Treponematosis and tuberculosis in the prehistoric southeastern United States • 179 



Figure 10. Irene Mound. NMNH 385411, SI joint lesion, 

 TB. 



Figure 1 1 . Irene Mound, NMNH 355562, ribs, pleural peri- 

 ostitis. 



sistance to tuberculosis (Hackett 1951; Myers 1951), but its 

 importance to nonspecific mechanisms safeguarding health 

 (e.g. phagocyte production) should not be forgotten. 



The human remains excavated from these sites some fifty 

 years ago and carefully curated as part of systematic museum 

 collections in Alabama and Washington, D.C., provide con- 

 vincing diagnostic evidence of the presence of two chronic 

 endemic infectious diseases. Analysis of the patterns of the 

 associated bone lesions indicates to some degree the breadth 

 of their prevalence within the populations, respecting neither 

 demographic parameters nor exalted social rank. But the 

 skeletal record alone cannot convey the full extent of the 

 biological costs of these insidious and persistent forms of 

 illness, the toll levied upon each successive generation in 

 terms of death, discomfort, deformity, decreased energy, and 

 general debilitation of resistance to other stresses. Each dis- 

 ease followed its own distinctive trajectory from childhood 

 infection through subsequent episodes of illness throughout 

 adult life, the one more blatantly disfiguring and the other 

 more subtly lethal . The presence of each made the presence 

 of the other a greater burden to the unfortunate individuals 

 who were doubly afflicted and to the populations in general. 

 Endemic treponematosis was no doubt regarded as one of 

 life's regular nuisances, while tuberculosis was a rarer but far 

 more serious matter. 



An eminent paleopathologist of the author's acquaintance 

 continually adjures his students to "remember that a dog may 

 have both ticks and fleas," and that differential diagnosis 

 should always be sensitive to the possibility of multiple 

 pathological conditions simultaneously affecting an individ- 

 ual. To apply this same analogy again in a somewhat different 

 manner, the skeletal lesions of endemic treponematosis and 

 tuberculosis may be likened to the parasites visible on a dog's 

 body. Their simple presence in terms of the amount of blood 



Zagreb Paleopathology Symp. 1988 



consumed, the burden of their collective weight, and the 

 minor irritation of their bites does not reflect directly the 

 magnitude of their potential impact upon the dog's health. 

 Hidden within them may be agents that produce serious ill- 

 ness or death, depending upon the circumstances surround- 

 ing host and parasites. 



In similar fashion, the degree of skeletal pathology ob- 

 served does not equal directly the biological costs of the 

 diseases in question, either in terms of numbers of individu- 

 als who were ill or the range of possible symptoms. Clinical 

 studies identify numerous cases that would be invisible in the 

 archeological record. What we actually see in the bones is not 

 the entirety of disease that did exist, but the evidence alerts us 

 to the presence of diseases whose true costs may be inferred 

 from the modem epidemiological and clinical literature. 



In the face of growing political pressure for reburial of 

 human skeletal remains in the United States and elsewhere, 

 paleopathologists should feel a particular obligation to bring 

 to bear our most sophisticated theoretical and methodologi- 

 cal capabilities to investigations of the dimensions of health 

 in the prehistoric past. Differential diagnosis provides a pow- 

 erful tool for conducting such analyses, and to ignore its full 

 potential is to deliberately limit the contributions of our re- 

 search. 



Acknowledgments 



This paper is the result of numerous discussions with Donald 

 J. Ortner, my advi.sor during a Postdoctoral Fellowship at the 

 Smithsonian Institution, about the problems and potential of 

 interpretation of skeletal disease. 1 have benefited greatly 

 from his sophisticated insights into critical issues, and he is 

 coauthor in fact, if not in name. Misinterpretations of the 

 data, however, are solely my own. 



