilis is quite possible, though
not definite. X-ray comparison with known syphilis shows definite similarity.
Also, syphilis is the most likely low-grade osteitis that would result in such
lesions over wide areas of the bone or skeleton. '"

Snow (1962:23) writes in his report subsequent to these findings that
other bones of Burial 14 were also involved. This is not surprising if syphilis
was the cause. These other bones, however, were not studied by the specialists.

The Bayshore Homes material, while suggestive and important, is not of
the same diagnostic calibre as the Palmer specimen. However, although there
is a difference of opinion about the metacarpal, there is agreement at the two







PALEOEPIDEMIOLOGY


r I~',


Fig. 9. Bayshore Homes,
photographs and radiographs
of some pathological bones


* (Burial 14, FSM 94387): (left
B to right) left femur, right tibia,
and left tibia.


152







BULLPEN


Fig. 10. Bayshore Homes, other pathological bones
from Burial 14 (FSM 94387): (left to right) right radius,
left ulna, right fibula with healed fracture, and
metacarpal.


institutions on the major verdict of probable syphilis. To this extent it seems
we have survived the hazard noted by Lent Johnson (1966), "...a major hazard
that faces all those who consult pathologists--the fact that pathologists may not
agree on interpretations of the same specimen. "

Weeden Island Culture Area

As the Palmer burial described above assures us that syphilis was pre-
sent in Florida in Weeden Island times and as data from Bayshore Homes, an-
other Weeden Island site, tends to support this finding, we are justly curious
to make a rapid--and, at this time, less detailed--survey of available know-
ledge of skeletal finds from other Florida sites of the Weeden Island time period.
We cannot expect that tertiary bone syphilis will be common--especially in as
complete manifestation and preservation as in the Palmer instance. However,
published observations of M. D. 's on documented skeletal finds, comments of
excavators, and material now being studied in the Florida State Museum collec-
tions, may add to our scanty knowledge. Present "gross" findings, in the light
of comparison with the Palmer pathology, may provide clues to a developing
spacio-temporal picture of pathology.







PALEOEPIDEMIOLOGY


Map 1, courtesy of Walker and Murciak (1971), suggests the extent of
Weeden Island sphere of influence. It calls our attention to areas where large
Weeden Island sites occur and to the periphery which has also been influenced
by Weeden Island trade and culture contact. It shows counties in Alabama,
Florida and Georgia where Weeden Island period material has been found. The
dark crosshatched counties are taken from data in Willey (1949). Lighter cross-
hatching has been added by Walker and Murciak (1971) plus a few other counties
from Florida State Museum records. Sites referred to below--whether of Weeden
Island or of other time periods--are superimposed on the map.

Areas along the Gulf Coast contain most of the largest and typical Weeden
Island culture sites per se. However, Weeden Island pottery has been found in
all the crosshatched counties. Walker and Murciak suggest Weeden Island may
be a Gulf Coastal Plain phenomenon, with connections west to the mouth of the
Mississippi River.

The Weeden Island site (Map 1, 10) --very near Bayshore Homes (Map 1,
9) and not far from the Palmer site (Map 1, 7)--receives its fame as the first
site where Weeden Island ceramic typology was delineated. As it is so well-
known, it has been added to Map 1 to show its location among the other Weeden
Island areas along the Gulf Coast. Unfortunately, it does not have a well-docu-
mented skeletal series (Willey 1949:108).

Crystal River (Map 1, 11). To the north of the Palmer, Bayshore, and
Weeden Island sites is the famous Crystal River site. The Crystal River burial
mounds (Bullen and Bullen, n. d.) have Weeden Island period ceramics in the
Main Burial Mound (burial mound proper and adjoining artificial elevation) and
in the Circular Embankment. Another burial mound, referred to as the Stone
Mound, is of the succeeding Safety Harbor period. It will be discussed later in
this report.

Clarence B. Moore (1903:382-83) excavated the Main Burial Mound when
it was undisturbed except by aboriginal activities. He took out 225 burials in
1903 according to what he considered a low estimate. Moore writes: "Many of
the bones bore marks of pathological lesion. Unfortunately no skulls were con-
sidered in good enough condition to save. He states categorically "...no object
indicating European provenance was met with throughout the entire investigation. "
In 1906 (1907:408), Moore removed 186 additional burials from the Main Burial
Mound (again a low estimate as scattered bones were not included). He writes
that only two skulls from this dig were found in a preservablee condition. No
reference is made to pathology.

As these two excavations of Moore' s removed at least 411 burials from
the burial mound proper and adjoining elevation, it is not surprising that few
burials were encountered in the Bullen excavations here. Of the few recovered,


154







BULLPEN




.i0^- '^^J- r *L^I''~ .-' $. ""u**"nS^"
r -
-i '-'" _.. ---..A .,-- J. -
,_ ;' .
..... .. C."o,"o tj..,_ '.;W K /, ,.

" "i ..I- .." ".-.- I ,- -- + ^ 7 .' "-' .
C~L--I -- *^ L^4 '1~ \..^*".^ "i. .i tl-


" -" i ;? ', ...T ^- ^. .. ""... !"".... ..r
,, ,, _. --* (n.
\ .. .* --,.. -*. ... -,,1 ^
,.. -, .... U O -__ --
,t l. I *-t +'- --k, IS L.L. t .oosA-


DISTRIBUtlON 01
wes ae


Lighthouse //z
Browne (Du-62)
Tick Island Mound 10. Weeden Island
Tick Island Archaic 11. Crystal River
Thursby 12. Hog Island
Aqui Esta 13. Sowell
Palmer 14. Moundville
Tierra Verde
Bayshore Homes


Map. 1. Distribution of Weeden Island and location of sites referred to in text.


* A P~

,7.~ i







PALE EPIDEMIOLOGY


only two (FSM 97094 and FSM 97107) show noticeable tibial pathology on pre-
liminary inspection. One of these tibiae (FSM 97094) is more suggestive of
Paget' s disease than of syphilis because the broken shaft reveals a distended
cortex with greatly enlarged medullary cavity. The tibial fragment of FSM
97107, on the other hand, has periostitis with anterior mid-shaft build-up of
bone, although the medullary cavity shows no narrowing in this specimen.
Without evidence of more distributed skeletal involvement, diagnosis is incon-
clusive at this stage of analysis. The prevalence of lesions noted by Moore for
the first 225 skeletons he excavated is all that is on record for his large series.

More specific data comes to us from Bullen's excavation in the Cir-
cular Embankment. This is still of the Weeden Island period but presumably
somewhat later than the Main Burial Mound. On preliminary inspection, a
number of burials exhibit pertinent pathology although no one specimen has
as complete involvement as the Palmer example.

Burial FSM-S 163 has extreme, irregular hyperostosis of the distal
two-thirds of one tibia with noticeable foci in some areas. Other areas have
diffuse thickening with wavy narrowing of the medullary canal observable at
a cross-sectional break. The proximal end of one ulna is greatly enlarged
with the medullary cavity nearly filled.

FSM 99148 has a definitely advanced syphilitic tibial midshaft if we
are to judge by comparison with the Palmer specimen. The bone is greatly
enlarged and thickened both interiorly and exteriorly. Thickening is diffuse.

FSM 99153 shows a diseased tibia, fibula, and two radii. Pathology
might be described as periostitis and osteitis with some misshapen tendencies
and thickening. Some incipient interior thickening, however, suggests syphilis.
It is probable that these are the bones of one individual, but bones of two other
persons were comingled in this burial.

FSM 98921 is a suspiciously pathological tibial fragment found in Moore' s
refilled 1917 excavation in the Circular Embankment adjacent to the Bullen dig.
While the medullary cavity is not filled, the tibia has diffuse build-up of bone
and suggests incipient tendencies to interior narrowing. Unfortunately Moore
(1918:571-73) does not refer to skeletal finds in the report of his 1917 work in
the Circular Embankment.

Hog Island (Map 1, 12) Hog Island is another Weeden Island site on the
Gulf Coast of peninsular Florida. It is about seven miles north of Cedar Key.
Much skeletal material has come from this mound, but most of it is in the hands
of individual collectors. Of the few specimens preserved in the Florida State
Museum, FSM 105006 has noticeable pathological tendencies. Of the two tibiae,
two fibulae, two ulnae and two radii present, one of each pair shows noticeable


156







BULLPEN


enlargement. One clavicle also suggests possible pathology, but more detailed
examination of this is needed. Although the tibial medullary cavity is not no-
ticeably narrowed, the distribution and nature of the pathology of this individual
are strongly indicative of syphilis.

Sowell Mound (Map 1, 13) The Sowell Mound in west Florida is a well-
known Weeden Island burial mound (Moore 1902:167-74; Willey 1949:64-70, 231,
399) dated by radiocarbon (Isotopes to A. D. 610 125 years (Percy et al. 1971).
Dailey (1971) in his preliminary paper on the skeletal material reported pathology
similar to the Bayshore Homes published account (Snow 1962). He illustrated a
long bone with noticeable enlargement. Dailey' s preliminary description of
pathology, the Weeden Island time period, and increased understanding of symp-
tomatology of bone syphilis help in placing the Sowell Mound in at least a "sus-
picious" category at this time concerning occurrence of syphilis. It may be in-
ferred in this context. Unfortunately, the case study approach cannot be used
for analysis of these presently comingled bones. Individual bones may well fall
into terminology of diffuse osteitis and periostitis.

Lighthouse Mound (Map 1, 1). The Lighthouse Mound in northeast Florida
is the largest Indian Mound on Amelia Island. It is of the St. Johns archaeolog-
ical period--a period on the east coast which covers a wide time span. Because
of Weeden Island trade sherds found at the site (Bullen and Griffin 1952:47), the
site is considered contemporaneous with Weeden Island on the Gulf Coast.

Clarence B. Moore dug the mound during his 1895-96 field trip to Florida
(Moore 1896, personal printing; 1922, Museum of the American Indian, Heye
Foundation, verbatim publication). Moore writes that "some previous investi-
gation in the immediate summit" had been made prior to his complete excava-
tion of the mound. The mound had a diameter of 75 feet and was 12 feet high--
15 feet from center of summit to yellow sand at the base.

Therefore, when Moore describes the burials (1896:24-25; 1922:57-59),
he has a nearly complete--at least a representative--skeletal inventory from
the mound. He writes: "Exclusive of loose bits of bone, doubtless thrown from
the previous excavation, seventy-four skeletons, all seemingly in anatomical
order, were met with, and one deposit of charred and calcined human remains....

"In no previous mound work have we found so great a percentage of pa-
thological specimens as in this mound, and, as has not been the case in other
mounds, entire skeletons seemed affected, and not one or possibly two bones
belonging to a skeleton. The pathological conditions were so marked and cra-
nial nodes so apparent that, in view of the fact that no objects positively indi-
cating White contact were discovered in the mound,... we must look upon
these bones as of pre-Columbian origin. We may state here that all bones
preserved by us came from depths in the mound which insure their deriva-


157







PALEOEPIDEMIOLOGY


tion from original burials. These bones, found 8 to 12 feet from the surface,
and lying beneath numerous undisturbed layers are as unmistakably of an early
origin as any yet described and much more reliable than most.

"Dr. Washington Matthews... has kindly consented to study and to report
upon these bones from the Light-house mound. "

Dr. Matthews, because of illness, was unable to do the Lighthouse study
and turned the bones over to D. S. Lamb, A.M., M. D. a pathologist at the
U. S. Army Medical Museum. Dr. Lamb' s report appeared in the Proceedings
of the American Association of Anatomists, vol. 10. He writes (1898:63-64):

"... in regard to the question of precolumbian syphilis; that is, the existence
of syphilis on the American continent prior to the coming of Columbus. The
testimony which I have to offer on the affirmative side consists in the fact of
a series of human bones from one and the same skeleton, which show the le-
sions of osteo-periostitis, both hyperostotic and ulcerative; lesions therefore
showing a constitutional disease. The shafts of the bones are alone affected;
the joint surfaces so far as they have been preserved are normal. These bones
were found... by Mr. Clarence B. Moore, of Philadelphia, and were sent by
him to Dr. Washington Matthews... for his opinion as to the nature of the le-
sions. The ill health of Dr. Matthews at that time precluded his giving any
attention to the matter and the duty was devolved on me.

"The bones were at first temporarily, afterwards permanently deposited
in the U.S. Army Medical Museum in this city (Washington). They are num-
bered 11,247 to 11,253 Pathological Series, and 3,579 to 3,583 Provisional
Pathological. They consist of the humeri, right ulna, radii, femora, tibiae
and fibulae. They are of the usual dark color and quite friable; the medullary
cavity filled with dark sand and rootlets.... They show in some places irregular
patches of flat, reticulated, hyperostotic growth, in others a more uniform
rounded thickening. The illustration [Fig. 11] shows the appearance of the left
tibia and fibula; the ulcerative stage is well marked. The skull was not sent
and its condition is not now known. In the present state of our knowledge I know
of no disease except syphilis in which a series of bones of the same skeleton
show the lesions illustrated and described. These bones were exhibited by me
in the Pathological Museum at the meeting of the British Medical Association
at Montreal, and a brief mention of them was made in the British Medical
Journal, Nov. 20, 1897, p. 1487. Prof. Osler's remark on seeing them was
that This man had the pox. "

"Pox" was one of the many names used to mean "syphilis. Sir William
Osler (1849-1919), the famous doctor and professor of medicine, was, of
course, active in a period when late stage syphilis was relatively common. It
is unfortunate that the skull of this individual was not sent with the long bones.


158







BULLPEN


Do. J. C. MCCONNML., DTL.

Fig. 11. Tibia and fibula from Lighthouse Mound
(Reproduced from Lamb 1898:64)
However, as Moore (1896:58) commented, "...entire skeletons seemed af-
fected.... pathological conditions were so marked and cranial nodes [italics
are mine] so apparent..., we can, with justification, assume that some in-
dividuals with long-bone pathology had skull involvement.

Dr. Williams, so liberally quoted above, was sufficiently interested in
Lamb' s 1910 account to go to Washington to examine the bones at the U. S.
Army Medical Museum. He writes (1932:968):

"In April, 1931, I visited the Army Medical Museum and...was able to
examine the specimens deposited in the museum by Clarence B. Moore. The
bones described by Lamb were immediately located under the catalogue num-
bers given by him, and his drawing [Fig. 11] and description [quoted above]
proved to be in general accurate. Roots and sand were still present in the fe-
murs. Places where the left fibula and left femur were broken showed that the
new growth of bone was periosteal in origin. The condition of the bones was
poor and did not seem to warrant examination with the x-ray or under the mi-
croscope. It was my opinion that they were in all probability syphilitic...."

I called the Army Medical Museum and ascertained that only two of the
bones with the numbers cited by Lamb and subsequently by Williams are still
in the collections. Fortunately they were examined there by two medically
knowledgeable investigators while still an intact assemblage--to say nothing
of the pronouncement of Sir William Osler.

The Browne Mound (Map 1, 2) is another burial mound in northeast
Florida of the same late St. Johns period as the Lighthouse Mound. It is con-
temporaneous with Weeden Island. A burial (FSM 93171) from the Browne
Mound (Sears 1959) in the Florida State Museum collections deserves com-
ment. The distal section of one tibia has obvious enlargement. The fibula
has a pronounced irregular enlargement in the shaft. The other fibula is nor-
mal. These bones take on importance because of the reported Lighthouse pa-
thology. The sites are not very far from each other and it is likely that there
was communication between them. The archaeology has a number of similari-
ties (Sears 1959). Of course, we cannot, at first glance, make a firm diagno-


159







PALE OE PIDEMIOLOGY


sis of syphilis; but we can keep our eye on this and on neighboring sites where
contact with the Lighthouse Mound and with Weeden Island peoples to the west
were a distinct possibility.

Crystal River (Map 1, 11). The Stone Mound or second burial mound
at the Crystal River site is of the Safety Harbor period that immediately fol-
lowed Weeden Island (Bullen and Bullen, n.d.). That data suggestive of syphi-
lis is very evident at the Stone Mound does not seem surprising. In looking
over the skeletal material, the most striking individual case (FSM 97077) has
extreme enlargement of the distal end of the left fibula. The left tibia shows
slight roughness. The distal third of the right fibula has some enlargement.
One ulna is markedly diseased. One radius has irregular enlargement of the
shaft. Other skeletons exhibited characteristic long bone enlargements of the
tibiae and fibulae.

Tierra Verde (Map. 1, 8). Tierra Verde is an island southwest of what
is now St. Petersburg. Much Safety Harbor pottery came from the Tierra
Verde burial mound (Sears 1967). A burial (FSM 99683) exhibits long bone
pathology with frequent shaft enlargements suggestive of syphilis. Bones af-
fected include one tibia, one fibula, and both femurs--one more than the other.

Aqui Esta (Map 1, 6). This site is also of the Safety Harbor period (Bul-
len 1969:418). Unfortunately we do not have bones of a complete--or even par-
tially complete--individual. However, two tibiae are of such pronounced--and
obviously differing--pathology that they were taken to the Armed Forces Insti-
tute of Pathology for detailed analysis. Kerley (November 27, 1963) reports:

"FSM-97485 consists of the badly-eroded shaft of a right tibia and the mid-
dle third of another right tibia. The longer tibial shaft (designated A) has a dif-
fuse osteitis with considerable thickening of the shaft by irregular periosteal
bone, particularly along the anterior surface, and many small resorptive areas.
[Figure 12] X-rays show regular outlines of the medullary cavity with a thick-
ened cortex containing dispersed focal areas of rarefaction. There are no se-
questrae or cloacae visible by X-ray, although the entire shaft of the bone has
been involved. This specimen is entirely compatible with syphilis. However,
it is very difficult to assert that a single bone represents syphilis without know-
ing whether any other bones of the skeleton were involved.

"There is also a short segment of another right tibial shaft (designation B)
that is involved along the entire length of the part of the bone that is present.
Grossly and radiographically it appears to represent an old, chronic osteomye-
litis. It is not possible to determine the origin of the infection from the speci-
men. It could very well have resulted from an open injury in the local area and
been limited to that tibia and overlying soft tissue. "

The location of this site and the Safety Harbor period pottery found there


160







BULLPEN


Fig. 12. Aqui Esta, FSM 97485, photographs and radiographs of pathological
right tibia (left to right: medial, lateral, lateral, and anterior views).







PALE OE PIDEMIOLOGY


make the possible syphilitic diagnosis of interest. Aqui Esta is the southern-
most known location of a Safety Harbor period burial mound.

Moundville (Map 1, 14). The well documented and much discussed site
of Moundville, in Alabama, is of interest to us here as it occurs on the
northern margin of the Weeden Island region (Map 1}. This Middle Missis-
sippi site (Moore 1905, 1907; DeJarnette 1952:283) equates in archaeological
time period with the Safety Harbor period in the Tampa Bay area and with the
Fort Walton archaeological period in west Florida--contemporaneous with
Safety Harbor. As has been pointed out above, Safety Harbor immediately
follows Weeden Island. Therefore Moundville obviously must be post-Weeden
Island.

Clarence B. Moore worked in pre-Columbian deposits at Moundville. He
writes (1907:340):

"Among hundreds of objects found by us during both our vists to Mound-
ville, not one, either as to material or in method of treatment, gave any indi-
cation of other than purely aboriginal prevenance, and it is our belief, as well
as that of eminent archaeologists who have examined the artifacts from Mound-
ville, that the occupancy of the site was prehistoric.... The same classes of ob-
jects were found there with human remains whose only trace was a black line
in the soil, as were encountered with better preserved skeletons. "

Bones excavated by Moore at Moundville showed pathology suggestive of
syphilis and some were given to the U. S. Army Medical Museum. A report
on the pathological bones by Dr. D. S. Lamb, included in Moore's Moundville
Revisited (1907:337-405), naturally attracts our attention. Moore (1907:339-40)
writes:
"During our first investigation [1905], fragments of human remains were
found presumably bearing traces of a specific disease. At our second visit many
bones were found, sometimes a number belonging to one skeleton, showing such
decided lesions that all these remains were carefully put aside and, later, were
given by us to the United States Army Medical Museum. The results of investi-
gation at that institution has kindly been reported to us as follows:

"Dr. James Carroll, First Lieut. and Asst. Surgeon, U. S. Army, Curator
Army Medical Museum,
"Sir:-
"In accordance with your instructions I have the honor to report that
the lot of bones from mounds at Moundville, Ala., contributed by Mr. Clarence
B. Moore, comprised about 70 pieces, some of them rather fragmentary. Of
these 70, fifty show the usual conditions found in bone-syphilis, such as perios-
teal nodes, especially along the crest of the tibia, irregular erosions, scleroses
and necroses of long bones, erosions of calvarium as from gummata; many bones
of the same skeleton being affected. I do not think there can be any doubt that
these bones are from cases of syphilis....
D. S. Lamb, Pathologist."


162







BULLPEN


Fig. 13. "Photograph of a skull. Note the deep stellate scars of Virchow and
the areas of erosion. Of the entire collection [from Moundville], this specimen
is the most typical of syphilis (Haltom and Shands 1938: 239). Compare with
Palmer skull, Figure 5.

Later excavations at Moundville by Jones, DeJarnette, and Haltom also
produced pathological bones which were studied by W. L. Haltom, M. D. and
A. R. Shands, Jr., M. D. (1938:228-42). They and DeJarnette (1953:283)
point out that the Middle Mississippi burials discussed here are easily differ-
entiated from relatively recent burials which are in large urns and very fre-
quently contain European material. Clearly both these and Moore's earlier
skeletal finds were in pre-Columbian deposits.

Haltom and Shands (1939:232) state: "Several specimens show changes


163







PALEOEPIDEMIOLOGY


Fig. 14. "...lateral roentgenogram of the skull shown in figure [13]. Note the
extreme thickening of the cortex...." (Haltom and Shands 1938:240). Compare
with lateral radiograph of Palmer skull, Figure 3.


which we believe conform very closely to the classic description of lesions pro-
duced by syphilis.... The long bones offer strong evidence of syphilitic changes
.... On the other hand, the skulls offer indisputable evidence. "

Figure 13 shows stellate scars on the one crania most typical of syphilis.
These can be compared with the stellate scars shown in the Palmer illustrations
(Fig. 5). The lateral radiograph of the Moundville skull with extreme thicken-
ing of the cortex (Fig. 14) likewise can be compared with the lateral Palmer ra-
diograph (Fig. 3).

It appears that there is evidence for the occurrence of syphilis at Mound-
ville in pre-Columbian Middle Mississippi times. In fact James B. Griffin
(1946:81) considers syphilis "almost a Mississippi 'determinant.'" As this
period comes after Weeden Island, we know the Mississippians at Moundville
did not introduce this disease to Florida.


164







BULLPEN


We have looked forward past Weeden Island times to the archaeological
period in Florida that immediately followed it. Now let us glance at some ma-
terial from the time just preceding the Weeden Island and St. Johns periods
we discussed earlier in this paper. I am sure the reader is all too well aware
that comparative data--both after and, now, before the Palmer find are not as
complete specimens as we would like to have. In the light of our present under-
standing, however, we may gain clues from this less complete--and less com-
pletely studied--data.

Thursby Mound (Map 1, 5). Clarence B. Moore (1894:64-82, 158-167)
dug the Thursby Mound and found distinctive pottery vessels and 48 animal effi-
gies very different from the St. Johns archaeological material found at the
St. Johns sites we have discussed above. Thursby finds are considered to be
of the early St. Johns period. Moore (1894:82) states in his report: "It will
be noticed that nothing indicating intercourse with the civilization of Europe
was found other than superficially in the Thursby Mound. "

A pathological tibia from Moore' s work at the Thursby Mound, in the
collections of the U.S. Army Medical Museum (cat. no. 10849), is of interest.
According to the record, it has hyperostosis. If this tibia came from one of
the burials in the lower parts of the mound, it is highly pertinent to this paper.
If, however, it came from one of the superficial burials with which were found
European objects, it obviously would not be important for the early St. Johns
time period. Records at the U.S. Army Medical Museum might clear up this
point as Moore wrote informative notes as to provenience with most of his ma-
terial.

Tick Island Mound (Map 1, 3). The Tick Island Mound and the major part
of the Thursby Mound are both of an early St. Johns period beginning about A. D.
200 (Bullen 1965:316). They date before the Lighthouse and other St. Johns sites
contemporaneous with the Weeden Island period. Here again evidence we have
comes from Tick Island skeletal material Moore (1894:49-63) sent to the U.S.
Army Medical Museum. William T. Lion, of the Medical Museum, has kindly
sent me mimeographed copies of early records of skeletal finds, notes, and
copy of a letter from Moore himself. One of the early entries lists a left tibia
(cat. no. 13379PS) which has erosion of the surface, thought at that time to be
from osteitis deformans. This specimen came from the brown sand layer of the
Tick Island mound. As to the Mound, Moore (1894:63) writes: "During our ex-
tended investigations in the Tick Island Mound absolutely nothing indicating con-
tact with the whites was met with, nor were objects of polished stone found other
than superficially. Today we can speak with even greater certainty as to its
antiquity. Because of such an early provenience, even these possible hints as to
inflammatory bone disease which might today be diagnosed as syphilis become
of interest.







PALE EPIDEMIOLOGY


Tick Island Archaic (Map 1, 4). The Tick Island Archaic site--about a
mile south of the Tick Island Mound referred to above---is a large and famous
site. The St. Johns periods (both early and late) are its most recent archae-
ological horizons. Three other major periods take it back to ancient milleniaa
the Florida Transitional(1000-500 B.C), the Orange, or fiber-tempered period,
which starts around 2000 B. C., and the preceramic Archaic--about 4000 B. C.
(Bullen 1965). These periods were originally found in this stratigraphic se-
quence at the Tick Island Archaic site before a contractor completely removed it
ten to fifteen years ago. During that time, the Florida State Museum (Bullen
1962) carried out a salvage dig to preserve some data on the people of the
Archaic preceramic period.

Bones had been crushed by the weight of overlying deposits and cemented
together by calcium carbonates (dissolved shell) deposited by percolating rain-
water. Several striking instances of pathology are illustrated here (Figs. 14-18).
Surfaces of bones are often caked with fragments of shell and calcite. Some
bones are cemented together. However, even these preliminary problems
cannot hide the distribution of pathology. Even lacking a detailed radiographic
and microscopic study, photographs of these bones may add to our knowledge.
Therefore they are included at this time rather than delaying possible infer-
ences--or at least the stimulation for further research.

Photographs 14-16 show long bones of one skeleton (Ti-146). (Skulls are
crushed and not yet in condition for study.) Both tibiae (Fig. 14) are misshapen
with observable, but not extreme, enlargements. Fibulae (Fig. 15) are both
strikingly enlarged except at the proximal ends of the shafts. Cross-section
at a break shows growth of bone and encroachment on the medullary cavity.
Likewise, ulnae (Fig. 16) are enlarged and medullary cavity shows encroachment at a
cross-sectional break. Figures 17 and 18 show long bones of another striking
case (Ti-134). Tibiae and fibulae show a more advanced stage of the disease
than those of Ti-146 Cross sections at break are again of interest. Right
fibula (Fig. 18) is enlarged. Cross-sectional view down the medullary canal
shows growth of bone. Right ulna and right radius with cross-sectional view
at break shows pathological detail. (In looking at cross-sectional views, it
must be remembered that these are not photographs of "cross-sections, but
views of the broken bone with the shaft still present.)

These pathological bones--as well as other less striking instances--in
the skeletal finds from the preceramic Tick Island Archaic period deposits
appear to have the distribution of disease we have had pointed out as typical
of syphilis. Syphilis may have been present in a recognizable form as early as
3300 B. C. in Florida. This figure is the average of four radiocarbon dates
(M-1264/5/8/70), all in direct association with the narrow sand zone in which
these burials were found.


166










BULLPEN


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PALE EPIDEMIOLOGY


Fig. 15. Tick Island Archaic,
A Burial Ti-146: pathological
fibula and cross section at
break.

(Facing page) Fig. 14. Tick
Island Archaic, Burial Ti-
146: pathological tibiae,
(left to right) anterior,
Lateral, and posterior views.






DISCUSSION

Epidemiologists have repeated again
and again that syphilis appears most fre-
quently in an "urban" setting. Particular-
ly where there is trade or where groups
gather for ceremonial or recreational
purposes, venereal spread of disease is
more apt to occur. Cockburn (1967:51)
writes in Infectious Diseases: "Culture
patterns, civilizations, trade routes,
occupations, population sizes are all of
great importance. "

While Weeden Island centers did
not approach the size of great cities,
their culture was based on large ceremonial
complexes with satellite villages. Crystal
River was a civic center with long-distance
trade connections. They had imported mi-
ca, rock crystal, and copper that came
from the Great Lakes. Weeden Island was
the first culture to have close ceramic
relationships across the Gulf Coastal
Plain to Louisiana as evidenced by simi-


168








BULLPEN


*q
m
*r
*


Fig. 16. Tick Island Archaic, Burial Ti-146: pathological ulnae,
(left to right) lateral, posterior views; and cross section at break.


169


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-, s.







PALEOEPIDEMIOLOGY


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2


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*~ ir :


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&*"?


P';1`


x44~'


Fig. 17. Tick Island Archaic,
Burial Ti-134: pathological
left tibia and fibula with
cross sections at breaks
(scale in cm).


anterior


f~dr4


170


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interior


Fig. 18. Tick Island Archaic, Burial Ti-134: pathological right fibula with
cross section at break; right ulna; and right radius with its cross section
at break ( cemented fragment of pelvis not removed).


r -







PALEOEPIDEMIOLOGY


lar pottery types. The Lighthouse Mound was the largest mound on Amelia
Island. It was in contact with Georgia and with west central Florida.

That Safety Harbor period sites--with their larger populations--show
syphilis continuing after Weeden Island times should not surprise us.

Tick Island Archaic (3300 B C.) was long before the civic center, mound-
building era, but it was probably the largest site of its time period in Florida--
if not in the Southeast.

It would seem that the above findings are in accord with epidemiological
theory.

The data presented in this report clearly demonstrate the presence of
syphilis in Florida before the arrival of Europeans. Perhaps more important
is the discovery of similar syphilitic-type pathology in bones from Tick Island
Archaic dated by radiocarbon to around 3300 Bo Co




References Cited


Aegerter, Ernest, and John A. Kirkpatrick
1963 Orthopedic Diseases. W. B. Saunders. Philadelphia.

Bullen, Ripley P.
1962 Indian Burials at Tick Island. Year Book 1961, American
Philosophical Society, pp. 477-80. Philadelphia.
1969 Southern Limits of Timucua Territory. The Florida Historical
Quarterly, vol. 47, no. 4, pp. 414-19. Gainesville.
1965 Florida's Prehistory. Chapter 23 in Florida from Indian Trail
to Space Age, vol. 1, pp. 3051l6, by Tebeau, Carson; Chauvin,
Bullen, and Bullen. Southern Publishing Company. Delray Beach.

Bullen, Ripley P. and Adelaide K.
n.d. The Palmer Site, Osprey, Florida.

Bullen, Ripley P., and John W. Griffin
1952 An Archaeological Survey of Amelia Island, Florida. Florida
Anthropologist, vol. 5 nos. 3-4, pp. 37-62. Gainesville.

Cockburn, Aidan
1967 Paleoepidemiology. In Infectious Diseases, Their Evolution and
Eradication, A. Cockburn, editor, pp. 50-65. Springfield.


172







BULLPEN


Dailey, R. C.
1971 The Physical Anthropology of the Sowell Population. Paper pre-
sented at the 23rd Annual Meeting of the Florida Anthropological
Society. St. Petersburg, Florida.

DeJarnette, David L.
1952 Alabama Archeology: A Summary. In Archeology of the Eastern
United States, J. B. Griffin, editor, pp. 272-84. Chicago.

Griffin, James B.
1946 Cultural Change and Continuity in Eastern United States Archae-
ology. In Man in Northeastern North America, F. Johnson,
editor, pp. 37-95. Andover.

Haltom, W. L., and A. R. Shands, Jr.
1938 Evidences of Syphilis in Mound Builders' Bones. Archives of
Pathology, vol. 25, pp. 228-42. Chicago.


Hrdlicka, Ale
1922 The Anthropology of Florida. Publications of the Florida State
Historical Society, No. 1. DeLand.

Johnson, Lent C., Discussant.
1966 In Human Palaeopathology, pp. 68-81. Yale University Press.
New Haven.


Lamb, D. S.
1898


Precolumbian Syphilis. Proceedings of the American Anatomists,
vol. 10, pp. 63-69.


Lorant, Stefan
1946 The New World. Duell, Sloan and Pearce. New York.

Moore, Clarence B.
1894 Certain Sand Mounds of the St. John's River, Florida. Journal of
the Academy of Natural Sciences of Philadelphia, vol. 10, pt. 1,
pp. 4-103; pt. 2, 128-246. Philadelphia.
1896 Certain Florida Coast Mounds North of the St. Johns River. In
Additional Mounds of Duval and of Clay Counties, Florida.
Privately printed.
1902 Certain Aboriginal Remains of the Northwest Florida Coast, pt. 2.
Journal of the Academy of Natural Sciences of Philadelphia, vol.
12, pp. 125-358. Philadelphia.


173







REFERENCES CITED


1903 Certain Aboriginal Mounds of the Florida Central West-Coast.
Journal of the Academy of Natural Sciences of Philadelphia,
vol. 12, pt. 3, pp. 361-438. Philadelphia.
1907 Moundville Revisited. Crystal River Revisited. Journal of the
Academy of Natural Sciences of Philadelphia, vol. 13, pt. 3,
pp. 334-405, 406-25. Philadelphia.
1918 The Northwest Florida Coast Revisited. Journal of the Academy
of Natural Sciences of Philadelphia, vol. 16, pt. 4, pp. 513-77.
Philadelphia.
1922 Additional Mounds of Duval and Clay Counties, Florida. Indian
Notes and Monographs. Museum of the American Indian, Heye
Foundation. New York.

Percy, George, Calvin Jamison, Katherine Gagel, Robin Heath, and Mark
Gottlob.
1971 Preliminary Report on Recent Excavations at the Sowell Mound
(8By3), Bay County, Florida. Paper presented at the 23rd Annual
Meeting of the Florida Anthropological Society. St. Petersburg,
Florida.

Sears, William H.
1959 Two Weeden Island Period Burial Mounds, Florida. Contributions
of the Florida State Museum, Social Sciences, no. 5. Gainesville.
1967 The Tierra Verde Burial Mound. Florida Anthropologist,
vol. 20, nos. 1-2, pp. 25-73. Tallahassee.

Snow, Charles E.
1962 Indian Burials from St. Petersburg, Florida. Contributions of
the Florida State Museum, Social Sciences, no. 8. Gainesville.

Walker, John W. and Joseph A. Murciak
1971 A Preliminary Report on the Andrews Site, Houston County,
Georgia, and Its Significance to the Study of Weeden Island
Culture. Paper presented at the 28th Southeastern Archae-
ological Conference. Macon.

Willey, Gordon R.
1949 Archeology of the Florida Gulf Coast. Smithsonian Miscellaneous
Collections, vol. 113. Washington.

Williams, Herbert U.
1932 The Origin and Antiquity of Syphilis: The Evidence from Diseased
Bones. Archives of Pathology, vol. 13, pp. 931-814, 931-983.
Chicago.


174










TREPONEMA T OSIS


Lyman O. Warren


The data presented in the previous paper (Bullen 1972) enable us to make
the claim for the presence in Florida of syphilis or a disease very much like
it in- pre-Columbian times. Furthermore, as Bullen points out, it would seem
that this disease flourished in a Weeden Island and Safety Harbor period setting,
roughly from about 700 to 1492 A. D.

Syphilis and other treponematoses

When we, in this country think of syphilis, we think of a disease con-
tracted through sexual exposure, that is venereal syphilis. However, there
are three diseases very similar to venereal syphilis which are acquired in
non-venereal ways. These are yaws, endemic syphilis, and pinta. These four
are sometimes referred to as the treponematoses by those who like to accen-
tuate their differences, and as treponematosis, by those who are more im*
pressed with their similarities.

Yaws Figures 1-2

Yaws, historically, has been a disease of dark skinned people--
children especially -- living in the tropics, under conditions of high heat and
humidity, heavy rainfall, and a dense, humus type top soil. It is transmitted
by skin contact, from child to child and from child to adult, and at times per-
haps, by an insect vector, as by the gnat, Hippelates palipes, in Jamaica.
The skeletal roentgenography has been described by C. J. Hackett in his "Bone
Lesions of Yaws in Uganda", It is of importance to archaeologists that the bone
lesions of yaws may be mistaken for those of syphilis.

Endemic Syphilis Figure 3

The term "endemic syphilis" was introduced by Ellis Herndon Hudson in
several articles and in his book of the same title, following 12 years experience
in a clinic sponsored by the Presbyterian Church in Deir es Zor, Syria. Endem-
ic syphilis existed in a pastoral setting among Bedouins in a context of poverty,
filth, congested living quarters and sexual innocence. The reservoir in children,
and transmission, as in yaws, was from child to child, and child to adult. Le-
sions were confined, for the most part, to the moist areas of the body -- mouth,
nares, peri-anal region and intertrigenous folds. In this, the distribution dif-
fered from yaws, which involved the skin everywhere. Hudson thought that the
dry climate and temperature changes--from night to day and season to season--
175
Florida Anthropologist, vol. 25, no. 4, December 1972













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TREPONEMATOSIS


accounted for the bodily distribution of lesions. The Bedouins were as little
concerned with the condition, as a skin condition, as we might be with acne,
and their name for it, "bejel", "beshel", or "belesh" translates as "the
sore". They showed no shame in discussing the condition, as they did for
venereal syphilis, which they recognized as something different, and called
"franji", the Frankish or French disease, which they attributed, correctly,
to loose living.

Hudson felt that endemic syphilis lay somewhere on a continnum between
yaws and venereal syphilis from an evolutionary standpoint, and went on to de-
velop the "Unitarian Theory" for the four treponematoses (yaws, endemic syph-
ilis, venereal syphilis and pinta). These four, he hypothesized, were, in fact,
one disease. He coined the term treponematosis for this entity and believed
that the four were due to one organism, the Treponema pallidum of syphilis.
The treponeme of yaws (T. pertenue) and of pinta (T. carate) would, by theory,
be variant strains of T. pallidum, as would be the treponeme responsible for
endemic syphilis. Venereal syphilis, he thought, was an index of urbanization.
It would appear whenever a primitive population threw off the rustic life and
became urban.

Implicit, but not completely spelled out in his book, Endemic Syphilis,
is the essential identity of the bony lesions of bejel and yaws, from both the
clinical and roentgenographic standpoints.

Pinta Figure 4

The last of the four treponematoses to be considered is pinta. The name
is Spanish and means "painted, referring to the piebald discoloration of its
victims. The disease exists primarily in American Indians of Latin America,
in particular Mexico, Columbia, and Ecuador. It is primarily a skin disease,
and does not involve bone, central nervous system, and aorta, as in venereal
syphilis; nor bone as in yaws and endemic syphilis. The causative organism,
T. carate, indistinguishable from the Treponema pallidum, seems to be the
mildest of the treponemes, with connotations of being so long adjusted to par-
asitizing humans as to be almost commensal, rather than pathogenic. From
this organism, because of its mildness, hopes have been raised to derive a
vaccine against syphilis and yaws. Pinta is a disease of poverty, ignorance,
and crowding and of rural rather than urban living. In this it resembles yaws
and bejel, but not venereal syphilis. Pinta has only been recognized as one of
the four treponematoses since 1939. Formerly it was considered a fungous
disease of the skin and indeed is sometimes associated with cutaneous mycoses.

Treponematosis Figure 5

All four diseases are caused by spirochaetes (treponemes) which have an


178




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identical appearance, identical serologic reactions, and almost identical cul-
tural requirements. These identities indicate an intimately inter-related group
with not only bacteriologic and serologic overlapping, but also clinical. For
example, Carl Weller described in Haiti what he considered aneurysmal dilata-
tion in yaws, but his critics said, and could not be disproved, that he was deal-
ing with unrecognized syphilis. Further, Hume, in Baltimore, observed a ne-
gress with clinical pinta who had never been 50 miles from Baltimore. Hume
considered this, too, was syphilis.

Altogether, Hudson' s term "Treponematosis" to cover the four diseases
(with the etiologic agent, T. pallidum responsible for all) has something to
recommend it, if not from the clinicians' viewpoint, from that of the archae-
ologist.

Variations in this disease, "Treponematosis, from region to region,
and from continent to continent, would be due to differences in gene pools,
climatologic differences, variations in living conditions, especially urbaniza-
tion, and so forth. Within the species of the Treponema pallidum there would
evolve, over time, strain differences, and evolution of the four diseases would
see to it that each world area would develop its own predominant disease, gen-
eralizing: yaws in Africa, bejel in Asia, pinta in the New World, venereal
syphilis in urban settings everywhere. Pinta, which we might term "Paleo-
Indian Syphilis, would have crossed the Bering land bridge 15, 000 years ago,
according to the "Evolutionary Theory" of Hackett, to wait through the millenia,
for the arrival, at the Spanish contact, of a non-immune gene pool.

The Columbian Theory

The Columbian Theory states that at the meeting of the cultures of the
Old and New World in 1493 and after, as part of the several features of the cul-
tural shock that took place then, there was an exchange of pathogens: the In-
dians received measles, malaria, and smallpox and the Europeans, the "great
pox, that is, venereal syphilis.

The evidence for the Columbian Theory lies in the medical literature,
archaeologic finds, and in clinical data. The medical literature of Europe,
which had been silent prior to 1493, flourished vigorously thereafter and con-
tinued on for 40 or 50 years. There was no doubt in the minds of the medical
men of those times: a new disease, at first without a name, later to be termed
"syphiliis" by the physician Fracastorius, had explosively appeared in Europe,
and had probably been introduced from the New World. "The Indians had been
infected since time immemorial" wrote Ruy Diaz de Isla, an exceptionally
acute Spanish practitioner of that period. (See Figures 6-9)

The archaeologic data consists of two bodies of evidence, one from the


180







WARREN


New World and one from the Old. The New World data is the presence of
"syphilitic" bone disease in pre-Columbian Indian skeletons, both in the north-
ern and southern hemispheres. The Old World data is of a negative kind: no
syphilitic bone changes have been discovered in Old World cemeteries (with
the possible exception of mild tibial and frontal osteitis in Saxon agricultur-
alists from East Anglia.) For example, a recent study, Angel' s People of
Lerna, involving over 250 Greek skeletons, of the Bronze Age especially,
reports considerable porotic hyperostosis but no syphilis. Moreover, twenty-
five thousand skulls of Egyptian mummies examined by Elliott Smith and Wood
Jones almost 50 years ago were devoid of syphilitic changes. No doubt, more
Old World data are needed, perhaps in particular, roentgenographic, to pick
up milder changes.

The clinical evidence, carrying connotations of incomplete immunity
built up by prolonged exposure, is that of Shattuck (1938) who wrote that the
modern Indians of Mexico and Central America had (1) a low incidence of syph-
ilis, (2) a high degree of latency, and (3) an almost complete absence of internal
organ involvement. And Oviedo, in his Natural History of the West Indies, com-
mented on the mildness of the disease in 16th century circum-Caribbean Indians
as contrasted with the severity in Spaniards. Parenthetically, Oviedo' s obser-
vations of non-venereal (as well as venereal) transmission recall Hudson' s
findings in endemic syphilis in Syria; unfortunately, Oviedo did not comment
on the presence or absence of the disease in children of the Indians.

Strain changes within the species Treponema pallidum
and the Modified Columbian Theory

While improved immunologic responses in the Indian population are hypo-
thesized by Shattuck and hinted at by Oviedo, more recent theorizing has been
directed toward the likelihood of strain differences arising within the species
Treponema pallidum in various parts of the world. The modified Columbian
theory suggests that while syphilis existed in pre-Columbian Europe, the strain
of T. pallidum responsible for it had become attenuated through the centuries and
that the new disease of 1493 and after did not represent so much an introduction
of a different organism as a more virulent strain of the old one. For example,
Hans Zinsser (1940) states that "it is not at all unlikely that a mild form of
syphilis occurred all over the world, including China (according to Dudgeon)
and Japan (according to Scheube), long before the 15th century". Moreover,
T. Dale Stewart (1952) considered it plausible "that Europe and America each
had its own variety of syphilis and therefore may have exchanged treponemata
for which the recipient populations lacked immunity. "

A short digression may enlighten the subject. Quite recently, it has been
shown that strains of Escherichia coli--- the generally inoffensive and ubiquitous
colon bacillus---- can be responsiTe for clinical outbreaks of diarrhoea, not


181







TREPONEMATOSIS


I -- aFig. 8. Title page from Sleber's Syphilis, 1497
Fig. 7. Syphilis, 1496, or 1498. Probably the earliest illustration of
Albert DUrer (Bloch.) syphilis ( Bloch.)


only in infants, but also in tourists. In Mexico, for example, these virulent
strains, which do not give the local population any trouble, may be responsible
for "La Turista, with varying degrees of crippling, usually mild, in tourists.
It is a fact that virulent strains of E. coli have been shown recently to cause
diarrhea in tourists (soldiers) to southeast Asia and Aden. This concept of
pathogenic strains elsewhere is useful on returning to consider the Treponema
pallidum, particularly with respect to its pathogenicity for bone.


182







WARREN


A g Fig. 9. Title page from
Grunpeck's Tractatus de
.. pestilentiale: Scorra sive
mala de Frangos, 1496(?)


















Diagnosis of Treponematosis of Bone

All three diseases, yaws, endemic syphilis and venereal syphilis affect
bone somewhat similarly, while pinta does not involve it at all. Some author-
ities feel thatthe bony manifestations of the three diseases cannot be differen-
tiated. Hackett (1951) states, for example: "In short, it may be said that apart
from the absence of osteochondritis in yaws, there are probably no bone lesions
that occur in one disease that may not be observed in the other" [with the ex-
ception of stellate scars (see pp. 135-37 above), ed.]. We are therefore undoubtedly
on safer grounds if, instead of talking of syphilis, we speak of treponematosis.
Theoretically this diagnosis should not be difficult.

In a single bone the grossly visible pathologic features of "yaws-syphilis"


183







TREPONEMATOSIS


are similar. All three anatomic components of the bone are involved: perio-
steum, cortex, and marrow. Thus we see (1) periosteal elevation and sub-peri-
osteal new bone formation; (2) cortical osteoporosis -- a unique system of pores
or porosities of the shaft of the bone, which Snow (1962) termed "coral bone";
and (3) an inner osteomyelitis affecting the marrow cavity.

In a single skeleton, treponematosis presents a characteristic, overall
distribution pattern: certain long (i. e. tubular) bones have a high incidence
of involvement, especially the tibia, clavicle, fibula, and femur. The skull,
too, especially the frontal bone, is frequently involved. A combination of skull
and bilateral tibial involvement is particularly to be looked for. The degree of
disease may vary from a mild periostitis or roughening to extensive destruc-
tion. In the case of tibias, anterior build-up of bone produces an effect which
formerly was referred to as "saber shins. "

Finally, if there is a sizable percentage of the total skeletal population
of a cemetery or mound which shows (1) the typical bone pathology for the
single bone, and (2) the typical distribution of pathology for the single skeleton,
we can add this third factor, the demographic data, to our diagnostic formula,
and ascribe the disease we are witnessing, with almost complete assurance, to
treponematosis. Table I shows radiographic evidence of venereal syphilis in
bones of 67 patients of Nashville, Tennessee (Kampmeier 1964). The table sug-
gests that a mixed group of bones as from a charnel house might present quanti-
tative data for treponematosis.

Table I-Bones showing Radiographic Evidence
of Venereal Syphilis in 67 Patients of
Nashville, Tenn. R.H. Kampmeier, 1964

Tibia 34 Ulna 3 Radius 1
Clavicle 17 Scapula 3 Metacarpal 1
Skull 15 Malar bone 2 Phalanx 1
Fibula 15 Mandible 2 Metatarsal 1
Femur 8 Facial bone 1 Phalanx 1
Humerus 5 Sternum 1 Ischium 1
Rib 4 Spine 1


Differentiating yaws and syphilis in bone

Although-the pathologic and roentgenographic pictures are identical in
yaws and syphilis, there are features which may enable a differentiation to be
made, as follows:

(1) Dactylitis (the fat phalanges of framboesia) is more common in yaws.
(2) Epiphysitis is more common in congenital syphilis.


184







WARREN


(3) "Goundou" (swollen maxilla) and "gangosa" (erosion of nasal bone)
are more often features of yaws.
(4) The peg incisor teeth of Hutchinson and "mulberry molars" are
features of congenital syphilis, not yaws. (Figures 11-12)
(5) Erosion of the anterior surface of the bodies of the thoracic verte-
brae, if present, would imply years of pounding by a contiguous aneu-
rysm, a stigma of syphilis, never of yaws.
(6) Charcot' s neurotrophic joints, which might be present as an ex-
tremely battered.pair of knee joints, would be a feature of neurosyph-
ilis, not yaws. (Figure 13)
(7) Finally, the skull in syphilis is said to show a worm-eaten appear-
ance of the outer table, whereas in yaws the destruction is said to be
punctate, not worm-eaten (Walter Putscher). (Figure 10)

No one, so far, has found evidence of neurosyphilis, aneurysm, or con-
genital syphilis in skeletal material from pre-Columbian American Indian
sources. This suggests, of course, that the strain of treponeme responsible
for the bone pathology did not have the appropriate chemistry to penetrate either
the blood brain barrier or placental barrier to produce central nervous system
or congenital syphilis. In this respect, the inferences we draw from Oviedo
and the clinical impressions of Shattuck may be correct, that the American In-
dian may have had an incomplete immunity for treponematosis as a result of
a long exposure to it.

Treponematosis and chronology in Florida

The data of the preceding paper (Bullen 1972) suggest that the greater
part of the bone treponematosis of Florida is a late phenomenon, i.e. Weeden
Island. Because of these facts we would like to bring in the unitarian hypo-
thesis of Hudson and others for a "Florida and Syphilis Hypothesis." The dis-
ease "Treponematosis", previously endemic as pinta or bejel, acquired
greater demographic significance in more extensively endemic or even epidemic
form for certain groups by Weeden Island times, specifically, increasing its
penetrance for bone. This was made possible by several late cultural develop-
ments including larger populations, more urban and ceremonial living, perhaps
with new religious importations, a change in dietary habits made possible by
agriculture, and opportunities of more contacts of people with people, some
of which may have been venereal. This may have taken place between 500 and
1000 A. D.

A gradual build-up of immunity over many generations saw to it that by
Spanish contact times treponematosis had become for the Florida Indians only
mildly pathogenic. But for the Spanish it would have been as virulent as "La
Turista" for us, only of infinitely more horrendous import. "Montezuma' s
Revenge" was not a virulent strain of Escherichia coli but of Treponema
pallidum.


185





'c~s.A.


, -


4 ~'


Fig. 10. Syphilitic skull, Peru (American Museum of
Natural History-Williams). Fig. 11. Peg-shaped in-
cisor teeth of Hutchinson. Fig. 12. Mulberry Molar
of Moon. Fig. 13. Charcot's neurotrophic knee joint.







WARREN


REFERENCES CITED

Angel, J. Lawrence
1971 The People of Lerna.
Smithsonian Institution Press. Washington.

Brothwell, Don and Sandison, A. T.
1967 Diseases in Antiquity. Springfield, Illinois.

Bullen, Adelaide K.
1972 Paleoepidemiology and Distribution of Prehistoric Treponemiasis
(Syphilis) in Florida. Florida Anthropologist, vol. 25, no. 4.

Fleming, William L.
1964 Syphilis Through the Ages. Medical Clinics of North America,
Vol. 48, pp. 587-612.

Hackett, C.I.
1951 Bone Lesions in Yaws in Uganda. Oxford.

Hudson, E.H.
1958 Non Venereal Syphilis. Williams and Wilkins. Baltimore.

1963 Treponematosis and Anthropology. Annals of Internal Medicine,
Vol. 58, No. 6, pp. 1037-1048.

Jarcho, S.
1966 Symposium on Human Paleopathology. National Academy of
Science, Washington, D. C. Yale University Press. New Haven.

Kampmeier, R.H.
1964 The Late Manifestations of Syphilis: Skeletal, Visceral, and
Cardiovascular. Medical Clinics of North America, Vol. 48.
pp. 667-697.
Leon, Luis A.
1969 Acotaciones Acerca del Carate o Mal del Pinto. Quito, Ecuador.

Morse, Dan
1969 Ancient Disease in the Midwest. Reports of Investigation, No. 15.
Illinois State Museum. Springfield, Ill.

Oviedo, G.F.
1959 Natural History of the West Indies. University of North Carolina
Studies in Romance Languages and Literatures. University of
North Carolina Press. Chapel Hill.







TREPONEMATOSIS


Sears, W.H.
1960 The Bayshore Homes Site, St. Petersburg, Florida. Contribu-
tions of the Florida State Museum, Social Sciences, No. 6.
Gaine sville.

Shattuck, George Cheever
1938 A Medical Survey of the Republic of Guatemala. Carnegie Institu-
tion of Washington. Washington.

Snow, C.E.
1962 Indian Burials from St. Petersburg, Florida. Contributions of
the Florida State Museum, Social Sciences, No. 8. Gainesville.

Stewart, T.D., and Lawrence G. Quade
1969 Lesions of the Frontal Bone in American Indians. American
Journal of Physical Anthropology, Vol. 30, No. 1, pp. 89-110.

Stewart, T. Dale
1971 Personal Communication

Willey, Gordon Randolph
1949 Archeology of the Florida Gulf Coast. Smithsonian Miscella-
neous Collections, Vol. 113. Smithsonian Institution.
Washington.

Williams, H. U.
1932 The Origin and Antiquity of Syphilis: The Evidence from
Diseased Bones. Archives of Pathology, Vol. 13, p. 779.

Zinsser, Hans
1940 Rats, Lice and History. Little, Brown and Company. Boston.


188











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