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Differential visibility of treponemal disease in pre-Columbian stratified societies Does rank matter.

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AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 144:185–195 (2011)
Differential Visibility of Treponemal Disease in PreColumbian Stratified Societies: Does Rank Matter?
Maria Ostendorf Smith,1* Tracy K. Betsinger,2 and Leslie Lea Williams3
1
Department of Sociology and Anthropology, Illinois State University, Normal, IL 61790-4660
Department of Anthropology, State University of New York College at Oneonta, Oneonta, NY 13820
3
Department of Anthropology, The Ohio State University, Columbus, Ohio 43210
2
KEY WORDS
treponematosis; status; Tennessee; Dallas phase; Mississippian Period
ABSTRACT
Treponemal disease is known to be
associated with the compromised community health of
permanent village settlement. This association explains
its high visibility in the village-based, arguably chiefdom level, agriculturalist societies of late prehistoric
(AD 1300–1600) North America. Within chiefdom-level
societies, health differences have often been demonstrated between mortuary-defined ‘‘elite’’ and ‘‘nonelite’’
individuals. This theoretically should predict statusbased differences in treponemal disease visibility. The
prediction is tested in a five-site osteological sample (N
5 650) from the Dallas phase (AD 1300–1550), a simple
mortuary-defined two-tiered presumptive chiefdom level
maize agriculturalist socioeconomic context from lower
east Tennessee. The Dallas phase results affirm a general pre-Colombian North American pattern of no sex
Tertiary stage and exclusively nonvenereal (yaws and/
or treponarid) treponemal disease are evident and ubiquitous in the osteoarchaeological record of late-prehistoric eastern North, America (Cook and Powell, 2005;
Powell and Cook, 2005a). This is particularly apparent
in the large sample of reported sites in the southeastern
United States (Bullen, 1972; Warren, 1972; Robbins,
1978; Eisenberg, 1986; Powell, 1986, 1988, 1991; Bogdan
and Weaver, 1988; Reichs, 1989; Ross-Stallings, 1989;
Hutchinson, 1993; Larsen et al., 2001; Cook, 2005; Cook
and Powell, 2005; Hutchinson et al., 2005; Powell et al.,
2005b; Weaver et al., 2005; Wilson, 2005; Hutchinson
and Norr, 2006; Hutchinson and Richman, 2006). This
visibility reflects the presence of epidemiological factors
conducive to treponemal disease endemicity: sedentism
and an aggregate settlement pattern (Aufderheide and
Rodrı́guez-Martı́n, 1998; Ortner, 2003; Cook and Powell,
2005; Powell and Cook, 2005a; Smith, 2006). The lateMississippian period (AD 1300–1550) in eastern North
America is characterized by an intensive maize agriculturalist subsistence strategy, a corollary of which is the
permanent village (Cook and Powell, 2005).
Additionally, the late-Mississippian period is associated with sociopolitical organization which includes a
differential mortuary treatment (mound versus village),
arguably indicating the presence of social elites of
ascribed and/or achieved status, which reflects some
manner of hierarchical and/or heterarchical power structure (Saxe, 1970; Peebles and Kus, 1977; Steponaitis,
1978; Bense, 1994; Chapman, 1994; Cobb, 2003; Pauketat, 2007). Health status differences have long been
observed between mound-interred (‘‘elite’’) and villageinterred (‘‘nonelite’’) individuals in the late-Mississippian
C 2010
V
WILEY-LISS, INC.
differences and display comparable adult to subadult
frequencies. The study also reveals that given a sufficient sample size, ‘‘elites’’ do indeed exhibit a significantly lower frequency of tertiary stage treponemal disease. This can be attributed to better baseline health,
which has been previously demonstrated in this sample.
It may also be affected by the mortuary inclusion of
achieved status individuals whose good health may
have facilitated sociopolitical advancement. Another
pattern that emerged is an apparent young adult age
bias in disease visibility. This suggests that tertiary treponemal disease morbidity may either directly or synergistically factor in early adult age at death. Future
research will address the veracity of this association.
Am J Phys Anthropol 144:185–195, 2011. V 2010 WileyC
Liss, Inc.
period; indeed, it has been the backbone of bioarchaeological inquiry for at least three decades (Buikstra and
Cook, 1980; Cohen and Armelagos, 1984; Powell, 1991;
Boyd, 1996; Danforth, 1999; Larsen, 1997, 2002; Steckel
and Rose, 2002). This interment-associated health disparity has also been amply demonstrated in studies of
east Tennessee late-Mississippian samples (Hatch and
Willey, 1974; Hatch, 1976; Guagliardo, 1980; Parham,
1982; Hatch et al., 1983; Jablonski, 1983; Scott, 1983;
Richardson, 1988; Betsinger, 2002; Betsinger and Smith,
2006, 2007, 2008; Vogel, 2007). In theory, the difference
in baseline health between the mound and village burials could translate into differential vulnerability and/or
differential morbidity to treponemal disease. A few studies in the Southeast have affirmed the sensitivity of treponemal disease to settlement patterning (Hutchinson et
al., 2005: 107–110; Wilson, 2005: 167; Smith, 2006).
However, no directed study has examined mortuary context defined social status as a health reflective parameter of epidemiological value. This is partly because the
mound-interred proportion of most Mississippian samples is small and subject to interment bias, resulting in
*Correspondence to: Maria Ostendorf Smith, Department of Sociology and Anthropology, Illinois State University, 332B Schroeder
Hall, Normal, IL 61790-4660. E-mail: msmith@ilstu.edu
Received 23 March 2010; accepted 22 June 2010
DOI 10.1002/ajpa.21381
Published online 25 August 2010 in Wiley Online Library
(wileyonlinelibrary.com).
186
M.O. SMITH ET AL.
Fig. 1. Map of east Tennessee indicating the locations of the five Dallas phase sites.
a mortuary population that is predominantly male with
few subadults. This can be remedied by a large multiplesite assessment. In east Tennessee, there is a large, multiple-site sample of mound plus village interments,
which date to the late-Mississippian (AD 1300–1550) period and belong to a single cultural phase (Dallas). Five
of these sites generated large osteological samples and
were canvassed for evidence of treponemal disease.
MATERIALS AND METHODS
The Dallas phase is a temporal and spatial cultural
context specific to the western flanks of the southern
Appalachian mountains of east Tennessee (see Fig. 1),
southeastern Kentucky, and northern Georgia. The economic and sociopolitical markers characteristic of the
late-Mississippian (AD 1300–1550) period are associated
with this phase. These include an intensive maize agriculturalist subsistence economy, residence patterning,
which includes permanent palisaded villages, and a central plaza flanked by one or more mounds within which
certain individuals were differentially interred. Mound
burials were routinely accompanied by relatively more
grave goods, often of nonlocal origin (Lewis and Kneberg, 1946; Hatch, 1976; Sabol, 1977; Scott, 1983; Polhemus, 1987; Chapman, 1994; Schroedl, 1998; Sullivan,
2001).
Treponemal disease is a chronic, infectious, nonpyogenic, and gummatous disease, transmitted by human
hosts. Based on epidemiological data, the nonvenereal
treponematoses are contracted in early childhood, and
breaks in the skin are the usual portals of entry (Aufderheide, and Rodrı́guez-Martı́n, 1998; Ortner, 2003; Powell
and Cook, 2005a). Paleopathological visibility is restricted to the osseous tertiary stage of the disease
American Journal of Physical Anthropology
which, of course, underestimates the true presence of
the disease in any prehistoric community.
Each skeleton in this study was examined for the presence of pathological change at three levels of treponemal
disease diagnostic reliability: ‘‘pathognomonic,’’ ‘‘indicative,’’ and ‘‘consistent with. ‘‘The pathognomonic (P) criteria are based on the progressive cranial lesion series
described by Hackett (1976: 30–46). These are the discrete superficial cranial lesion, the circumvallate cavitating lesion, stellate scarring, and the contiguous series of
lesions identified as caries sicca. Although gross nasopalatal remodeling (goundou-gangosa) is a diagnostic criterion of treponemal disease (Hackett, 1976: 65), in this
study, destruction per se was not identified as etiologically treponemal independent of corroborating pathognomonic lesions (e.g.,, circumvallate or stellate craniofacial
scarring). Postcranial pathological changes indicative (I)
of treponemal disease and diagnostically used in this
study in the absence of corroborating cranial evidence
are anterior bowing of the tibiae known as sabre shins
(true and pseudo-bowing) and nodes with cavitating
lesions on any long bone (Hackett, 1976; Aufderheide
and Rodrı́guez-Martı́n, 1998; Ortner, 2003). A few individuals who presented with predominantly, if not exclusively, noncavitating nodal lesions were subjectively
included as indicative cases if multiple bones were
involved. Pathological changes deemed consistent with
(CW), but not exclusive to, treponemal disease include
discrete surface nodes without cavitating lesions (Cook
and Powell, 2005: 457–462; Hackett, 1976: 84–85) in conjunction with advanced periostitis of long bone shafts.
These criteria were used in seven cases to support a diagnosis of probable treponemal disease. Individuals with
expanded long bone shafts without other indicative or
consistent with criteria were not diagnosed as trepone-
187
TREPONEMAL DISEASE VISIBILITY IN STRATIFIED SOCIETIES
TABLE 1. Sample demography by mortuary context
Subadults
Males
Females
Unsexable adults
Site
YS
OS
YA
MA
OA
A
YA
MA
OA
A
YA
MA
OA
A
Unsexable/
unageable
Total
Village Citico
Cox
Hiwassee Is
Sale Creek
Toqua
Mound Citico
Cox
Hiwassee Is
Sale Creek
Toqua
Total
16
47
37
8
48
0
6
4
0
2
168
5
10
3
2
6
0
2
1
1
2
32
8
19
6
3
8
1
8
1
1
2
57
16
4
4
8
27
0
2
3
4
6
74
1
0
2
0
3
0
0
0
0
0
6
2
26
4
2
1
0
11
0
1
3
50
10
13
17
1
11
1
2
0
2
3
60
20
3
12
7
21
0
2
3
1
2
71
2
0
5
0
6
0
0
0
0
0
13
4
26
2
3
5
1
9
0
0
2
52
1
2
0
0
1
0
1
1
1
0
7
1
0
0
0
2
0
0
0
0
1
4
0
0
0
0
0
0
0
0
0
1
1
1
17
1
1
5
1
7
0
0
7
40
0
9
0
0
0
0
1
0
0
0
10
87
176
93
35
144
4
51
13
11
31
645a
YS, young subadults, 2–13 years; OS, older subadults, 14–18 years; YA, young adults, 18–34 years; MA, middle-aged adults, 35–49
years; OA, older/mature adults, 501 years; A, adult, 181 years.
a
Excluding five unprovenienced individuals: one from Sale Creek (older adult male) and four from Hiwassee Island (1 older subadult, 3 young adult females).
mal. Nondiagnostic periostitis on any and all bones was
also recorded.
Five Dallas phase sites yielding a total of 650 human
skeletal remains were examined (Table 1). The age and
sex information were provided by a permanent data
bank managed by the F. H. McClung Museum, Knoxville, TN [see Smith (2006)]. The sample was in good to
excellent condition, that is, cortices were not eroded or
exfoliated. To increase the reliability of the nonpathological sample size, a minimum preservation threshold was
set at 50-plus percent of the calotte, three upper limb
diaphyses, and three lower limb nonfibular diaphyses.
For epidemiological reasons, the infant component (less
than two years of age) was not included. In an effort to
distinguish between possible status differences in childhood, treponemal morbidity and the subadults were subdivided into a younger (2–13 years) and an older (14–
\18 years) cohort. Adults were likewise subdivided into
broad age cohorts: young (18–34, years), middle aged
(35–49 years), and mature (50 plus years).
The nonparametric statistical tests used were chisquare when sampling units were above five cases and
Fisher’s exact test when they fell below. Confidence level
was set at 95%.
RESULTS
From the combined provenienced and unprovenienced
sample of 650 individuals, at least 37 (5.7%) and a maximum of 44 (6.8%) individuals are identified as supportable cases of treponemal disease (Table 2). The minimum
frequency consists of individuals displaying pathological
changes pathognomonic (P) or indicative (I) of treponemal infection. The maximum frequency includes seven
cases displaying pathological changes (e.g., healed
nodes), which are consistent with (CW) treponematosis
but do not ultimately exclude other diseases. In the
adult (181 years of age) component of the combined
sample, 7.5% (33/439, P 1 I) to 8.7% (38/439, P 1 I 1
CW) of the adults are identified as displaying treponemal disease (Table 3). In the subadult category (2 years
to \18 years), 2.0% (4/201, P 1 I) to 3.0% (6/201, P 1 I
1 CW) have treponemal disease.
Craniofacial treponemal cases
The 37 pathognomonic and indicative (P and I) cases
include five individuals who exhibit some combination of
the successive cranial lesions (i.e., the initial, discrete,
and contiguous, series) described by Hackett (1976). The
initial series of clustered pits is seen in two cases, both
male, Sale Creek Burial 4 (501 years old) and Toqua
Burial 357 (30–50 years old), who also exhibit discrete
series lesions of clustered pits and circumvallate scarring. The three remaining cases are also middle-aged
adults. Toqua Burial 430 (Fig. 2a) and Citico Burial 142
display cavitating lesions of the discrete series of lesions;
Citico Burial 142 also has stellate scarring. The frontal
bone of Toqua Burial 28 (Fig. 2b) is largely covered with
stellate depressions and rounded healed nodules reflective of the contiguous series of lesions (caries sicca)
described by Hackett.
This study pointedly examined the nasopalatal area
for evidence of treponemal associated pathological
remodeling (i.e., goundou or gangosa). Four cases in the
five-site sample of preserved paranasal facial bones (4/
224, 1.8%) display reactive remodeling of the nasal area.
Two individuals are from the Citico site sample and two
are from the Cox site sample (Table 2). A possible fifth
case with nasopalatal remodeling is the pathognomonic
case of Sale Creek Burial 4. The nasal bridge may have
been remodeled, but the contour is obscured by plaster
and shellac. Although traumatic injury, disseminated
rhinitis, or paranasal neoplastic disease can also result
in paranasal bone damage, the four identified cases display the kind of osteitic changes attributed to treponemal disease (Delahaye et al., 1968; Kanan et al., 1971;
Draws et al., 1988). Citico Burial 142 (Fig. 3a), previously identified as having cavitating cranial lesions, has
thickened nasal bones, a rounded inferior nasal margin
and a laterally expanded nasal aperture. Citico Burial
192 (Fig. 3b) also has rounded nasal processes of the
maxilla as well as an obliteratively remodeled nasal
bridge flanked by porotic pitting. The treponemal etiology of the remodeling is evident by the distinct stellate
scars near nasion (Fig. 3c) and on the right malar bone
(Fig. 3d). Burial 192 also has periosteal plaques on the
anterior surface of both tibiae. Cox Burial 6, a 25–35year-old male, has a depressed nasal bridge and remodeled superior-lateral nasal margins, the treponemal etiology of which is suggested by cavitating lesions on the
palate, expanded diaphysis of the left clavicle, cavitating
lesions on the right and cavitating nodes on the left humerus, and at least one rib fragment with a cavitating
lesion. Additional pathological changes on this burial
consistent with treponemal disease consist of a noncaviAmerican Journal of Physical Anthropology
188
M.O. SMITH ET AL.
TABLE 2. Treponemal cases
Demographic
Skeletal elements
involved
Site-case
Context
Treponemal determination
Citico–4
Citico–14
V
V
Subadult, 5–6
Male, 35–49 (MA)
Tibia
Femur, tibia, ribs
Citico–106
Citico–142
V
V
Male, 35–49 (MA)
Female, 30–40 (MA)
Tibia
Cranium, femur, tibia
Citico–163
Citico–192
V
V
Female, 35–49 (MA)
Female, 35–49 (MA)
Femur, tibia
Nasals, tibia
Citico–195A
Citico–196
V
V
Female, 35–49
Male, 20–30 (YA)
Cox–6
V
Male, 25–35 (YA)
Cox–92
Cox–94
Cox–100
Cox–122
Cox–126A
Cox–128
Cox–139
V
V
V
V
V
V
V
Female, 201 (A)
Female, adult (A)
Subadult, 10–13
Male, adult (A)
Male, 24–36 (YA)
Male, 25–30 (YA)
Male, 241 (A)
Tibia
Clavicle, humerus,
femur, tibia, fibula
Nasals, clavicle, scapula,
humerus, femur, tibia, ribs
Radius, tibia
Tibia
Tibia
Clavicle, humerus, ulna, tibia
Clavicle, radius, femur, tibia
Tibia
Facial bones, humerus, tibia
Cox–166
Cox–181
Cox–191
Cox–192
Hiw–7
Hiw–8
Hiw–10
Hiw–15B
V
V
V
V
V
V
V
V
Female, 251 (A)
Male, 23–39 (YA)
Subadult, 15–19
Female, 17–22 (YA)
Female, 18–23 (YA)
Subadult, 10
Female, 20–30 (YA)
Male, 291 (A)
Clavicle, femur, tibia
Tibia
Tibia, fibula
Clavicle, radius, ulna, tibia
Clavicle, ulna, tibia
Tibia
Tibia
Clavicle, tibia
Hiw–23
V
Female, 18–23 (YA)
Hiw–53
Hiw–69
Hiw–96
Hiw–102
Hiw–104
Sale Cr–4
Toqua–28
Toqua–47
Toqua–103
Toqua–129
V
V
V
V
V
U
M
V
M
V
Female, 35–45 (MA)
Male, 20–25 (YA)
Female, 35–49 (MA)
Female 23–28 (YA)
Female, 35–40 (MA)
Male, 501 (OA)
Male, 35–49 (MA)
Female, 18–23 (YA)
Male, 35–49 (MA)
Undetermined, adult (A)
Toqua–167
Toqua–180
Toqua–238
V
V
V
Male, 25–30 (YA)
Female, 35–49 (MA)
Subadult, 12–15
Clavicle, humerus, radius,
femur, fibula, tibia
Clavicle, tibia
Ulna, tibia
Tibia
Femur, tibia
Clavicle, ulna, tibia
Cranium
Cranium, humerus, femur, tibia
Cranium, tibia
Tibia
Clavicle, radius, ulna,
humerus, femur, tibia
Tibia
Clavicle, tibia
Femur, tibia
Toqua–244
Toqua–249
Toqua–254
Toqua–357
V
V
V
V
Male, 501 (OA)
Subadult, 6.5–7.5
Male, 35–49 (MA)
Male, 35–49 (MA)
Tibia
Tibia
Tibia
Cranium, tibia
Toqua–423
Toqua–430
V
V
Undetermined, adult (A)
Male, 35–49 (MA)
Tibia, fibula
Cranium, femur, tibia
CW (anterior expansion w lesions)
I (sabre shin, cavitating nodes, shaft
expansion, periosteal plaques)
CW (bilateral anterior expansion)
P (stellate scar, cavitating lesion,
remodeled nasal margins, periosteal
plaque)
I (cavitating node, periosteal plaque)
I (remodeled nasal margins, periosteal
plaque)
I (sabre shin)
I (cavitating nodes, shaft expansion)
I (cavitating nodes; remodeled nasal
margins, periosteal plaque)
I (cavitating node)
I (nodal anterior expansion)
I (sabre shin)
I (cavitating node, shaft expansion)
I (cavitating node, periosteal plaque)
I (anterior nodal expansion)
I (cavitating node, remodeled nasal
margins)
I (cavitating node, shaft expansion)
I (cavitating node)
I (nodal anterior tibial expansion)
I (cavitating node, shaft expansion)
I (nodal lesion, anterior tibial expansion)
CW (anterior expansion)
CW (anterior expansion)
CW (anterior tibial expansion, possible
lesion)
I (cavitating node, shaft expansion)
I (cavitating node, shaft expansion)
CW (anterior tibial expansion)
I (sabre shin)
I (nodal lesion)
I (cavitating node, shaft expansion)
P (circumvallate scar)
P (stellate scar, shaft expansion)
P (stellate scar, nodal lesion)
I (multiple nodal lesions)
I (bilateral nodal lesions,
shaft expansion)
I (cavitating node)
CW (anterior tibial expansion)
I (bilateral multiple nodal lesions, shaft
expansion)
I (sabre shin, nodal lesion)
I (sabre shin)
I (sabre shin, nodal lesion)
P (stellate scar, cavitating node, sabre
shin)
I (sabre shin)
I (cavitating node, nodal lesion)
M, mound; V, village; U, undetermined; for Treponemal Determination: P, pathognomonic; I, indicative; CW, consistent with; w, with;
for Demographic: A, adult; YA, young adult; MA, middle-aged adult; OA, older adult.
tating node on the mid-diaphysis of the left femur and
elevated areas of periosteal plaque on both tibiae. Cox
Burial 139, an adult age-indeterminate male, also exhibits a rounded, inferior nasal margin. Postcranially, this
individual has multiple cavitating nodes on the right humerus and cavitating nodes on both tibiae which are
pathological changes indicative of treponemal disease.
American Journal of Physical Anthropology
Postcranial treponemal cases
Pathological changes of the postcrania indicative of
treponemal disease include anterior, ‘‘bowing’’ of the
tibiae (sabre shins) by differential periosteal deposition
or abnormal growth and, cavitating nodes on the long
bones or ribs (Ortner, 2003: 286, 294–296). Thirty-three
189
TREPONEMAL DISEASE VISIBILITY IN STRATIFIED SOCIETIES
TABLE 3. Treponemal cases by site and age groups
Site
Age group
Citico
Adults
Subadults
Total
Adults
Subadults
Total
Adults
Subadults
Total
Adults
Subadults
Total
Adults
Subadults
Total
Adults
Subadults
Total
Coxa
Hiwassee Islandb
Sale Creekb
Toqua
TOTAL
P
1/70
0/21
1/91
0/152
0/65
0/217
0/61
0/45
0/106
1/39
0/12
1/51
3/117
0/58
3/175
5/439
0/201
5/640
(1.4%)
(0%)
(1.1%)
(0%)
(0%)
(0%)
(0%)
(0%)
(0%)
(2.6%)
(0%)
(2.0%)
(2.6%)
(0%)
(1.7%)
(1.1%)
(0%)
(0.8%)
I
5/70
0/21
6/91
10/152
2/65
12/217
6/61
0/45
6/106
0/39
0/12
0/51
7/117
2/58
10/175
28/439
4/201
32/640
CW
(7.1%)
(0%)
(6.6%)
(6.6%)
(3.1%)
(5.5%)
(9.8%)
(0%)
(5.7%)
(0%)
(0%)
(0%)
(6.0%)
(3.4%)
(5.7%)
(6.4%)
(2.0%)
(5.0%)
1/70
1/21
2/91
0/152
0/65
0/217
3/61
1/45
4/106
0/39
0/12
0/51
1/117
0/58
1/175
5/439
2/201
7/640
(1.4%
(4.8%)
(2.2%)
(0%)
(0%)
(0%)
(4.9%)
(2.2%)
(3.8%)
(0%)
(0%)
(0%)
(0.9%)
(0%)
(0.6%)
(1.1%)
(1.0%)
(1.1%)
P1I
6/70
0/21
6/91
10/152
2/65
12/217
6/61
0/45
6/106
1/39
0/12
1/51
10/117
2/58
12/175
33/439
4/201
37/640
(8.6%)
(0%)
(6.6%)
(6.6%)
(3.1%)
(5.5%)
(9.8%)
(0%)
(5.7%)
(2.6%)
(0%)
(2.0%)
(8.5%)
(3.4%)
(6.9%)
(7.5%)
(2.0%)
(5.8%)
P 1 I 1 CW
7/70
1/21
8/91
10/150
2/65
12/215
9/61
1/45
10/106
1/39
0/12
1/51
11/117
2/58
13/175
38/439
6/201
44/640
(10%)
(4.8%)
(8.8%)
(6.7%)
(3.1%)
(5.6%)
(14.8%)
(2.2%)
(9.4%)
(2.6%)
(0%)
(2.0%)
(9.4%)
(3.4%)
(7.4%)
(8.7%)
(3.0%)
(6.9%)
P, pathognomonic; I, indicative; CW, consistent with.
a
Excludes 10 unageable/unsexable individuals who were not included in sex or age statistical computations.
b
Includes unprovenienced individuals.
Fig. 2. Pathognomonic lesions on the frontal bones of Toqua Burial 430 (a) and Toqua Burial 28 (b).
individuals, exhibit postcranial changes indicative of
treponematosis; four of these additionally exhibit cranial
lesions. The indicative pathological change of sabre shins
is present in nine individuals. For six of these, anterior
bowing is the only presenting pathology. The three other
individuals display reactive changes elsewhere on the
skeleton: Toqua Burial 357 has pathognomonic cranial
lesions, Citico Burial 14 has an expanded distal left
femur, and, along with Toqua Burial 244, has cavitating
rib lesions. One individual (Toqua 254) with sabre shins
also displays additional nodal lesions on these bones.
One of the subadults, Toqua Burial 249, is the only individual with the abnormally stimulated growth of ‘‘true’’
sabre shins.
For 15 individuals of the collective sample, the primary diagnostic criterion is the treponemal disease-indicative cavitating node on one or more of the long bones
(Hackett, 1976: 82, 93–97; Ortner, 2003: 286). At the Cox
site, six of the 12 treponemal cases have cavitating nodal
lesions as the primary presenting pathology (Fig. 4a).
Four individuals have nodal lesions on multiple bones
and two individuals (Burials 181 and 192) have cavitating nodal lesions exclusively on the tibiae. In the Citico
sample, two individuals (Burials 163 and 196) exhibit
cavitating lesions as the primary diagnostic pathology.
Burial 196 displays clavicular and humeral cavitating
lesions. Preservation of Burial 163 restricted the evidence to the multiple cavitating nodes on the tibiae. At
Hiwassee Island, three individuals were diagnosed on
the basis of cavitating nodal lesions on at least one bone.
All three have clavicle and tibia involvement, and two of
these have other affected bones. At Toqua, four individuals display cavitating nodes. Two of these individuals
were diagnosed exclusively by the presence of a cavitating node. Toqua Burial 167 has a single cavitating node
on a tibia (Fig. 4b) in contrast to Burial 129, who has
nodal lesions on the clavicles, humerus, forearms, femora, and tibiae.
Healed nodes (Fig. 4c) are consistent with but not
exclusive to treponemal disease (Hackett, 1976: 82–90).
Seven individuals exhibit distinct nodes, which, based on
the pattern of bone involvement, are considered here to
be likely cases of treponemal disease. Healed tibial nodes
are the only pathological change on four of the seven.
These four consist of two well-preserved individuals from
the Cox site, a third poorly preserved Cox individual,
American Journal of Physical Anthropology
190
M.O. SMITH ET AL.
Fig. 3. Citico Burials 142 (a) and 192 (b) illustrate remodeled nasal margins. The treponemal-specific periostitis on Burial 142
is multiple cavitating cranial lesions and stellate scars and, on Burial 192, stellate scars on the nasal bridge (c) and right zygomatic
bone (d).
and Toqua, Burial 103, who has no upper limb data and
nonpathological femora. The other three burials display
periostitic remodeling on other bones. One is a well-preserved subadult from the Toqua sample (Burial 238),
who displays no upper body pathological changes but
does have an expanded right femoral shaft. The two
other cases are from the Hiwassee Island site. In addition to the healed tibial nodes, Hiwassee Island Burial 7
has bilateral expansion of both clavicles and an
expanded distal left ulnar shaft (a possible sequella of
traumatic injury). Hiwassee Island Burial, 102 has periostitis on the left femoral diaphysis. The addition of
these seven individuals to the 37 cases identified as
either pathognomonic or indicative (P 1 I) for treponemal disease elevates the sample to 44 and increases the
total sample frequency to 7%.
Of the less than 20 arguable (i.e., P 1 I) treponemal
cases with preserved rib bone fragments, four individuals have at least one rib lesion (Fig. 4d). No other individual from any of these samples displays reactive bone
on any rib.
Mound and village treponemal cases
Of the entire sample of 650 individuals, 110 are
mound burials, 535 are village interments, and 5 individuals, including one that is a pathognomonic treponeAmerican Journal of Physical Anthropology
mal case, are unprovenienced. Approximately 68% (439
of 650) of the total sample is adult (i.e., 181 years of
age). Ninety-one of these adults are mound interments
and consist of 43 males, 28 females, and 20 skeletally
unsexable adults (Table 1). The 13 remaining mound
interments are subadults (i.e., 2–18 years of age) and
reflect 12% of the mound sample. Five of these moundinterred subadults are sexable adolescents. Two mound
burials, or 1.8% of the total sample, are arguable cases
of treponemal disease. Both individuals are middle-aged
(i.e., 35–50 years of age) males, and both are from the
Toqua sample. Burials 28 and 103 display reactive
changes pathognomonic for and consistent with a diagnosis of treponemal disease, respectively. The two cases
represent 4.7% of the mound male sample and 2.2% of
the mound-interred adults.
Of the ageable mound-interred adult sample, 19 or
41% (19/46) are ‘‘young adult’’ or under 35 years of age,
and the remaining 27 individuals (59%) are ‘‘middle age’’
(35–50 years of age). The P and CW treponemal cases
discussed earlier are 2 of 27 or 7% of the middle-aged
cohort. Despite the cases being the same sex and within
the same age cohort, there is no statistically significant
difference between the sexes or by age cohort.
In the village sample of 535 interments, 169 adult
individuals were sexed as female, 144 adults were sexed
as male, 41 individuals were sex-indeterminate, and 182
TREPONEMAL DISEASE VISIBILITY IN STRATIFIED SOCIETIES
191
Fig. 4. Nodal lesions. Cavitating nodes on the anterior tibiae of Cox Burial 192 (a) and the anterior right tibia of Toqua Burial
167 (b). An exemplary healed node (c) on the anterior tight tibia of Hiwassee Island Burial 104. Toqua Burial 430 displayed cavitating nodes on the left tibia, multiple pathognomonic cavitating lesions on the cranium, and cavitating lesions on several rib fragments (d).
individuals, including 17 sexable adolescents, are subadults. Forty-one individuals or 7.7% of the total sample,
have lesions which can support a diagnosis of treponemal disease. Of these, 34 (6.4%) are pathognomonic or
indicative cases. Of the sexable adult male sample, 13
individuals or 9.0% present with lesions that are pathognomonic or indicative for treponemal disease. Adding
the three males who display lesions categorized as consistent with the disease, the male cohort frequency
increases to 11.1%. From the sexable adult female
cohort, 15 cases (8.9%) display pathognomonic or indicative lesions and two have lesions consistent with the disease (17 of 68 or 10.1%). Of 182 village subadult interments, 6 individuals (3.3%) exhibit pathological changes
that are arguably treponemal (P 1 I 1 CW).
Because of provenience ambiguities, five individuals
are not included in the Tennessee mound/village statistical comparisons but are included in the total sample frequencies for interarea comparisons. These individuals
are one mature adult male from the Sale Creek sample
who displays pathognomonic skeletal change (circumvallate cranial lesions), and four individuals from the
Hiwassee Island sample: three young adult females and
one unsexable subadult (Table 1).
Mound-village comparisons
To minimize sampling error, as the individual mound
samples are small, primary statistical tests were under-
taken on the collective five-site sample. Concordant with
previous studies that tested for within sample sex difference in treponemal cases (Cook and Powell, 2005; Powell
and Cook, 2005a), there are no statistically significant
differences in the collective sample or within the mound
and the village samples (P values, ranging from 0.5155 to
0.9557). The tests were conducted with and without the
cases deemed consistent with (CW) a diagnosis of treponemal disease and the 22 sexable adolescents.
A comparison of the total (i.e., P, I, and CW) treponemal case frequency between the collective mound sample
and the collective village sample yields a statistically significant difference (P 5 0.0207) (Table 4). When the test
is restricted to the adult component (total provenienced
N 5 435), pathognomonic and indicative (P 1 I) case frequencies become statistically significant (P 5 0.0402).
When the total mound to village subadults (total provenienced N 5 200) are compared, neither the number of P
and I cases nor the addition of the CW cases result in a
statistically significant test (Table 4). Sampling bias in
the median age of mound subadult interments compared
to the village subadult median age may obscure status
differences, so the subadult age category was subdivided
into a younger (2–13 years of age) and older cohort (14–
18 years of age). No statistically significant differences
emerge for either test (Table 4). However, these results
should be considered tentative as few subadults were
diagnosed with treponemal disease and few subadults
were interred in the mound.
American Journal of Physical Anthropology
192
M.O. SMITH ET AL.
TABLE 4. Status-based comparisons of treponemal disease
Pathognomonic
and indicative
Site
All sites combined
Mound
Village
P-value
All sites combined
Mound
Village
P-value
All sites combined
Mound
Village
P-value
All sites combined
Mound
Village
P-value
All sites combined
Mound
Village
P-value
All sites combined
Mound
Village
P-value
All sites combined
Mound
Village
p-value
(all demographic groups)
2/110 (1.8%)
34/535 (6.4%)
0.0670**
(adults)
2/91 (2.2%)
30/344 (8.7%)
0.0402*
(young adults)
0/24 (0%)
11/100 (11.0%)
0.1235
(middle-aged adults)y
2/24 (8.3%)
11/125 (8.8%)
1.0000
(subadults)
0/18 (0%)
4/182 (2.2%)
1.0000
(younger subadults)
0/12 (0%)
2/156 (1.3%)
1.0000
(older subadults)
0/6 (0%)
2/26 (7.7%)
1.0000
Pathognomonic,
indicative, and
consistent with
2/110 (1.8%)
41/535 (7.7%)
0.0207
2/91 (2.2%)
35/344 (10.2%)
0.0111*
0/24 (0%)
13/100 (13.0%)
0.1247
2/24 (8.3%)
13/125 (10.4%)
1.0000
0/18 (0%)
6/182 (3.3%)
1.0000
0/12 (0%)
4/156 (2.6%)
1.0000
0/6(0%)
2/26 (7.7%)
1.0000
* Significant at P \ 0.05 level, Fisher’s exact test.
**
Significant at P \ 0.10 level, Fisher’s exact test.
y
The old adult age category was not statistically analyzed due
to small sample size.
Age cohort comparisons
In late-Mississippian societies, mound interment has
axiomatically been implied to mean ascribed status, but
differential mortuary treatment of achieved status individuals by age and sex has been suggested for Dallas
phase sites (Scott, 1983; Sullivan, 2001, 2010). The
mound sample may therefore be biased by individual life
histories which may alter the median age (young vs.
mature) and/or the sex ratio, which can, in turn, affect
the visibility of particularly chronic disease processes.
Because there were no sex differences, all adults were
broadly segregated into young (18–34 years of age),
middle-aged (35–50 years of age), and old age (501
years of age) categories. Comparing the total adult
mound and total adult village samples by age cohort,
there were no significant differences with or without the
CW treponemal case frequencies between younger adults
or between middle-aged adults (Table 4). There were too
few old age individuals to statistically assess (Table 1).
Independent of mortuary context, it is possible that
age per se affects the visibility of chronic treponemal disease. Young adults are 19.1% (n 5 124) of all interments,
10.5% of which are arguable (i.e., P 1 I 1 CW) treponemal cases. Middle-aged adults are 52.4% of the total
sample, and 10.0% of which are in some way arguable
treponemal cases. Twenty individuals can be assigned to
the 501 age category and are 3.1% of the total sample.
Two individuals, or 10.0% of that age cohort, are arguably treponemal disease. There is no statistically signifiAmerican Journal of Physical Anthropology
cant difference between any of the age comparisons (P
values ranging from 0.4641 to 1.0000).
DISCUSSION
Most osteoarchaeological site samples yield a few individuals who display a particular array of bone changes
which are diagnostic for treponemal disease. This identification either demonstrates a presence of the disease or
its ubiquity, depending on the level of sedentism or aggregate village habitation that the sample reflects. Few
sample circumstances yield double digit case numbers
which would enable statistical evaluation. The paleoepidemiological value of the lower east Tennessee sample is
not only the number of cases, it is the tight temporal,
spatial, and sociosettlement context. That is, all the sites
are Dallas phase (AD 1300–1550) from the same steepsided riverine valley physiographic context of lower east
Tennessee, reflect the same sociopolitical organization,
and aggregate settlement pattern and subsistence strategy. The results of this multisite examination are consistent with many of the broad temporal and geographic
trends observed in the published literature. Specifically,
no statistically significant sex differences have been
observed in the published literature [see Cook and
Powell (2005) and Powell and Cook (2005a)], and none is
demonstrated here. This absence of sex difference mirrors the results of recent evaluations of other chronic
diseases in the Dallas sample [e.g., Betsinger (2002) and
Betsinger and Smith (2006, 2007)].
Another paleoepidemiological trend that the Dallas
phase data is comparable to is the adult to subadult case
frequency. The general pre-Columbian North American
pattern observed across four chronological periods
([1000 BC, 1000 BC–1000AD, 1000AD-Contact, and
post-Contact) is that adults display tertiary treponemal
disease approximately double the frequency of subadults
(10.6% vs. 5.1%) (Cook and Powell, 2005: 462). The raw
frequency of treponemal disease in the total Dallas subadult cohort (2–18 years of age) is between 2.0 and 3.0%;
the collective adult frequency is between 7.5 and 8.7%.
The generic continental pattern of treponemal disease
frequency over time as reported by Cook and Powell
(2005: 466) is an increase from 5% from Archaic period
([1000 BC) hunter–collector subsistence economies to
a post-1000 AD frequency for sedentary agriculturalists
of 9%. The temporal difference reflects the acknowledged sensitivity of treponemal disease to sedentism and
an aggregate village settlement pattern (Aufderheide
and Rodrı́guez-Martin, 1998; Cook and Powell, 2005;
Hutchinson et al., 2005; Larsen, 2002; Ortner, 2003;
Smith, 2006). The Dallas phase total sample frequency is
5–7%, with the adult involvement ranging between 7.6
and 8.7%. There are no Archaic period interments from
east Tennessee, but there is a late Woodland/early Mississippian (AD 700–1100) temporal horizon (the Hamilton Mortuary, Complex or HMC), geographically identical to the five Dallas phase sites reported here and characterized as having a dispersed settlement pattern
(Schroedl et al., 1990). Not surprisingly, the five-site
sample has a lower total (adult plus subadult, N 5 268)
frequency of 4.1 (P 1 I) to 6.3% (P 1 I 1 CW) and 4.5 (P
1 I) to 6.9% (P 1 I 1 CW) for the adult component (N 5
245) (Robbins and Smith, 2008).
Geographic differences in the reported frequency of
treponemal disease in the Southeast in general, or the
riverine mid-South in particular, may reflect differing
TREPONEMAL DISEASE VISIBILITY IN STRATIFIED SOCIETIES
interobserver diagnostic criteria or real local ecological
or demographic factors (e.g., population density, community, hygiene, proportion of subadults, or median age at
death), which would certainly affect the archaeological
visibility of tertiary treponemal disease (Hutchinson
et al., 2005; Powell et al., 2005a,b). The nearest cluster
of sites which are relatively contemporaneous to the Dallas phase and, with comparable ecologic, economic, and
settlement patterns, is from north Georgia. For five
reported late-prehistoric sites dated from the middle to
late-Mississippian period (AD 1200–1550), no cases were
identified of 225 total individuals (Williamson, 1998;
Hutchinson et al., 2005). Indeed, no cases (0 of 143) are
identified from earlier horizons (i.e., 500 BC–AD 800)
from this geographic context (Thomas and Larsen, 1979;
Larsen, 1982; Williamson, 1998). This result starkly contrasts with the late-prehistoric Georgia coast Irene
Mound site with 8.3% (20 of 241) total sample frequency,
and five large late-prehistoric Florida coast sites with a
frequency of 2.1% (Hutchinson, 1993). The relevant variable for these interior Georgia to coastal differences as
well as the Moundville Alabama sample is argued to be
village size and density (Powell et al., 2005b; Hutchinson
and Norr, 2006). Settlement patterning may indeed
explain the lower east Tennessee Dallas phase results
relative to adjacent north Georgia as it may account for
the Dallas and HMC differences. However, as Dallas
phase mound-interred and village-interred individuals
share the same village residency, it is clearly not simply
aggregate settlement.
A status-based difference in treponemal disease visibility has apparently not been previously documented
(Powell et al., 2005b). This is not surprising as most
osteoarchaeological contexts which preserve both mound
and village interments yield a small mound sample, and
health parameters per se may not universally distinguish by status. By pooling several mound/village Dallas
phase samples together, a larger mound sample is generated. However, even with 1001 individuals and with two
identified treponemal disease cases, sampling error cannot be excluded. If the results are indeed borne out by
further site sampling, there are several reasons why
mound interment may affect treponemal disease visibility in the Dallas sample. The first of these is, of course,
better general health. Previous research on Dallas phase
skeletal material, including samples utilized in this
study (e.g., Cox, Toqua, and Citico), indicated that
mound interments experienced better general health in
life (as measured by stature, porotic hyperostosis, cribra
orbitalia, nonspecific infections, and dental asymmetry)
than the rest of the population (Hatch and Willey, 1974;
Hatch, 1976; Parham, 1982; Hatch et al., 1983; Jablonski, 1983; Betsinger, 2002; Smith, 2004; Vogel, 2007).
The progress of treponemal disease includes alternating
relapses and remissions (Powell and Cook, 2005b:
14–16), and it is possible that the better general health
of mound burials resulted in fewer or longer intervals
between the acute or secondary phases of endemic treponemal disease. Social factors contributing to fewer tertiary disease stage cases in mound burials may include
better shamanistic palliative care. For the ethnohistoric
southeastern Indian generally, and the southern Appalachian Muskogean and Cherokee peoples specifically, the
causes of disease are retribution (e.g., for failure to
observe rituals, disrespecting animals, and ghosts) or
victimization (conjuring by enemies, witchcraft) [see
Swanton (1928, 1946), Hudson (1976), Mooney (2006),
193
Mooney and Olbrechts (1932), and Fogelson (1975)],
which may reflect the manner or intensity of shamanistic medicinal ritual applied to any one particular individual. Indeed, virtue may have been generally perceived as
a proxy for health. Dallas phase society arguably
includes many achieved status individuals (Lewis and
Kneberg, 1946; Hatch, 1976">1977; Parham, 1982, 1987;
Hatch et al., 1983; Scott, 1983; Polhemus, 1987; Schroedl
et al., 1990; Chapman, 1994; Schroedl, 1998; Sullivan,
2001) whose socially valued accomplishments may have
been predicated on good health. There may also have
been some degree of health-impacting social segregation
within Dallas. This may have included restricted body
contact and, like the ethnohistoric Cherokee, kin-based
sharing of food or utensils (Reed, 1993; Mooney, 2006).
When age cohorts with adequate sample sizes are compared, no statistically significant difference was detected
between the young adult cohort (18–34 years) and the
middle-aged (35–50) adults (P-values ranging from
0.4641 to 1.0000). If treponemal disease was simply a
chronic progressive disease process, there would be an
increase in frequency with age which might rise to the
level of statistical significance. However, it is not linear,
and as the status difference conveniently illustrates, personal and community health factors affect disease visibility. Therefore, there appears to be a bias of treponemal
cases in the young adult age-at-death cohort. Indeed,
preservation bias may even obscure a young adult case
overrepresentation. The authors suspect an underenumeration of middle-aged individuals in some of the Dallas
samples (i.e., aged simply as ‘‘25-plus’’ or ‘‘adult’’). If that
is indeed true, the frequency of treponemal cases in that
cohort may be inflated and is, therefore, obscuring a
young age bias. Additionally, in clinical untreated contexts, lesions in nonvenereal treponematosis in later life
tend to be more severe and of longer duration (Powell
and Cook, 2005b: 14–15). There were no apparent differences between younger and middle-aged adults in the
pattern (e.g., number of bones involved) or severity of
the lesions. This also suggests a possible young adult
bias. The role (if any) that tertiary stage treponemal disease played in early adult mortality, either as the primary cause of morbidity or as a proxy for underlying
chronic health issues, can be further addressed. In the
future, more sites will be sampled, and multiple stress
indicators (e.g., linear enamel hypoplasia and porotic
hyperostosis, stature) will be marshaled to confirm a status difference and test for a real rather than apparent
young adult age bias.
ACKNOWLEDGMENTS
The authors thank Dr. Jefferson Chapman, Dr. Lynne
P. Sullivan for access to the osteoarchaeological collections, and Mr. Bob Pennington for technical assistance.
The authors also thank the reviewers for their thoughtful suggestions.
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American Journal of Physical Anthropology
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