Treponematosis and tuberculosis in tiie prehistoric southeastern United States • 175 



function is compromised and death follows. Tuberculosis 

 was a major cause of death in children, adolescents and 

 young adults before the development of effective surgical 

 and antibiotic therapy and was responsible for 260 deaths per 

 100,000 residents in Germany in 1892 (Ortner and Putschar 

 1 98 1 : 1 42 ). Mortality from tuberculosis is particularly high in 

 populations under severe stress from malnutrition, over- 

 crowded and unsanitary living conditions, other diseases, 

 and psychosocial stress (Hrdlicka 1909; Hoeprich 1977; My- 

 ers 195 1 ). Under more healthful conditions, successful repair 

 of tissue destruction permits extended survival of the host, an 

 outcome incidentally in the pathogen's favor as it promotes 

 subsequent infection of other hosts. 



Table 1 summarizes the contrasting morbid and mortal 

 effects of endemic treponematosis and tuberculosis. These 

 differing patterns have important implications for paleo- 

 pathological studies of the two diseases, for the following 

 reasons. Tuberculosis is less "visible" than endemic trep- 

 onematosis in skeletal series. In older museum collections, 

 spinal elements tend to be less well represented than long 

 bones because vertebrae are more prone to postmortem de- 

 struction and because in many field situations they were less 

 systematically collected. In the Moundville series, for exam- 

 ple, fewer than 407c of the individuals were represented by 

 thoracic and/or lumbar vertebrae, the most common sites of 

 tubercular bone lesions. By contrast, more than 70% were 

 represented by the postcranial bones most characteristically 

 affected by treponemal infection. 



The nature of the lesions produced by the different diseases 

 also plays a role in affecting favorably or unfavorably the 

 chances for postmortem preservation. The osteolytic lesions 

 characteristic of tuberculosis destroy bone tissue and weaken 

 the fabric of affected skeletal elements. The osteoblastic le- 

 sions characteristic of endemic treponematosis produce addi- 

 tional bone, thickening the cortex of affected long bones and 

 rendering them more resistant to dissolution. 



Materials and methods 



The first population sample discussed in this paper was exca- 

 vated from the prehistoric American Indian community of 

 Moundville located on the Black Warrior River some 13 

 miles southeast of Tuscaloosa in west central Alabama. It 

 represents the Mississippian occupation of the site, which 

 lasted from A. D. 1050 to 1550. By the mid- 14th century, an 

 estimated 3000 individuals were concentrated within the pro- 

 tective palisade and in small "suburban" clusters located 

 nearby. The subtropical climate and the easily cultivated, 

 fertile soils encouraged the development of a sophisticated 

 subsistence regimen combining maize, squash, and beans 

 with a wide variety of plentiful wild plant foods, game, and 

 fish (Peebles 1978). 



More than 1500 burials were excavated at Moundville 

 between 1929 and 1941 by the Alabama State Museum of 

 Natural History, and are presently curated at the Laboratory 



Zagreb Paleopathology Symp. 1988 



for Human Osteology at the University of Alabama in 

 Tuscaloosa. From this large series, 564 skeletal individuals 

 were selected on the basis of preservation and archeological 

 provenience for investigation of the social and biological 

 dimensions of health (Powell 1988). 



The second population sample represents a late prehistoric 

 community at the Irene Mound site, located near the mouth 

 of the Savannah River on the Atlantic coast. This occupation 

 was contemporaneous with Moundville, spanning three cen- 

 turies (a. D. 1 1 10- 1400) during the Savannah and early Irene 

 phases of the local Mississippian cultural tradition. Sub- 

 sistence and other aspects of life in this smaller community 

 were similar to those noted for Moundville. Continuous ar- 

 cheological excavations at the site from 1939 to 1940 sup- 

 ported by federal relief funds recovered 265 skeletal individ- 

 uals, presently curated at the National Museum of Natural 

 History, Smithsonian Institution, in Washington. D.C. The 

 data reported here were collected as part of a general assess- 

 ment of health at Irene Mound (Powell 1990). 



For each series, all available bones were examined for 

 macroscopic evidence of skeletal pathology. Observed le- 

 sions were classified as osteoblastic or osteolytic in morphol- 

 ogy, as active or quiescent at the time of death, and according 

 to their extent of involvement. The differential diagnoses of 

 treponematosis and tuberculosis were based on identification 

 of pathognomonic lesions and comparisons of the patterns of 

 associated nonspecific skeletal pathology (Figure 1). 



Venereal 

 Syphilis 



Endemic Syphilis Yaws 



Ivloundville 

 Treponematosis 



Figure 1. Distribution of skeletal lesions in four treponemal 

 syndromes. Solid shaded areas are those most frequently 

 affected; hatched areas are less often involved. Figures show- 

 ing syphilis and yaws after Steinbock 1976. 



