Skeletal lesions from a historic Afro-American cemetery • 125 



be attributed to iron deficiency result- 

 ing from a reliance upon com and a lack 

 of red meat in the diet, as suggested by 

 the historical literature (Kiple and Ki- 

 ple 1977:285). Some of these lesions 

 can be attributed to sickle cell, but this 

 genetic trait should account for only a 

 small percentage of the observed cases 

 (Ortner and Putschar 1981:254-258). 

 The 24% craniotabes for children dying 

 between 3 and 20 months can be at- 

 tributed to vitamin D deficient rickets, 

 associated with the historically postu- 

 lated low milk consumption caused by 

 a high rate of lactose intolerance com- 

 mon among Afro-Americans, and the 

 documented scarcity of cattle among 

 the sharecroppers (Kiple and Kiple 

 1977:290; Kiple and King 1981:72). At 

 least some of the extensive childhood 

 periosteal deposits and the ossified 

 hematomas among the adults may be 

 attributable to vitamin C deficiency 

 (Ortner and Putschar 1981:271-272) 

 caused by a lack of fruits and vegeta- 

 bles in the diet. These high rates of le- 

 sions specific for dietary deficiencies 

 indicate a very inadequate diet in the 

 Cedar Grove community between 1 890 

 and 1927. 



The high frequency of active sys- 

 temic periostitis found among both pre- 

 matures and neonates suggests the exis- 

 tence of at least one dominant disease. 

 Farley's (1970:12) suggestion of con- 

 genital syphilis can be tested with the 

 skeletal data. Steinbock (1976:98-99) 

 describes early congenital syphilis as 

 occurring between birth and three to 

 four years, being associated with uni- 

 versal bone changes which include peri- 

 ostitis and diaphyseal osteomyelitis, 

 and having a mortality of at least 50%. 

 Ortner and Putschar (1981:198) state 

 that congenital syphilis leads to early 

 fetal death, delivery of a premature or 

 mature diseased stillborn fetus, or de- 

 livery of a living infected newborn. 

 They further state that syphilitic perios- 

 titis can have begun in utero and be 

 present at birth (1981:198). Steinbock 

 (1976:100-101) states that cranial os- 

 teitis can impact both cranial tables. 



The association of endocranial new 

 bone formation and long bone peri- 

 ostitis found in a prehistoric Native 

 American skeletal sample has been at- 

 tributed to one of the treponematoses 

 by Cook and Buikstra (1979:658). 



All five Cedar Grove skeletons with 

 dental ages younger than birth (seven to 

 eight fetal months) exhibit systemic 

 periostitis involving virtually every 

 bone. All but 2 of the 1 1 individuals 

 dying at birth exhibit systemic perios- 

 titis, while one of the exceptions has 

 only endocranial periostitis. Of the 18 

 deaths between three months and 3.5 

 years, 48% exhibit systemic periostitis. 

 Taken together, the high frequency of 

 prematures with systemic periostitis, 

 the high neonatal mortality associated 

 with active systemic periostitis, and the 

 absence of systemic periostitis after 3.5 

 years all suggest congenital syphilis as 

 the dominant disease entity. This diag- 

 nosis is further strengthened by the 

 presence of Hutchinson's maxillary in- 

 cisors on one 10-year old. These four 

 maxillary incisors match the classic de- 

 scription of Hutchinson's defect includ- 

 ing notching, barrel shape, and con- 

 vergent lateral margins (Steinbock 

 1976:107). The diagnosis as Hutchin- 

 son's incisors was also confirmed by 

 histological examination (Marks 1984). 

 If the diagnosis of widespread con- 

 genital syphilis is correct, then the 

 characteristic lesions of venereal syph- 

 ilis should also be evident in the adult 

 sample. The ranking by frequency of 

 {jeriostitis among the older individuals 

 is tibia, fibula, radius, ulna, and femur. 

 This ranking is fairly consistent with 

 that reported for venereal syphilis 

 (Steinbock 1976:112). Of particular 

 importance is the high frequency of 

 periostitis of the arm bones at Cedar 

 Grove, which is a fairly uncommon lo- 

 cation for other infectious diseases and 

 consistent with the presence of venereal 

 syphilis (Steinbock 1976:112). Absent 

 from Cedar Grove are the characteristic 

 cranial lesions of syphilis, the saber 

 shins, and the extensive osteomyelitis 

 of the tibiae (Ortner and Putschar 



1981:201-218; Steinbock 1976:108- 

 136). Despite the absence of un- 

 disputed acquired syphilis among the 

 adults, the diagnosis of congenital 

 syphilis as the major cause of still- 

 births, high neonatal mortality, and 

 widespread systemic infection appears 

 very reasonable. 



A second pathological phenomenon 

 is indicated by the fact that, while the 

 frequency of lesions in all other bones 

 continues to decline, the tibia, fibula, 

 and endocranium show a relatively 

 large increase between one and five 

 years (Tables 1 and 2). In fact, 58% of 

 the deaths between one and five years 

 occur at 18 months of age. The 18- 

 month modal age at death, a common 

 age of weaning, combined with an in- 

 crease in infections of the tibia and 

 fibula is highly suggestive of weanling 

 diarrhea (Scrimshaw et al. 1968:216- 

 260). This syndrome is characterized 

 by low-protein weaning diets which 

 contribute to lowered resistance to in- 

 fection and initiate a cycle of diarrhea 

 and infectious disease. The presence of 

 protein malnutrition resulting from 

 amino acid deficiencies associated with 

 corn- and pork-dominated diets has 

 been noted in the historic literature (Ki- 

 ple and Kiple 1977:287). 



The presence of rib periostitis that is 

 not associated with systemic infection 

 has been previously identified in two 

 children ( 1 3 and 20 months), one adult 

 male, and two adult females. The loca- 

 tion of these lesions on the medial sur- 

 face of the rib body and their gross ap- 

 pearance conform with the lesions 

 identified by Kelley and Micozzi 

 (1984) as being associated with pulmo- 

 nary tuberculosis among cadaver speci- 

 mens from the same time period as 

 Cedar Grove. As tuberculosis is identi- 

 fied as the leading cause of death 

 among Afro-Americans at the turn of 

 the century (Farley 1970:70; Holmes 

 1937:76), assigning 6% of the Cedar 

 Grove deaths to this disease is appropri- 

 ate. This is not to say that the rib lesions 

 associated with other infected bones are 

 not also attributable to tuberculosis, but 



Za/treh Palenpalhology Symp. J9SS 



