A CONTRIBUTION TO THE DEBATE OVER THE ORIGIN AND ...

A CONTRIBUTION TO THE DEBATE OVER THE ORIGIN AND DEVELOPMENT
OF TREPONEMAL DISEASE: A CASE STUDY FROM SOUTHERN ILLINOIS
By
Twana Jill Golden
BA, Southern Illinois University Carbondale, 2004
A Thesis
Submitted in Partial Fulfillment
Of the Requirements for the
Master of Arts Degree
Department of Anthropology
In the Graduate School
Southern Illinois University
Carbondale
December 2007

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THESIS APPROVAL
A CONTRIBUTION TO THE DEBATE OVER THE ORIGIN AND DEVELOPMENT
OF TREPONEMAL DISEASE: A CASE STUDY FROM SOUTHERN ILLINOIS
By
Twana Jill Golden
A Thesis Submitted in Partial
Fulfillment of the Requirements
for the Degree of
Master of Arts
in the field of Anthropology
Approved by:
Susan M. Ford, Chair
Tracy Prowse
Heather Lapham
Graduate School
Southern Illinois University Carbondale
November 2007

AN ABSTRACT OF THE THESIS OF
TWANA JILL GOLDEN, for the Master of Arts degree in Anthropology, presented on
May 11, 2007, at Southern Illinois University at Carbondale.
TITLE: A CONTRIBUTION TO THE DEBATE OVER THE ORIGIN AND
DEVELOPMENT OF TREPONEMAL DISEASE: A CASE STUDY FROM
SOUTHERN ILLINOIS.
MAJOR PROFESSOR: Dr. Susan M. Ford
There is a long-standing debate over the origin of syphilis, one of the treponemal
diseases. Some researchers believe syphilis originated in the Old World but was
misdiagnosed as such diseases as leprosy or tuberculosis (Baker and Armelagos 1988;
Rothschild & Rothschild 1996). Others believe syphilis originated in the New World and
was brought to the Old World by Columbus’ crew in 1493; still others believe treponemal
disease originated in Africa spreading with humans as they migrated throughout the
world, mutating to form the syndromes: pinta, yaws, bejel and venereal syphilis (Ortner
2003).
This study explores the possible presence of treponemal disease in Pre-Columbian
North America. 54 individuals from the Archaic Period (4000-2900 BC) site of Carrier
Mills in Saline County, Southern Illinois were examined for characteristic signs of
treponemal disease, including 9 infants, 2 adolescents and 43 adults. Analysis suggests
many individuals suffered from some syndrome closely matching the expected effects of
a treponemal disease. Osteitis, periosteal reaction, lesions, joint fusion, and saber shins
i

were among the characteristics found in this population. Therefore, the Black Earth site
of the Carrier Mills Archaeological District in southern Illinois provides strong evidence
of treponemal disease in the New World prior to 1493 AD.
ii

ACKNOWLEDGMENTS
First, I would like to express my deepest sincerities to God and to my family, my
mother Helen, my father Larry, my brother Brad, and my grandmother Mary Jane for all
that they have done for me. For helping me make it through many tough times in
graduate school, for their emotional support, words of encouragement, and for helping
me to become the person I am today. I wouldn’t be where I am today without them!
Special thanks are also due to my wonderful committee members: Dr. Susan M.
Ford (chair) for all of her encouragement and confidence in me, Dr. Heather Lapham for
all of her help and allowing me the space at Stotlar to conduct my research, and Dr. Tracy
Prowse, whose enthusiasm with the “skellies” helped me to find a new appreciation for
my research. I would also like to thank Dr. Robert S. Corruccini for all of his advice,
everyone at the Center for Archaeological Investigations and our wonderful anthropology
secretaries, Tedi Thomas and Becki Bondi, for all of their help and support through
graduate school.
I would like to extend a great round of applause to all of my fabulous friends who
took the time to listen and ask me questions to help me figure out what the bones were
telling me. To Jennifer, Jeff, Mags, Kate, Val, Kim, Jess, and Erica for their support
throughout graduate school when times were so tough. And last but not least, to
everyone in my cohort and the Newman Community. I love you all!
Thanks and God Bless you all!
iii

TABLE OF CONTENTS
Abstract............................................................................................................................. i
Acknowledgements......................................................................................................... iii
Table of Contents............................................................................................................ iv
List of Tables .............................................................................................................. vi
List of Figures ............................................................................................................. vii
Chapter 1 Introduction ......................................................................................................1
Chapter 2 Theories and Etiologies....................................................................................5
2.1 Hypotheses of the Origin of Treponemal Disease .............................................5
2.2 Hypotheses of the Development of Treponemal Disease..................................6
2.3 Syndromes of Treponemal Disease ...................................................................9
2.3.1 Yaws ....................................................................................................10
2.3.2 Endemic Syphilis .................................................................................13
2.3.3 Venereal Syphilis.................................................................................15
2.3.4 Congenital Syphilis..............................................................................17
2.4 Other Studies of Treponematoses ....................................................................19
2.5 Other Similar Diseases.....................................................................................24
2.5.1 Tuberculosis.........................................................................................24
2.5.2 Leprosy ................................................................................................28
2.5.2.1 Lepromatous Leprosy (LL)......................................................29
2.5.2.2 Tuberculoid Leprosy (TT) .......................................................30
2.5.3 Tumors .................................................................................................31
2.5.4 Osteomyelitis .......................................................................................32
2.5.5 Paget’s Disease ....................................................................................34
2.6 Differential Diagnosis......................................................................................35
2.7 Objectives ........................................................................................................38
Chapter 3 Materials and Methods...................................................................................40
3.1 Materials ..........................................................................................................40
3.1.1 The Sample – Carrier Mills Archaeological District ...........................40
3.1.2 Burial Population – Black Earth Site...................................................41
3.2 Methods............................................................................................................44
3.3 Summary..........................................................................................................49
Chapter 4 Results ............................................................................................................55
4.1 Likelihood of Treponemal Disease..................................................................55
4.1.1 Certain..................................................................................................59
iv

4.1.2 Highly Likely.......................................................................................63
4.1.3 Possible ................................................................................................64
4.1.4 None.....................................................................................................66
4.1.5 Differential Diagnosis and Summary...................................................66
4.2 Type of Treponemal Disease ...........................................................................68
4.2.1 Bone Groups ........................................................................................69
4.3 Comparison of Findings...................................................................................71
4.4 Summary..........................................................................................................73
Chapter 5 Discussion and Conclusions.........................................................................109
5.1 Differential Diagnosis of Treponemal Disease..............................................109
5.2 Comparisons to Other Sites ...........................................................................111
5.3 Carrier Mills – Life in the Archaic ................................................................116
5.3.1 General Middle and Late Archaic......................................................117
5.3.2 Inferences of Life at Carrier Mills .....................................................117
5.4 History and Origin of Treponemal Disease ...................................................121
5.5 Conclusions....................................................................................................123
Literature Cited ............................................................................................................125
Appendices....................................................................................................................137
A Differential Diagnosis......................................................................................137
B Summary of Burials .........................................................................................145
Permission Letter to Use Maps............................................................................163
Vita ..............................................................................................................................164
v

LIST OF TABLES
TABLE 3.1 – Total Sample versus sub-sample..............................................................51
TABLE 4.1 – Pathological Markers of Infants...............................................................76
TABLE 4.2 – Pathological Markers of Adolescents ......................................................78
TABLE 4.3 – Pathological Markers of Young Adults ...................................................80
TABLE 4.4 – Pathological Markers of Middle Adults...................................................84
TABLE 4.5 – Pathological Markers of Old Adults ........................................................88
TABLE 4.6 – Summary and Percentages of Possible Treponemal Markers..................90
TABLE 4.7 – Percentages of Possible Treponemal Disease ..........................................94
TABLE 4.8 – Bone Groups of Infants............................................................................95
TABLE 4.9 – Bone Groups of Adolescents....................................................................96
TABLE 4.10 – Bone Groups of Young Adults...............................................................97
TABLE 4.11 – Bone Groups of Middle Adults..............................................................99
TABLE 4.12 – Bone Groups of Old Adults .................................................................101
TABLE 4.13 – Bone Groups of Carrier Mills compared to Confirmed Disease..........102
vi

LIST OF FIGURES
FIGURE 3.1 – Carrier Mills Archaeological District.....................................................52
FIGURE 3.2 – Carrier Mills Archaeological Sites (Areas A, B, C).............................. 53
FIGURE 3.3 – Map of Archaic Period Burials...............................................................54
FIGURE 4.1 – Percentages of Treponemal Markers in Juveniles and Adults..............103
FIGURE 4.2 – Percentages of Treponemal Markers in Males, Females, and
Total Sample .........................................................................................104
FIGURE 4.3 – Likelihood of Treponemal Disease in Individuals at Carrier Mills......105
FIGURE 4.4 – Burial 38 Drawing of skull showing location of lesions ......................106
FIGURE 4.5 – Burial 38 Left 3 rd metacarpal with unifocal bone loss and
woven bone ...........................................................................................107
FIGURE 4.6 – Burial 38 Right tibia posterior midshaft 6 lesions with woven and
sclerotic reaction ...................................................................................107
FIGURE 4.7 – Burial 38 Left fibula lateral close up of cloaca ....................................108
FIGURE 4.8 – Burial 38 Left 1 st metatarsal plantar with woven and sclerotic
reaction..................................................................................................108
vii

CHAPTER 1
INTRODUCTION
“The ‘Great Pox’ spread rapidly, afflicting victims with suppurating sores that ate
away flesh and bone and was followed by deformity, insanity and death” (Pook 2001:1).
This was believed to be the “Wrath of God,” his punishment for decadence and
immorality (Salt 2002). The “Wrath of God” is better known today as syphilis. Syphilis,
or the “Great Pox,” as it was referred to in Medieval times, was for most people a
terrifying disease with many consequences. The biggest question to revolve around the
disease of syphilis is its place of origin: just where did this foul disease originate?
In anthropology today, there is a long-standing debate concerning the origin of
treponemal disease. This debate began near the end of the 19 th century (Ortner 2003) and
includes two major themes: 1) where did the first treponemal disease originate; and 2) is
treponemal disease one syndrome or several different syndromes, known collectively as
treponematoses? Some researchers argue that syphilis originated in the Old World but
was not diagnosed as syphilis until the fifteenth century, due to its similarities to other
diseases such as leprosy and tuberculosis (Holcomb 1934; Crosby 1969; Rothschild and
Rothschild 1996; Bogdan and Weaver 1992). Other scholars argue that syphilis
originated in the New World and was brought to the Old World by Christopher Columbus
and his crew in 1493 AD, following their return from the New World (Baker and
1

Armelagos 1988; Cockburn 1963). Still other theories suggest that syphilis originated in
Africa, spreading as humans migrated throughout the world and becoming the syndromes
of treponemal disease we know today (Hudson 1965; Ortner 2003; Bogdan & Weaver
1992).
In order to study disease in ancient populations, we must turn to the discipline of
paleopathology. Paleopathology is the “study of disease, both human and nonhuman, in
antiquity using a variety of different sources including human mummified and skeletal
remains, ancient documents, illustrations from early books, painting and sculpture from
the past, and analysis of coprolites” (Ortner 2003:8). In studying ancient human remains
we can gain a glimpse of what ancient peoples’ lives might have been like.
Paleopathology is particularly important in the study of archaeological human
remains. In these ancient contexts, written records of health and medical practices are
often missing (Lovell 2000). Paleopathology aims to rebuild the life of diseases
historically and geographically, to shed light on cultural processes and their interaction
with disease, to trace the evolution of diseases through time, and to gain a better
understanding of disease processes and how they affect the growth and development of
bone through the study of human archaeological remains (Ibid.).
The most important step in paleopathological investigation is a clear description
of the changes observed on the bones and the documentation of these changes (Lovell
2000). Part of documenting the changes involves recording any patterns of lesions found
on the bone and also within the individual. If lesions are found on the bones, it is
important to identify the specific bone, the section of bone involved, the aspect of the
bone, and the distribution of the lesions on the bone (Ibid.).
2

When pathological lesions are found on the bones of an individual, we must ask
ourselves 1) if the lesions occur on one side of the body or if they are bilateral when
paired bones are present, 2) if there are similar lesions elsewhere on the skeleton of the
individual, and 3) if there are different types of lesions on the skeleton (Lovell 2000).
These types of questions are crucial in the differential diagnosis of skeletal lesions (Ibid.).
Treponemal disease is but one of many different diseases that affect the human
skeleton. Treponematosis, along with tuberculosis, leprosy, tumors, osteomyelitis, and
Paget’s disease leave destructive lesions on the skeleton. The lesions of these diseases
are so similar that differential diagnosis becomes difficult. Hence, the distribution of
lesions within the skeleton of an individual and within the sample become very important
factors.
The purpose of this research is to contribute to the debate on the origin and
development of treponemal disease. Was treponemal infection present in the New World
prior to 1493 AD? Powell and Cook (2005:4) state that treponemal disease has been
present in North America “at least fifteen centuries before the first voyage of Columbus.”
According to Rothschild (2003; 2005), the oldest known skeletal population in North
America to exhibit treponemal infection inhabited the Windover site in Florida, which
dates to approximately 7900 B.P. Other sites where treponematoses have possibly been
detected in North America include: Carrier Mills in Illinois (ca. 6300 B.P.); the Ward site
in Kentucky (ca. 4300 B.P.); the Lu-25 site in Alabama (ca. 4300 B.P.); the Oconto
County site in Wisconsin (ca. 3250 B.P.); Frontenac Island in New York (ca. 2000 B.P.),
Libben in Ohio (1200-850 B.P.) and Amaknak in Alaska (Rothschild 2003; 2005). Was
treponemal infection found in Illinois prior to 1493 AD and, if so, during what time
3

period did it originate? According to Baker and Armelagos (1988), treponemal disease
has existed in Illinois for the past 3,000 years. Most of the sites discussed are from the
Middle to Late Woodland (1000 BC – AD 1000) and Mississippian (AD 1000 – 1400)
periods; two sites mentioned date to the Late Archaic (3000 – 1000 BC) period, the
Klunk site (920 BC) (Powell et al. 2005) and the Morse site (1500 – 1000 BC) (Baker
and Armelagos 1988). Is there more evidence supporting the presence of a treponemal
infection from the Archaic period in Illinois? This research provides strong evidence
that a treponemal disease did exist within the Archaic period sample of the Carrier Mills
Archaeological District. Further analysis provides confirmation that a non-venereal form
of treponemal disease, similar to yaws, was present in Illinois prior to 1493 AD.
The importance of this research is to help elucidate the place of origin of
treponemal disease so that the disease itself may be better understood. This study is just
one component of this ongoing debate. The many components together will tell us where
treponemal disease originated, so that we can learn how it spread and whether or not it is
one or several different syndromes. Studies of disease in ancient populations provide
insight into the geographical and chronological distribution of disease, responses to
stress, the conditions of a society and its growth and how the society functioned as a
whole (Armelagos 1969). Cultural differences, life patterns and life-span may also be
inferred from the skeletons through examination of burial practices, burial goods, the
determination of age and sex, and overall health of the individuals in the sample. This
research and analysis will use a narrow focus on the paleopathological evidence found in
the Carrier Mills Archaeological District to determine the presence or absence of
treponemal disease and to also attempt to address some of these larger issues.
4

CHAPTER 2
THEORIES AND ETIOLOGIES OF DISEASES
2.1 Hypotheses of the Origin of Treponemal Disease
There are two major hypotheses concerning the geographic origin of syphilis.
The first one is the Columbian Hypothesis, based on statements from Columbus’
contemporaries Ulrich von Hutten and Ruy Diaz de Isla that Christopher Columbus and
his crew brought syphilis back to Europe upon their return in 1493 from the New World,
where syphilis supposedly originated (Crosby, Jr 1972; see also: Baker and Armelagos
1988; Bogdan and Weaver 1992; Cook 1993; Rodríguez-Martín 2000). This theory
gained its’ popularity in the sixteenth century and is still used today. Crosby (1969)
states that the “pox” was brought back from the New World to the Old World by
Columbus and his crew in the 1490’s. The evidence he gives is the historical accounts of
the physicians and the historians at the time of the epidemic. The reports that exist were
written after the epidemics, but Crosby (1969) suggests that the reason for this is that the
more prominent people of the times wanted to suppress any and all negative reports about
the New World. Therefore, with the absence of written reports, perhaps lost or buried in
archives until after the epidemics, and with the agreement of the disease being new to
Europe, treponemal disease must have originated in the Americas.
5

The second hypothesis is the Pre-Columbian Hypothesis, which suggests that
syphilis existed in the Old World long before Christopher Columbus’ historic journey to
the New World. Since leprosy already existed in the Old World, researchers from the
1400’s and 1500’s (Francisco Villalobos, John Maynard, Petrus Andraes Matthiolous,
Ruiz Diaz de Isla) believed that syphilis may have been misdiagnosed as leprosy
(Holcomb 1934). In other words, doctors in Medieval times thought the two diseases
were one based upon their similar symptoms and did not realize that a separate disease
even existed other than leprosy (Baker and Armelagos 1988; Bogdan and Weaver 1992;
Rodríguez-Martín 2000). Cockburn (1963:154) states that the original peoples of the
“New World were already infected when they first crossed the Bering land bridge tens of
thousands of years ago.” Humans carried many different parasites with them when they
began migrating to other lands, including some form of treponeme. This means that
treponemal disease was everywhere that humans inhabited before the time of ocean travel
(Cockburn 1963), hence before Christopher Columbus sailed the ocean blue.
2.2 Hypotheses on the Development of Treponemal Disease
In addition to the two major hypotheses regarding the geographic origin of
syphilis, there are three major hypotheses involving the development of the syndromes.
These hypotheses are referred to as the Unitarian Hypothesis, the Non-Unitarian
Hypothesis, and Livingston’s Alternative Hypothesis. The Unitarian Hypothesis suggests
only a single treponematosis was present in both the Old and New Worlds before
Columbus’ journey. This theory, proposed by Hudson (1965), suggests that since there
6

were no specific differences between the bacteria of the four syndromes, the syndromes
should all be classified as strains of one disease known as treponematosis. This
treponemal disease is extremely flexible and evolved with various human populations,
forming the different syndromes that are known today. Hudson (1965) also proposes that
yaws was the first treponematosis and that it probably originated in sub-Saharan Africa,
accompanying humans as they extended their range through migrations to other lands. As
humans migrated, the climate changed, causing yaws to evolve into endemic
treponematosis (Ibid.). Humans became more sedentary and villages emerged. Endemic
treponematosis flourished through children because the barriers of clothing and personal
hygiene had not come into effect yet (Ibid.). Other changes occurred as urban life
emerged, discouraging the spread of endemic treponematosis and encouraging venereal
treponematosis. The sexually transmitted bacteria became more successful within
sedentary villages due to natural selection. The mode of transmission remained the same,
direct contact of an open sore but because humans changed their behaviors, the bacteria
found new ways to invade the host. Treponemal disease then would be a biological
gradient based on each person’s physical and cultural states, presenting itself as different
clinical patterns according to climate and human behaviors such as better hygiene,
wearing more clothing and improved living conditions (Ibid.).
The Non-Unitarian Hypothesis suggests that there are four treponematoses; pinta,
yaws, endemic syphilis, and venereal syphilis, resulting from the mutations of the first
treponemal bacteria (Aufderheide and Rodríguez-Martín 1998; Rodríguez-Martín 2000).
Hackett (1967) proposes that before 20,000 B.C., the first treponemal disease would have
been pinta, which arose from an animal infection. A genetic mutation, which took place
7

about 10,000 B.C., resulted in yaws, a much more invasive disease with tissue
destruction. The next mutation occurred about 7,000 B.C., also the time when a climatic
change occurred in Africa, Asia and Australia, which resulted in endemic syphilis, in
these dry, warmer regions of the world. A third mutation occurred around 3,000 B.C.,
that resulted in a mild form of venereal syphilis. The last mutation occurred in late
fifteenth century in Europe, with a much more serious form of venereal syphilis occurring
as the result (Ibid.). As humans began to cluster in villages and wear more clothing, the
treponemal bacterium had to adapt to its human host in order to survive. The changing
environmental conditions along with the mutations in the bacteria meant that bacteria that
were transmitted through sexual contact were the favored bacteria. The bacteria that
were transmitted through skin-to-skin contact were the bacteria that died out.
The last hypothesis is Livingston’s Alternative Hypothesis. Livingstone (1991)
believes that there is not enough evidence to assume that the treponemal diseases have
adapted in humans throughout human evolution because it is a newer disease, which has
mutated into several different syndromes of treponemal infection, but was introduced to
the New World at the time of Columbus (Ibid.). He suggests that the increase in rates of
the treponemal disease in cases in the Americas is due to an introduction of an extremely
toxic form of treponemal infection from the Old World as a result of increased contact
with Africa (Livingstone 1991; Rodríguez-Martín 2000). This would have been a new
strain of treponemal infection to the Europeans, which would have resulted in a low
immunity to the disease, causing it to spread rapidly through the sexual practices in
Europe at this time, thus increasing the virulence or infectiousness of the disease
(Aufderheide and Rodríguez-Martín 1998; Rodríguez-Martín 2000).
8

Of these hypotheses of origin and development, it is likely that the disease
developed due to a variety of factors. Treponemal disease likely originated with humans,
spreading as humans migrated to new lands. Therefore, treponemal disease would have
existed in both the Old and New Worlds before Columbus’ journey. It is likely that the
syndromes of treponematoses are all different syndromes that have existed independently
in different parts of the world at different times and, in other times coexisting in the same
parts of the world. Now that we have some idea of the hypotheses concerning the origin
and development of treponemal disease, the four syndromes of treponemal disease are
described in detail in the following section.
2.3 Syndromes of Treponemal Disease
They were byles, sharpe, and standynge out, hauynge the
simylitude and quantite of acornes, from which came so foule humours,
and so great stinche, that who so ever ones smelled it, thoughte hym selfe
to be enfecte. The colour of these pusshes [pustules] was derke grene, and
the syghte therof was more grevouse unto the patiente than the peyne it
selfe: and yet their peynes were as thoughe they had lyen in the fyre
(Ulrich von Hutten 1540:2).
This was the first recorded description of syphilis from the 1500’s. Today’s
description is much more scientific, but not significantly different in detail. The first
symptom of syphilis is a painless ulcer or chancre (Lukens 2005). After the chancre
9

develops, various skin eruptions follow which contain mucous patches that ooze
yellowish-greenish pus.
Treponemal disease is a chronic infectious disease caused by the bacterium
Treponema pallidum. These bacteria are known as spirochetes. The disease caused by
Treponema pallidum can be broken down into four different syndromes, with a fifth
syndrome being transmitted congenitally. The syndromes are: Pinta, Yaws, Endemic
Syphilis, Venereal Syphilis and Congenital Syphilis. The differences among the
syndromes mostly depend upon the geographic region in which the infected individual
lives (Larsen 1997; Aufderheide and Rodríguez-Martín 1998; Ortner 2003). Listed
below are the syndromes of syphilis with a brief description of each one, except for Pinta
(Treponema pallidum careteum) which affects only the skin and will not be discussed
here because it cannot be found in the archaeological record. Appendix A is a key of
differential diagnosis between yaws, endemic syphilis, venereal syphilis, congenital
syphilis, tuberculosis, leprosy, tumors, osteomyelitis and Paget’s disease.
2.3.1 Yaws
Yaws (Treponema pallidum pertenue) is a chronic, recurrent, infectious, non-
venereal form of the treponematoses that is usually acquired in childhood through direct
contact of an open sore or indirect contact by flies or other insects. Therefore, yaws is
most often seen in children and adolescents (Ortner 2003; Aufderheide and Rodríguez-
Martín 1998). Transmission may also occur congenitally (Ortner 2003). Congenital
yaws results when a woman acquires yaws later in life, transmitting the bacteria to the
fetus via the bloodstream. This does not mean that a young pregnant woman acquiring
10

yaws cannot pass the pathogen to the fetus, but that if an older pregnant woman acquires
yaws, she is more likely to pass the pathogen to her fetus, since yaws is typically acquired
in childhood. Only the skin and bones are affected by this treponemal disease. Yaws can
occur in three different stages. The first stage is characterized by the “mother yaw,” or
the first lesion. This mother yaw appears at the initial site of infection, usually the legs,
between five to eight weeks after the initial exposure (Powell and Cook 2005). The
mother yaw will become larger or thicker, circular, and begin to itch resulting in a tumor
that will eventually form a lesion. This stage can last for six months and it ends with the
mother yaw healing spontaneously (Powell and Cook 2005; Aufderheide and Rodríguez-
Martín 1998).
After a period of latency, the second stage begins with similar lesions to the
mother yaw. The lesions from this second stage form a general pattern all over the body
(Powell and Cook 2005). These lesions are small and either de-pigmented or hyper-
pigmented. If this stage is not treated, it can last up to five years, alternating between
remissions and relapses (Ibid.). Bone lesions may occur at this stage in the shafts of long
bones, the paranasal maxillae, or the hand phalanges. Plantar lesions may also develop in
the feet causing severe debilitation and resulting in individuals walking on the edges of
their feet (Ibid.).
The final or tertiary stage is the most destructive stage of yaws, occurring after a
period of latency that can last for several years. This is the stage that has the most
extensive skeletal lesions. Although very destructive to skin, mucous tissues and bone,
the central nervous system, cardiovascular system and internal organs are not affected,
which is seen in venereal syphilis (Powell and Cook 2005). The most common bone
11

affected is the tibia, followed by the fibula, clavicle, femur, ulna, radius and bones of the
hands and feet (Aufderheide and Rodríguez-Martín 1998). The most typical or
characteristic feature of this stage is the saber shin, also known as “boomerang leg”
(Roberts and Manchester 1995; Ortner 2003). Saber shin is a remodeling of the anterior
crest of the tibia, followed by bone deposition. Rarely the posterior aspect of the tibia’s
shaft is changed. This remodeling of bone results in a curved appearance similar to that
of a cavalry saber blade, hence the name saber shin (Powell and Cook 2005).
Another feature that characterizes yaws is dactylitis (Aufderheide and Rodríguez-
Martín 1998; Douglas et al.1997). Dactylitis is a bone change occurring in the hands that
leads to enlargement of the phalanges. These bony changes in the hands are more
common in young individuals and are uncommon in venereal syphilis (Aufderheide and
Rodríguez-Martín 1998). Skull lesions are uncommon in yaws, but when they do occur,
they are less severe than cases with venereal syphilis. The frontal or parietals may have
shallow, pitted cortical lesions but the most destructive lesions are more likely to occur in
the nasal-pharyngeal region of the cranium (Powell and Cook 2005). Seven to 8% of
cases with skeletal involvement have extensive destruction of the nasal area and of the
maxilla (Aufderheide and Rodríguez-Martín 1998). This results in the condition known
as gangosa (Roberts and Manchester 1995). Gangosa is the destructive ulceration of the
nasal-palatal region of the face. In 5% of cases with gangosa, perforation of the hard
palate occurs, and it is more severe than in cases found with venereal syphilis
(Aufderheide and Rodríguez-Martín 1998). Nasal-palatal destruction and tibial
involvement are frequently found in yaws.
12

Differential diagnosis between yaws and venereal syphilis can be very
complicated. For this reason, geographic factors play an important role in the diagnosis
of yaws (Aufderheide and Rodríguez-Martín 1998). Yaws is generally found in rural
areas of western and equatorial Africa, Latin America, the Caribbean Islands, Southeast
Asia, North Australia, New Guinea, and the islands of the Southern Pacific Ocean
(Aufderheide and Rodríguez-Martín 1998; Roberts and Manchester 1995). Rothschild
(2003) speculates that yaws may be the treponemal infection that was present in North
America before Columbus’ journey.
2.3.2 Endemic syphilis
Endemic syphilis (Treponema pallidum endemicum) is an acute, infectious
disease that occurs primarily in children between the ages of two and ten years within
rural areas. Transmission of endemic syphilis occurs directly and indirectly through
contact of the infectious lesions of the skin and mucous membranes or through
contaminated linens. The infection may be spread by the shared use of eating and
drinking implements, such as pipes, toothpicks, or cigarettes (Aufderheide and
Rodríguez-Martín 1998; Powell and Cook 2005). The initial lesion is small, painless, and
often unobserved resulting in a cutaneous and mucosal rash with inflammatory
destructive lesions on the skin, bones and the naso-pharyngeal region (Powell and Cook
2005; Aufderheide and Rodríguez-Martín 1998). A latent period can occur for months or
even years, followed by infectious lesions that have a hard irregular center consisting of
dead cells and pus. These lesions affect the skin, nasopharynx and bones (Powell and
13

Cook 2005). Spontaneous healing of the lesions may occur, but the damage they cause
can be debilitating.
The skeletal lesions that occur in endemic syphilis are almost identical to those
occurring in yaws (Aufderheide and Rodríguez-Martín 1998). These skeletal lesions are
also morphologically indistinguishable from the skeletal lesions of venereal syphilis
(description provided below). The differences between yaws and endemic syphilis can
be seen when looking at the population as a whole. In an epidemiological approach,
Rothschild et al. (2000) describe endemic syphilis as having a high population frequency,
occurring in both subadults and adults, affecting few bone groups and very little if any
involvement of the hands and feet, unlike yaws. With endemic syphilis, as with the other
treponematoses, the tibia is the most frequently affected bone, with the typical features
being the deformity of the saber shin (Aufderheide and Rodríguez-Martín 1998; Roberts
and Manchester 1995). Some of the other more commonly involved bones include the
fibula, ulna, radius, clavicle, phalanges and calcaneus (Aufderheide and Rodríguez-
Martín 1998). Nasal-palatal destruction and tibial involvement are frequently found in
this syndrome. Transmission does not occur congenitally, thus endemic syphilis does not
leave any traces on the teeth such as the commonly found Hutchinson’s incisors or
mulberry molars that are found in congenital syphilis, which are discussed below (Ibid.).
Endemic syphilis has a low mortality rate and acts as an endemic disease, limited
to regions of low socioeconomic levels and bad hygiene (Aufderheide and Rodríguez-
Martín 1998). This syndrome is often found in arid and warm climates of the eastern
Mediterranean Sea, southwestern Asia, and sub-Saharan Africa (Ibid.). Rothschild
14

(2003) speculates that not only yaws but also endemic syphilis was present in North
America before Columbus’ journey.
2.3.3 Venereal Syphilis
Venereal syphilis (Treponema pallidum pallidum) is an acute, sub-acute, or
chronic infectious disease that has three different phases and is the most dangerous of the
syndromes (Aufderheide and Rodríguez-Martín 1998; Powell and Cook 2005).
Transmission occurs directly through sexual contact. Indirect transmission can occur
through infected objects such as needles or nonsexual contact of an open sore
(Aufderheide and Rodríguez-Martín 1998).
Venereal syphilis is characterized in its primary stage by a lesion or chancre at the
point of entry (Ortner 2003). A period of incubation occurs for approximately three
weeks. After this period a small, painless chancre appears on the genitals (Powell and
Cook 2005). If the chancre is not treated, the bacteria will rapidly multiply, spreading
throughout the body via the bloodstream (Ortner 2003). This leads to the secondary stage
which includes a variety of lesions appearing on the skin and genitals (Powell and Cook
2005).
In the secondary stage a rash develops, which affects the skin and mucous
membranes (Aufderheide and Rodríguez-Martín 1998). The lesions in this stage are
highly infectious. The bones of the distal limbs are often involved, resulting in periostitis
and osteitis. The various lesions in this phase usually occur in the first year, but they can
last up to four years (Powell and Cook 2005).
15

After a period of latency, the tertiary stage develops. In this third stage the
lesions that occur affect the skin, skeletal, cardiovascular, and central nervous systems in
20 - 50% of cases, if left untreated (Aufderheide and Rodríguez-Martín 1998). This is
why venereal syphilis is the most dangerous syndrome. Seventy percent of all the
skeletal lesions occur on the tibia, cranial vault, and bones of the nasal cavity (Ortner
2003). This syndrome has been nicknamed the “Great Imitator” because the symptoms
of this disease are so variable and many resemble those of other diseases, such as leprosy,
tuberculosis, tumors, osteomyelitis, and Paget’s disease (Aufderheide and Rodríguez-
Martín 1998).
Aufderheide and Rodríguez-Martín (1998) state the most characteristic skeletal
lesions of venereal syphilis are those of the skull, specifically the parietal and the frontal
bones. This characteristic is known as Caries sicca and is manifested as sunken,
destructive areas of bone loss and bone growth forming an irregular surface on the cranial
vault. In other words, the cranial vault contains a series of hills and valleys instead of
being smooth. Other commonly affected bones include the tibia, nasal-palatal region,
sternum, clavicle, vertebrae, femur, fibula, humerus, ulna and radius (Ibid.). Of the
previous bones named, the tibia exhibits syphilitic lesions ten times more often than the
others (Bogdan and Weaver 1992). Ortner (2003) states the spine is rarely involved, but
when it is involved, the cervical vertebrae are most often affected. Nasal-palatal
destruction can be found in a less severe form than seen in yaws, and the most commonly
affected joint is the knee (Aufderheide and Rodríguez-Martín 1998; Roberts and
Manchester 1995).
16

2.3.4 Congenital Syphilis
Venereal syphilis can also be transmitted from the mother to the fetus, which
results in congenital syphilis. This may occur in two ways. First, congenital syphilis
may be transmitted from a mother with venereal syphilis, through the placenta to the
fetus, infecting the fetus with spirochetes (bacteria). The infected fetus will either be
aborted or die soon after birth (Aufderheide and Rodríguez-Martín 1998). The
spirochetes cause a degeneration of the cells that develop into bone. This results in a 50
% fatality rate of affected fetuses, but in the case of a mild infection, infants may live for
many years with a dormant phase of congenital syphilis (Ibid.). The second way that
transmission may occur is during birth as the infant passes through the birth canal of an
infected mother (Powell and Cook 2005).
Congenital syphilis can be divided into two different phases, an early phase and a
late phase. The early phase occurs in infants from birth to four years (Powell and Cook
2005). The most characteristic symptom in newborns is rhinitis, which is an
inflammation of the mucous membranes in the nose (Lukens 2005). This inflammation
causes the formation of the permanent central incisors and first molars to be disrupted,
resulting in the dental stigmata of congenital syphilis described below. A rash develops
on the surfaces of the hands, feet, anus and mouth (Powell and Cook 2005). The skeletal
system becomes involved, leading to osteochondritis (i.e. inflammation of the bone and
cartilage), perichondritis (i.e., an inflammation of the connective tissue membrane that
surrounds the cartilage) and periostitis (i.e., an inflammation of the membrane of
connective tissue that covers all bones). The shafts of the tibiae are the most commonly
involved long bones, but any bone can be involved. Infants who survive this stage will
17

have lesions that heal spontaneously, so much so that there are no traces of the lesions
later in life (Ibid.).
According to Aufderheide and Rodríguez-Martín (1998), osteochondritis of the
metaphysis is found in the majority of the archaeological specimens. Periostitis of the
tibia and the femur can also be found (Ortner 2003). The most frequently involved bones
are the tibia, radius, ulna and the cranium (Aufderheide and Rodríguez-Martín 1998).
The late phase of congenital syphilis occurs in children and adolescents from five
to fifteen years of age (Powell and Cook 2005). This is the phase where disfiguration of
the cranium occurs. Saddle nose may occur which results in the bridge of the nose
collapsing. Other alterations of the skull include Parrot’s sign (prominent frontal bosses),
a high palatal arch, and a disproportionate size of the maxillae and mandible (Ibid.).
Postcranial alterations of the skeleton include flaring scapulae, thickening of the sternum
and clavicles, swelling of the knees, and saber shins. The alterations to the skeleton
discussed here remain with the individual throughout life (Ibid.).
According to Cook (1993) and Aufderheide and Rodríguez-Martín (1998),
characteristics to look for in the teeth of an individual with congenital syphilis are
Hutchinson’s incisors, mulberry molars and Moon’s molars, which may also be
associated with saddle nose. Hutchinson’s incisors are permanent central incisors that
are smaller than normal and exhibit a shallow notch in the middle of the incisal edge, a
screwdriver shape, the presence of a diastema between the incisors, a dirty grey surface,
with the crown surfaces tapering mesially and distally (Shafer et al. 1974; Hillson 1996;
Pindborg 1970; Hillson et al. 1998). Moon’s molars or bud molars are permanent first
molars exhibiting a clinched appearance of the crown, a narrow occlusal area giving the
18

tooth a domed or bud-like appearance, and bulbous crown formation (Colby et al.1971;
Hillson 1996; Hillson et al.1998). Fournier’s or mulberry molars are permanent first
molars with the occlusal surface altered so that it looks like a mulberry and the tooth is
also smaller than the normal first and second molars (Hillson 1996; Pindborg 1970). The
permanent canines, both upper and lower, may also be affected, but these changes are not
as noticeable as with the permanent incisors and molars. A hypoplastic defect occurs on
the canines in the form of a circular groove around the tip of the tooth (Hillson et al.
1998; Jacobi et al. 1992). This circular groove may become a shallow notch due to
attrition. The canine may also be yellowish in color and may have a puckered appearance
(Jacobi et al. 1992).
2.4 Other Studies of Treponematoses
Brothwell (1970) suggested an evolutionary tree for the treponemes which
included extinct forms of the disease. The evolutionary tree began at the base with a non-
human treponeme branching into two forms, one branch for extinct forms and one branch
for pinta. The tree trunk then continues branching to form yaws, then possibly another
branch for more extinct forms, with the trunk continuing until it branches off with
endemic syphilis and then finally branching into venereal syphilis. This tree would
represent various forms of the treponemes advancing to more complicated forms which
would not be ancestral to the varieties of treponemes that occur today (Brothwell 1970).
My point here is that another form of treponematosis could have been present in North
America besides the syndromes of yaws, endemic syphilis, and venereal syphilis we
19

know today. This other form could have existed for thousands of years and then due to
forces of natural selection, it could have become selected against and died, thus becoming
extinct.
In 1995 Rothschild, Hershkovitz, and Rothschild proclaimed the earliest evidence
of treponemal disease came from Homo erectus. They reanalyzed periosteal reaction
patterns of several H. erectus skeletal remains housed at the National Museum of Kenya
in Nairobi. They found involvement of the long bones and upper and lower extremities.
The periosteal reaction distribution pattern most closely resembled that of yaws. Their
study would confirm an African origin for treponemal disease dating to the Middle
Pleistocene (Rothschild et al. 1995).
Another study conducted by Rothschild and Rothschild (1996) resulted in
conclusions about the effects of venereal syphilis, yaws and endemic syphilis on
populations. Venereal syphilis had a low population frequency (5-14%), a median
number of bone groups were affected (2), and saber shins occurred without remodeling,
or no periosteal reaction was evident on the surface of bones. Bone involvement in
children was also rare (Ibid.). For cases with yaws, there was a high population
frequency (21-33%), a median number of bone groups were affected (4), the hands and
feet were affected, bone lesions occurred in subadults, and saber shins exhibited
periosteal reaction (Ibid.). Endemic syphilis occurred with a high population frequency
(25-40%), a median number of bone groups were affected (2), saber shins showed
evidence of periosteal reaction, and the hands and feet were rarely affected (Ibid.).
Rothschild et al. (2000) state that tibial changes are found in 99% of individuals
with treponemal disease and therefore the tibia is critical to diagnosis of treponemal
20

infection. Treponemal disease can be recognized on the basis of periosteal reaction along
with osteitis (Ibid.). Other diagnostic criteria include saber shin, the frequency of hand
and foot involvement, and the number of bone groups affected (Ibid.). “Bone group” is
an artificial construct used by Rothschild et al. (2000):
“to quantitate the extent of skeletal involvement. Involvement of a skeletal
component is treated as 1 bone group, whether that involvement is unilateral or
bilateral. Carpal, tarsal, metacarpal, metatarsal, and phalangeal involvement are
each considered single bone groups, whether ≥ 1 are affected.” (pg. 937).
For example, the tibiae would be considered a bone group, as would the radii. Each
group of bones in the hands and feet are considered a bone group. If one distal phalanx
on the right hand is affected, then the hand phalanges are considered to be affected, no
matter if it is the right or left side.
In the study conducted by Rothschild et al. (2000), venereal syphilis was
identified as affecting few bone groups (1.9), having a low population frequency (14% or
less), unilateral tibial involvement and saber shin associated with periosteal remodeling.
Yaws affected a median number of bone groups (4), had a high population frequency
(more than 20%), affected the hands and feet frequently and produced bone lesions in
subadults. Endemic syphilis affected few bone groups (2), exhibited a high population
frequency (more than 20%), and occurred in subadults as well as adults (Ibid.).
Rothschild et al. (2000) also found that in cases of yaws and endemic syphilis (bejel),
21

subadults and adults were affected at the same frequencies, while in populations with
syphilis, subadults were affected with a 5% or less frequency.
The study conducted by Rothschild et al (2004) found some of the same results as
the study by Rothschild (2005). Both studies found that bone involvement occurred in 2–
13% of individuals with venereal syphilis, while individuals with yaws or endemic
syphilis had bone involvement of 20–40%. Rothschild (2005) states the most critical
skeletal criterion in diagnosing a treponemal disease is the pattern of periosteal reaction,
tibial remodeling and bone destruction. This study also found that in cases of syphilis
less than 5% of children have skeletal involvement. Children with yaws or endemic
syphilis exhibited a rate of 10–20% skeletal involvement (Ibid.). Venereal syphilis rarely
affected the hands and feet and the incisors and first molars were only affected in cases
with venereal syphilis. Finally, the saber shin remodeling that occurs in venereal
syphilis hinders the signs of periosteal reaction, making it difficult to see the actual
reaction (Ibid.).
In a study by Hutchinson and Richman (2006), skeletal samples were examined
from the prehistoric southeastern United States to try to aid in the debate on the origin
and geographic distribution of syphilis. The skeletal samples encompass a broad
geographic and topographic range, including such time periods as the Archaic (8000 –
1000 BC) through the protohistoric (AD 1500 – 1600) periods. Their study assesses the
presence of treponemal disease, venereal and nonvenereal, in an evolutionary context
according to geographic, physiographic, and temporal patterns of treponemal disease.
Hutchinson and Richman (2006) suggest that increases in the frequency of positive cases
are due to an increase in population density and changing human behaviors. In other
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words, the evolution of treponemal disease was caused by the changing environment and
living conditions of the human host, instead of changes occurring within the pathogen
itself. The bacteria, therefore did not change; genetically treponemal disease is one
species that has adapted to the changing environment of the human host.
Smith (2006) conducted a study on skeletal remains in the Western Tennessee
River Valley consisting of eight sites spanning the Middle (6000-3000 BCE) to Late
(2500-ca. 1000 to 500 BCE) Archaic and Early Woodland (500 BCE-0 CE) periods. Her
study focused on sedentism and the advent of pottery, which she predicts can be
correlated to the appearance of diseases like treponemal disease (Ibid.). The evidence of
pottery at a site means that the community was using the site for long periods of time.
This would mean that villages were beginning to emerge. The emergence of villages and
a larger group of people living closer together would allow the spread of such diseases as
the treponematoses.
Smith (2006) found that out of 581 individuals, 13 (9 adults and 4 sub-adults)
exhibited “periostitis pathognomonic or indicative of treponemal disease” (Smith
2006:207). The syndrome believed to have affected these samples is of a non-venereal
form. This evidence is pre-Columbian with an increase in frequency occurring after 1000
CE. The increase in frequency was attributed to the advent of sedentism and agriculture
(Ibid.).
Levréro et al. (2007) conducted a recent study on a population of gorillas from the
Republic of Congo who exhibited skin lesions indicative of yaws. In this study 17% of
the 377 gorillas exhibited some type of lesion (Ibid.). The locations of the lesions were
mainly on the faces of the gorillas. They found that in some instances the lesions were so
23

deep that they produced debilitating handicaps (Ibid.). It is interesting that yaws affects
gorillas in some of the same ways as it affects humans. Levréro et al. (2007) found that
yaws affected young gorillas, males were affected more than females, unmated adult
males suffered more with lesions, and in non-breeding groups the immature gorillas
suffered more from yaws. With the presence of yaws among non-human primates, this
study and others like it can help us to determine what life might have been like for our
hominid ancestors who suffered from nonvenereal treponemal disease.
2.5 Other Similar Diseases
Treponemal disease produces effects on the bones of an individual that are very
similar to other diseases. In the past others believed that perhaps syphilis was not
recognized as a disease because it was so similar to tuberculosis or leprosy. Hackett
(1967) states that leprosy was used as a blanket term to refer to several different diseases
present in Europe in Medieval times. The Bible and medieval documents are used to
demonstrate the confusion between syphilis and leprosy (Baker and Armelagos 1988).
Here, I will describe the diseases of tuberculosis and leprosy, in order to aid in the
process of differential diagnosis between treponematoses, tuberculosis, and leprosy.
Other diseases that affect the skeleton in similar ways to treponemal disease include
tumors, osteomyelitis and Paget’s disease. These other diseases will also be discussed in
the section below.
2.5.1 Tuberculosis
24

Tuberculosis is an acute and chronic infectious disease caused by the bacterium
Mycobacterium tuberculosis or M. bovis. M. tuberculosis is the most common bacterium
that affects humans. M. bovis can also affect humans, but it is most commonly found in
cattle (Ortner 2003). M. tuberculosis is transmitted from human to human through the air
by inhaling bacteria within moisture droplets that have been spread into the air from the
cough of an infected person (Aufderheide and Rodríguez-Martín 1998). The disease
usually begins in the lungs as a respiratory infection. The bacteria then multiply in the
lungs, spreading to surrounding tissues (Ibid.). The tissues may die, resulting in an area
of scar tissue that may contain live M. tuberculosis bacteria that can remain dormant for
some time. These dormant bacteria can reactivate the disease if other stressors affect the
lung, such as invasion of the lung by cancer or from the person contracting HIV/AIDS
(Powell 1992; Aufderheide and Rodríguez-Martín 1998). This process is known as the
primary infection (Aufderheide and Rodríguez-Martín 1998). The primary infection can
lead to a secondary infection by the dissemination of the bacteria via the blood stream to
any or all of the organs in the body. Thus, the infection reaches the skeletal system via
the bloodstream (Ortner 2003). The most important factor to remember in the destruction
of the skeletal tissue is the “pattern of resorptive lesions with little evidence of
proliferative, reactive changes” (Aufderheide and Rodríguez-Martín 1998:134). In other
words, tuberculosis causes a resorption of bone with very little bone growth or evidence
of a reaction occurring.
Skeletal tuberculosis is most often found in areas of trabecular bone (Aufderheide
and Rodríguez-Martín 1998). For this reason, the spine is involved in more than 40% of
the skeletal lesions. The most common area of involvement in the vertebrae is the
25

anterior surface of the thoracic or lumbar vertebral body, which occurs in approximately
80% of cases (Ibid.). Erosion occurs producing an abscess that extends into the
intervertebral space. Herniation of the intervertebral disk occurs, causing the spread of
the abscess through the cartilaginous defect and into the vertebral body. This produces a
“narrowing of the affected intervertebral disk space” (Aufderheide and Rodríguez-Martín
1998:122). The abscess then progresses in a vertical fashion to an adjacent vertebral
body, where the process occurs again. Posterior involvement of the vertebral body only
occurs in approximately 20% of the cases of skeletal tuberculosis, with the same type of
process occurring as in anterior vertebral body involvement. Occasionally the vertebral
neural arch, processes or articular elements are directly involved (Ibid.). A progressive
destruction of the vertebral body often leads to the collapse of the vertebral body. This
collapse causes shortening of the trunk of the individual and anterior bending of the spine
above the collapsed area, which is known as kyphosis. In kyphosis, usually two or three
thoracic vertebrae are involved, but it may involve as many as six or more vertebrae
(Ibid.). Only 10% of cases result in paraplegia, due to the compression of the spinal cord
and nerves (Ibid.).
Other sites of tuberculosis in the skeletal system involve the joints. Bacilli are
disseminated to the trabecular bone of long bones, which resides in the metaphysis. Most
often the hip and knee are involved (Aufderheide and Rodríguez-Martín 1998).
Involvement of the hip occurs in 20% of cases, this being the second most frequent site of
skeletal lesions (Ibid.). It is most common in children between the ages of three and ten
(Ibid.). Most frequently bone destruction occurs in the acetabulum, but the femoral head,
neck and trochanter may be affected. Dislocation of the hip may occur if there is
26

extensive destruction of the area through exposure of the bone by ulceration of the
cartilage (Ibid.). Exposure of the bone will result in bone-on-bone contact causing
eburnation. Eburnation may cause the femur neck to crumble, thus dislocating the hip
(Ibid.). Only 16% of cases of skeletal tuberculosis involve the knee, resulting in
deforming lesions on the surface of the knee, and upper extremity joints are involved
much less frequently (Ibid.).
The ribs, flat pelvic bones, sternum, and sometimes the cranium in adults are
involved (Aufderheide and Rodríguez-Martín 1998). Rib lesions occur in 9% of
individuals with pulmonary tuberculosis (Ibid.). The internal surfaces of the ribs are
affected by a mild to moderate periostitis. This usually involves several adjacent ribs
with ribs four to eight being the most common ones involved. Sometimes the central
portion of the rib body is involved, but rarely are the costal head and neck affected. Rib
lesions are more common on the left side of the thorax (Ibid.). The cranium is rarely
involved in tuberculosis, but when it does occur, it affects young adults almost
exclusively. The most common area of involvement is the cranial vault. Here,
tuberculosis appears as “small numerous areas of destruction, less than 2 cm in diameter,
with poorly defined margins and some surrounding reactive sclerosis” (Aufderheide and
Rodríguez-Martín 1998:140). The lesions often cross the sutures of the cranium, and the
destruction starts on the outside and moves to the inside of the skull. The facial bones,
mandible and cranial base may be involved, but it is rare (Ibid.).
Since tubercular skeletal lesions that occur in areas other than spine are almost
indistinguishable from other diseases, it is important to study the lesions and their
distribution not only within the skeleton, but also within the population being examined.
27

Only about 1% of all patients with tuberculosis have exhibited skeletal lesions
(Aufderheide and Rodríguez-Martín 1998). The main difference between tuberculosis
and treponemal disease is that tuberculosis destroys already existing bone tissue, while in
treponemal disease there is a proliferation of new bone (Powell 1992). Tuberculosis does
not produce new bone, it only destroys bone.
2.5.2 Leprosy
True leprosy was not known until after 300 BC (Baker and Armelagos 1988). In
Medieval times leprosy was the term used for disfiguring, depigmenting diseases often
spread by sexual contact, heredity, and breastfeeding. The transmission of leprosy in
Medieval times was thought to be from sexual intercourse (Ibid.). Since leprosy is not
transmitted sexually, nor is it hereditary, this gives reason to believe that venereal
syphilis was confused as leprosy (Ibid.). On the other hand, Crane-Kramer (2002)
disagrees that there was any confusion between leprosy and syphilis and provides an
analysis of skeletal material (600 individuals) that suggests a diagnostic confusion
between leprosy and syphilis did not exist in Medieval times.
Leprosy, or Hansen’s disease, as it is sometimes referred to, is a chronic
infectious disease caused by the bacterium Mycobacterium leprae. In humans it affects
the skin, nasal tissues, peripheral nerves, and the skeleton (Aufderheide and Rodríguez-
Martín 1998). Leprosy has a worldwide distribution, but it is more commonly found in
tropical and subtropical areas of Asia, Africa, and the Americas (Ortner 2003). This
disease is found more commonly in rural areas as opposed to urban ones (Aufderheide
and Rodríguez-Martín 1998). Transmission occurs by the inhalation of the M. leprae
28

acteria through moisture droplets in the air. Direct skin-to-skin contact may also
transmit the bacterium from person-to-person through an ulcerated, infected lesion
(Ibid.). The ratio of infected males to females is 2:1 (Ortner 2003). Bones are only
directly involved in approximately 5% of all patients with leprosy (Ibid.). In leprosy,
more commonly there is a resorption of bone, whereas bone lesions are less frequent.
This resorption occurs in the nasal spine (Buckley and Tayles 2003). Leprosy has two
main clinical forms: lepromatous leprosy (LL) and tuberculoid leprosy (TT) (Aufderheide
and Rodríguez-Martín 1998). Both of these forms of leprosy are discussed below.
2.5.2.1 Lepromatous Leprosy (LL). This form of leprosy creates alterations to the
anterior face (Steyn and Henneberg 1995). It begins as a chronic “inflammation of the
nasal mucous membrane” (Lukens 2005:1278), known as rhinitis. The nasal membrane
forms lesions, becomes encrusted, and may bleed, which produces a perforation of the
inner wall of the nose (Aufderheide and Rodríguez-Martín 1998). This infection may
spread to the superior surface of the hard palate, to the nasal bone, nasal spine and the
central maxilla. Erosion of these areas can lead to collapse of the bridge of the nose,
resulting in the feature known as saddle nose, which is unique to lepromatous leprosy
(Ibid.).
If the lepromatous rhinitis spreads to the maxilla, it will erode the maxillary bone
beginning in the midline and extending to the palate (Aufderheide and Rodríguez-Martín
1998). This results in the loss of the upper central incisors and may even extend to the
canines. The mandible is not affected. All of the facial changes discussed above are
together known as facies leprosa, which can be seen in archaeological specimens (Ibid.).
29

Postcranially the long bones of the extremities are sometimes affected, beginning
with the metaphysis and possibly spreading to the epiphysis or medullary canal
(Aufderheide and Rodríguez-Martín 1998). Involvement occurs more commonly in the
hands and feet. In the hands, the most common area of involvement is the phalanges.
Complete destruction of the distal phalanges may occur, which results in shortening of
the fingers (Ibid.). In the feet, the metatarsals are the most commonly affected bones, as
well as the talus and the calcaneus. This may result in club-shaped stumps for the feet
(Ibid.). The bones of the hands and feet are very badly disfigured through the destruction
that occurs from leprosy (Manchester and Roberts 1989).
2.5.2.2 Tuberculoid Leprosy (TT). In tuberculoid leprosy the number of bacteria in the
skin lesions are greatly reduced, which means that this form of leprosy is much less
infectious (Aufderheide and Rodríguez-Martín 1998). The characteristic changes of
facies leprosa present in lepromatous leprosy are absent in tuberculoid leprosy (Ibid.).
Skin lesions are fewer in number, usually a single lesion occurs, but the lesions that do
occur extend to much deeper levels. Similar effects on the bones are seen in lepromatous
leprosy and tuberculoid leprosy, but the effects of tuberculoid leprosy on bones occur
much earlier and more intensively than does lepromatous leprosy (Ibid.).
Leprosy has been found to affect the tibia and fibula (Aufderheide and Rodríguez-
Martín 1998). Here it produces pitting and longitudinally striated subperiosteal bone
deposits. The lateral surface of the tibia also exhibits vascular grooves. The fibula is not
as affected as the tibia. These changes often occur bilaterally and symmetrically in the
tibia and fibula and are more prominent in the distal third portion of the bones (Ibid.).
30

2.5.3 Tumors
Treponemal disease can be very similar to many types of tumors also seen within
the bones of an individual. The different tumors discussed here are osteosarcoma,
meningioma, metastatic carcinoma, and multiple myeloma. Osteosarcoma is a malignant
tumor that develops from the connective tissue of bone. In ancient remains they are most
commonly found in individuals under the age of 30 and males are affected more often
than females (Aufderheide and Rodríguez-Martín 1998; Ortner 2003). This tumor is
found in long bones, most commonly the proximal femur and the head of the humerus.
Osteosarcoma may also affect individuals over the age of 30. In this group, the tumor
affects the flat bones and the skull, with the mandible frequently affected (Aufderheide
and Rodríguez-Martín 1998). New bone formation may occur sometimes resulting in the
appearance of an “onion skin.” Bone spicules that lie perpendicular to the affected bone
surface may also occur. This characteristic is known as a ‘sunburst effect’ (Ibid.).
Meningioma is a soft tissue tumor that affects the membranes of the brain and
spinal cord. The skeletal evidence for these tumors can be found in the spine, but most
are found inside the cranium. This tumor more commonly affects older individuals with
the average age being 45 years (Aufderheide and Rodríguez-Martín 1998). Most of these
lesions are found on the interior of the skull vault with hyperostosis occurring on the
exterior above the lesion. The hyperostosis may be so pronounced that it causes a
thickening of the skull. A spiculated appearance may result from these changes (Ibid.).
Metastatic carcinoma is a malignant tumor occurring most commonly in
individuals over the age of 40. The vertebrae, pelvis, ribs, major long bones, sternum and
31

skull are the most commonly affected bones found in individuals suffering from this type
of tumor (Aufderheide and Rodríguez-Martín 1998). Characteristics to look for in the
archaeological record are pathologic fractures and vertebral collapse with multiple bone
lesions (Ibid.).
Multiple myeloma is a malignant tumor usually occurring in individuals over the
age of 40 and more often in males than females (Ortner 2003). The lesions of this tumor
are strictly lytic, restricted to a particular area, small and round, resorbing bone instead of
producing new bone and having a scalloped edge (Aufderheide and Rodríguez-Martín
1998; Ortner 2003). Most often the lesions are seen in the flat bones, particularly the
skull. In the skull, the lesions can occur internally, externally or both. Eventually the
inner and outer table of the skull is penetrated, resulting in a punched-out appearance. In
the later stages of the disease, the lesions may affect the long bone metaphyses, especially
in the femur and humerus, and collapse of the vertebral body may occur (Aufderheide
and Rodríguez-Martín 1998; Ortner 2003). The most commonly affected bones are the
vertebrae, ribs, skull, pelvis, femur, clavicle, and scapula (Aufderheide and Rodríguez-
Martín 1998).
2.5.4 Osteomyelitis
Osteomyelitis is an infection within bone and bone marrow caused by bacteria
that commonly produce pus (Aufderheide and Rodríguez-Martín 1998). It is
distinguished from periostitis by the involvement of the marrow cavity. The most
commonly affected areas are those of the knee, distal tibia, proximal femur, and
sometimes the humerus is affected (Ibid.). All age groups and any part of the skeleton
32

can suffer from osteomyelitis (Ortner 2003). In children, usually the proximal and distal
ends of the bone are affected, the areas where growth occurs. In adults the ends of the
bones as well as the shafts are affected (Aufderheide and Rodríguez-Martín 1998).
Osteomyelitis usually only affects one bone, although multiple bones can be involved.
The bones become enlarged and deformed through the processes of destruction of the
bone and bone formation. Osteomyelitis is characterized by an area of dead bone that is
surrounded by new bone and has a cloaca (hole) that allows pus to drain from the infected
area. The dead bone is known as a sequestrum, while the new bone is an involucrum.
Healing may occur, but some pitting and cavities will remain in the affected bone (Ibid.).
Osteomyelitis is not commonly found in the bones of the hands and feet. If it
does occur, an expanded involucrum will result which resembles changes found in
congenital syphilis and tuberculosis found in children. In adults the foot phalanges are
more apt to be involved (Ortner 2003). Osteomyelitis is not commonly found in the
vertebrae. If it does occur, adults are affected more often than children, and usually only
one vertebra is involved. The cervical vertebrae are most commonly involved with the
sites of infection in the neural arch and spinous processes (Ibid.). It is also rare to find
osteomyelitis in the skull. When it does occur, the most common area is that of the
frontal bone. The infection will cross sutures, spreading throughout the cranial vault and
into the parietals, but the occipital is rarely involved. The outer table is usually affected
more than the inner table (Ibid.). Middle ear infections can result in osteomyelitis
affecting the mastoid, temporal, and petrous bone, and the mandible and maxilla can also
be affected (Ibid.). No matter what bone is affected, osteomyelitis is characterized by the
presence of a sequestrum and an involucrum.
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2.5.5 Paget’s Disease
The cause of this disease is unknown. Paget’s disease is characterized by both
bone resorption and new bone formation that occurs simultaneously. The most common
age group affected is those individuals over the age of 60, and males are more commonly
affected than females (Aufderheide and Rodríguez-Martín 1998; Ortner 2003). Bones
that are affected most commonly are the pelvis, femur, skull, tibia, vertebral column,
clavicles and ribs. The fibula and the bones of the hands and feet are usually not
involved (Ortner 2003). In the skull, both the inner and outer tables are thinned. In later
stages of progression, new bone is produced on the inner and outer tables and also within
the diploë. This phase may last for many years, producing a thickening of the cranium 2-
3 cm in depth (Aufderheide and Rodríguez-Martín 1998). The infection usually crosses
over the suture lines (Ortner 2003). The facial bones generally are not affected, but when
they are, severe deformity is the result (Aufderheide and Rodríguez-Martín 1998; Ortner
2003).
Paget’s disease affects all areas of the vertebrae, mostly the lumbar, but the most
noticeable changes occur on the vertebral body (Aufderheide and Rodríguez-Martín
1998). The center of the vertebral body may become depressed, fusion of adjacent
vertebral bodies may occur, and the outer edges may also become widened and dense
(Ibid.).
The long bones may also be affected by Paget’s disease. A thickening of the
cortex occurs, but the medullary cavity is left intact, although it may become narrowed
(Ortner 2003). Bowing occurs from the deposition of new bone on the femur
34

anterolaterally and on the tibia laterally. Fractures can also be seen with the most
common being fissure-like stress fractures (Aufderheide and Rodríguez-Martín 1998).
2.6 Differential Diagnosis
To summarize, these diseases are best differentiated by the profile of effects
outlined in Appendix A. Treponemal disease most often affects the skull, hands, tibiae,
fibulae, and feet of an infected individual. Tuberculosis most often affects the spine or
vertebral column, causing collapse of the vertebral body(s) of an individual.
Tuberculosis can also affect the skull, but unlike treponemal disease, there is usually only
a single lesion affecting both the inner and outer tables with very little, if any, bony
reaction and irregular margins that are destructive in nature (Mitchell 2003).
Tuberculosis destroys bone while treponematosis produces new bone. Treponemal
disease produces a general increased swelling of the diaphyses in long bones, whereas
tuberculosis does not (Steinbock 1976). Treponemal disease produces multiple lesions, a
larger area of involvement in the long bone shafts, an altered medullary cavity, an uneven
cortex with bone formation and destruction unlike the changes seen in tuberculosis
(Steinbock 1976).
Leprosy affects the maxillary bone, palate, hands and feet of an individual
through the resorption of bone. In treponemal disease there is a remodeling and
formation of bone, whereas in tuberculosis and leprosy there is a resorption of bone.
Treponemal disease can also affect the spine, but it affects the cervical vertebrae more
35

commonly, whereas tuberculosis more commonly affects the thoracic and lumbar
vertebrae.
Other things to consider for a differential diagnosis between treponemal disease
and tuberculosis or leprosy are the distribution of lesions within the population.
Tuberculosis skeletal lesions are found in 1% of the population (Aufderheide and
Rodríguez-Martín 1998), while periosteal reaction greater than 2% of the population is
considered to be treponemal disease (Rothschild et al. 2004). Proliferative lesions are not
as common in leprosy because of the resorption of bone and leprosy only affects 5% of
the skeleton (Ortner 2003). A higher frequency of skeletal involvement should indicate a
treponemal disease. Nonvenereal treponemal disease has the highest population
frequency (20-40%) that involves periosteal reaction (Rothschild 2000). No other disease
has a population frequency this high involving periosteal reaction. Venereal syphilis has
a low population frequency (14% or less) and because of this reason it is harder to
differentiate from other diseases when considering lesions within the skeleton of an
individual (Ibid.).
Osteosarcoma involves only one bone, while treponemal disease occurs bilaterally
in long bones and in older individuals (Aufderheide and Rodríguez-Martín 1998;
Steinbock 1976). Meningioma affects the skull, never the postcranial skeleton
(Aufderheide and Rodríguez-Martín 1998). Meningioma produces a thickening of the
inner and outer tables of the skull and also a widening of the diploë, unlike treponemal
disease (Steinbock 1976). Metastatic carcinoma lesions are usually small, not necrotic
and regeneration of the bone does not occur. Unlike treponemal disease these lesions are
widely scattered and the lesions do not coalesce (Steinbock 1976). Treponemal disease
36

forms new bone growth surrounding the lesions and treponemal disease also exhibits
postcranial lesions (Kelley 1980). The lesions occurring in multiple myeloma are lytic
lesions and they are smaller than the lesions occurring in treponemal disease
(Aufderheide and Rodríguez-Martín 1998). Steinbock (1976) states that the lesions
occurring in multiple myeloma are smaller, not necrotic, do not regenerate the bone and
are widely scattered lesions that do not coalesce, which is unlike those lesions seen in
treponemal disease. Kelley (1980) adds that in treponemal disease there is a formation of
new bone that surrounds the lesions and that the lesions of treponemal disease also occur
in the postcranial skeleton.
Pyogenic (pus-producing) osteomyelitis usually involves fewer bones than
treponemal disease. Osteomyelitis also produces the characteristic sequestrum,
involucrum, and cloaca in the postcranial skeleton, whereas in treponemal disease these
pathologic changes are rarely observed (Aufderheide and Rodríguez-Martín 1998;
Steinbock 1976). Osteomyelitis usually does not involve the cranium, whereas
treponemal disease does (Steinbock 1976). Kelley (1980) states that osteomyelitis is
more destructive than treponemal disease, involving joints more often.
Paget’s disease produces massive thickening of the skull vault, while in
treponemal disease there is bone formation and bone loss that produces hills and valleys,
not an extreme expansion of the diploë (Aufderheide and Rodríguez-Martín 1998).
Histologic examination of the bones also reveals the mosaic pattern of Paget’s disease
that is not found in treponemal disease (Steinbock 1976). Kelley (1980) states that
Paget’s disease and treponemal disease differ in the age of onset and that Paget’s disease
is a localized infection that lacks cloacae, whereas treponemal disease is widespread and
37

may occasionally possess cloacae in the postcranial skeleton. Paget’s disease can
produce periosteal reaction but the frequency is never greater than 1% in individuals
under the age of 40 years (Rothschild 2005). In Paget’s disease, cortical thickening of
the tibia occurs on the posterior portion, while in treponemal disease, cortical thickening
occurs on the anterior portion of the tibia (Ibid.).
2.7 Objectives
In summary, there are several hypotheses revolving around the geographic origins
and development of treponemal disease. Did it originate in the New World or the Old
World? Was Columbus’ voyage responsible for bringing it to Europe, where it became
more virulent? Has it always been present in the genus Homo and migrated with humans
as they moved to new lands? Is it one disease that transforms depending upon the
environment and social factors of the human host or is it several different organisms that
are very similar?
Treponemal disease leaves markers on the bones that may be similar to other
diseases. These other diseases are tuberculosis, leprosy, tumors, osteomyelitis, and
Paget’s disease. Looking at the distribution of lesions within a skeleton and the
prevalence of lesions at the population level helps to differentiate between the different
diseases that affect the bones.
In the pages to come, through the study of an early (Archaic) prehistoric
population in North America, the Carrier Mills sample from Southern Illinois, these
questions will be addressed; 1) Is there a treponemal disease within this sample?; 2) If
38

there is a treponemal disease, then which one is it?; 3) What does this study tell us about
the lifestyle of this population?; and 4) What does this mean in terms of the history and
origin of treponematoses?
39

CHAPTER 3
MATERIAL AND METHODS
3.1 Materials
3.1.1 The Sample – Carrier Mills Archaeological District
The focus of my research was on the human skeletal remains recovered from the
Carrier Mills Archaeological District, which is located in southern Illinois, in Saline
County, 2.5 km south of the village of Carrier Mills and north of the South Fork of the
Saline River (see Figure 3.1) (Jefferies and Morrow 1982). Excavation of the site was
performed in 1978 and 1979 by the Center for Archaeological Investigations at Southern
Illinois University, Carbondale (Jefferies and Morrow 1982). There are three major sites;
11SA86, 11SA87, 11SA88, and several smaller sites within the 57 hectares of the district.
The Black Earth site (11SA87) is the largest and most complex site (Jefferies and
Morrow 1982) and it is the site that contains the human skeletal remains examined in this
research. There are three main areas within the Black Earth site: A, B, and C (see Figure
3.2). The skeletons examined in this study are from Area A, which produced the most
burials, with 201 burial features containing 223 individuals (Jefferies 1982b). Some of
the burials were located in the plow zone and were severely disturbed, while the majority
of the burials were recovered from the midden zone, which was undisturbed and located
in the central portion of Area A. Most burials date from the Middle Archaic (4500-3000
40

BC) to Late Archaic (3000-1000 BC) periods, but a few have been identified as
Woodland period burials (1000 BC – AD 1000) (Jefferies and Morrow 1982).
Skeletal preservation for both the Archaic and Woodland period groups is good to
excellent as a result of the soil having a high pH level and a good drainage system. The
soil also contained high carbonate concentrations that slowed deterioration of the bone,
but left hard deposits on the surfaces of the bones (Bassett 1982). These deposits
hindered both the initial analysis conducted by Bassett (1982) and the research conducted
here.
3.1.2 Burial Sample
The burial sample of the Black Earth site (11SA87) has been dated using
radiocarbon dating techniques. Eight charcoal samples were analyzed from undisturbed
features within the Area A midden. The samples were collected based on their specific
vertical positions, so that midden deposition rates could be calculated (Bassett 1982).
These charcoal samples produced dates ranging from 3955 to 2910 B.C. (Jefferies
1982a). It is believed that the inhabitants occupied this area from approximately 4000
B.C. to 2900 B.C., due to the dates revealed from the radiocarbon dating (Bassett 1982).
The inhabitants were hunter-gatherers who were becoming more accustomed to a
sedentary lifestyle, which implies that there was also a gradual increase in the population
over time. An increase in population also results in an increase in plant and animal
species found in archaeological sites. For these reasons, the Archaic period has been
characterized as having an “increasing regional specialization and adaptation marked by
the appearance of large, intensively occupied sites” (Jefferies and Morrow 1982;19), and
41

it is also a time when specialized tool forms begin to appear. There is evidence within
this Archaic period site of multiseasonal occupation, meaning that this site was probably
occupied year-round instead of being a seasonal camp that depended upon the
environment and availability of foods (Jefferies and Morrow 1982). The increase in
population size along with multiseasonal occupation also suggests that since people were
staying in one place for long periods of time, they had to have a place to bury their dead.
Therefore, the Archaic period is also the time in which we begin to see archaeological
evidence for an increase in the use of cemeteries.
Everett J. Bassett (1982) performed the original osteological analysis on all of the
Carrier Mills burials (approximately 500 burials). This analysis took place between the
years of 1980 and 1982. The general descriptions of the burials as described by Bassett
(1982) can be found in Appendix F of The Carrier Mills Archaeological Project: Human
Adaptation in the Saline Valley, Illinois, Volume 2. This appendix includes the burial
number, cultural affiliation, sex, age group category, estimated age of the individual,
preservation/completeness evaluation of the remains, osteitis evaluation, and any other
pathological information that was observed by Bassett (1982).
Area A contains 237 individuals with 157 dating to the Archaic (4000 – 2900
B.C.) period, 35 from the Woodland (1000 B.C. – A.D. 1000) period, and 45 are of
undetermined date (but either Archaic or Woodland). Of the total Archaic period sample,
there are 51 juveniles, 54 males, 47 females and 5 individuals that are of undetermined
sex. Within the juvenile sample, there are 46 infants (birth to 3 yrs), 4 children (3 to 12
yrs), and 1 adolescent (12 to 20 yrs). There are an additional 6 adolescents (12 to 20 yrs)
whose skeletal remains were complete enough to determine sex and are included in the
42

data for males and females instead of juveniles. Of the adult sample, there are 45 young
adults (20 to 35 yrs), 49 middle adults (35 to 50 yrs) and 6 old adults (>50+ yrs) within
this sample. Males outnumber females in a ratio of 1.5:1.
A “treponemal-like” infection has been identified within this skeletal sample
(Bassett 1982). Individuals in the sample exhibit some characteristics that are associated
with treponemal disease, but these traits may also be associated with other diseases,
particularly tuberculosis (Bassett 1982). Bassett (1982) found periosteal involvement,
lytic lesions, and saber-shins throughout this sample. The most common bones affected
were the long bones and the cranium, but the ribs, vertebrae, scapulae, clavicles, and
bones of the hands and feet were also affected. He used osteitis as a general term to
describe all bone inflammation, but because it was so widespread, he developed a rating
system of slight, moderate and severe to help in the analysis (Bassett 1982).
Osteitis indicates that an infection was present at the time of death. In Bassett’s
(1982) terminology and analysis, ‘slight’ osteitis meant that the infection is present on the
anterior portion of the tibiae; it may also be present on the fibulae, posterior tibiae and the
anterior femora with slight periosteal remodeling distinguishable. Bassett’s (1982)
category of ‘moderate’ osteitis meant that the infection is also present on the posterior
femora, the humeri, radii, ulnae, clavicles, metatarsals, metacarpals, and maybe even the
ribs, with saber-shin (an anterior bowing of the tibiae) being noticeable. Bassett’s (1982)
category of ‘severe’ osteitis indicated obvious saber-shin, deep lesions visible on the
tibiae, other long bones and the cranium.
Previous research of the human skeletal remains from the Carrier Mills
Archaeological District includes: Miller (1981) on postcranial nonmetric traits, Larsen
43

(1981) on the relationships between the stress indicators of Harris lines and dental
asymmetry, Brandon (1986) on dietary inferences through dental analysis, Anderson
(1998) on measuring stress through tibial growth patterns in juveniles, Van Arsdale
(1998) on the sexual division of labor through the patterns of vertebral osteoarthritis, and
Clapper (2006) on activities based on musculoskeletal stress markers. This research will
explore the tentatively identified treponemal disease within the Archaic period group.
3.2 Methods
This study was conducted in 2006-2007 at the Center for Archaeological
Investigations curation facility in Carbondale, Illinois, where the sample from Area A of
the Black Earth site of the Carrier Mills Archaeological District is housed. The entire
sample of Area A individuals was sorted according to cultural affiliation (e.g. Woodland
[1000 BC – AD 1000] or Archaic [4000 – 2900 BC] periods). The Archaic period
sample of 157 individuals was then sorted numerically according to burial number. The
sub-sample (54 individuals) that was visually examined were the first 54 individuals
excavated from the Archaic period. Table 3.1 gives the categories (e.g. infants, young
adults, males, females, etc.) and the percentages of the individuals in the total sample
(157) versus the percentages of individuals from the sub-sample (54). Also compared
from the total sample and the sub-sample in this Table are the numbers of males, females,
and juveniles, the numbers of individuals diagnosed by Bassett (1982) as having slight,
moderate, severe, and no osteitis, and the number of burials that were considered to be
complete based on a rating of 1, 2, and 3 with 1 being the least complete and 3 being the
44

most complete. As can be seen from Table 3.1, the percentages of males, females,
juveniles, and undetermined from the sub-sample are nearly equivalent to those of the
entire sample. The percentage that is lacking the most is that of the juveniles.
Figure 3.3 is a map of the Archaic period burials. This map indicates that the
burials were widely distributed throughout the entire Stratum 1 area of the site, the core
area. The central and western portions of the Stratum 1 layer of Area A contain the most
burials. This map contains all but five individuals from the sub-sample (54) used in this
study. On the original map of all of the Archaic burials, there were a few outliers to the
North, South and West along the trenches for this site. This map has been cropped to
show a closer view of the densest concentration of burials, or the core area of the site.
Another reason why the map lacks the total number of Archaic burials (157) is that some
burials were left out of the initial analysis by Lynch (1982) due to preservation issues.
Only 124 burials were analyzed and plotted on the map. It is apparent that by sampling
the first 54 individuals, the subsample included individuals widely distributed across the
site except in the southeast quandrant. There was nothing distinct or different about the
site preservation, burial context, or mixture of individuals in that quadrant (Brian Butler,
personal communication).
Bassett’s (1982) age assessment for the juveniles was based on five criteria:
dental calcification, occipital development, long bone length, dental eruption, and the
union of epiphyses. Each individual was also assigned an approximate error factor
depending on the estimated age of the individual (Bassett 1982). Sex determination was
not attempted for the juveniles.
45

Adult age estimation, as assessed by Bassett (1982), was based on five criteria of
progressive changes in the human skeleton. These changes occur in areas of the auricular
surface, pubic symphysis, cranial suture closure, functional dental wear, and involution of
the cortical and trabecular bone of the proximal femur. The most useful indicators were
the auricular surface, because it has the most variation and is preserved more frequently
in the Carrier Mills sample, followed by the pubic symphysis, the second most preserved
indicator in the sample (Bassett 1982). Adults missing all of the aging indicators due to
poor preservation were separated into 3 different age categories: 18-35 years, 35+ years,
and 18+ years depending on the amount of skeletal degeneration related to age. Each
individual was also assigned an approximate error factor depending on the estimated age
of the individual (Ibid.).
Sex indicators utilized by Bassett (1982) for the adults were the characteristics of
the pelvis, skull, and postcranial robusticity. The most useful indicators are those of the
pelvis. Three non-metric methods were used for the pelvis: “1) the ventral arc of the
pubis, the subpubic concavity, and the medial aspect of the ischiopubic ramus, 2) the
sciatic notch, and 3) the feminine preauricular sulcus” (Bassett 1982:1039). The
characteristics of the skull utilized to indicate the sex of the individuals were:
“1) development of the nuchal ridges, 2) presence or absence of the external
occipital protuberance, 3) mastoid size, 4) robusticity of the mandible, and 5)
presence and size of the supraorbital ridges” (Bassett 1982:1039).
46

Individuals with ambiguous, contradictory, incomplete, or poorly preserved
characteristics were assigned Male (?), Female (?), or just a simple (?).
A sub-sample of 54 individuals from the Archaic (4000 – 2900 B.C.) period
sample was examined, in this study. Of the 54 individuals, nine are infants (birth to 3
yrs), two are adolescents (12 to 20 yrs), nineteen are young adults (20 to 35 yrs), twenty
are middle adults (35 to 50 yrs), and four are old adults (>50+ yrs). These age categories
follow the standard age categories as described by Buikstra and Ubelaker (1994). There
are twenty-six males: 1 adolescent, 12 young adults, 12 middle adults, and 1 old adult;
seventeen females: 1 adolescent, 6 young adults, 7 middle adults, 3 old adults; nine
juveniles, and two individuals of undetermined sex: 1 young adult and 1 middle adult,
which results in the same ratio of 1.5 males to 1 female as that seen in the entire sample.
Here, Bassett’s (1982) determination of sex and age were used as a reference
point for the specimens and initial estimate. However, Bassett’s work was not tightly
focused, due to his research being broad, including determining such factors as sex, age,
disease, demography, growth, stature, dating techniques and a general description of the
burials from the entire Carrier Mills Archaeological District, which consists of nearly 500
skeletons. Therefore, his sex determination and age estimates were reevaluated, resulting
in some changes during this analysis.
Of the 54 individuals in this research, the sex determination for five of them was
changed. Burials 45, 66, 84, 86, and 89 were originally identified as male, but were
reclassified as female based upon wide sciatic notches, small mastoids, and complete
perforation of the olecranon fossa of the humerus. Age categories were also changed for
eight of the 54 individuals. Burials 29, 45, and 94, originally categorized as young
47

adults, were changed to middle adults. Burial 50 was originally a middle adult and was
changed to a young adult. Burials 66, 100, and 114, originally adolescents, were changed
to young adults. Burial 103, a middle adult in Bassett's analysis, was reclassified as an
old adult. These changes were not due to altered estimates of absolute age but to
reconsiderations of the age ranges in each category. For example, Burial 29 was
originally classified as a young adult (20-35), but upon examination of the age of the
individual, which was determined to be approximately 44 years of age, this individual
was reclassified as a middle adult (35-50).
During the examination, data were entered into an Excel database using the
skeletal code key, following the Standards For Data Collection manual (Buikstra and
Ubelaker 1994). The following information was recorded in the Data Collection
Worksheet: burial number, skeletal element, side, section, aspect, pathology, lesion
location and lesion type. Also noted in the database are additional observations on
diagrams, sketches of where the lesions occur if any, photographs taken of the
pathological changes, and any comments regarding the examination.
The teeth of the nine infants were visually examined, particularly the permanent
incisors and permanent first molars, for the characteristic changes of congenital syphilis,
including Hutchinson’s incisors, Mulberry molars and Moon’s molars. The canines were
examined for evidence of hypoplasias as well. The teeth of the adults were also
examined for pathological changes.
Any abnormal shape in bone, size and formation, and bone loss specific to
treponemal infection was recorded. All bones presenting these features were set aside,
labeled and photographed. Photographs were taken throughout the data collection and at
48

the conclusion of the analysis. A Nikon Coolpix 7600 digital camera was used,
uploading images into a computer with each image assigned a number, and the number
recorded in the database.
3.3 Summary
In summary, one third of the Archaic period skeletal sample of the Carrier Mills
Archaeological District was examined, specifically those of the Black Earth site, for
evidence of treponemal disease. These data were then used to address the following two
questions: 1) Is there evidence of a treponemal disease within this sample? and 2) If there
is a treponemal disease, which one is it?
To determine if there is a treponemal disease in the Carrier Mills skeletal sample,
twenty-eight different pathological features were first examined. After determining the
presence and absence of these features, it was decided that five primary features should
be used to determine the likelihood of treponemal disease within this sample. The five
primary traits/markers were decided upon after consulting Ortner (2003) and Bogdan and
Weaver’s (1992) diagram showing the distribution of the most frequent sites of skeletal
lesions due to treponematoses. These five primary markers are 1) cranial 2) hand 3) tibial
4) fibular and 5) foot involvement.
To answer the question of which treponemal disease is present in this sample, a
differential diagnosis based on a profile of the effect of treponematoses on populations
used by Rothschild et al. (2000) was utilized. This profile highlights the differences
between yaws, endemic syphilis, and venereal syphilis through the comparison of cases
49

with confirmed disease. The differences include: hand and foot involvement, adult
versus juvenile, and the average number of bone groups affected. In order to examine
these questions, the data were summarized based on presence of periosteal and other
lesions by: age group, sex, bones included, and uni- or bilaterality. The results of this
study are presented in the following chapters.
50

Category
Table 3.1. Carrier Mills Archaic Burials Statistics
Total Sample
(157)
Sub-Sample
(54)
Total % of total Total
% of
total
Infants 46 29% 9 17%
Children 4 3% 0 0%
Adolescents 7 4% 2 4%
Young Adults 45 29% 19 35%
Middle Adults 49 31% 20 37%
Old Adults 6 4% 4 7%
Total Adults 100 64% 43 80%
Total Juveniles 57 36% 11 20%
Males 54 34% 26 48%
Females 47 30% 17 31%
Juveniles, unsexed 51 32% 9 17% if rest of sample
Undetermined 5 3% 2 4% with no osteitis*:
Slight Osteitis 49 31% 23 43% 23/157 15%
Moderate Osteitis 7 4% 7 13% 7/157 4%
Severe Osteitis 1 1% 1 1% 1/157 1%
No Osteitis 100 64% 23 43% 123/157 78%
Complete 1 (least) 27 17% 5 9%
Complete 2 60 38% 15 28%
Complete 3 (most) 70 45% 34 63%
Total sample % of total = t/157*100
Sub-sample % of total = t/54*100
Total juveniles = Infants + Children + Adolescents
Total adults = young adults + middle adults + old adults
Males = all the males in the sample (adults and determined adolescents)
Females = all the females in the sample (adults and determined adolescents)
Juveniles = infants + children + undetermined adolescents
* This is just an example of what the results of the study would be if the rest of the
Carrier Mills Archaic burial sample were not infected with osteitis. This demonstrates
that the percentage of osteitis found in this sample is still high (20%).
51

Figure 3.1 Location of Carrier Mills Archaeological District in southern Illinois.
Image adapted from Jefferies & Morrow 1982.
52

Figure 3.2. Location of Carrier Mills Archaeological District Sites (SA86, SA87,
SA88). Image adapted from Jefferies & Morrow 1982.
53

Figure 3.3. Locations of Archaic burials by sex determination.
Shaded burials indicate burials in this study. Adapted from Lynch 1982.
54

CHAPTER 4
RESULTS
Appendix B provides a summary of the Burials exhibiting skeletal lesions that are
possible treponemal characteristics for each of the 54 Carrier Mills Archaic individuals
that were examined. The appendix contains the burial number, age/sex category of the
individual, completeness of the skeleton, and degree of osteitis that the skeletal remains
exhibit. Also contained in this appendix are the notes pertaining to the coding of the
human skeletal remains as designated during this analysis.
Of the total number of Archaic period skeletons, Bassett (1982) diagnosed 49
with slight osteitis, seven with moderate osteitis, and one male with severe osteitis. Of
the subsample of 54 individuals that were examined in this study, Bassett (1982)
diagnosed 23 of them with slight osteitis (12 males, 10 females and 1 of undetermined
sex), 7 with moderate osteitis (5 males and 2 females), 1 male with severe osteitis, and 23
without any signs of osteitis. While the results presented here are similar in scope of
affected individuals, there are some differences and a more detailed understanding of the
pattern of affected bones.
4.1 Likelihood of Treponemal Disease
55

Determination of the presence or absence of a treponemal disease and which
syndrome is present is based on the presence or absence of osteitis/periostitis changes in
different bones and bone groups, by age, sex, and uni- or bilaterality. Tables 4.1 – 4.5
provide an initial summary of the presence of osteitis or other pathological feature of
each burial, by bone/bone group, and sex for each age group in the Carrier Mills Archaic
sample. All the tables contain the burial number, estimated age in years of the individual,
sex of the individual, and the presence, absence, or observability of the 28 different
pathological markers used in this study. Markers falling into the five primary sets of
features for distinguishing treponemal disease from other diseases are numbered and in
bold. These five primary marker sets are: 1) cranial involvement; 2) hand involvement;
3) tibial involvement; 4) fibular involvement; and 5) foot involvement. The tables also
contain the number of pathological markers associated with each burial and the number
of bone groups affected in each burial. Table 4.1 contains the information for the infants,
Table 4.2 contains the adolescents, Table 4.3 consists of the young adults, Table 4.4 is the
middle adults, and finally the old adults are in Table 4.5.
By looking at Tables 4.1 – 4.5, it is immediately apparent that osteitis and related
pathological lesions were widespread in this sample. The Totals column is the total
number of individuals affected for each pathological marker. In Table 4.1 (Infants), of
the 28 pathological markers, 17 are found on individual infants, while 11 are not. Of the
17 markers found, 10 markers occur on four or more affected individuals. Table 4.2
(Adolescents) shows that 17 of the 28 pathological markers are exhibited on individual
juveniles. Table 4.3 (Young Adults) shows that 23 of the 28 pathological markers are
exhibited on young adult skeletons; 6 of the pathological markers occur on 10 or more
56

affected individuals. From Table 4.4 (Middle Adults), it is clear that 24 of the 28
pathological markers occur on one or more of these skeletons, and 8 of the pathological
markers are found on 10 or more affected individuals. Table 4.5 (Old Adults) shows that
out of the 28 pathological markers, 18 affect old adult skeletons, with 13 of those
affecting 2 or more individuals. This demonstrates that the skeletal remains for this sub-
sample have a high frequency of bone infection.
Table 4.6 contains a summary and the percentages of occurrence for these 28
possible pathological markers (either osteitis on a bone/group or other feature) found
within the sample. The data are broken down into the numbers of infants, adolescents,
young adults, middle adults, and old adults possessing each marker, but since treponemal
disease also affects males more than females, the numbers of males, females, and
unknown (adults of undetermined sex) exhibiting each marker are also included.
Percentages were calculated based on the number of individuals affected for the juveniles
(infants + adolescents), adults, males and females relative to the number preserving that
bone for this sample.
The adults are affected considerably more than juveniles in this study (see Table
4.6 and Figure 4.1). Focusing on the five primary markers, the cranium is affected far
more in the adults (67%) than in the juveniles (36%). The hands are affected far more in
the adult (72%) sample than in the juvenile (18%) sample. The bilateral tibiae are more
affected in the adult (93%) versus the juvenile (100%) sample. The bilateral fibulae are
affected in almost all individuals in which both are present, including 80% of the adults
and 67% of the juveniles. Involvement of the feet is also seen considerably more in the
adults (78%) than in the juveniles (43%).
57

The results in Table 4.6 indicate that males are generally affected more in this
sample than are females (see also Fig. 4.2). Although the frontal/parietal region is
affected in fewer males (37%) than females (54%), nasal/palatal involvement was seen in
38% of males, but no females. The hands are also affected more in males (75%) than in
females (63%). Bilateral tibiae are affected in almost equal frequency in males (95%)
and females (92%). Saber shin, however, is found in 29% of males, but no females.
Bilateral fibulae involvement is again about the same in males (78%) than in females
(77%). But the feet are affected far more in males (87%) than in females (67%). It is
interesting that the male sample is affected more in the hands, feet and saber shin tibia
deformity. This could be due to the absence of some of the skeletal elements or to
observer error, but as reviewed earlier, treponemal disease generally affects males more
than females (Aufderheide and Rodríguez-Martín 1998).
The considerable differences in the adult versus the juvenile sample could be due
to the frequent absence of hand and foot bones, tibiae, and fibulae in the juvenile sample.
Table 4.6 further demonstrates the high level of occurrence of many pathological markers
indicative of a treponemal infection, in addition to the five primary markers (in bold),
although some (particularly dental features) are conspicuously lacking. While the
absence of dental markers could be due to missing permanent incisors and first molars or
to attrition in some cases, it may also be indicative that this infection could be
nonvenereal in nature. Nonvenereal treponemal disease does not affect the teeth.
Table 4.7 is a summary of the likelihood of the Carrier Mills Archaic burial sub-
sample suffering from treponemal disease. Listed are the numbers of burials with a
rating system as follows: ‘none’, ‘possible’, ‘highly likely’ and ‘certain’ for suffering
58

from treponemal disease. The ratings are based on the five primary markers of cranial,
hands, tibiae, fibulae, and feet involvement. Thus, if a burial did not exhibit
osteitis/pathology for any of these five primary areas, the individual was scored not to
have a treponemal disease (“None”). If a burial had involvement in one, two or three of
these areas, the individual was considered to have “Possible” treponemal disease. If a
burial exhibited involvement in four or five of these areas, then it was considered to be
“Highly Likely” that the individual had a treponemal disease. A “Certain” for
treponemal disease was coded if the individual possessed all five of the markers, had
lesions that perforated the cortex, and had the saber shin deformity. If an individual had
fewer than five of the primary markers, but exhibited the saber shin deformity, that
individual was also considered ‘certain’ for treponemal disease. As has been noted, most
of the individuals in this study exhibited infection of the bone on at least one or more
elements. Almost all of the 11% of individuals categorized as ‘none’ had at least one
bone with osteitis , but since none of the primary marker elements were affected, they
were placed in the category of ‘none’. A visual summary of the likelihood of treponemal
disease in the Carrier Mills individuals is shown in Figure 4.3. Below is a discussion of
the individuals included in each of the likelihood categories based on the five primary
marker sets. In discussing individual burials, they will be abbreviated as Burial = B +
number (Burial 38 = B38).
4.1.1 Certain
Six individuals (11% of the sample) were diagnosed as ‘certain’ for treponemal
disease, and all of these were males. The most severe case exhibited all 5 characteristic
59

markers on the skeleton, had lesions perforating the cortex, and had saber shin tibiae.
B38 is a middle adult male approximately 40 years old, previously diagnosed as severe
osteitis (Bassett 1982). This unfortunate individual had lesions on his entire skeleton. Of
the five primary markers used for diagnosis of the skeletons, this individual possessed
pathological lesions in all 5 areas of the skeleton: crania, hands, tibiae, fibulae, and feet
involvement. This individual also exhibited saber shin deformity of the tibia, which was
a bilateral phenomenon.
The cranium of B38 exhibits lesions on the frontal, left parietal, left maxilla, left
and right mandible, right nasal, left and right lacrimal, and occipital bones. The frontal
contains 8 lytic lesions ranging in size from

also affected. These were all in the forms of lesions. Figure 4.5 is the left third
metacarpal showing one lesion surrounded by woven bone.
The tibiae of B38 exhibit bilateral lesions. The right tibia has approximately 10
lesions on the surface that perforate the cortex. They range in size from ~0.5 cm to 1.5
cm wide. Eight of them are surrounded by woven and sclerotic reaction. This tibia also
exhibits the most prominent marker of treponemal disease, the saber shin. Figure 4.6
shows the right tibia, posterior midshaft with six lesions surrounded by woven and
sclerotic reaction. The left tibia also has approximately 10 lesions on the surface that
perforate the cortex. They range in size from 1 to 1.5 cm long. Woven and sclerotic
reaction also surrounds eight of them, and it also has the saber shin characteristic.
The fibulae of B38 both exhibit lesions, woven bone, and a sclerotic reaction.
The right fibula is bowed medio-laterally and it has five lesions, which are all
approximately 1.5 cm long. The left fibula has one long lesion (~11 cm in length) that is
best described as a cloaca that is surrounded by sclerotic reaction. Figure 4.7 is a closeup
of the lateral left fibula showing the cloacae and the surrounding sclerotic reaction.
The feet of B38 are severely infected. Of the tarsals, the right side is affected.
The calcaneus has lesions and osteophytes. All the metatarsals of both feet are affected.
The right metatarsals have lesions and woven bone. The first metatarsal is fused with the
first phalanges. The left metatarsals are swollen with woven bone and sclerotic reaction,
trabecular coarsening and cortical thinning. Figure 4.8 shows the plantar surface of the
first left metatarsal showing woven and sclerotic reaction.
The other five burials are not as severely affected as B38. These five burials are
B104, B25, B48, B33 and B65. B104 is a middle adult male of 46 years exhibiting
61

involvement of all of the five primary markers and the characteristic saber shin
deformity. In the hands, the metacarpals exhibit bone loss, woven bone and deposition of
bone. The hand phalanges also exhibit deposition of bone and bone loss. The carpals
exhibit bone loss as well. The tibiae have woven bone and sclerotic response anteriorly
as well as striations medially. The left tibia has two lesions on the lateral surface at the
proximal end and the saber shin deformity. The right tibia has one lesion proximal
laterally and also has the saber shin deformity. The fibulae also exhibit woven bone and
sclerotic response along with striations on the entire shafts. The foot phalanges have bone
deposition and loss.
B25, a young adult male of 33 years, shows involvement of the hands, tibiae, and
fibulae. The hands have woven bone on the phalanges along with bony growths. The
metacarpals are misshapen, like they have been twisted. The right tibia has a
concentration of woven bone on the anterior midshaft along with the saber shin
deformity. The left tibia has striations, osteitis, and the saber shin deformity.
B48 is a young adult male, aged 20-35 years, possessing markers on the tibiae,
fibulae, and feet. The right tibia exhibits striations on the shaft medially and the saber
shin deformity. The left tibia has striations medially on the shaft and has a patch of
woven bone on the distal 1/3 of the shaft along the postero-medial surface, as well as the
saber shin deformity. Both fibulae exhibit striations along the entire shaft. In the feet,
the tarsals have bone loss and the fifth intermediate and distal phalanges are fused on one
foot (side unclear).
B33 is a middle adult male, 35 years of age. This particular individual has
involvement of the palate, hands, tibiae, fibulae, and feet. There is pitting on the palate.
62

Three hand phalanges exhibit unifocal bone loss. The right tibia exhibits a slight saber
shin, with both tibiae having striations on the medial shaft but no apparent thick spongy
growth on either tibia. The fibulae have striations on the shaft and are flattened, while
the right fibula has sclerotic reaction on the medial surface of the distal shaft. The
metatarsals have bone loss and woven bone present. Both ulnae are bowed at the distal
end.
B65 is a middle adult male of 49 years who exhibits involvement of the hands,
tibiae, fibulae, and feet. The intermediate and proximal hand phalanges look swollen and
have spicules along the shafts. The right tibia has the saber shin deformity, a thick
spongy patch of bone on the medial surface of the proximal end, and striations on the
medial shaft. The left tibia is missing. The fibula is not smooth, but exhibits osteitis that
is bubbly in appearance. The metatarsals have bone loss, woven and sclerotic reaction on
the shafts. Both ulnae and radii are bowed on the distal end.
4.1.2 Highly Likely
Out of the 54 individuals examined, 15 (28%) were scored as ‘highly likely’ for
displaying pathological lesions consistent with treponemal disease. One of the infants fit
into this category with four of the primary markers. B32 (age 0.8 yrs) had cranial, tibial,
fibular, and foot involvement. On the cranium, the left orbit exhibits extensive woven
bone, while the left temporal also has extensive woven bone present. The tibiae from
B32 exhibit woven bone, as well as the fibulae. One of the adolescents, B89 (female, 16
years), had four of the five primary markers, including involvement of the hands, tibiae,
fibulae, and feet.
63

Of the young adults, three were ranked as ‘highly likely’ for having treponemal
disease, with each having four of the five primary markers. These three burials are B35,
B82, and B84. B35 (male, 21 years) had involvement of the crania, hands, tibiae, and
feet. B82 (undetermined sex, 25 years) had involvement of the hands, tibiae, fibulae, and
feet. B84 (female, 29 years) had involvement of the crania, hand, tibiae, and fibulae.
Six of the middle adults were ‘highly likely’ to have been affected by treponemal
disease. Four of these burials had four primary markers, B7, B91, B99, and B110. B7
(female, 47 years) exhibited involvement of the crania, hands, tibiae, and feet. B99
(female, 35 years), and B110 (male, 36 years) both exhibited involvement of the hands,
tibiae, fibulae, and feet. B91 (male, 42 years) had involvement of the crania, hands,
tibiae, and fibulae. The other two burials had five of the primary markers, B86 (female,
35 years), and B93 (male, 42 years). Although B86 and B93 possessed all five traits,
they were not categorized as certain for having a treponemal disease because neither of
them showed signs of saber tibia.
All four of the old adults were categorized as ‘highly likely’ for suffering from
treponemal disease. B1 (female, 56 years), and B4 (female, 58 years) possessed all five
primary markers, but again they were not categorized as ‘certain’ for having a treponemal
disease because neither of them showed signs of saber tibia. The other two burials, B51
(male, 51 years), and B103 (female, 53 years), both had involvement of four of the
primary markers: hands, tibiae, fibulae, and feet.
4.1.3 Possible
64

The majority of the individuals in this study were considered ‘possible’ for
treponemal disease (28 out of 54, or 52%). Individuals with one, two or three of the five
primary marker sets were categorized as ‘possible’ for having suffered from treponemal
disease. Of the infants examined, five were scored as ‘possible’ cases for treponemal
disease. B77 (1.3 years) had hand involvement, while B30 (0.2 years) and B40 (0.6
years) both had cranial involvement. B62 (0.4 years) had cranial and tibial involvement,
while B87 (0.8 years) had tibial and fibular involvement. One of the two adolescents was
scored as ‘possible’ for suffering from treponemal disease. B116 is a male of
approximately 16 years of age. He possessed two of the primary markers; involvement
of the fibulae and feet.
Twelve of the young adults were scored as ‘possible’ for suffering from
treponemal disease. Three young adults all exhibited only one of the primary marker
sets. B39 (male, 22 years) and B109 (female, 21 years) both had hand involvement. B83
(female, 20 years) had tibial involvement. B69 (male, 29 years) possessed two of the
primary markers, involvement of the hands and feet. The other eight of the young adults
all possessed three of the five primary markers. B66 (female, 21 years) had cranial,
tibial, and fibular involvement. B105 (male, 27 years) had involvement of the hands,
fibulae, and feet. B50 (male, 34 years), B95 (male, 34 years), and B100 (male, 20+
years), B111 (female, 22 years), B113 (male, 26 years), and B114 (male, 20 years) all
possessed markers on the tibiae, fibulae, and feet.
Ten of the middle adults were scored as ‘possible’ cases of treponemal disease.
Four of these ten possessed two of the primary markers. B29 (male, 44 years) had cranial
and tibiae involvement. B85 (female, 40 years) had involvement of the fibulae and feet.
65

B94 (undetermined sex, 44 years) had involvement of the hand and foot. B121 (male, 39
years) had cranial and hand involvement. The other six individuals all had three of the
five primary markers. B17 (female, 50 years) exhibited involvement of the tibiae,
fibulae, and feet. B45 (female, 37 years), B49 (male, 46 years), and B72 (male, 38 years)
all suffered from hand, tibiae, and fibulae involvement. B106 (female, 47 years) had
cranial, tibiae, and fibulae involvement, while B124 (male, 42 years) exhibited
involvement of the hands, tibiae, and feet.
4.1.4 None
Of the 54 individuals examined, 5 (9%) were scored as having no signs of
treponemal disease, although these individuals did exhibit infection. Of the infants
examined, B21 (1.7 years), B46 (0.1 years), and B63 (0.4 years) did not contain any of
the five primary markers and therefore were scored as ‘none’ for having treponemal
disease. Two of the young adults were scored as ‘none’ for suffering from treponemal
disease. B3 (male, 27 years) and B41 (female, 18-35 years) did not have any of the five
primary markers.
4.1.5 Differential Diagnosis and Summary
There are five other diseases that have often been difficult to differentiate from
treponemal disease in prehistoric populations: tuberculosis, leprosy, tumors,
osteomyelitis, and Paget’s disease (see Chapter 2 for specific descriptions).
As reviewed above, tuberculosis affects the spine of individuals; more than 40%
of the skeletal lesions are seen in the spine (Aufderheide and Rodríguez-Martín 1998).
66

Most commonly the thoracic and lumbar vertebrae are affected. Collapse of the vertebral
column may occur, usually involving, but not limited to, two or three vertebrae. The hip,
knee and ribs may also be affected (Ibid.). In this study, some of the cervical, thoracic
and lumbar vertebrae are affected in all of the age categories. The vertebrae that are
affected do not have abscesses that progress horizontally to cause collapse of the
vertebral body. Most of the vertebrae exhibit signs of degenerative arthritis and, in some
cases, Schmorl’s nodes. Cranial involvement is generally characteristic of treponemal
disease and not tuberculosis. In tuberculosis a single lesion that affects the inner and
outer tables is often seen. This lesion is not accompanied by any bony reaction. In the
cranial lesions observed in this study, there are multiple lesions affecting the outer table
and they are accompanied by bony reaction.
Leprosy (Lepromatous) most often affects the face in individuals (see Chapter 2).
It causes a resorption of bone in the nasal spine. Leprosy also causes erosion of the
maxillary bone and the palate, and it also affects the hands and feet. In this study, none
of the individuals exhibited resorption of the nasal spine or of the vertebral column. The
hands and feet of the individuals in this study were affected, but resorption of the distal
phalanges of the hands was not seen, nor was the diagnostic club-shaped foot of leprosy
recognizable in the feet of the individuals in the Carrier Mills sample.
The lesions occurring in the individuals of this study also do not fit the profile
outlined above (Chapter 2) for various tumors. Osteosarcoma involves only one bone,
meningioma never affects the postcranial skeleton, metastatic carcinoma and multiple
myeloma produce small lesions without regeneration of bone and the lesions are not
necrotic. The individuals in this study have lesions that are large, surrounded by
67

egeneration of bone with some necrosis, and the lesions are multiple affecting the cranial
and postcranial skeleton.
Osteomyelitis produces sequestra, involucra, and cloaca in the postcranial
skeleton and does not usually affect the cranium. In this study no sequestra or involucra
were observed, and the cranium is affected in some individuals. Paget’s disease produces
massive expansion of the skull vault and is a localized infection that may cause periosteal
reaction, but this percentage is never greater than 1%. In this study no extreme expansion
of the skull vault was observed. The infection in this study is widespread and affects far
more than 1% of the sample.
Thus it appears overwhelmingly likely that the Carrier Mills sample suffered from
some type of treponemal disease. Eighty–nine percent of this sample possessed between
one to five of the primary markers for treponemal disease. Some form of periosteal
involvement was observed in all but one individual from this study, and this individual
(Burial 41) was not complete. Now that it has been determined that a treponemal disease
did exist in the Carrier Mills Archaeological District sample, the differential diagnosis of
which syndrome of treponemal disease existed at Carrier Mills will be examined and
determined.
4.2 Type of Treponemal Disease
Distinguishing between the different syndromes of treponemal disease is a very
hard task. Many of the bony alterations that occur in one syndrome also occur in the
other syndromes. The saber shin deformity of the tibiae can be found in all of the
68

treponematoses that affect the skeleton. Deformity of the nasal-palatal region may also
be seen as well as lesions affecting any bone of the body. The lesions are
morphologically indistinguishable between the different syndromes. Caries sicca is one
characteristic that is not seen in all of the treponematoses. This is the destruction of the
cranium produced by venereal syphilis in the tertiary stage. According to Rothschild et
al. (2004:64), “periosteal reaction diffusely affecting multiple bones of more than 2% of
the population is basically a manifestation of treponemal disease.” A frequency of 2-14%
indicates the presence of syphilis, while frequencies of 20-40% indicate the presence of
either yaws or endemic syphilis (Rothschild et al. 2004).
Rothschild et al. (2000) developed a rubric and summary table of differential
diagnosis, relying on the frequency of occurrence in a sample, the ages affected, and the
bone groups involved, using a specific set of bone groups. This study will draw on that
table to determine which treponemal disease existed in this sample.
4.2.1 Bone Groups
Tables 4.8- 4.12 contain data on the different bone groups affected within the
sample. The tables are divided into the five different age categories; Table 4.8 is infants,
Table 4.9 is adolescents, Table 4.10 consists of young adults, Table 4.11 is middle
adults, and Table 4.12 contains old adults. Each table consists of the burial numbers for
that age group, estimated age in years, sex of the individual, and then a listing of the bone
groups showing osteitis or dental changes characteristic of treponemal disease. The
different bone groups included are the nine defined and used by Rothschild et al. (2000):
tibiae, fibulae, femora, humeri, radii, ulnae, hand bones, foot bones, clavicles, cranial,
69

plus one additional group added for this study, teeth. The “teeth" group includes only the
incisors and the molars. This group is important for distinguishing the different
treponemal syndromes; thus it is included in this study. If any bone in a particular bone
group is affected, then it is indicated as present with an X. Multiple X’s are used for the
hands and feet because the carpals, tarsals, metacarpals, metatarsals, hand and foot
phalanges are each considered separate bone groups (following Rothschild et al. 2000).
If no member of the bone group is affected, it is indicated with an N. If the bone group
was not observable or missing, there is an O on these tables. The number of bone groups
affected (marked with an X) for each burial is then totaled.
The data presented in Tables 4.8 – 4.12 indicate that there are many bone groups
affected in most members of this sample instead of just a few bone groups. This sample
is thus polyostotic, meaning that when looking at the bone groups, an average number
greater than three are affected (Rothschild et al. 2000).
Table 4.13 is a comparison of the numbers of bone groups affected within the
Carrier Mills Archaic burial sample and the numbers found in individuals with confirmed
cases of syphilis, yaws and endemic syphilis summarized by Rothschild et al. (2000).
The numbers of adults and juveniles evaluated are totaled and the percent affected is also
shown. The Carrier Mills sample has unilateral tibial involvement, but it also has
bilateral tibial involvement, which was not taken into account in the Rothschild et al.
(2000) study because two of their five populations were from ossuaries, hindering the
assessment of a disease process involving bilaterality of the tibia. Also shown in this
table are the age (years before present), of the different sites/samples, average numbers of
bone groups affected, whether or not the hands/feet are affected in greater than 5% of the
70

cases, and the distribution or number of individuals affected according to the different
bone groups.
It is clear from this comparison that the disease process which affected the
individuals at Carrier Mills was not venereal syphilis. In fact, it is most like the pattern
of involvement seen in yaws, but with far greater expression in terms of both numbers of
individuals and average numbers of bone groups affected (see discussion in Chapter 5).
4.3 Comparison of Findings
Bassett (1982) found that the most common sites of localized infection for the
skeletons of the Carrier Mills sample were the temporal area, the shoulder region, and the
tibiae. His findings were consistent for both males and females. The fingers and the os
coxae were also affected in males. Bassett (1982) also found widespread infection
throughout the skeletal sample, no matter the age or sex of the individuals. This infection
consisted of periosteal involvement, lesions, and saber shins of the tibiae. Out of the
nearly 500 individuals from the Middle Archaic (4500 – 3000 BC) to the Woodland
(1000 BC – AD 1000) periods, Bassett (1982) diagnosed 122 cases of slight osteitis,
characterized by slight periosteal involvement of the anterior and posterior tibiae, the
fibulae, anterior femora, and slight remodeling of the periosteum. There were 35 cases of
moderate osteitis, in which he included periosteal involvement of these same bones but
also the posterior femora, humeri, radii, ulnae, clavicles, metatarsals, metacarpals, and in
some instances the ribs. A diagnosis of moderate osteitis also included a thick spongy
growth on the tibiae and noticeable saber shins (Bassett 1982). The individuals affected
71

the most were classified as having severe osteitis; there were 8 cases of these. This
includes all the affected bones from the two previous classifications with the addition of
deep lesions on the tibiae, other long bones, and crania. The saber shin became very
obvious in these cases as well. Bassett (1982) suggested this infection was non-venereal
due to symptoms occurring in young individuals as well as older individuals.
The results of the present study mostly agree with the results of Bassett’s (1982)
study. There is widespread infection present in all groups of this burial sample. Bassett
(1982) diagnosed all infants in this study as having no osteitis. I would disagree. Of the
nine infants examined here, 4 have cranial involvement, 3 have tibial involvement, 8 have
involvement of the thoracic or lumbar vertebrae, and all 9 have involvement of at least
one long bone. This disagreement could be due to difficulties in assessing the normal
patterns of bone growth and development in infants.
Another area of disagreement centers on the diagnosis of saber shins on some
individuals. Bassett (1982) diagnosed Burials 1, 25, 33, 48, 65, 103, and 104 as having
moderate osteitis. His diagnosis also included thick spongy growth on the tibiae and
noticeable saber shins of these individuals. I did not categorize the disease process on
these individuals in precisely the same way. Burial 1 has medial striations on both tibiae,
and saber shin was not observed for either tibia. The left tibia did not have thick spongy
growth although the right tibia did have spongy growth on the lateral surface of the shaft.
Burial 25 does exhibit saber shin tibiae. The right tibia also has a concentration of woven
bone at the midshaft that extends from the anterior to medial surface. Burial 33 has a
slight saber shin of the right tibia. No thick spongy growth was observed on either tibia.
Burial 48 exhibits saber shin on both tibiae. The tibiae both have striations on the shafts
72

medially, but there is not thick spongy growth visible on the right tibia. The left tibia has
a patch of thicker spongy growth medial to posterior on the distal third of the shaft that is
barely noticeable. Burial 65 has saber shin on the right tibia. There are striations on the
medial shaft and a thick spongy patch of bone on the proximal third of the shaft medial.
The left tibia is missing. Burial 103 may have slight bowing of the tibiae, but it is so
slight that this burial is considered not to have saber shin tibiae. Both tibiae do have
striations medially on the shafts, but there is not any thick spongy growth on either tibia.
Burial 104 exhibits saber shin on both tibiae. There are striations on the shafts of both
tibia medially, there is spongy bone on both anterior shafts, and both have lesions on the
proximal shafts lateral, the left has two lesions, while the right has one lesion. Bassett
(1982) diagnosed eight individuals with saber shin tibiae and the present study diagnosed
six individuals with saber shin tibiae, including Burial 38.
Most of the findings in Bassett’s (1982) original study of the Carrier Mills
skeletal sample that pertain to the individuals in this sample were confirmed. There are
differences pertaining to the infants and to the individuals diagnosed as having saber shin
tibiae. These differences can be attributed to observer error (given the large amount of
analysis undertaken at once by Bassett) and to the many new advances in paleopathology
since 1982.
4.4 Summary
Treponemal disease was determined to be present in this sub-sample based on the
presence of osteitis/periostitis changes in different bones/groups by age, sex, and uni- or
73

ilaterality of the extremities. Five primary marker sets (cranial, hand, tibial, fibular, and
foot) were used to determine the likelihood of a treponemal disease within this sub-
sample. Thirty-nine percent of the sub-sample were categorized as highly likely - to -
certain for having treponemal disease, 52% were possible for exhibiting treponemal
disease, and 9% had indications of a general infection, but were classified as not having
had a clear indication of treponemal infection.
Rothschild et al. (2004) concluded that 2% or more of a population with periosteal
reaction is indicative of a treponemal disease. They also state that a frequency of 20-40%
indicates either yaws or endemic syphilis in a population. The results of this study show
that 91% of the sub-sample display some kind of periosteal reaction, which is a
considerably greater amount than the 2% necessary to indicate treponemal disease. The
present study also found that 39% of the individuals were categorized as highly likely - to
-certain for treponemal disease. This would fall into the range of the 20-40% (at least)
that is indicative of a nonvenereal treponemal infection, like yaws.
From the comparison in Table 4.13, the profile of age and bone group
involvement make it clear that the Carrier Mills Archaeological District suffered from a
syndrome of treponemal disease most like yaws. When Carrier Mills is compared to the
confirmed cases of yaws summarized by Rothschild et al. (2004), the number of
individuals affected are higher in frequency, with much greater than 5% (in fact 99%) of
the Carrier Mills sample affected as a whole (only one individual without evidence of
bone disease), and the hands and feet are also affected with a much higher prevalence rate
than 5%. Sixty percent of the individuals in this study had involvement of the hands,
while 73% had involvement of the feet (see Table 4.6). This is a significant amount, too
74

high of a percentage to be considered venereal syphilis or endemic syphilis. What do
these figures tell us about the Carrier Mills sample? In the Discussion and Conclusions
Chapter, I will examine more closely: 1) the differential diagnosis of treponemal disease,
2) what life might have been like for the Archaic peoples of Carrier Mills, Illinois, and 3)
what this study means in terms of the history and origin of treponemal disease.
75

Table 4.1. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS
Infants (n=9, age = birth to 3 years)
Burial Number B21 B30 B32 B40 B46 B62 B63 B77 B87 TOTALS
Estimated Age (years) 1.7 0.2 0.8 0.6 0.1 0.4 0.4 1.3 0.8 -
Sex of individual Juv Juv Juv Juv Juv Juv Juv Juv Juv -
1 Frontal/Parietal Involvement A P P P A P A A A 4
1 Nasal/Palatal Involvement
A A A A A A A A A 0
Hutchinson's Incisors
A A A A A A A A A 0
Moon's Molars A A A A A A A A A 0
Mulberry Molars A A A A A A A A A 0
Clavicle Involvement A P P P P P P P P 8
Bilateral Humerus Involvement P P P P P P P P P 9
Unilateral Humerus Involvement
A A A A A A A A A 0
Bilateral Radius Involvement - A P P P A A P A 4
Unilateral Radius Involvement
- P A A A P P A P 4
Bowed Radius - A A A A A A A A 0
Bilateral Ulna Involvement - A P A P P A P P 5
Unilateral Ulna Involvement
- P A P A A P A A 3
Bowed Ulna - A A A A A A A A 0
2 Hand Involvement
A A A A A A A P A 1
Rib Involvement A P P P P P P P P 8
Cervical Vertebrae Involvement A A A A A A A A A 0
Thoracic Vertebrae Involvement A A P P P P P P A 6
Lumbar Vertebrae Involvement P A P P P P A P P 7
Periarticular Resorptive Foci (V)
A A A A A A A A A 0
Bilateral Femur Involvement A A P P A P A P P 5
Unilateral Femur Involvement A P A A P A A A A 2
3 Bilateral Tibia Involvement - - P - - - - - P 2
3 Unilateral Tibia Involvement - A A - - P - - A 1
3 Saber Shin Tibia - A A - - A - - A 0
76

Table 4.1. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS,
continued.
Infants (n=9, age = birth to 3 years)
Burial Number B21 B30 B32 B40 B46 B62 B63 B77 B87 TOTALS
Estimated Age (years) 1.7 0.2 0.8 0.6 0.1 0.4 0.4 1.3 0.8 -
Sex of individual Juv Juv Juv Juv Juv Juv Juv Juv Juv -
4 Bilateral Fibula Involvement - - P - - - - - P 2
4 Unilateral Fibula Involvement
- - A - - - - - A 0
5 Foot Involvement A A P - A - - - A 1
Number of Pathological Features 2 7 12 9 8 10 6 9 9 72
Number of Bone Groups Affected
1 5 8 5 5 6 4 6 7 -
The five primary markers are numbered and indicated in bold.
P = present A = absent - = not observable
77

Table 4.2. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS
Adolescents (n=2, age = 12 to 20 years)
Burial Number B89 B116 TOTALS
Estimated Age (years) 16.5 16.3
-
Sex of individual F M -
1 Frontal/Parietal Involvement A A 0
1 Nasal/Palatal Involvement
A A 0
Hutchinson's Incisors
A A 0
Moon's Molars A A 0
Mulberry Molars A A 0
Clavicle Involvement P P 2
Bilateral Humerus Involvement - P 1
Unilateral Humerus Involvement
P A 1
Bilateral Radius Involvement A A 0
Unilateral Radius Involvement
P P 2
Bowed Radius A A 0
Bilateral Ulna Involvement A P 1
Unilateral Ulna Involvement
P A 1
Bowed Ulna A A 0
2 Hand Involvement
P A 1
Rib Involvement P P 2
Cervical Vertebrae Involvement P A 1
Thoracic Vertebrae Involvement
P P 2
Lumbar Vertebrae Involvement P P 2
Periarticular Resorptive Foci (V)
A A 0
Bilateral Femur Involvement P - 1
Unilateral Femur Involvement P - 1
3 Bilateral Tibia Involvement P - 1
3 Unilateral Tibia Involvement P - 1
3 Saber Shin Tibia A - 0
78

Table 4.2. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS,
continued.
Adolescents (n=2, age = 12 to 20 years)
Burial Number B89 B116 TOTALS
Estimated Age (years) 16.5 16.3
-
Sex of individual F M -
4 Bilateral Fibula Involvement A - 0
4 Unilateral Fibula Involvement
P P 2
5 Foot Involvement P P 2
Number of Pathological Features 15 9 24
Number of Bone Groups Affected
12 6 -
The five primary markers are numbered and indicated in bold.
P = present A = absent - = not observable
79

Table 4.3. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS
Young Adults (n=19, age = 20 to 35 years)
Burial Number B3 B25 B35 B39 B41 B48 B50 B66 B69 B82
Estimated Age (years) 27 33 21 22 20-35 20-35 34 21 29 25
Sex of individual M M M M F M? M F M ?
1 Frontal/Parietal Involvement A P P A - - - P A A
1 Nasal/Palatal Involvement
A P A - - - - A A A
Hutchinson's Incisors
A A A - - - - A A A
Moon's Molars A A A - - - - A A A
Mulberry Molars A A A - - - - A A A
Clavicle Involvement A P P - A - - P P P
Bilateral Humerus Involvement A A A - - - - P A P
Unilateral Humerus Involvement
A A A A A - P A A P
Bilateral Radius Involvement A A A - - - A P A A
Unilateral Radius Involvement
A P A A A - A A P P
Bowed Radius A A A A A - A A A A
Bilateral Ulna Involvement A P A A - - A A A A
Unilateral Ulna Involvement
A A P A A - A P A P
Bowed Ulna A A A A A - A P A P
2 Hand Involvement
A P P P - - A A P P
Rib Involvement A A A A - - A P A P
Cervical Vertebrae Involvement A A P - - - - A A A
Thoracic Vertebrae Involvement
P P P P A A - P P P
Lumbar Vertebrae Involvement P P P P - - P P P P
Periarticular Resorptive Foci (V)
P A A A A - A P P A
Bilateral Femur Involvement P P P P - - P P - P
Unilateral Femur Involvement A A A A A - A P A P
3 Bilateral Tibia Involvement - P P - - P P - - P
3 Unilateral Tibia Involvement - P P - A A A P - A
3 Saber Shin Tibia - P A - A P A A - A
80

Table 4.3. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS,
continued.
Young Adults (n=19, age = 20 to 35 years)
Burial Number B3 B25 B35 B39 B41 B48 B50 B66 B69 B82
Estimated Age (years) 27 33 21 22 20-35 20-35 34 21 29 25
Sex of individual M M M M F M? M F M ?
4 Bilateral Fibula Involvement - P A - - P P - - P
4 Unilateral Fibula Involvement
- A A - A A A P - P
5 Foot Involvement - A P - A P P - P P
Num. of Pathological Features 4 13 11 4 0 4 6 14 7 16
Num. of Bone Groups Affected
1 8 7 3 - 4 7 7 4 10
The five primary markers are numbered and indicated in bold.
P = present A = absent - = not observable
81

Table 4.3. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS, cont.
Young Adults (n=19, age = 20 to 35 years)
Burial Number B83 B84 B95 B100 B105 B109 B111 B113 B114 TOTALS
Estimated Age (years) 20 29 34 20+ 27 21 22 26 20 -
Sex of individual F F M M? M F F M M -
1 Frontal/Parietal Involvement A P - - - A A A A 4
1 Nasal/Palatal Involvement
- A - - - A A A A 1
Hutchinson's Incisors
A A - - - A A A - 0
Moon's Molars A A - - - A A A A 0
Mulberry Molars A A - - - A A A A 0
Clavicle Involvement A P - - - A A A A 6
Bilateral Humerus Involvement P P - - - A A - P 5
Unilateral Humerus Involvement
A A - - - P A A A 3
Bilateral Radius Involvement A A - - - P A - A 2
Unilateral Radius Involvement
A A - - A A A A A 3
Bowed Radius A A - - A A A A A 0
Bilateral Ulna Involvement A A - - - P A - A 2
Unilateral Ulna Involvement
A A - - A A A A A 3
Bowed Ulna A A - - A A A A A 2
2 Hand Involvement
A P - - P P A A A 8
Rib Involvement A P - - - P A A A 4
Cervical Vertebrae Involvement P P - - - - A - A 3
Thoracic Vertebrae Involvement
P P - - - P P - P 12
Lumbar Vertebrae Involvement P P A - - P P - P 13
Periarticular Resorptive Foci (V)
A A A - - A P - A 4
Bilateral Femur Involvement P P - A - P P P P 13
Unilateral Femur Involvement P P P P P A A A A 7
3 Bilateral Tibia Involvement P P P P A - P P P 12
3 Unilateral Tibia Involvement A A P A A - A A A 4
3 Saber Shin Tibia A A A A A - A A A 2
82

Table 4.3. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS, cont.
Young Adults (n=19, age = 20 to 35 years)
Burial Number B83 B84 B95 B100 B105 B109 B111 B113 B114 TOTALS
Estimated Age (years) 20 29 34 20+ 27 21 22 26 20 -
Sex of individual F F M M? M F F M M -
4 Bilateral Fibula Involvement A P - P P - P P P 10
4 Unilateral Fibula Involvement
A A P A A - A P A 4
5 Foot Involvement A A P P P - P P P 11
Num. of Pathological Features 7 12 5 4 4 8 7 5 7 138
Num. of Bone Groups Affected
3 7 5 5 6 6 3 4 6 -
The five primary markers are numbered and indicated in bold.
P = present A = absent - = not observable
83

Table 4.4. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS
Middle Adults (n=20, age = 35 to 50 years)
Burial Number B7 B17 B29 B33 B38 B45 B49 B65 B72 B85
Estimated Age (years) 47 50 44 35 40 37 46 49 38 40
Sex of individual F F M M M F M M M F
1 Frontal/Parietal Involvement P - P A P A - P A -
1 Nasal/Palatal Involvement
A - - P P A - P - -
Hutchinson's Incisors
- - - A A A - A - -
Moon's Molars - - - A A - - A - -
Mulberry Molars - - - A A - - A - -
Clavicle Involvement A P - P P P - P - A
Bilateral Humerus Involvement A P - A P P - A A -
Unilateral Humerus Involvement
P A - A P A P P A P
Bilateral Radius Involvement A A - A P A P A A -
Unilateral Radius Involvement
P A - A P A A A P -
Bowed Radius A A - A A A A P A -
Bilateral Ulna Involvement A A - A A A A A A A
Unilateral Ulna Involvement
P A - A P A A A A A
Bowed Ulna A A - P P A A P P A
2 Hand Involvement
P A A P P P P P P A
Rib Involvement A A - A P P A A A P
Cervical Vertebrae Involvement P - - P P P P A A P
Thoracic Vertebrae Involvement P A - P P P P P P P
Lumbar Vertebrae Involvement P P - P P P P P P P
Periarticular Resorptive Foci (V)
P P - P P P P P A P
Bilateral Femur Involvement A A A P P P P A P P
Unilateral Femur Involvement A A A A A A P P A A
3 Bilateral Tibia Involvement P - P P P P P - - -
3 Unilateral Tibia Involvement P P A A A A A P - -
3 Saber Shin Tibia A A A P P A A P - -
84

Table 4.4. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS,
continued.
Middle Adults (n=20, age = 35 to 50 years)
Burial Number B7 B17 B29 B33 B38 B45 B49 B65 B72 B85
Estimated Age (years) 47 50 44 35 40 37 46 49 38 40
Sex of individual F F M M M F M M M F
4 Bilateral Fibula Involvement A P A P P P P - - -
4 Unilateral Fibula Involvement
A A A P P A A P - P
5 Foot Involvement P P P P P A A P - P
Number of Pathological Features 12 7 3 14 21 11 11 15 6 9
Number of Bone Groups Affected
7 4 3 7 13 8 6 7 5 5
The five primary markers are numbered and indicated in bold.
P = present A = absent - = not observable
85

Table 4.4. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS, cont.
Middle Adults (n=20, age = 35 to 50 years)
Burial Number B86 B91 B93 B94 B99 B104 B106 B110 B121 B124 TOTALS
Estimated Age (years) 35 42 42 44 35 46 47 36 39 42 -
Sex of individual F M M ? F M F M M M -
1 Frontal/Parietal Involvement P A P A A P P A A - 8
1 Nasal/Palatal Involvement
A P A A A A A A P - 5
Hutchinson's Incisors
A A A A A - A A A A 0
Moon's Molars A A A A A - A A A A 0
Mulberry Molars A A A A A - A A A A 0
Clavicle Involvement A A P P A P A P P A 10
Bilateral Humerus Involvement A P A P A A P P P - 8
Unilateral Humerus Involvement
A A P - A A A A A P 7
Bilateral Radius Involvement P P A A A A A P P - 6
Unilateral Radius Involvement
A A P P P A A A A P 7
Bowed Radius P A A A A A A A A A 1
Bilateral Ulna Involvement A P A - A A A A A A 1
Unilateral Ulna Involvement
A A A P P P A A A P 6
Bowed Ulna A A A A A P A A P A 5
2 Hand Involvement
P P P P P P A P P P 16
Rib Involvement A P A P P P A A P P 9
Cervical Vertebrae Involvement A A A P A A A A P P 9
Thoracic Vertebrae Involvement P P P P P P A P P P 17
Lumbar Vertebrae Involvement P P P P P A P P P - 17
Periarticular Resorptive Foci (V)
A A P A A A P P P P 13
Bilateral Femur Involvement A P A - P A P P P P 12
Unilateral Femur Involvement P A A - A P A A P A 5
3 Bilateral Tibia Involvement A P P - P P P P - - 12
3 Unilateral Tibia Involvement P A P - P A A A - P 8
3 Saber Shin Tibia A A A - A P A A - A 4
86

87
Table 4.4. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS, cont.
Middle Adults (n=20, age = 35 to 50 years)
Burial Number B86 B91 B93 B94 B99 B104 B106 B110 B121 B124 TOTALS
Estimated Age (years) 35 42 42 44 35 46 47 36 39 42 -
Sex of individual F M M ? F M F M M M -
4 Bilateral Fibula Involvement P P P - P P P A - - 11
4 Unilateral Fibula Involvement
A A A - A P A P - A 7
5 Foot Involvement P A P P P P A P - P 14
Number of Pathological Features 10 11 12 10 11 13 7 11 13 11 218
Number of Bone Groups Affected
8 8 10 9 9 9 4 9 7 8 -
The five primary markers are numbered and indicated in bold.
P = present A = absent - = not observable

Table 4.5. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS
Old Adults (n=4, age = >50+ years)
Burial Number B1 B4 B51 B103 TOTALS
Estimated Age (years) 56 58 51 53
-
Sex of individual F F M F
-
1 Frontal/Parietal Involvement P P - - 2
1 Nasal/Palatal Involvement
A A - - 0
Hutchinson's Incisors
A A - - 0
Moon's Molars
A A - - 0
Mulberry Molars
A A - -
0
Clavicle Involvement A A A P 1
Bilateral Humerus Involvement A P - P 2
Unilateral Humerus Involvement P A P A 2
Bilateral Radius Involvement A A A P 1
Unilateral Radius Involvement A A A A 0
Bowed Radius A A A A 0
Bilateral Ulna Involvement A P P A 2
Unilateral Ulna Involvement A A A A 0
Bowed Ulna A A A P 1
2 Hand involvement P P P P 4
Rib Involvement A A A P 1
Cervical Vertebrae Involvement A A - A 0
Thoracic Vertebrae Involvement P A P P 3
Lumbar Vertebrae Involvement P A P A 2
Periarticular Resorptive Foci (V) P P A A 2
Bilateral Femur Involvement P P - P 3
Unilateral Femur Involvement P A P A 2
3 Bilateral Tibia Involvement P P P P 4
3 Unilateral Tibia Involvement A P A A 1
3 Saber Shin Tibia A A A A 0
88

Table 4.5. PATHOLOGICAL MARKERS ASSOCIATED WITH THE CARRIER MILLS ARCHAIC BURIAL SAMPLE INDIVIDUALS,
continued.
Old Adults (n=4, age = >50+ years)
Burial Number B1 B4 B51 B103 TOTALS
Estimated Age (years) 56 58 51 53 -
Sex of individual F F M F -
4 Bilateral Fibula Involvement P P A P 3
4 Unilateral Fibula Involvement A A P A 1
5 Foot Involvement P P P P 4
Number of Pathological Features 11 10 9 11 37
Number of Bone Groups Affected 7 9 8 8 -
The five primary markers are numbered and indicated in bold.
P = present A = absent - = not observable
89

Table 4.6. SUMMARY & PERCENTAGES OF POSSIBLE TREPONEMAL MARKERS FOUND IN CARRIER MILLS
# of # of % of # of # of # of % of % of
Infants Adol Juv Y Adults M Adults O Adults Adults Total
Markers (n=9) (n=2) (n=11) (n=19) (n=20) (n=4) (n=43) (t=54)
1 Frontal/Parietal Involvement 4/9 0/2 36% 4/13 8/16 2/2 45% 43%
1 Nasal/Palatal Involvement 0/9 0/2 0 1/11 5/14 0/2 22% 16%
Hutchinson's Incisors 0/9 0/2 0 0/11 0/13 0/2 0 0
Moon's Molars 0/9 0/2 0 0/12 0/12 0/2 0 0
Mulberry Molars 0/9 0/2 0 0/12 0/12 0/2 0 0
Clavicle Involvement 8/9 2/2 91% 6/13 10/17 1/4 50% 60%
Bilateral Humerus Involvement 9/9 1/1 100% 5/11 8/16 2/3 50% 63%
Unilateral Humerus Involvement 0/9 1/2 9% 3/15 7/18 2/4 32% 27%
Bilateral Radius Involvement 4/8 0/2 40% 2/12 6/17 1/4 27% 30%
Unilateral Radius Involvement 4/8 2/2 60% 3/15 7/18 0/4 27% 34%
Bowed Radius 0/8 0/2 0 0/16 2/18 0/4 5% 4%
Bilateral Ulna Involvement 5/8 1/2 60% 2/13 1/18 2/4 14% 24%
Unilateral Ulna Involvement 3/8 1/2 40% 3/16 6/19 0/4 23% 27%
Bowed Ulna 0/8 0/2 0 2/16 6/19 1/4 23% 18%
2 Hand Involvement 1/9 1/2 18% 8/15 16/20 4/4 72% 60%
Rib Involvement 8/9 2/2 91% 4/14 9/19 1/4 38% 50%
Cervical Vertebrae Involvement 0/9 1/2 9% 3/10 9/18 0/3 39% 31%
Thoracic Vertebrae Involvement 6/9 2/2 73% 12/14 17/19 3/4 86% 83%
Lumbar Vertebrae Involvement 7/9 2/2 82% 13/14 17/18 2/4 89% 87%
Periarticular Resorptive Foci (Vert.) 0/9 0/2 0 4/15 13/19 2/4 50% 39%
Bilateral Femur Involvement 5/9 1/1 60% 13/14 12/19 3/3 78% 74%
Unilateral Femur Involvement 2/9 1/1 30% 7/18 5/19 2/4 34% 33%
3 Bilateral Tibia Involvement 2/2 1/1 100% 12/13 12/13 4/4 93% 94%
3 Unilateral Tibia Involvement 1/4 1/1 40% 4/15 7/16 1/4 34% 35%
3 Saber Shin Tibia 0/4 0/1 0 2/15 4/16 0/4 17% 15%
90

Table 4.6. SUMMARY & PERCENTAGES OF POSSIBLE TREPONEMAL MARKERS FOUND IN CARRIER MILLS, cont.
# of # of % of # of # of # of % of % of
Infants Adol Juv Y Adults M Adults O Adults Adults Total
Markers (n=9) (n=2) (n=11) (n=19) (n=20) (n=4) (n=43) (t=54)
4 Bilateral Fibula Involvement 2/2 0/1 67% 10/12 11/14 3/4 80% 79%
4 Unilateral Fibula Involvement 0/2 2/2 50% 4/15 6/17 1/4 31% 33%
5 Foot Involvement 1/5 2/2 43% 11/15 14/18 4/4 78% 73%
The five primary markers are numbered and indicated in bold.
n = number of individuals in age category
t = total number of individuals in the sample
% of juveniles = infants + adolescents/observable # X100
% of adults = young + middle + old adults/observable # X100
% of total = juveniles + adults/observable # X100
% of males = number of males affected/observable # X100
% of females = number of females affected/observable # X100
91

Table 4.6. SUMMARY & PERCENTAGES OF POSSIBLE TREPONEMAL MARKERS FOUND IN CARRIER MILLS, cont.
# of % of # of % of
Males M Females F
Markers (n=26) (t=26) (n=17) (t=17)
1 Frontal/Parietal Involvement 7/19 37% 7/13 54%
1 Nasal/Palatal Involvement 6/16 38% 0/12 0
Hutchinson's Incisors 0/15 0 0/12 0
Moon's Molars 0/16 0 0/11 0
Mulberry Molars 0/16 0 0/11 0
Clavicle Involvement 12/18 67% 6/17 35%
Bilateral Humerus Involvement 7/16 44% 8/14 57%
Unilateral Humerus Involvement 8/22 36% 5/17 29%
Bilateral Radius Involvement 5/19 26% 4/15 27%
Unilateral Radius Involvement 8/23 35% 3/16 19%
Bowed Radius 1/23 4% 1/16 6%
Bilateral Ulna Involvement 4/21 19% 2/16 13%
Unilateral Ulna Involvement 5/23 22% 4/17 24%
Bowed Ulna 7/23 30% 2/17 12%
2 Hand Involvement 18/24 75% 10/16 63%
Rib Involvement 7/22 32% 8/16 50%
Cervical Vertebrae Involvement 6/18 33% 6/14 43%
Thoracic Vertebrae Involvement 20/21 95% 13/17 76%
Lumbar Vertebrae Involvement 19/21 90% 14/16 88%
Periarticular Resorptive Foci (Vert.) 10/22 45% 9/17 53%
Bilateral Femur Involvement 16/21 76% 13/16 81%
Unilateral Femur Involvement 9/25 36% 6/17 35%
3 Bilateral Tibia Involvement 18/19 95% 11/12 92%
3 Unilateral Tibia Involvement 6/21 29% 7/15 47%
3 Saber Shin Tibia 6/21 29% 0/15 0
92

Table 4.6. SUMMARY & PERCENTAGES OF POSSIBLE TREPONEMAL MARKERS FOUND IN CARRIER MILLS, cont.
# of % of # of % of
Males M Females F
Markers (n=26) (t=26) (n=17) (t=17)
4 Bilateral Fibula Involvement 14/18 78% 10/13 77%
4 Unilateral Fibula Involvement 10/22 45% 3/16 19%
5 Foot Involvement 20/23 87% 10/15 67%
The five primary markers are numbered and indicated in bold.
n = number of individuals in age category
t = total number of individuals in the sample
% of juveniles = infants + adolescents/observable # X100
% of adults = young + middle + old adults/observable # X100
% of total = juveniles + adults/observable # X100
% of males = number of males affected/observable # X100
% of females = number of females affected/observable # X100
93

Table 4.7. PERCENTAGES OF POSSIBLE TREPONEMAL DISEASE
Likeli- None Possible Highly Certain
hood - - Likely -
# Markers 0 Markers 1-3 Markers 4-5 markers 5 + markers
Burials 5/54 28/54 15/54 6/54
Percent 9% 52% 28% 11%
Note: Based on cranial, hands, tibiae, fibulae, and feet, and involvement.
Please see text for descriptions.
94

Table 4.8. BONE GROUPS AFFECTED IN THE CARRIER MILLS ARCHAIC BURIAL SAMPLE
Infants (n=9, age = birth to 3 years)
Burial Numbers B21 B30 B32 B40 B46 B62 B63 B77 B87 TOTALS
Estimated Age (years) 1.7 0.2 0.8 0.6 0.1 0.4 0.4 1.3 0.8 -
Sex of Individual Juv Juv Juv Juv Juv Juv Juv Juv Juv -
Bone Group - - - - - - - - - -
Tibia O N X O O X O O X 3
Fibula O O X O O O O O X 2
Femora N X X X X X N X X 7
Humerus X X X X X X X X X 9
Radius O X X X X X X X X 8
Ulna O X X X X X X X X 8
Hand Bones N N N N N N N X N 1
Foot Bones N N X O N O O O N 1
Clavicle N X X X X X X X X 8
Cranial N X X X N X N N N 4
Teeth N N N N N N N N N 0
TOTALS 1 6 9 6 5 7 4 6 7 51
X = affected bone group, N = non-affected bone group, O = not observable
95

Table 4.9. BONE GROUPS AFFECTED IN THE CARRIER MILLS ARCHAIC BURIAL SAMPLE
Adolescents (n = 2, age = 12 to 20 years)
Burial Numbers B89 B116 TOTALS
Estimated Age (years) 16.5 16.3 -
Sex of Individual F M -
Bone Group - - -
Tibia X O 1
Fibula X X 2
Femora X O 1
Humerus X X 2
Radius X X 2
Ulna X X 2
Hand Bones XX N 2
Foot Bones XXX X 4
Clavicle X X 2
Cranial N N 0
Teeth (incisors, molars) N N 0
TOTALS 12 6 18
X = affected bone group,N = non-affected bone group, O = not observable
96

Table 4.10. BONE GROUPS AFFECTED IN THE CARRIER MILLS ARCHAIC BURIAL SAMPLE
Young Adults (n = 19, age = 20 to 35 years)
Burial Numbers B3 B25 B35 B39 B41 B48 B50 B66 B69 B82
Estimated Age (years) 27 33 21 22 20-35 20-35 34 21 29 25
Sex of Individual M M M M F M? M F M ?
Bone Group - - - - - - - - - -
Tibia O X X O N X X X O X
Fibula O X N O N X X X O X
Femora X X X X N O X X N X
Humerus N N N N N O X X N X
Radius N X N N N O N X X X
Ulna N X X N N O N X N X
Hand Bones N XX X XX O O N N X X
Foot Bones O N XX O N XX XXX O X XX
Clavicle N X X O N O O X X X
Cranial N X X N O O O X N N
Teeth (incisors, molars) N N N O O O O N N N
TOTALS 1 9 8 3 0 4 7 8 4 10
X = affected bone group, N = non-affected bone group, O = not observable
97

Table 4.10. BONE GROUPS AFFECTED IN THE CARRIER MILLS ARCHAIC BURIAL SAMPLE,
continued.
Young Adults (n = 19, age = 20 to 35 years)
Burial Numbers B83 B84 B95 B100 B105 B109 B111 B113 B114 TOTALS
Estimated Age (years) 20 29 34 20+ 27 21 22 26 20 -
Sex of Individual F F M M? M F F M M -
Bone Group - - - - - - - - - -
Tibia X X X X N O X X X 13
Fibula N X X X X O X X X 12
Femora X X X X X X X X X 16
Humerus X X O O O X N N X 7
Radius N N O O N X N N N 5
Ulna N N O O N X N N N 5
Hand Bones N XX O O XX XX N N N 13
Foot Bones N N XX XX XX O X X XX 20
Clavicle N X O O O N N N N 6
Cranial N X O O O N N N N 4
Teeth (incisors, molars) N N O O O N N N N 0
TOTALS 3 8 5 5 6 6 4 4 6 54
X = affected bone group, N = non-affected bone group, O = not observable
98

Table 4.11. BONE GROUPS AFFECTED IN THE CARRIER MILLS ARCHAIC BURIAL SAMPLE
Middle Adults (n = 20, age = 35 to 50 years)
Burial Numbers B7 B17 B29 B33 B38 B45 B49 B65 B72 B85
Estimated Age (years) 47 50 44 35 40 37 46 49 38 40
Sex of Individual F F M M M F M M M F
Bone Group - - - - - - - - - -
Tibia X X X X X X X X O O
Fibula N X N X X X X X O X
Femora N N N X X X X X X X
Humerus X X O N X X X X N X
Radius X N O N X N X X X O
Ulna X N O X X N N X X N
Hand Bones X N N X XXX XXX XX X X N
Foot Bones XX X XX XX XXX N N X O XX
Clavicle N X O X X X O X O N
Cranial X O X X X N O X N O
Teeth (incisors, molars) O O O N N O O N O O
TOTALS 8 5 4 9 14 8 7 10 4 5
X = affected bone group, N = non-affected bone group, O = not observable
99

Table 4.11. BONE GROUPS AFFECTED IN THE CARRIER MILLS ARCHAIC BURIAL SAMPLE, continued.
Middle Adults (n = 20, age = 35 to 50 years)
Burial Numbers B86 B91 B93 B94 B99 B104 B106 B110 B121 B124 TOTALS
Estimated Age (years) 35 42 42 44 35 46 47 36 39 42 -
Sex of Individual F M M ? F M F M M M -
Bone Group - - - - - - - - - - -
Tibia X X X O X X X X O X 17
Fibula X X X O X X X X O N 15
Femora X X N O X X X X X X 15
Humerus N X X X N N X X X X 14
Radius X X X X X N N X X X 13
Ulna N X N X X X N N X X 10
Hand Bones X XX XXX XXX XX XXX N X XXX X 31
Foot Bones XXX N XX XX XX X N XXX O XX 28
Clavicle N N X X N X N X X N 10
Cranial X X X N N X X N X O 11
Teeth (incisors, molars) N N N N N O N N N N 0
TOTALS 9 9 11 9 9 10 5 10 9 8 74
X = affected bone group, N = non-affected bone group, O = not observable
100

Table 4.12. BONE GROUPS AFFECTED IN THE CARRIER MILLS ARCHAIC BURIAL SAMPLE
Old Adults (n = 4, age = >50+ years)
Burial Numbers B1 B4 B51 B103 TOTALS
Estimated Age (years) 56 58 51 53 -
Sex of Individual F F M F -
Bone Group - - - - -
Tibia X X X X 4
Fibula X X X X 4
Femora X X X X 4
Humerus X X X X 4
Radius N N N X 1
Ulna N X X X 3
Hand Bones X XX XX X 6
Foot Bones XX XX X XX 7
Clavicle N N N X 1
Cranial X X O O 2
Teeth (incisors, molars) N N O O 0
TOTALS 8 10 8 10 36
X = affected bone group, N = non-affected bone group, O = not observable
101

Table 4.13. NUMBERS OF BONE GROUPS AFFECTED IN CARRIER MILLS SAMPLE
COMPARED TO CONFIRMED DISEASE
Carrier
Confirmed Disease*
Parameter
Mills Syphilis Yaws Bejel
Date, years before present
Adults
> 3000 60-90 500 50-200
No. evaluated 43 2906 214 40
No. (%) affected
Juveniles
42(98%) 145(5%) 71(33%) 10(25%)
No. evaluated 11 50 60 10
No. (%) affected 11(100%) 0(0%) 8(14%) 1(10%)
>5% affected Yes No Yes Yes
Bilateral tibial involvement Yes - - -
Unilateral tibial involvement Yes Yes No No
Saber shin without surface reaction No Yes No No
Average no. of bone groups affected 6.3 1.9 4.0 2.0
Average no. of bone groups > 3 Yes No Yes No
Hands/Feet >5%
Distribution, no. affected
Yes No Yes No
Tibia 67 96 35 14
Fibula 58 41 20 3
Femora 77 41 31 3
Humerus 59 16 10 0
Radius 42 8 13 1
Ulna 36 6 15 0
Hand Bones 122 2 9 0
Foot Bones 128 0 12 0
Clavicle 43 4 3 0
Cranial 22 38 7 1
Teeth (incisors, molars) 0 - - -
* Adapted from Rothschild et al. 2000, and Rothschild and Rothschild 1994,
based on 3280 skeletons of known treponemal pathology.
102

Percentages
100
90
80
70
60
50
40
30
20
10
0
Figure 4.1. Percentages of Treponemal Markers in Juveniles and Adults
Juveniles
Adults
Fron/Par Nas/Pal Hand Bi Tib Uni Tib Saber Tib Bi Fib Uni Fib Foot
103

Percentages
100
90
80
70
60
50
40
30
20
10
0
Figure 4.2. Percentages of Treponemal Markers in Males, Females, and Total Sample
Fron/Par Nas/Pal Hand Bi Tib Uni Tib Saber Tib Bi Fib Uni Fib Foot
Males
Females
Totals
104

Likelihood %
60%
50%
40%
30%
20%
10%
0%
Figure 4.3. Likelihood of Treponemal Disease in Individuals at Carrier Mills
None
Possible
Highly Likely
Certain
105

106

Figure 4.4. Cranium of Burial 38 showing location and size of lesions.
106

Figure 4.5. Burial 38 Left 3 rd metacarpal with unifocal bone loss and woven bone.
Figure 4.6. Burial 38 Right tibia posterior midshaft 6 lesions with woven and sclerotic
reaction.
107

Figure 4.7. Burial 38 Left fibula lateral close up of cloaca.
Figure 4.8. Burial 38 Left 1 st metatarsal plantar with woven and sclerotic reaction.
108

CHAPTER 5
DISCUSSION AND CONCLUSIONS
5.1 Differential Diagnosis of Treponemal Disease
The distribution of pathological alterations in the skeletons from Carrier Mills is
almost certainly indicative of an endemic treponemal infection and not of leprosy,
tuberculosis, or some other disease. Differentiating between the three syndromes of
treponemal disease affecting the human skeletal system can be very challenging. The
syndromes yaws, endemic syphilis, and venereal syphilis leave similar periosteal changes
on the same bones, for the most part. Rothschild et al. (2000) suggest that an
epidemiological approach can discriminate between the different syndromes of
treponematoses. This chapter provides an epidemiological approach to discriminating
between the different treponematoses as applied to the human skeletal remains from the
Carrier Mills Archaeological District.
Venereal syphilis was not the syndrome of treponemal disease affecting the
Carrier Mills sample. This was concluded from comparing the confirmed cases of
venereal syphilis in samples from the Rothschild et al. (2000) study to the present study
(see Table 4.13). In the confirmed cases of venereal syphilis, prevalence in the
population is small: very few adults have affected bone groups (5%), while none of the
juveniles are affected. In the Carrier Mills sample, 98% of the adults have affected bone
109

groups, and 100% of the juveniles are affected. (Note that this comparison is based on
the nine bone groups of Rothschild et al. plus teeth, not the five "primary markers" used
earlier to indicate any evidence of a treponemal infection). The hands and feet are only
affected in fewer than 5% of the sample of the confirmed cases of venereal syphilis. For
the Carrier Mills sample, more than 5% of the hands and feet are involved. The average
number of bone groups affected in the confirmed cases of venereal syphilis is few, at 1.9
(Rothschild et al. 2000). The average number of bone groups for the Carrier Mills study
is much higher at 6.3. On the basis of both adults and juveniles affected, more than 5%
of the hands and feet being affected, and the average number of bone groups being
greater than 3, the Carrier Mills Archaic sample could not have suffered from venereal
syphilis.
By comparing the Carrier Mills sample to that of the confirmed cases of endemic
syphilis (bejel), it is concluded that endemic syphilis was not the treponemal disease
affecting this sample either. In the confirmed cases of endemic syphilis, 25% of the
adults are affected and 10% of the juveniles are affected (see Table 4.13). In the Carrier
Mills sample, 98% of the adults are affected, while 100% of the juveniles are affected.
While it is true that greater than 5% of the juveniles are affected in the confirmed cases of
endemic syphilis, it is still a very small percentage compared to ubiquity seen in the
Carrier Mills juveniles. The hands and feet are affected in fewer than 5% of individuals
of the confirmed cases of endemic syphilis (see Table 4.13). In the Carrier Mills study,
the hands and feet are affected greater than 5%. The average number of bone groups
affected in the Carrier Mills sample is 6.3, while the average number of bone groups in
the confirmed cases of endemic syphilis is much smaller, at 2.0. Based on these figures,
110

endemic syphilis is not the treponemal disease affecting the Carrier Mills Archaic
sample.
The comparison of the confirmed cases of yaws to that of the Carrier Mills study
strongly supports that the Carrier Mills Archaic sample suffered from a treponemal
disease most like that of yaws, among known modern treponemal syndromes. In yaws,
greater than 5% of the individuals have involvement of the hands and feet, there is a
greater frequency of adults and juveniles affected, and the average number of bone
groups affected is greater than three (see Table 4.13). This is the pattern seen in the
Carrier Mills sample. It is overwhelmingly apparent that a treponemal disease
resembling that of yaws affected the Carrier Mills Archaic sample. So what does this tell
us about the life of the Carrier Mills Archaic people as compared to other
contemporaneous North American sites located nearby and what does it mean in the
context of the debate on the origin of treponemal disease?
5.2 Comparisons to Other Sites
The findings of this research can now be compared to other nearby or Archaic
sites. The first two sites are those of Moundville and Irene Mound. Powell (1991) found
similar pathological evidence of nonvenereal treponemal disease at both of these sites.
Moundville is a Mississippian (AD 1050-1550) period occupation site located in west
central Alabama. The total number of excavated burials from this site is 1500; of these
Powell (1991) selected 564 for her study. Irene Mound is also a Mississippian (AD
1110-1400) site located near the mouth of the Savannah River on the Atlantic Coast.
111

Two hundred and sixty-five individuals were selected from this site for analysis. Both of
these samples revealed extensive periostitis on the long bone shafts of the tibia, fibula,
radius, and ulna, along with saber shin deformity (Ibid.). In the Moundville sample,
small, circular depressions were found on the cranial vaults. Skeletons from Irene
Mound, on the other hand, exhibited evidence of gangosa. A young adult female from
Irene Mound exhibited lesions of the frontal, palate, maxilla and extensive remodeling of
the nasal aperture (Ibid.).
When Carrier Mills is compared to Moundville and Irene Mound, there are clear
similarities. Numerous foci of periostitis along the long bone shafts of the tibiae and
fibulae, as well as saber shin deformity are found in the skeletons from all three sites.
The Irene Mound skeletons display evidence of gangosa, while those from Carrier Mills
do not, although at both Irene Mound (IM) and Carrier Mills (CM) there are lesions on
the frontal bones of two individuals (a young adult female (IM) and a middle adult male
(CM)). The differences in the disease profile between these sites could be attributed to
the time span between the sites; Irene Mound and Moundville are both Mississippian,
while Carrier Mills is Archaic.
Pete Klunk Mounds in west central Illinois is a Late Archaic (900 BC) site (Cook
2002; Powell et al. 2005). This site only produced 22 individuals, with one of these, a
young adult male 18-25 years, exhibiting evidence of treponemal disease. The
characteristics of this individual include: thickened and rounded margins of the nasal
aperture; small nasal spurs; the floor of the nasal cavity, the bony palate and the lacrimal
canals displaying reactive new bone formation; the palate thickened with a small
perforation; the anterior nasal spine somewhat resorbed, broad and irregular; and the
112

midline crest irregular, porous and raised (Cook 2002). All of these characteristics can be
found in the gangosa deformity of yaws (Ibid.).
Pete Klunk Mounds and Carrier Mills do not seem to have many similarities,
except for the fact that the most severe case at both sites is male. Cook (2002) concluded
that the characteristics found in the young adult male at Pete Klunk were those of
gangosa from yaws. None of the individuals examined at Carrier Mills had the gangosa
deformity. It is possible that the characteristics visible in the Carrier Mills site belong to
a different syndrome of treponemal disease. Perhaps this syndrome is an earlier form of
yaws that did not have advanced gangosa deformity.
Eva II is a late Middle Archaic (5000-3000 BC) site in western Tennessee with
approximately 71 adults and adolescents recovered from the site (Powell et al. 2005).
Two burials exhibit characteristics of treponemal disease. Burial 11 is a middle adult
male that exhibits the following characteristics: surface pitting, round depressions with
radiating striae, and raised areas of bone with multiple shallow round depressions on the
frontal and parietals; the palate is perforated; there is periostitis on the ribs, left humerus,
left radius, left fibula, right clavicle, both femora, and both tibiae (Ibid.). The second is
Burial 36, an adult of indeterminate age and sex, although Powell et al. (2005) state that
this was probably a male. This adult exhibits several characteristics: the frontal and right
posterior parietal have thickened cortical bone with circular depressions; there are also
stellate scars, circumvallate lesions and areas of porosity on the cranium; 6 rib fragments
have lesions on the dorsal surface which are circular depressions with woven bone; the
left tibia and both femora exhibit nodular cavitation; the left clavicle has lesions that are
113

coalescing and penetrating; the distal metaphysis of the left humerus is thickened; and the
midshaft of the right radius has reactive bone and superficial cavitation (Ibid.).
Eva II (EII) and Carrier Mills (CM) have many similarities. All three burials with
major symptoms appear to be males (EII 11, 36, and CM 38). The frontal and parietals
have multiple shallow round depressions and surface pitting, and periostitis is seen in
multiple long bones including the femora, tibiae, fibulae, and radii. The frontal lesions of
CM Burial 38 show focal superficial cavitation. Powell et al. (2005) conclude that this is
a non-venereal treponemal disease due to the fact that there is no evidence found for
congenital cases or the characteristic dental stigmata of congenital syphilis.
The Barrett site is in the Green River Valley of McLean County, Kentucky. This
site includes 412 individuals: 237 adults, 41 children, 101 infants, and 33 individuals of
undetermined age. The Archaic site dates to 5620 BP or 4520 BP according to new
radiocarbon dates (Powell et al. 2005). Pathological changes in this sample include a
high frequency of lesions involving the nasal cavity, palate and face that are resorptive in
nature (Ibid.). The palates display pitting and a large incisive foramen. The crania
exhibit lesions of the vault that include clustered pits, radial scars, circumvallate
cavitation, and confluent clustered pits (Ibid.). The postcranial skeleton exhibits diffuse
pitting, linear striations, periosteal plaques, remodeled and active lesions of which the
tibia and fibula are the most affected (Ibid.).
The skeletal materials from Barrett and Carrier Mills have a few similarities.
Again they differ in the characteristics involving the face. The Barrett skeletal collection
has many characteristics of the gangosa deformity, while Carrier Mills does not. Carrier
Mills Burial 38 exhibits focal superficial cavitation and clustered pits on the cranium,
114

similar to what is seen at Barrett. Both Barrett and Carrier Mills individuals exhibit
linear striations, periosteal plaques, and remodeled lesions of the tibiae, fibulae, and
femora.
The last site is that of Indian Knoll from the Archaic (3352-2013 BC) period
located along the Green River in western Ohio County, Kentucky (Cassidy 1972; Powell
et al. 2005). This site includes 1234 skeletons (Cassidy 1972). The original analysis of
this site was performed by Snow (1948), who concluded that syphilis was present in this
population based on 4 affected individuals. Burial 9 is that of a young woman with
palatine and maxillae involvement; Burial 13 is that of a young woman whose nasal
aperture exhibits scarred, rounded over borders; Burial 508 is that of a young man who
has similar characteristics to those of Burial 9; and Burial 490, the most affected
individual, has lesions on the frontal, maxillae, hard palate, humerus and radii (Ibid.).
The humerus includes sinus formation and drainage, while the radii exhibit “lace-like
fenestration” of bone (Snow 1948:506).
Cassidy (1972) examined 285 individuals from Indian Knoll; 70 of those were
affected in some way, and she diagnosed the characteristics as those of endemic
treponematosis. The analysis revealed that 2.4 % of the Indian Knoll individuals were
affected from all age groups (see Cassidy 1972 for a complete chart of the individuals
affected). The characteristics found include: thickening of the periosteal surface, raised
discolored vascular plaques, thickened cortexes, narrow longitudinal striations, smooth
billowed areas, and swollen bones perforated by sinuses and bowed (Ibid.). The bones
affected include the tibia, fibula, femur, ulna, radius, humerus, clavicle, ribs, zygomatics,
and frontal (Ibid.).
115

Kelley (1980) conducted a study of 813 individuals from Indian Knoll. Twenty-
eight (3.4%) of these individuals were diagnosed as having characteristics of treponemal
disease. Eight adults, 4 males and 4 females, between the ages of 20-35 years and 20
juveniles between the ages of 1-3 years exhibited destructive lesions of the nasal, palatal
and calvarial bones, bowing and swelling of long bone shafts in children and infants, and
saber tibiae (Ibid.). No dental stigmata were found, which the author concluded was
indicative of nonvenereal treponemal disease (Ibid.). For a complete list of burials and
their characteristics, see Kelley (1980).
Indian Knoll and Carrier Mills also share similarities. Both have raised,
discolored, vascular plaques, narrow longitudinal striations, swollen bones, bowed bones,
sinus formation and saber shin tibiae. Neither site produced any evidence of dental
stigmata.
In comparing Carrier Mills to these other sites, there are many similarities and
there are some differences. The biggest difference is the absence of nasal resorption or
the characteristics of the gangosa deformity in Carrier Mills. Perhaps the Carrier Mills
individuals suffered from another form of nonvenereal treponemal disease similar to
yaws / endemic syphilis suggested for the other sites, but not quite the same. What is
clear is that there was a nonvenereal form of treponematosis present and in fact
widespread in this sub-sample from Carrier Mills.
5.3 Carrier Mills – Life in the Archaic Period
116

The majority of the burials from the Black Earth site of the Carrier Mills
Archaeological District are dated to 4000 – 2900 BC, the Middle to Late Archaic periods.
Before inferences can be made about life at Carrier Mills during the Archaic period, it is
pertinent to give a general description of the Middle to Late Archaic periods. This
description will aid in the understanding of life during the Archaic time period.
5.3.1 General Middle and Late Archaic Period
Muller (1986) characterizes the Middle Archaic in the Lower Ohio River Valley
as a time of increased sedentism, an increased use of a wider variety of plants, the
exploitation of small game, and the cultivation of seeds, all occurring during a much drier
and warmer climate than today.
The Late Archaic period, according to Muller (1986), was a time when a more
complex social and economic organization began to develop but without social
distinction between people, and domesticated plants were utilized to a much greater
degree. Long-distance exchange systems also began to develop. Evidence of these
exchange systems is seen through the presences of such materials as conch shell and
copper objects found at Carrier Mills. The Late Archaic was also a period when we
begin to see the first archaeological evidence of cemeteries and perhaps (also indicative
of increased sedentism), in some areas, the emergence of achieved status (Muller 1986).
5.3.2 Inferences of Life at Carrier Mills
Life of the Carrier Mills Archaic peoples must have been very harsh. There were
many changes occurring in the environment. People were accessing new resources and
117

learning how to better utilize older ones; small game animals, plants, and nuts. They
were discovering that a sedentary lifestyle had fewer benefits than a hunter-gatherer
lifestyle. Living in settled groups provided more protection from enemies, and better
hunting strategies, but the availability of a broad range of foods decreased. People were
forced to rely on certain crops and if these crops failed, malnutrition became a serious
problem.
Examining the paleopathological evidence from Carrier Mills, it can be concluded
that this sample suffered from an endemic treponemal disease, very similar to yaws. This
disease affected both juveniles and adults. In this study, the adults appeared to exhibit
considerably more advanced stages of the disease than the juveniles, but in the overall
skeletal sample of Carrier Mills there is evidence of a high infant mortality rate, with
27% of the population dying within the first year of life (Bassett 1982). It must be
remembered that 100% of those dying as juveniles had some expression of bony effects
from the disease (or other infection).
Yaws is acquired in childhood and is seen more commonly in children and
adolescents. In this study, there were not any children (aged 4-11 years) included and
there were only two adolescents. Of the 9 infants that were examined, some of them
were missing their hands, tibiae, fibulae, and foot bones. These factors could be the
reasons why the adults show a considerably higher amount of infection than the juveniles
– an artifact of preservation, sampling strategy, and overall illness of the population.
Yaws would have been a major stressor in this population. In a study of the
juvenile tibial growth patterns of the Carrier Mills sample, Anderson (1998) found that
the growth patterns in the Carrier Mills juveniles closely resembled the tibial growth
118

patterns of children from South America suffering from chronic malnourishment. This
form of stress then would be chronic, and not episodic, resulting in no recovery period
from the stressor. Yaws would have infected this population for long periods of time.
Thus, if a juvenile contracted the disease and lived into adulthood, the individual would
have suffered through the three different phases of the disease. The individual would
have had many lesions on the skin, with some of the lesions excreting pus. Since the
disease affected the individual throughout his/her lifetime, there would not be time for
periods of recovery from other stressors.
In the study of the wild gorillas by Levréro et al. (2007), the third stage of yaws
caused deep lesions to occur that cause necrosis of the surrounding tissues. The lesions
found in the gorilla population were mainly located on their faces. These deep lesions
produced gangosa, which results in death of the tissues of the nose and lips. Some
deformities of the jaws were also recorded (Ibid.). Most (70%) of the gorillas suffered
from type A lesions which are pinkish, smooth lesions with oozing surfaces (Ibid.). Only
19% of the affected gorillas suffered from type C lesions, which are deep, mutilating
lesions. The gorillas with type C lesions exhibited difficulties in chewing, due to the
absence of lips, or in some cases deformities of the jaws (Ibid.). Locomotion was also
hindered for some of the individuals due to their inability to rest their limbs on the ground
because of the lesions.
If we look back at this study of Carrier Mills, there are only six individuals with
nasal/palatal involvement; 1 is a young adult and five are middle adults. This
demonstrates that the individuals would have had the disease for a length of time because
these characteristics are occurring in older individuals. Usually it is in the third stage that
119

we see destructive lesions, although in the Carrier Mills study, no extreme cases of
gangosa were found. If the individuals were suffering from fleshy lesions on or around
the nose and lips, this would hinder their sense of smell and their ability to eat, therefore
resulting in chronic malnourishment. If the women were pregnant, suffering from the
complications of eating, they would have been malnourished but their babies would have
also been malnourished. Maybe this is one of the reasons for the chronic malnourishment
found in Anderson’s (1998) study of the Carrier Mills individuals, although the level of
oral infection was not high.
Van Arsdale’s (1998), study of vertebral osteoarthritis at Carrier Mills found that
adult males suffered harsher lifestyles than adult females. In this study, adult males are
affected far more than adult females, but both sexes would have suffered consequences in
providing for their families. The adult male life in the Archaic period must have been
laden with disease, complicated by the stresses of hunting and other activities while
dealing with the complications of a treponemal disease similar to yaws. Individuals
whose hands and feet were affected would have had complications in walking, picking up
tools, making tools, and the many different tasks associated with hunting such as
preparing the kill for the journey back to the village. For women, the complications
would involve problems with gathering berries, caring for the young, not being able to
walk and difficulties in preparing food. Fishing may have also been an important activity
for both sexes at Carrier Mills, one made more difficult for the many individuals with
infected hands.
Other complications that might arise would be with communication. Severe
destruction of the face could result in a harsh voice (Powell and Cook 2005). Loss of
120

teeth and the hard palate would result in difficulty in speaking and eating. Nonetheless,
the skeletons of most adults overall are those of robust and strong individuals (Bassett
1982; Clapper 2006). Levréro et al. (2007) state that yaws is rarely lethal. In their study
of the gorilla population, only one female gorilla disappeared from the population being
studied. Other gorillas survived as long as the two years and eight months of the study
with serious handicaps (Ibid.). Perhaps then death resulted from general infection or
maybe death was the result of chronic malnourishment.
5.4 History and Origin of Treponemal Disease
This study of the Carrier Mills skeletal sample contributes to the hypothesis that a
non-venereal form of treponemal disease existed in North America at least 3000 years
before the present. The majority of the burials from the Black Earth site of Area A are
dated to the Middle to Late Archaic, spanning a time period of 4000 – 2900 BC. This
means that the most conservative date for the presence of a yaws type of infection in
North America would be 4900 years before present, and the earliest date could be 6000
years before present. Therefore, a yaws-like treponematosis was likely in North America
long before Columbus and his crew arrived in 1492 AD.
Recently Rothschild (2003) suggested that the earliest evidence for treponemal
infection similar to yaws was at the Windover site in Florida, 7900 years BP. However,
the Windover site has not yet been confirmed as the oldest site in North America
exhibiting treponemal disease by any detailed pathological analysis of the skeletal
collection. Walker et al. (2005) propose that collections from the Santa Barbara Channel
121

Area of Southern California (4000 – 5000 years ago) are some of the oldest remains
exhibiting evidence for treponemal disease in the Western Hemisphere.
The presence of a yaws-like treponemal infection at Carrier Mills provides the
earliest evidence for treponematosis in Illinois at 6000 – 4900 BP, and perhaps the oldest
well-documented evidence in the Western Hemisphere. The second oldest site discussed
in Illinois is the Pete Klunk site, which dates to 2900 BP (Powell et al. 2005). Other sites
from Illinois include Morton Mounds, Fisher, Parker Heights, Rose Mounds, Gibson, J
Gay, L Gay, Ledders, and Yokem all dating from 1000 BC to AD 1000 (Powell et al.
2005).
As discussed in Chapter 2, the first hypothesis concerning the origin of syphilis is
the “Columbian theory” whose supporters believe that Columbus and his crew brought
venereal syphilis back to Europe from the Americas. The Carrier Mills study does not
support this hypothesis, as it was a non-venereal form of treponemal disease that existed
in this sample, namely yaws. Thus, unless yaws transformed to venereal syphilis in the
ships crossing the Atlantic Ocean, Columbus and his crew could not have brought back
venereal syphilis from North America to Europe.
The second hypothesis, the “Pre-Columbian theory”, suggests that venereal
syphilis existed in Europe long before Columbus’ journey to the New World and that
Columbus brought the disease to the Americas. As detailed above, this study proves that
a non-venereal form of treponemal disease, most like yaws, did exist in North America
before Columbus’ journey. The Pre-Columbian theory can only be true if we include the
evidence of non-venereal treponemal disease as evidence of the existence of the
122

treponematoses, which could include venereal syphilis, in North America before
Columbus’ journey.
The other three hypotheses; Livingston’s Alternative Hypothesis, the Unitarian
and the Non-Unitarian hypotheses, are all hypotheses suggesting early presence of
treponemal disease in the Old World. Was there only a single treponematosis existing in
both the Old and New Worlds before Columbus’ journey that evolved into the other
syndromes following the evolution of humans through time? Alternatively, was there
one treponematosis that began as an animal infection, eventually infecting humans and
evolving into the different syndromes of treponemal disease as a result of the pathogen
adapting to different environmental circumstances? This study alone does not attempt to
answer these questions. Perhaps if we examine a broad range of studies involving
treponemal disease, these types of questions can be answered. Therefore, further
research into the theories of development of treponemal disease needs to be undertaken.
5.5 Conclusions
This study found that a treponemal disease likely did affect the Carrier Mills
sample. This syndrome was most similar to that of yaws, but not precisely identical to
the pattern of symptoms seen in modern yaws. Other researchers believe that it is
possible that another form of treponematosis did exist thousands of years ago (Baker and
Armelagos 1988), with many evolutionary changes having occurred since then. We
know that gradual change does occur over time within plants, animals and even in
bacteria, so it is possible that another form of treponematosis did exist thousands of years
123

ago. This would account for the many similarities found in the Carrier Mills individuals
to the treponemal disease of yaws. The treponemal disease in this study is most like
yaws, but it is more widespread, occurring in the population far more frequently. It is
almost as if this treponemal disease was a “super-" or a "hyper-yaws”.
Life in the Archaic of Carrier Mills must have been harsh, with a yaws-like
treponematosis affecting all age groups, possibly causing high infant mortality rates but
also affecting people throughout their lifetimes. As for the debate on the origin of
treponemal disease, this research strongly favors the hypothesis that a non-venereal form
of treponematoses existed in North America before Columbus’ historic journey.
Therefore, Columbus most likely did not return to Europe with venereal syphilis
contracted from the peoples of the Americas. However, it could be possible that
Columbus and his crew returned to Europe with a non-venereal form of treponematosis
from the Americas, but this would not explain the epidemic of venereal syphilis in 16 th
century Europe.
124

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136

APPENDICES

APPENDIX A. DIFFERENTIAL DIAGNOSIS OF DISEASES IN THIS STUDY
Names of Yaws Bejel Venereal
Diseases Syphilis
Parameters
% of Population 20-40% 20-40% 2-14%
Age Groups Primarily Primarily Subadults
Child, Adol; Child 2-10; & Adults
Adults Subadults; of sexual
Adults maturity
Bone Groups Median Few Few
Skeletal Involvement 5-15%
Common Bones Affected Tibia 99% Tibia 99% Parietal &
Frontal;
Tibia 99%
Bones Affected
Skull X - X
Tibia X X X
Fibula X X X
Clavicle X X X
Femur X - X
Ulna X X X
Radius X X X
Hands X X -
Feet X X -
Humerus - - X
Sternum - - X
Vertebrae - - X (Cervical)
Nasal/Palatal X X X
Nasal Bones X X X
Other Changes
Joints Affected - - Knee, Elbow,
Shoulder
Cranial Changes - - Outer surface
sutures not crossed
Periosteal Reaction X X X
Osteitis X X X
Congenital Transmission Possible No Yes
137

APPENDIX A. DIFFERENTIAL DIAGNOSIS OF DISEASES IN THIS STUDY, continued.
Names of Yaws Bejel Venereal
Diseases
Characteristic Features
Syphilis
Symmetrical Dacty- Nasal-Palatal Nasal-Palatal
destruction -
litis, Gangosa, destruction - rare, empty
nasal cavity,
Periostitis, joint Periostitis of short
bones of hand &
smooth
swelling, Fibula
feet, lateral walls,
tunnel-like
rarely deformed, Fusiform enlarge- passageradius/ulna
bowed ment way, Caries sicca
Angulation of fingers bone deposition, Cardiovascular &
Shortened fingers Little medullary central nervous
systems,
Saber shin tibia changes,
unilateral
Saber shin tibia tibial involvement
Saber shin tibia
Geographic
Locations
X = affected
- = not sure if
affected
138
Africa, Latin America E Mediterranean Worldwide
Carribean SW Asia but more
SE Asia Sub-Saharan in Urban areas
N Australia Africa
New Guinea North America
North America (rural areas)
(rural areas)
Sources: Ortner 2003, Hackett 1976, Rothschild et al. 2000, Aufderheide & Rodriguez-
Martin 1998, Rothschild et al.
2004

APPENDIX A. DIFFERENTIAL DIAGNOSIS OF DISEASES IN THIS STUDY, cont.
Names of Congenital Tuberculosis Leprosy
Diseases Syphilis
Parameters
% of Population
Age Groups Primarily All ages; All ages;
Fetus & 2:1 ratio of 2:1 ratio of
Neonate; males to males to
Infant females females
Bone Groups - - -
Skeletal Involvement - 3% 5%
Common Bones Affected Spine; areas of Skull,
cancellous bone; Hands & Feet
long bones -
metaphysis &
epiphysis; cranial
vault
Bones Affected
Skull X X X
Tibia X - X
Fibula - - X
Clavicle - - -
Femur X - -
Ulna X - -
Radius X - -
Hands - X X
Feet - X X
Humerus - - -
Sternum - X -
Vertebrae - X (Thoracic,Lumbar) -
Nasal/Palatal - - X
Nasal Bones - X X
Other Changes
Joints Affected - Sacro-iliac, knee, -
Ankle, shoulder
elbow
Cranial Changes - Inner surface -
Periosteal Reaction X - -
Osteitis X - -
Congenital Transmission Solely No No
139

APPENDIX A. DIFFERENTIAL DIAGNOSIS OF DISEASES IN THIS STUDY, cont.
Names of Congenital Tuberculosis Leprosy
Diseases
Characteristic Features
Syphilis
Osteochondritis, Bony ankylosis, Facies Leprosa,
vertebral TB - pitting &
Metaphysis,
L1,
vertebral
perforation
Periostitis,
collapse, of palate & nasal
septum,
Hutchinson's incisor Spina ventosa, absorption
Mulberry molars Desctruction of
mandibular
of anterior nasal
Moon's molars
angle spine, ascending
absorption of
max.
alveolus, loosing
& shedding of
incisors &
canines
Geographic
Locations
X = affected
- = not sure if
affected
140
Worldwide
Worldwide except for Arctic
regions
Rural areas
Sources: Ortner 2003, Hackett 1976, Rothschild et al. 2000, Aufderheide & Rodriguez-
Martin 1998, Rothschild et al.
2004

APPENDIX A. DIFFERENTIAL DIAGNOSIS OF DISEASES IN THIS STUDY, cont.
Names of Osteosarcoma Meningioma Metastatic
Diseases
Parameters
% of Population
Older
Carcinoma
Age Groups Ancient populations individuals Most commonly
under age 30
males affected
Average age 45 individuals over
more
than females
age of 40
Bone Groups - - -
Skeletal Involvement - - -
vertebrae,
Common Bones Affected More common Spine, Cranium, pelvis,
in longbones; Skull vault ribs, major long
also affected flat bones, sternum,
Bones Affected
bones, skull with
mandible most
affected
skull
Skull X X X
Tibia X - X
Fibula X - -
Clavicle - - -
Femur X - X
Ulna X - -
Radius X - -
Hands - - -
Feet - - -
Humerus X - X
Sternum - - X
Vertebrae - X X
Nasal/Palatal - - -
Nasal Bones
Other Changes
- - -
Joints Affected Prox femur
Head of humerus
- -
Cranial Changes - Inner surface -
Periosteal Reaction - - -
Osteitis - - -
Congenital Transmission - - -
141

APPENDIX A. DIFFERENTIAL DIAGNOSIS OF DISEASES IN THIS STUDY, cont.
Names
of Osteosarcoma Meningioma Metastatic
Diseases Carcinoma
Characteristic Features
Onion Skin Hyperostosis,
thickening of
pathologic
fractures,
appearance,
the
skull,
vertebral collapse
bone spicules per-
spiculated with multiple
pendicular to surface
Sunburst Effect
appearance bone lesions
Sources: Ortner 2003, Hackett 1976, Rothschild et al. 2000, Aufderheide & Rodriguez-
Martin 1998, Rothschild et al. 2004
142

APPENDIX A. DIFFERENTIAL DIAGNOSIS OF DISEASES IN THIS STUDY, cont.
Names of Multiple Osteomyelitis Paget's Disease
Diseases
Parameters
% of Population
Myeloma
Most common
Age Groups Most commonly All age groups
age
individuals over group - individuals
age of 40, males over 60, males
more than
more than
females
females
Bone Groups - - -
Skeletal Involvement
Common Bones
- - -
Affected flat bones, skull, any bone, pelvis, femur,
long bone meta- knee, distal tibia, skull, tibia,
prox
vertebrae,
physes, femur, femur,humerus, clavicles,
humerus, pelvis, uncommonly: ribs
collapse of cervical vertebrae,
Bones Affected
vertebral body,
ribs, scapula
skull - frontal
Skull X X Frontal X
Tibia - X X
Fibula - - -
Clavicle X - X
Femur X X X
Ulna - - -
Radius - - -
Hands - - -
Feet - - -
Humerus X X -
Sternum - - -
Vertebrae X X Cervical X Lumbar
Nasal/Palatal - - -
Nasal Bones
Other Changes
- - -
Joints Affected - knee -
Cranial Changes internal & outer table inner & outer
external tables, diploe
Periosteal Reaction - - -
Osteitis - - -
Congenital
Transmission - - -
143

APPENDIX A. DIFFERENTIAL DIAGNOSIS OF DISEASES IN THIS STUDY, cont.
Names
of Multiple Osteomyelitis Paget's Disease
Diseases Myeloma
Characteristic Features
lytic lesions re- usually affects longbones =
stricted to particular only 1 bone, thickening of cortex
area, small, round, sequestrum, medullary cavity in
tact,bone
resorbing bone, involucrum
resorption,
scalloped edges,
new bone
formation,
punched out thickening of
appearance cranium, fissure-like
stress fractures
Sources: Ortner 2003, Hackett 1976, Rothschild et al. 2000, Aufderheide & Rodriguez-
Martin 1998, Rothschild et al. 2004
144

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness * * Notes
1 Old Adult >50% but Moderate Parietal - 3-5 foci inside skull; 1st meta-
56 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS,
continued.
Degree
Burial Age/Sex Complete- of
Osteitis
Num Category ness * * Notes
humerus - unifocal bone loss, osteitis; right
femur - striations, osteitis; thoracic
vertebrae - multifocal bone loss, compression;
lumbar vertebrae - multifocal
bone
loss, schmorl's nodes on 2, compression
Clavicle - both swollen, left has woven
103 Old Adult >50% but Moderate bone;
53 yrs 50% but None Calcaneus - woven bone; unilateral tibia -
50 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness * * Notes
bodies, sacrum
29 Mid Adult >50% but Slight Frontal - multifocal bone loss; calcaneus -
44 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness *
cranium
* Notes
unifocal, multifocal bone loss, deposition
of woven bone, sclerotic reaction;
unilateral
other long bone - right humerus - osteitis,
woven bone, multifocal bone loss, right
radius - woven & sclerotic reaction,
right ulna - sclerotic reaction, left ulna -
woven bone; cervical - multifocal bone
loss;
thoracic - multifocal bone loss anterior
body of 1; lumbar - sclerotic reaction
anterior bodies of 2; periarticular resorptive
foci - cervical -inferior superior bodies,
thoracic - inferior bodies & 1 facet, lumbar
-
superior (4) & inferior (1) bodies
45 Mid Adult comp. Slight Clavicle - osteitis on both, right - unifocal
37 yrs 90% post- bone loss; ribs - 1st ribs - woven bone;
cranial
carpals - multifocal bone loss,
Female comp.
cranium
metacarpalswoven
bone, osteitis, hand phalanges -
multifocal bone loss, osteitis;
bilateral tibia - woven bone, striations;
bilateral fibula - striations; bilateral
other long bone - humerus - woven bone,
femur - woven & sclerotic reaction,
striations; cervical - compression; thoracicunifocal
bone loss,
compression, woven bone; lumbar -
unifocal
bone loss, compression, woven bone; periarticular
resorptive foci -
cervical bodies & facets, thoracic bodies &
facets, lumbar bodies & facets, sacrum -
1st vertebrae
49 Mid Adult comp. Slight Metacarpals - unifocal bone loss, hand
46 yrs 90% postcranial
phalanges - unifocal bone loss; bilateral
Male comp. tibia - woven bone, bowed
medial lateral, striations, osteitis; bilateral
fibula - striations, osteitis,sclerotic reaction;
148

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness *
cranium
* Notes
bilateral other long
bone - radius - woven & sclerotic reaction,
woven bone, femur - woven bone, sclerotic
reaction; thoracic - fusion, compression,
multifocal bone loss; lumbar -compression,
multifocal bone loss; periarticular
resorptive
foci - cervical bodies & facets, thoracic
bodies & facets, lumbar bodies, sacrum
1st vertebrae
65 Mid Adult comp. Moderate Clavicle - left - woven bone; intermediate
49 yrs 90% postcranial
phalanges swelled; metatarsals - multifocal
Male comp. bone loss, woven & sclerotic reaction,
unifocal bone loss, osteitis; unilateral tibiaright
- woven bone, striations; unilateral
fibula - don't know which side - osteitis;
unilateral other long bone - right humerus -
woven bone - smudge-like, right femur -
woven bone, left femur -
striations;thoracicfusion,
compression, multifocal bone loss;
lumbar - compression, multifocal bone
loss; periarticular resorptive foci - thoracicsuperior
& inferior bodies, lumbar -
superior & inferior bodies, sacrum - 1st
vertebrae
72 Mid Adult >50% but None Metacarpals - unifocal bone loss; unilateral
38 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness * * Notes
85 Mid Adult >50% but None Ribs - woven bone posterior & anterior of
40 yrs 50% but Slight Nasal/palatal - porosity & coalescence of
42 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness *
cranial
* Notes
Male comp. carpals, hand phalanges - sclerotic
reaction; tarsals, metatarsals - sclerotic
reaction, metatarsals - unifocal bone loss;
bilateral tibia - striations; unilateral tibia -
right - sclerotic reaction; bilateral fibula -
striations, sclerotic reaction;unilateral other
long bone - right radius - swollen, striations,
left radius - woven bone, deposit of woven
bone, right humerus - unifocal bone loss;
thoracic - T8-9 fused, unifocal multifocal
bone loss; lumbar -fusion -L4-5, sacrum,
coccyx, L2-3 - fused, L2 compression;
periarticular resorptive foci - thoracic -
articular surfaces of 6 affected -
mostly inferior, cervical - bodies & facet
94 Mid Adult >50% but None Clavicle - both woven & sclerotic reaction,
44 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness * * Notes
bilateral tibia - striations; unilateral tibia -
right - bowed medial-lateral, unifocal bone
loss; bilateral fibula - striations; bilateral
other long bone - femur -unifocal bone loss,
striations; unilateral other long bone -
right radius - unifocal bone loss, swollen,
left ulna - unifocal bone loss; thoracic -
unifocal bone loss; lumbar - schmorl's
nodes
104 Mid Adult >50% but Moderate Parietal - unifocal multifocal bone loss;
46 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness *
cranial
* Notes
Male comp.
cranium
loss, metatarsals - sclerotic reaction,
unifocal multifocal bone loss, woven bone,
cloacae, circumscription, foot phalanges -
unifocal bone loss, abnormal shape, woven
bone; bilateral tibia - striations, sclerotic
reaction; unilateral fibula - radius - flared/
swollen, femur - striations; thoracic - some
bodies are angled to the left, unifocal bone
loss; lumbar - unifocal multifocal bone loss;
periarticular resorptive foci - thoracic -
transverse processes of 4
121 Mid Adult comp. None Palatal - porosity, bump of bone; clavicle -
39 yrs 90% post- both - deposition of woven bone; ribs -
cranial
woven bone some anterior
Male comp.
shafts,deposition
of woven bone on 12th rib; carpals - multifocal
bone loss, hand phalanges - woven
bone, metacarpals - abnormal shape;
bilateral other long bone - humerus -
sclerotic reaction, radius - swollen radial
tuberosities, femur - striations; unilateral
other long bone - left femur - deposition of
woven bone; cervical - compression;
thoracic - unifocal bone loss 9 bodies,
compression; lumbar - compression,
deposition of bone on spinous processes;
periarticular resorptive foci - cervical -
bodies & facets, thoracic - facets
124 Mid Adult >50% but Slight Ribs - woven bone on some anterior, 1
42 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness * * Notes
- unifocal bone loss;periarticular resorptive
foci - cervical - bodies superior & inferior,
thoracic - inferior facets of 6, superior
facets 2
Yng cranium
Bilateral other long bone - femur -
3 Adult comp. None striations;
27 yrs 90% postcranial
thoracic - schmorl's nodes 1 body, com-
Male comp. pressed; lumbar - schmorl's nodes
3 bodies; periarticular resorptive foci -
cervical - superior 4 bodies
Yng cranium
25 Adult comp. Moderate Clavicle - left acromial end is larger than
33 yrs 90% postcranial
right; metacarpals - abnormal shape - wide,
Male comp. twisted, hand phalanges - woven bone,
bony growths; bilateral tibia - striations;
unilateral tibia - right - concentration of
woven bone; bilateral fibula - striations,
pin pricks; bilateral other long bone - ulna -
multifocal bone loss, femur - woven bone,
striations; unilateral other long bone - left
radius - woven bone; thoracic - unifocal
multifocal bone loss 12 bodies; lumbar -
unifocal multifocal bone loss 5 bodies
Yng cranium
35 Adult comp. None Parietal - unifocal bone loss near sagittal
21 yrs 90% postcranial
suture; clavicle - multifocal bone loss
Male comp. sternal end - groove w/several smaller
holes; carpals - unifocal bone loss; metatarsals
- unifocal bone loss, foot phalangesunifocal
bone loss; bilateral tibia -
striations, multifocal bone loss; unilateral
tibia - left - unifocal bone loss; bilateral
other long bone - femur - woven bone,
striations; unilateral other long bone - right
ulna - unifocal bone loss; cervical -
unifocal bone loss 6 bodies; thoracic -
unifocal multifocal bone loss 8 bodies;
lumbar - unifocal multifocal bone loss
4 bodies
154

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category
Yng
ness * * Notes
39 Adult >50% but None Carpals - multifocal bone loss, hand
22 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness * * Notes
focal bone loss 7 bodies multifocal bone
loss on all, compression; lumbar - unifocal
bone loss 5 bodies, multifocal bone loss
on all, compression; periarticular resorptive
foci - thoracic - 5 inferior facets
Yng cranium
69 Adult comp. None Clavicle - both - woven & sclerotic reaction
29 yrs 90% postcranial
acromial ends, sternal ends swollen;carpal
Male comp. woven bone; metatarsals - woven bone on
all 5 present; unilateral other long bone -
left radius - woven bone; thoracic - T12 -
multifocal bone loss on inferior body, 2
facets larger, T11 - schmorl's nodes, 2
larger facets, compression, T9(?) - deep
lesion superior body, schmorl's node inferior
body, sclerotic reaction on some; lumbar-
L1 -schmorl's node inferior body, L2 -large
lesion posterior body inferior, schmorl's
node superior body, L4, L5 - schmorl's
node inferior body, some compression;
periarticular resorptive foci - cervical - 2
inferior facets, thoracic - T10 & 11
posterior bodies
Yng cranium
82 Adult comp. Slight Clavicle- left -woven bone; ribs- deposition
25 yrs 90% postcranial
of woven bone on shafts; metacarpals -
Unde- comp. woven bone on shafts of 2; calcaneus -
termined woven bone, 1st metatarsals - woven bone;
bilateral tibia - woven bone, striations,
osteitis; bilateral fibula - woven &
sclerotic reaction; unilateral fibula - left -
unifocal bone loss; bilateral other long bone
humerus - osteitis, femur - striations,
osteitis; unilateral other long bone - right
radius - unifocal bone loss, woven bone,
left ulna - concentration of woven bone,
right femur - woven bone; thoracic - multifocal
bone loss, woven bone anterior
bodies of 2; lumbar - multifocal bone loss,
compression
156

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category
Yng
ness * * Notes
83 Adult >50% but Slight Bilateral tibia -striations; bilateral other long
bone - humerus -woven bone, femur -
20 yrs

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness * * Notes
18 + yrs unifocal bone loss, talus - sequestrum;
Male
Yng
bilateral tibia - woven bone, striations;
bilateral fibula -sclerotic reaction, striations;
unilateral other long bone - femur -not sure
which side - striations
105 Adult

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness * * Notes
20 yrs 90% postcranial
metatarsals - woven bone; bilateral tibia -
Male comp. striations, woven bone; bilateral fibula -
woven & sclerotic reaction, multifocal bone
loss; bilateral other long bone - humerus -
woven bone, femur - striations, woven
bone; thoracic -unifocal multifocal bone
lossschmorl's node on 1 inferior body;
lumbar - unifocal bone loss horizontal
lesions across 4 bodies
cranium
Clavicle -both have woven bone; ribs -
89 Adol comp. Slight woven
16 yrs 90% postcranial
bone sternal ends; metacarpals - woven
Female comp.
cranium
bone, hand phalanges - woven bone;
calcaneus - woven bone, metatarsals -
woven bone, foot phalanges - woven bone;
bilateral tibia - striations, woven bone;
unilateral tibia - right - unifocal bone loss;
unilateral fibula - not sure which side -
striations, woven bone; bilateral other long
bone - femur - striations, woven bone; unilateral
other long bone - left femur - unifocal
bone loss, radius - not sure which side -
swollen, unifocal bone loss, woven bone,
ulna - not sure which side - striations,
humerus - not sure which side -woven
bone;
cervical - unifocal multifocal bone loss;
thoracic - unifocal multifocal bone loss,
compression; lumbar - unifocal multifocal
bone loss
116 Adol comp. None Clavicle - both woven bone; ribs - woven
bone on several anterior; calcaneus -
16 yrs 90% postcranial
woven
Male comp. bone; unilateral fibula - right - woven bone;
bilateral other long bone - humerus - woven
bone, ulna - woven bone; unilateral other
long bone - right radius - woven bone;
thoracic - unifocal multifocal bone loss,
schmorl's nodes on 3 bodies, compression;
159

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness *
cranium
* Notes
lumbar - L1-5 - woven & sclerotic reaction,
schmorl's nodes L1,2,3 superior & inferior
bodies, compression, L4 - unifocal
bone loss - horizontal lesion
21 Infant comp. None Bilateral other long bone - humerus - woven
1.7 90% postcranial
bone, swollen/flared; lumbar - unifocal bone
UJ comp.
cranium
loss
30 Infant comp. None Frontal or parietal? - woven bone inside
0.2 90% postcranial
w/grooves, frontal - woven bone above &
UJ comp.
cranium
inside orbits; clavicle - don't know which
side - woven bone around sternal end; ribswoven
bone anterior & posterior & at both
ends of some; bilateral other long bone -
humerus - woven bone over most of shaftsworse
at ends; unilateral other long bone -
right radius - woven bone, right ulna -
woven
bone, right femur - woven bone
32 Infant comp. None Frontal -woven bone inside orbits -extensive
0.8 90% post- & other parts of frontal; clavicle - both -
cranial
woven bone around ends; ribs - woven
UJ comp.
cranium
bone
at ends & anterior shaft of some; metatarsals
- woven bone on 1; bilateral tibia -
woven bone; bilateral fibula - woven bone;
bilateral other long bone - humerus - woven
bone, radius - woven bone, ulna - woven
bone, femur - woven bone; thoracic -
unifocal
bone loss; lumbar - unifocal bone loss
40 Infant comp. None Frontal or parietal? - woven bone inside;
0.6 90% postcranial
clavicle - both - woven bone on both ends;
UJ comp. ribs - woven bone on 1; bilateral other
long bone - humerus - woven bone, radius -
woven bone, femur - woven bone; uni-
160

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness *
cranium
* Notes
lateral other long bone -left ulna -woven
bone; thoracic - unifocal bone loss;
lumbar - unifocal bone loss
46 Infant comp. None Clavicle - both - woven bone; ribs - woven
0.1 90% postcranial
bone, sternal ends appear to be swollen;
UJ comp.
cranium
bilateral other long bone - humerus - woven
bone radius - woven bone, ulna - woven
bone; unilateral other long bone - left femurwoven
bone; thoracic - unifocal bone loss;
lumbar - unifocal bone loss
62 Infant comp. None Frontal or parietal? - woven bone superior,
0.4 90% postcranial
frontal - woven bone inside the orbits;
UJ comp.
cranium
clavicle - both - woven bone; ribs - woven
bone, sternal ends appear to be swollen;
unilateral tibia - not sure what side - woven
bone; bilateral other long bone - humerus -
woven bone, ulna - woven bone, femur -
woven bone; unilateral other long bone -
right radius - woven bone; thoracic -unifocal
multifocal bone loss; lumbar -unifocal
multifocal bone loss
63 Infant comp. None Clavicle - not sure which side - woven bone;
0.4 90% postcranial
rib - woven bone anterior shafts & ends of
UJ comp. some; bilateral other long bone - humerus -
woven bone; unilateral other long bone -
radius - not sure which side - woven bone,
right ulna - woven bone; thoracic -
multifocal bone loss
77 Infant >50% but None Clavicle - both - woven bone at ends; ribs -
1.3

APPENDIX B. SUMMARY OF CARRIER MILLS ARCHAIC BURIAL SAMPLE
INDIVIDUALS SHOWING POSSIBLE TREPONEMAL CHARACTERISTICS, cont.
Burial Age/Sex Complete-
Degree
of
Osteitis
Num Category ness *
cranium
* Notes
multifocal bone loss; lumbar - multifocal
bone loss
87 Infant comp. None Clavicle - both - woven bone at ends; ribs -
0.8 90% postcranial
woven bone at ends; bilateral tibia - woven
UJ comp. bone; bilateral fibula - woven bone;
bilateral other long bone - humerus - woven
bone, unifocal bone loss, ulna -woven bone,
femur - woven bone; unilateral other long
bone - radius - not sure which side - woven
bone; lumbar - multifocal bone loss
* Taken from Bassett (1982)
162

Twana Jill Golden
PO Box 2382
Carbondale, IL 62902
October 29, 2007
Center For Archaeological Investigations
Southern Illinois University
Carbondale, IL 62901
Dear Dr. Butler:
This letter will confirm our recent telephone conversation. I am completing a masters
thesis at Southern Illinois University entitled “A Contribution to the Debate Over the
Origin and Development of Treponemal Disease: A Case Study from Southern Illinois.”
I would like your permission to reprint in my thesis maps from the following:
Jefferies RW, Butler BM, editors. 1982. The Carrier Mills Archaeological
Project: Human Adaptation in the Saline Valley, Illinois Volume 1. Southern
Illinois University at Carbondale: Center for Archaeological Investigations,
Research Paper No 33.
The maps to be reproduced are:
Figure 1. Location of the Carrier Mills Archaeological District in Southern
Illinois. Page 4 of the volume.
Figure 3. Locations of Sites in the District. Page 6 of the volume.
The requested permission extends to any future revisions and editions of my thesis,
including non-exclusive world rights in all languages, and to the prospective publication
of my thesis. These rights will in no way restrict publication of the material in any other
form by you or by others authorized by you. Your signing of this letter will also confirm
that the Center for Archaeological Investigations owns the copyright to the abovedescribed
material.
If these arrangements meet with your approval, please sign this letter where indicated
below and return it to me. Thank you very much.
Sincerely,
Twana Jill Golden
PERMISSION GRANTED FOR THE
USE REQUESTED ABOVE:
_________________________ Date:_______________
Dr. Brian M. Butler
163

VITA
Graduate School
Southern Illinois University
Twana Jill Golden Date of Birth: January 28, 1972
P.O. Box 2382, Carbondale, Illinois 62902
Southeastern Illinois College at Harrisburg
Associate In Applied Science, Electronic Data Processing, May 1993
Southern Illinois University at Carbondale
Bachelor of Arts, Anthropology, May 2004
Special Honors and Awards:
Scholastic Honors Award, College of Liberal Arts, Southern Illinois University
Carbondale, 2003
Scholastic Honors Award, College of Liberal Arts, Southern Illinois University
Carbondale, 2004
Excellence in Anthropology, Southern Illinois University Carbondale, 2004
Thesis Title:
A Contribution to the Debate Over the Origin and Development of Treponemal
Disease: A Case Study from Southern Illinois
Major Professor: Susan M. Ford
164