An Earlier Investigation of Skeletal and Dental Indicators of Health Based on Skeletal

An assessment of health and lifestyle among pre-1521 Chamorro from Saipan, Commonwealth of the Northern Mariana Islands.

Michael Pietrusewsky1, Michele Toomay Douglas1, Marilyn Swift2, Randy Harper2, Michael A.

Fleming2

1Department of Anthropology, University of Hawaii at Manoa

2Swift and Harper Archaeological Resource Consulting, Saipan.

Abstract

Earlier investigations of health and disease in the Mariana Islands (Guam, Rota, Tinian, and Saipan) suggested that the pre-contact inhabitants of Saipan experienced more stress than the pre-contact Chamorro living on Guam. Smaller land mass, lower rainfall, slightly cooler temperatures, and superficial ground water make Saipan more susceptible to environmental perturbations (e.g., drought, typhoon, etc.) than Guam. Utilizing general and specific indicators of stress recorded in skeletal remains from two recently excavated sites on Saipan, the Chalan Monsignor Guerreo Road Project (CMG) and the Southern Sewer Line System (SSLS) sites, this new study focuses on the health and lifestyle of pre-1521 Chamorro living on Saipan. Chamorro subsistence economies included reliance on cultivated tree and root crops, fishing, and possibly rice. The non-specific indicators of systemic stress investigated include cribra orbitalia (CO), linear enamel hypoplasia (LEH), and stature. The more specific indicators of stress examined include trauma, infection, and dental disease (e.g., antemortem tooth loss (AMTL), caries, dental abscess, etc.). The two new Saipan series have significantly lower dental caries prevalence (P = 0.0001), and significantly higher CO and calculus prevalence than the extant Saipan samples. Comparisons between skeletons from Saipan and Guam reveal significantly higher frequencies of CO, AMTL, and dental attrition; and significantly lower frequencies of dental caries in the Saipan series. Although not statistically significant, slightly higher frequencies of treponemal infection and limb bone fractures are observed in the Saipan series. The results of this new study provide partial support of the previous assessment that the prehistoric inhabitants of Saipan were subjected to greater stress levels than those living on Guam. Cultural habits such as chewing betel-nut and other environmental and cultural differences are examined to explain these results.

This research was funded in part by Capital Improvement Funds, Saipan, CNMI.

1 Introduction

The Mariana Islands form an archipelago consisting of a northern and southern arc of 15 islands stretching north-south between 13º and 21º latitudes in the western Pacific Ocean (Figure

1). Guam, Rota, Tinian, and Saipan, located in the southern group, are the largest islands in the archipelago. All the islands north of Guam, includingRota, Tinian, and Saipan, are presently administered as a cCommonwealth of the United States ( and referred to as the Commonwealth of the Northern Mariana Islands-- (CNMI) while Guam is a territory of the United States. When the first Europeans arrived in 1521, they found the islands inhabited by a single group of people who spoke Chamorro, an Austronesian language. Today the climate of the Mariana Islands is classified as marine tropical with a pronounced summer monsoon often associated with tropical storms and cyclones (Hanson and Butler 1997). Although not uniformly distributed throughout the year, the maximum annual rainfall of the southern islands reaches 100 inches.

Guam, the largest island of the chain, is 5419 km2 in size and divided into a volcanic southern section of mountainous grasslands and a northern uplifted limestone plateau surrounded by cliffs which was heavily forested prior to human habitation. The highest point on Guam is

406 meters. Fringing reefs, lagoons, and bays are found on the west side of the island (e.g.,

Tumon and Agana Bays) which also served as the population center in ancient times. Freshwater is found in year-round rivers and streams, as well as small pools captured in the mountains.

Saipan measures approximately 24 km north-south by 8.75 km east-west, and is about

120.6 km 2 in area. Geographically, Saipan is situated approximately 2,400 km east of the

Philippine Islands, 6,000 km west of Hawaii, 5.0 km north of Tinian, and 200 km north-northeast

2 of Guam.The 122 km2 island of Saipan lies approximately 120 miles to the north of Guam with the smaller island of Rota in between. Saipan is composed of a volcanic core is a volcanic island overlain with younger uplifted limestone plateaus of varying elevations and steep escarpments

(Carruth 2003). A central mountainous spine bisects the island with the highest point on Mount

Takpochao at 466 meters above mean sea level. Located within the southwestern portion of the island are an extensive swamp and the largest (brackish water) lake in the Northern Mariana

Islands known as Lake Susupe. The western coast is flanked by a large lagoon and fringing reefs

(Young 1989).limestones (Carruth 2003). The highest point is 470 meters. Large fringing reefs are found on the west side of the island along with a sizable marshy area surrounding the 45 acre brackish Lake Susupe. Freshwater on this island comes from a freshwater lens in saturated limestone aquifers within the island mass; the level of groundwater fluctuates with the tides and may be intermittently accessible at springs and seeps in the coastal areas (Carruth 2003). For the smaller islands like Saipan and Rota, surface water is scarce, which often leads to serious water shortages. The islands’ susceptibility to droughts, severe tropical storms and cyclones cause periodic devastation of reef systems and terrestrial vegetation, contamination of fresh water sources with sea water, and damage to other resources on these islands (Butler 1988:11).

The precontact subsistence economies of the Chamorro included reliance on cultivated tree and root crops typical of the tropical island environment such as coconut, banana, breadfruit, taro, yam, and possibly rice – all foods rich in carbohydrates. The Mariana Islanders diet was also rich in marine resources, including fish and shellfish, found in the surrounding reefs, reef flats, and deep water environments (Alkire 1977:7; Butler 1988:16). In addition to agriculture

3 and fishing, Chamorro subsistence also included gathering and hunting (Butler 1990; Hunter-

Anderson and Butler 1995). Birds, coconut and land crabs, and fruit bats may have provided additional protein but the islands had very limited terrestrial fauna; the common domesticates in

Polynesia, e.g., dog, pig, chicken, are not found in the Mariana Islands. The mineral content of drinking water and food is another matter of concern in island ecosystems.

Human occupation of the Mariana Islands began sometime around 3500 B.P. (Moore

1983; Athens 1986; Russell and Fleming 1986; Bonhomme and Craib 1987; Butler 1995; Athens and Ward 1999). Linguistic similarities between the Chamorro language and languages of island

Southeast Asia and the Philippines provide compelling evidence that people from the late

Neolithic cultures colonized the Mariana Islands (Bellwood 1997). Ceramic studies further suggest that colonization of the Marianas was concurrent with outward expansions from

Southeast Asia and eastern Melanesia (Butler 1994:34).

Chamorro prehistory is traditionally divided into three periods: Pre-Latte, Transitional

Pre-Latte, and Latte Periods. The term, latte is applied to a form of paired stone pillars and cup- shaped capitals or capstones, which were used to support houses, meeting halls and religious structures (Davis 1990; Graves 1986; Butler and Hanson and Butler 1997). On the larger islands, principally Guam, during the Pre-Latte Period (1500 B.C. - A.D. 400) population size was small, consisting of coastal villages which relied on fishing, shellfish and agricultural subsistence. Red ware ceramic vessels exhibit thin walls, carinated shoulders, and are finished with a well-defined red slip or paint and polished surface (Moore 1983, Hunter-Anderson and Butler 1995:26).

Lime-impressed decorative motifs distinguish other ceramics from this period. The Transitional

4 Pre-Latte Period (A.D. 400 - 1000) designates a time of adaptive change associated with saw an increase in population growth and settlement expansion outward from coastal settings into the islands’ interiors (Hunter-Anderson and Butler 1995:66) with a thicker pottery (suitable for storage and boiling) and pelagic and reef fishing. This expansion appears to have involved more intensive use of terrestrial resources with the effect of increasing the diversity of areas in which crops were raised. The Latte Period (A.D. 1000 - 1521) is characterized by the presence of the latte structures in larger villages, large thick pottery, an increase in mortars, pestles and pounders; a shift from bivalve to gastropod shellfish, more reef and lagoon fishing, and inland settlements. Archaeological evidence for settlement in the Latte Period document a widespread distribution on coastal margins and in caves, rock shelters and upland Theplateaus. The chronological sequence used here is based on work by Moore (1988).

Latte structures are nearly always associated with burials, typically interred within the perimeter defined by the latte postholes and perpendicular to the length of the structure. Burials recovered outside the defined latte tend to be more variable in position and orientation (Davis

1990; Graves 1991).

The Latte Period extends into the proto-historic Period which began with Magellan’s historic landfall in Guam in 1521 and culminated on Saipan between the late 1600s and early

1700s with the forcible removal of the Chamorro population to Guam. Ethnographic accounts have suggested that, at the time of contact, Chamorro society was a ranked society divided into descent groups marked by clans (Hunter-Anderson and Butler 1995:21). A system of alliances

5 developed between the different clans, which served to control access to resources and to redistribute resources among villages in different environmental zones.

Stable isotopic analysis for reconstruction of the Latte Period Marianas paleodiet found most individuals sampled from Rota, Saipan, and Guam had “largely terrestrial plant-based diets and consumed varied, but relatively small amounts of marine protein” (Ambrose et al.

1997:359). An unexpected finding was evidence for significantly greater consumption of sugar cane and/or seaweed on Saipan than on the other two islands. The authors noted that sugar cane contains substances that prevent tooth decay which is consistent with the low rate of caries found in Marianas teeth, but suggested further archaeobotanical research to substantiate the finding.

Isotopic studies of paleodiets of earlier Latte Period (A.D. 500 – 1100) burials from Saipan

(McGovern-Wilson and Quinn 1996) indicated a greater reliance upon open ocean or deep sea environments than on coastal/lagoonal habitats characteristic of the later Latte period paleodiets.

A more recent analysis of stable isotope data from Latte Period burials on Rota indicated some individuals had significantly greater access to marine foods than others (Pate et al. 2001).

Prehistoric Chamorro technology included, amongst other things, digging sticks and stone-hafted implements (Alkire 1977). The men engaged in most of the work associated with planting and harvesting, and activities that required heavy physical labor such as house and canoe building, and latte construction. Women were responsible for the collection of marine resources, preparing food, and making baskets, mats, and pottery (Alkire 1977).

In 1997 Hanson and Butler (1997) estimated that beginning in the 1980s, the skeletal remains of over 1500 individuals had been recovered from the Mariana Islands, largely the result

6 of cultural resource management (CRM), or contract archaeology, projects in the islands. Since this initial inventory, the remains of several hundred more individuals have been recovered as a result of subsequent CRM projects, which have allowed researchers new opportunities to investigate the health and lifestyle of the early Chamorro.

Previous investigation of health and disease in the Mariana Islands suggested that the prehistoric Chamorro from Saipan, in the Northern Mariana Islands, experienced higher levels of specific as well as non-specific indicators of health, including dental enamel hypoplasia, cribra orbitalia, and treponemal infection than the prehistoric Chamorro living on Guam (Pietrusewsky et al. 1997). The reason for this island difference was hypothesized as Saipan’s greater susceptibility to environmental perturbations which would affect human health because of its smaller land mass, lower rainfall, freshwater lens, and slightly cooler temperatures.

Utilizing general and specific indicators of stress recorded in 26 prehistoric (pre-1521) human skeletons recently recovered from two sites on Saipan as a result of CRM archaeological investigations, this paper re-examines the health and lifestyle of Chamorro living on Saipan before contact and makes comparisons with Chamorro skeletons from Guam. It is predicted that the estimators of physiological stress examined in this study will be greater in the prehistoric skeletons from Saipan than in those from Guam.

Skeletal Series

Twenty-six adult skeletons from two recently excavated sites on Saipan, the Chalan

Monsignor Guerreo Road Project (CMG) Site and Southern Sewer Line System (SSLS) Site are analyzed in this study. Both the CMG and Beach Sewer System projects are situated on the

7 western coastal lowland which borders this large lagoon. Project design for the Chalan

Monsignor Guerrero drainage system ran a roughly perpendicular line from inland to the coast; conversely, the Beach Sewer System paralleled the coast at a distance between 90 m and 150 m from the shoreline. Coastal areas of both projects are within a National Historic Landmark which commemorates the landing beaches of the U.S. WWII invasion.

Chalan Monsignor Guerreo Road Project (CMG) Site

A total of 28 burials, of varying degrees of completeness and preservation, were recovered in 2001 during archaeological investigations by Swift and Harper Archaeological Consulting

(Saipan) associated with the Chalan Monsignor Guerrero Road Improvements Project (CMGR),

Phase III, Saipan, Commonwealth of the Northern Mariana Islands (CNMI). Ten of the best preserved and complete skeletons from this site were analyzed by Pietrusewsky and Douglas

(2001). Although disturbed by both prehistoric and more modern human activities, the burials from the CMGR project represent prehistoric Chamorro. Radiocarbon analysis of bone samples obtained from eight of the CMGR burials indicate dates that span the period A.D. 1050 – 1450

(M. Swift, personal communication, February 17, 2010). The absence of historic artifacts associated with any of the burials from the CMGR site further confirms the skeletons represent

Chamorro living on Saipan during the Latte Period, well before initial contact with the Spanish in 1521.

Southern Sewer Line System (SSLS) Site

In 2005, forty-three burials, of varying degrees of completeness and preservation, were excavated by Swift and Harper Archaeological Consulting (Saipan) during archaeological

8 investigations associated with the Southern Sewer Line System Upgrade, Phase II (SSLS)

Project [referred to as the Beach Road Sewer Line System site in Pietrusewsky (2006)] on the southwest coast of Saipan, Commonwealth of the Northern Mariana Islands (CNMI). An examination of 16, or approximately one-third, of the most complete and best preserved burials from the SSLS project area is reported Pietrusewsky (2006).

Although disturbed by both prehistoric (i.e. procurement of long limb bones for spear manufacture and the removal of skulls for ancestor worship) and more modern human activities during the Japanese Period and post WWII construction/reconstruction Period (e.g., sewer and water line construction and road compaction), previous research in the project vicinity has identified cultural deposits dating as early as the Pre-Latte and extending into the Latte Period

(M. Swift, personal communication, August 10, 2006). Additionally, historic deposits that date to the Japanese Period, World War II, and post-invasion U.S. military camps have been noted for the project area. Three of the burials (Nos. 6, 24, and 24B) from this site have radiocarbon dates that range between A.D. 1420 – 1450 (late Latte Period) and four burials (Nos. 16, 20A, 21A, &

22) have dates that range between A.D. 1640 and 1670 (Swift, personal communication,

February 17, 2010). The burials associated with the later dates places them around the time of

Spanish contact and extends into the Spanish mission period. (M. Swift, personal communication, February 17, 2010). This was a time of great strife and conflict with the missionaries instructing the "natives" to give up their pagan ways and bury the skulls which they held in high regard as part of the practice of ancestor worship. By the end of the 1600s, the

Spanish military had removed most of Saipan's Chamorros to Guam and Saipan was left as a

9 staging area for Tinians and the Gani (inhabitants of the Mariana Islands north of Saipan). The burials associated with the later dates approach the time when the Chamorro on Saipan were engaged in a strong resistance to Spanish rule (M. Swift, personal communication, January 27,

2010). None of the burials from the SSLS site was associated with historic artifacts, which strengthen the assertion that these skeletons are those of native Saipan Chamorro. A final archaeological report detailing these excavations and radiocarbon dates for these burials is in preparation (Swift, personal communication, February 17, 2010 et al. n.d.).

Information previously recorded in 349 skeletons from six sites located on Saipan and six sites on Guam (Pietrusewsky et al. 1997) is compared with the SSLS and CMG skeletal series.

The names, minimum number of individuals represented, and other information for these skeletal series are given in Table 1. The majority of these skeletons are from the transitional pre-Latte

(A.D. 1 - A.D. 1000) and Latte (A.D. 1000 - A.D. 1521) periods. The age and sex of the skeletons from these sites are given in Table 2.

Methods

The methods used to determine age-at-death and sex follow standard osteological procedures described in Buikstra and Ubelaker (1994) and Pietrusewsky and Douglas (2002).

The skeletal and dental indicators of health investigated in this paper include those that are attributable to non-specific systemic stress during development (e.g., LEH, cribra orbitalia, stature) and those that suggest specific stressors (e.g., trauma, infection, dental disease).

More detailed information on the methods used to record the dental and skeletal indicators of health summarized in this paper are provided in Pietrusewsky and Douglas (2002).

10 Additional background information on these indicators will be introduced in the appropriate section when discussing the results. Fisher’s exact test was used to test for significant differences of the discontinuous data and Student’s t-test for continuous data (Thomas 1986).

The chi-square statistic with Yates’ correction was used to test for significant differences of the discontinuous data and t-test for continuous data (Thomas 1986).

Results

Stature

Because of the lack of population-specific stature formulae for Chamorro skeletons the stature estimates reported here are based on formulae for Polynesian Maori (Houghton et al.

1975) using the maximum and/or physiological length measurements for adult males and females. If more than one stature estimate was calculated, the estimate having the least error was selected.

The average stature for four SSLS males is 173.8 cm and 171.4 cm for four CMG males, a nonsignificant difference (Table 3). The average statures (164.6 cm) for three SSLS females is not significantly different from the average stature for two CMG females (Table 4). The average stature for 8 eight males from the SSLS and CMG sites is 172.6 cm (Table 3) and the average stature for 6 six females is 159.7 cm (Table 4). These average statures are similar to those reported by Pietrusewsky et al. (1997) for Saipan males (175.0 cm) and females (160.2 cm). The average stature for all the male Saipan skeletons (173.9 cm) is nearly two centimeters greater than the average stature reported for one site on Guam, Aptoguan (172.4 cm). The average stature for Saipan females (160.0 cm) is approximately three centimeters less than the average

11 reported for Aptoguan females (162.8 cm). Unpaired t-test results indicate that none of the differences is statistically significant.

The stature estimates for prehistoric skeletal Chamorro series are considerably taller (10 cm taller for males) than those reported Chamorro people living on Saipan in 1938 reported by

Hasebe (see Hunt 1950a, 1950b) for living Chamorros from Saipan.

Dental Enamel Hypoplasia

Unless otherwise indicated, the frequencies of dental enamel hypoplasia and dental pathology in the skeletal remains from Mariana Islands are reported on a per tooth/tooth socket basis. The sexes are combined in this analysis because of small sample sizes.

Developmental defects of enamel (DDE), or dental enamel hypoplasia, which have various manifestations including pits, bands, depressions, discoloration, or linear defects

(furrows) of the enamel surface result from a disruption of enamel development (phase of amelogenesis) during infancy and early childhood (Goodman and Rose 1991; Hillson 1996,

2005). Dental enamel hypoplasias are a non-specific indicator of childhood stress because a single cause can rarely be attributed to a specific defect. Disruption of enamel development is associated with a variety of stressors affecting the mother and/or growing child including malnutrition, metabolic disorders, acute and chronic infections, physical trauma, and hereditary conditions (Goodman et al. 1984; Goodman and Rose 1990, 1991; Hillson 2008).

In this study the most common form of dental enamel hypoplasia was linear enamel hypoplasias (LEH), generally visible as one or more transverse furrows or grooves of varying depths on the crown surfaces of teeth. For that reason, our reporting is limited to LEH. Linear

12 enamel hypoplasias in the permanent teeth from the Mariana Islands ranged in severity from slight to moderate grooves and often there was more than one defect per tooth. Observations of

LEH in these teeth are complicated by betel staining which may be thick enough to obscure the defects. All teeth were scored for the presence/absence of these disruptions, but because defects are more frequent in the incisor and canine teeth frequencies are reported for those teeth only.

Compared to the CMG site, a significantly higher frequency of LEH is reported in the SSLS series (Table 5). This difference is likely the result of the very few observations made in the

CMG teeth because of betel staining, but also suggests increasing stress over time. The frequency of LEH in the SSLS and CMG maxillary and mandibular incisor and canine teeth, sexes combined, is 32.4%. Although not statistically significant, a slightly higher frequency of

LEH (37.5%) is observed in the previously examined series from Saipan. The frequency of occurrence of LEH in the combined Saipan series (34.0%) is not significantly different from that observed for the combined Guam series (31.0%).

Cribra orbitalia (CO)

Cribra orbitalia, a porosity of the orbital roof, which is a form of porotic hyperostosis of the cranial vault, is commonly attributed to the presence of transient iron deficiency anemia

(Palkovich 1987; Steinbock 1976; Stuart-Macadam 1989, 1991) or megaloblastic anemia

(Walker et al. 2009). We report the frequency of cribra orbitalia by adult individuals, sexes combined, in Table 6. Samples sizes are extremely small, and while the difference in the prevalence of CO in the SSLS (66.7%) and CMG (50.0%) series is not statistically significant; it does suggest increasing stress over time. The overall frequency of CO for the combined SSLS

13 and CMG series (60.0%) is significantly higher than the frequency (16.0%) reported for earlier examined skeletons from Saipan (Pietrusewsky et al. 1997).

Although higher, Tthe combined frequency of CO (20.0%) for all the skeletons from

Saipan is not statistically higher than the frequency of CO for the Guam series (7.1%). Another

Saipan skeletal series from Hafa AdaiHafadai Hotel Extension Beachsite (Pietrusewsky 1986b) had a relatively high frequency of CO (55.6%) similar to the frequencies reported for the SSLS and CMG series. In contrast to these relatively high frequencies of CO, those previously reported for Oleai (3.7%) and the San Antonio (7.7%) sites on Saipan are much lower (Pietrusewsky et al.

1997). Some of the observed differences in this stress indicator may be attributed to sex. Cribra orbitalia was not observed in any of the females from Guam or Saipan previously reported by

Pietrusewsky et al. (1997).

Limb Bone Fractures

Fractures of the adult long limb bones provide an indication of the frequency and type of traumatic, accidental or deliberate, injury in a population (Walker 1989). Although healed fractures of other bones in the skeleton are observed in Mariana skeletal series, because of difficulties in establishing frequencies in these kinds of fractures, we are concentrating on the long limb bones. Fracture frequency is estimated using the corresponding number of complete, or nearly complete, bones reported. The difference in the frequencies of limb bone fractures in the SSLS (0.0%) and CMG series (5.9%) is not statistically different (Table 7). Healed fractures of an ulna and a femur were observed in the CMG series. The combined frequency of limb bone fractures in the SSLS and CMG series (4.2%) is relatively high but not statistically significant

14 when compared to the frequency of healed fractures in previously examined skeletal series from

Saipan (0.0%). The frequency of limb bone fractures for the combined Saipan series is 1.1%, a frequency that is not significantly different from the frequency (0.8%) for the skeletons from

Guam. Accidental or deliberate injury, as indicated by limb bone fracture, is rare in the prehistoric Mariana Islanders.

Spondylolysis

Spondylolysis, or fracture of the lumbar vertebrae at the pars interarticularis (the narrow area connecting the inferior facets of the neural arch with the superior facets), has been related to repeated stress to the lower lumbar vertebrae by physical activities requiring flexion of the lumbar spine with the legs extended (Merbs 1989; Ortner and Putschar 1981). More recently,

Arriaza (19975) has proposed that hyperextension of the lower back under stressful conditions as another explanation for spondylolysis. A genetic predisposition for stress fractures in the lower back has also been advanced. The difference in the frequencies of spondylolysis in the SSLS

(14.3%) and the CMG (0.0%) series is not statistically significant (Table 7). The overall frequency of occurrence of spondylolysis in the lumbar vertebrae from the SSLS and CMG series (7.1%) is not statistically different from that (0.0%) reported in earlier studies of skeletons from Saipan. Although the combined frequency of all the Saipan series (1.3%) is lower than the frequency reported for the series from Guam (6.7%), the difference is not significant.

Betel Staining and Dental Pathology

Betel Stained Teeth

15 Betel nut (Areca catechu) chewing, with or without, the use of pepper leaf (Piper betle) and/or slaked lime, is common throughout South Asia, Southeast Asia, and the western Pacific.

Although the use of the term ‘betel nut’ is not botanically correct; given that it is the nut or seed of the fruit of the oriental palm Areca catechu that is used in betel-quid preparations, betel nut and betel nut chewing are commonly used. Regular use of betel quid causes the teeth and gums to be stained a bright orange/red color. Tooth staining, either as a result of chewing a quid containing the areca nut, betel leaf, and slaked lime and/or deliberate application of a mixture of betel nut and lime slurry, has been reported in adult dentitions for many archaeological skeletal series from the Mariana Islands (e.g., Leigh 1929; Howden 1984; Hanson 1988, 1995, Hanson and Butler 1997; Hocart and Frankhauser 1996; Pietrusewsky 1986b; Pietrusewsky et al. 1992,

1997). The staining of the tooth enamel, common among the present day Chamorro, is usually light to dark brown/reddish brown in color.

Because there is now a substantial epidemiological literature demonstrating a link between betel chewing and cariostasis (e.g., Möller et al. 2009; Schamschula et al. 2010) and other oral-dental pathologies including periodontal disease in living people (e.g., Jeng et al.

1996; Chang et al. 1998; Trivedy and Warnakulasuriya 2002; Chatrchaiwiwatana 2006) and a documented increase in dental attrition (Kumar et al. 2004; IARC 2004), we report the frequency of stained teeth for our skeletal series (Table 8). Significantly more of the SSLS teeth (81.7%) are betel stained than the CMG teeth (69.0%), but both series are consistent with one other

Saipan skeletal series, Oleai. Overall, the Saipan series (75.3%) has a significantly greater frequency of betel-stained teeth than the Guam series (53.3%).

16 Betel Stained Teeth

A very common observation in mortuary samples from the Mariana Islands is the presence of incidental tooth staining (Leigh 1929; Hanson 1988; Hanson and Butler 1997;

Pietrusewsky 1986b, Pietrusewsky et al. 1992, 1997). The staining, usually light to dark brown/reddish brown in color, occurs in the permanent teeth of adults. Chewing a quid containing the areca nut (Areca catechu), betel leaf (Piper betle), and slaked lime, common among the present day Chamorro, is often attributed to the observed dental staining. Because there is now a substantial epidemiological literature demonstrating a link between betel chewing and cariostasis and other oral-dental pathologies, we report the frequency of stained teeth for our skeletal series (Table 8). Significantly more of the BRSS teeth (81.7%) are betel stained than the

CMG teeth (69.0%), but both series are consistent with other Saipan skeletal series. Overall, the

Saipan series (75.3%) has a significantly greater frequency of betel-stained teeth than the Guam series (53.3%).

Antemortem Tooth Loss (AMTL)

The loss of teeth before death (antemortem tooth loss - AMTL) can be attributed to several causes indicative of pathological processes including periodontal disease, carious lesions, and alveolar defects. While not statistically significant, a somewhat higher frequency of AMTL is observed in the CMG series (8.1%) than in the SSLS series (4.8%) (Table 9). The majority of the AMTL (n=8 teeth) occurs in one CMG individual, a middle-aged male. The overall frequency of AMTL in the dentitions from the BRRS and CMG sites, sexes combined, is 6.2%.

AMTL occurs in 7.3% of tooth sockets in the earlier examined skeletal series from Saipan

17 reported by Pietrusewsky et al. (1997). The overall frequency of AMTL for all the Saipan skeletal series (7.1%), is significantly different from the frequency of AMTL reported for six skeletal series from Guam (5.3%).

Dental Caries

Dental caries is a demineralization of the tooth structures caused by organic acids produced by bacterial processes involved in the fermentation of dietary carbohydrates (Hillson,

2008:313). Very low frequencies of dental caries were observed in the SSLS (2.0%) and CMG

(2.6%) series; the difference between the two series is not statistically significant (Table 9). The overall frequency of carious lesions (2.2%) in the BRRS and CMG teeth, sexes combined, is significantly lower than the frequency of dental caries (10.2%) reported for other Saipan series

(Pietrusewsky et al. 1997). The frequency of carious lesions in the combined Saipan series

(7.1%) is significantly lower than that reported for the Guam series (10.1%).

Alveolar Bone Loss

Two distinct types of bone loss from the alveolar process are recorded in the BRRS and

CMG series. The first type, referred to in this study as alveolar resorption, is related to the removal of alveolar bone due to inflammation of the supporting tissues of the teeth associated with periodontal disease (Hildebolt and Molnar 1991; Hillson 2008). The second type of alveolar bone loss is the one concentrated around the apex of the tooth roots, originating from infections of the pulp, so-called periapical inflammation; a term that has been suggested to replace the older and somewhat incorrect less correct designation, periapical dental abscess (Dias and Tayles

1997; Oxenham et al. 2006; Hillson 2008). While we have adopted the term alveolar defect for

18 this type of bone loss in the present paper, it is referred to as dental abscess in previous work

(e.g., Pietrusewsky et al. 1997; Steckel and Rose 2002).

Alveolar Resorption

In this study, alveolar resorption is scored as the amount (none, slight, moderate, and marked) of tooth root exposed above the alveolar bone margin. A statistically higher frequency of advanced (moderate and marked expressions) alveolar resorption is observed in the SSLS series (68.7%) than the CMG (0.0%) series (Table 10). This result must be taken with caution because of the very low number of observations made in the CMG series due to poor preservation. The overall frequency of advanced levels of resorption of the alveolus in the BRRS and CMG series (61.1%) is similar to the frequency reported for the earlier examined Saipan series (57.7%). The frequency of advanced alveolar resorption in the combined Saipan series

(58.6%) is significantly higher than that reported for the Guam series (28.3%) suggesting periodontal disease was more prevalent for those living on Saipan.

Alveolar Defects

No statistically significant difference was found for the frequencies of alveolar defects in the SSLS (4.2%) and CMG (7.3%) series. The combined frequency of alveolar defects, in the

BRRS and CMG series (5.1%) is not significantly different from that reported by Pietrusewsky et al. (1997) for Saipan (6.4%). The overall frequency of alveolar defects for Saipan (6.0%) is higher than the frequency reported for the Guamanian series (4.6%), but the difference is not significant.

Dental Calculus

19 One of the most common dental diseases in the living is dental plaque, a dense accumulation of microorganisms and associated extracellular material on the tooth’s surface, which is enhanced in high carbohydrate diets and severe dental attrition (Hillson 2008, Lieverse et al. 2007). Dental calculus is calcified or mineralized dental plaque, composed primarily of calcium phosphate mineral salts deposited between and within remnants of formerly viable microorganisms (White 1997). Dental calculus attaches to the tooth surface at the base of a living plaque deposit. Two forms of calculus are generally recognized, supragingival (on the tooth crowns and sometimes roots) and subgingival (a less obvious layer that primarily coats the surface of the root); subgingival calculus , only the latter occurs coincident with periodontal disease while supragingival calculus occurs with periodontally diseased or healthy teeth (White

1997; Lieverse 1999; Hillson 2008). Dental calculus, both supra- and subgingival occurs in the majority of adults worldwide. The etiology of dental calculus is dependent upon a number of factors that contribute to the mineralization of plaque. Among these are an alkaline oral environment, “salivary flow rate, hydration, calcium and phosphate levels in the blood, mineral content of drinking water, silicon content in both food and water, and plaque accumulation”

(Lieverse 1999, Lieverse et al. 2007:332).

A distinction between the two kinds of dental calculus (supragingival and subgingival) was not made in this study. In the BRRS and CMG teeth, dental calculus was mainly confined to the tooth crown and cemento-enamel junction. Here, we report the overall frequency of advanced

(moderate and marked) calculus as described in Brothwell (1981: Figure 6.14b). No significant difference was found for the frequency of advanced calculus in the SSLS (17.1%) and CMG

20 (11.1%) series (Table 11) The combined frequency of advanced calculus in the BRRS and CMG teeth (15.1%) is significantly higher than the frequency of calculus reported for the Saipan series

(Pietrusewsky et al. 1997). The frequency of advanced calculus build-up for the combined

Saipan series (10.5%) is significantly lower than the frequency (15.6%) observed in the Guam series (Pietrusewsky et al. 1997).

Dental Attrition

Dental attrition is the physiological wearing away of the occlusal and proximal surfaces of the teeth in function (Clarke and Hirsch 1991:243). In the BRRS and CMG series occlusal attrition was recorded on an absent, slight (enamel wear), moderate (dentin exposure), and marked (pulp exposure) gradient. There is no statistical difference in the frequency of advanced dental attrition observed in the SSLS (48.3%) and CMG (42.7%) series (Table 11). The combined BRRS and CMG frequency of advanced attrition (46.2%) is similar to that reported for

Saipan by Pietrusewsky et al. (1997). The combined frequency (48.7%) of advanced attrition for the Saipan series is significantly higher than the frequency reported for the Guam series (26.3%).

Infectious Diseases

Specific bone infections include tuberculosis, leprosy, treponematoses, and fungal infections. Treponemal infections include pinta, yaws, and syphilis, which are caused by the spirochete, Treponema pallidum. Only yaws and syphilis affect the skeleton. Infection with the organism Treponema pallidum may produce lesions of the cranial vault, as well as very characteristic symmetrical appositional lesions of the long limb bones. (Steinbock 1976).

21 As is the case for much of the Pacific, it is widely acknowledged that venereal syphilis was absent in the Mariana Islands prior to contact with Europeans (Baker and Armelagos 1988;

Stewart and Spoehr 1952). Bony lesions with manifestations typical of treponemal infections from the Mariana Islands and elsewhere in the Pacific, are usually diagnosed as evidence of yaws

(see e.g., Rothschild and Heathcote 1993). One of the first published accounts of yaws in skeletal remains from the Marianas is that of Stewart and Spoehr (1952), who described multiple lesions in the cranium and limb bone shafts of a 13-14 year old from the Latte Period Blue Site on

Tinian (dated A.D. 854  145). Since then many other examples of treponemal infection have been reported (e.g., Douglas and Ikehara 1992; Douglas et al. 1997; Hanson, 1988, 1989,

Pietrusewsky 1986b, 1988; Pietrusewsky and Batista 1980; Pietrusewsky and Douglas 199895;

Pietrusewsky et al. 1992, 1997; Rothschild and Heathcote 1993; Stodder et al. 1992).

Bony changes attributed to treponemal infection (e.g., periosteal reaction, gummatous osteitis and cloacae) were not observed in the adult skeletal remains from the SSLS site on

Saipan. The remains of two adult males, one middle-aged and the other 20-25 years of age, (2/6,

33.3%) from the CMG site exhibit lesions that are consistent with treponemal (yaws) infection

(Pietrusewsky and Douglas 2001). The bones affected in these two individuals include the tibiae, fibulae and one radius.

The frequencies of treponemal infection in the adults from the SSLS (0.0%) and CMG

(33.3%) sites are not significantly different (Table 12). The combined frequency of treponemal infection (12.5%) in the SSLS and CMG series is very similar to the frequency (12.8%) previously reported for skeletons from Saipan (Pietrusewsky et al. 1997). The overall frequency

22 of treponemal infections in all the skeletons from Saipan (12.7%) is lower, but not significantly different, from the frequency of treponemal infections (8.1%) reported for the adult skeletons from Guam (Pietrusewsky et al. 1997). Two of the highest frequencies of treponemal infection in the Mariana Islands occur in skeletons from the Songsong Village site on Rota (33.3%) and the

Hafa AdaiHafadai Hotel Extension Hotel site on Saipan (30.4%) (Pietrusewsky et al. 1997).

Discussion/Conclusion

Comparisons between BRRS and CMG

The non-specific indicators of stress show similar male and female average statures and similarly high frequencies of CO between the two new skeletal series from Saipan, but significant differences in the incidence of LEH. A significantly higher frequency of LEH was observed in the SSLS series when compared to CMG. Several of the burials from the SSLS site have radiocarbon dates that place these individuals around the time of contact with the Spanish in the 1600s and 1700s when the Chamorro on Saipan were engaged in a strong resistance to

Spanish rule. This would undoubtedly be a time of unprecedented change in the lives of the indigenous people of Saipan who were just beginning to respond both biologically and culturally to the challenges brought about by contact with Europeans. The higher frequency of LEH in the

SSLS series may indicate greater childhood stress for individuals in this skeletal series than those in the CMG series. Although not significant, the somewhat higher frequency of CO reported in the SSLS skulls supports this interpretation. However, the frequency of LEH in the SSLS series is consistent with frequencies previously reported for other Saipan skeletal series, suggesting the

23 low frequency in the CMG samples may be an outlier or a reflection of small sample size.

Likewise, the significantly higher frequency of betel-stained teeth in the SSLS series may be contributing to the very low number of teeth observable for LEH (n=17) in the CMG series and influencing the incidence of LEH and dental pathologies. Based on findings in living people, the skeletal effects of habitual areca nut chewing might be high rates of reddish brown stained teeth, calculus, and alveolar resorption and dental attrition, both of which might contribute to a higher rate of AMTL and low rates of caries.

Significantly more advanced alveolar resorption is observed in SSLS tooth sockets than in CMG tooth sockets. Likewise, although not statistically significant, lower frequencies of caries and higher frequencies of calculus and attrition reported along with more significantly more advanced alveolar resorption in the SSLS dentitions would seen to support the observed effects of regular areca nut chewing. Alveolar defects are uncommon in both series. Larger sample sizes are needed to confirm these observed trends.

Treponemal infection is not found in the SSLS skeletons, but is found in two CMG individuals, a difference that is not statistically significant. Two specific indicators of stress, fractures of the limb bones and vertebral spondylolysis, are uncommon in both of these series.

Only one SSLS individual has spondylolysis and two CMG individuals have long limb bone fractures.

The few significant differences in stress indicators between these two new skeletal samples from Saipan may be explained by small sample sizes, preservation issues, and betel staining. An increase over time is suggested in the rates of LEH, CO, betel staining, and

24 advanced calculus, though the differences are not statistically significant. Combining the two series to compare them to the other extant skeletal series from Saipan is warranted.

Discussion/Conclusion

Comparisons between BRRS and CMG

The non-specific indicators of stress show similar male and female average statures and similarly high frequencies of CO between the two new skeletal series from Saipan, but significant differences in the incidence of LEH. Although the larger series from BRSS has a much higher level of LEH than the CMG skeletons it is consistent with findings in other Saipan skeletal series, suggesting the low frequency in the CMG samples may be an outlier or compromised in some fashion. Betel staining may contribute to the very low number of teeth observable for LEH (n=17) in the CMG series.

Two specific indicators of stress, fractures of the limb bones and vertebral spondylolysis, are uncommon in both of these series. Only one BRSS individual has spondylolysis and two

CMG individuals have long limb bone fractures.

Betel-stained teeth are common in both skeletal series, influencing the scoring of LEH as noted above, and the incidence of other dental pathologies.

Betel nut (Areca catechu) chewing, with or without, the use of pepper leaf (Piper betle) and/or slaked lime, is common throughout South Asia, Southeast Asia, and the western Pacific.

Tooth staining, either as a result of chewing the Areca nut and/or deliberate application of a mixture of betel nut and lime slurry, has been reported in many archaeological skeletal series from the Mariana Islands (e.g., Howden 1984; Hanson 1995, Hanson and Butler 1997; Hocart

25 and Frankhauser 1996; Pietrusewsky et al. 1997). There is now considerable literature on the cariostatic effects of regular chewing of betel (e.g., Möller et al. 2009; Schamschula et al., 2010) as well as a demonstrated association with periodontal disease in living people (e.g., Jeng et al.

1996; Chiang et al. 1998; Trivedy and Warnakulasuriya 2002) and a documented increase in dental attrition (but only a reference in Polish so far!)?

Based on findings in living people, the skeletal effects of habitual betel nut chewing might be high rates of reddish brown stained teeth, calculus, and alveolar resorption and dental attrition, both of which might contribute to a higher rate of AMTL; and low rates of caries.

Although antemortem tooth loss (AMTL) is greater in the CMG series (8.1%) than in the

BRSS series (4.8%), the incidence of caries is similarly low, suggesting the AMTL is the result of severe dental wear or periodontal disease. Significantly more advanced alveolar resorption is seen in BRSS tooth sockets than in CMG tooth sockets, but again, observations are limited in the CMG dentitions because of preservation issues. Alveolar defects are uncommon, and similar levels of advanced calculus and advanced attrition are noted in both of these series. Treponemal infection is not found in the BRSS skeletons, but is found in two CMG individuals, a difference that is not statistically significant.

The few significant differences in stress indicators between these two new skeletal samples from Saipan may be explained by small sample sizes, preservation issues, and betel staining. An increase over time is suggested in the rates of LEH, betel staining, and advanced calculus, though the differences are not statistically significant. Combining the two series to compare them to the other extant skeletal series from Saipan is warranted.

26 Comparisons between combined SSLS-CMG series and Saipan

When the BRSSSSLS and CMG skeletal data are combined and compared to previously reported skeletal series from Saipan (Pietrusewsky et al. 1997), three statistically significant differences are found. The rate of CO in the BRSSSSLS-CMG series (60.0%) is much higher than the rate reported for the earlier examined combined Saipan series (16.0%), suggesting significant childhood stress in these adults. However, not all the previously examined series from

Saipan had low frequencies; the frequency of CO in a small series of skeletons from the Hafa

Dai Beach site on Saipan was 55.6% (Pietrusewsky et al. 1997). The much reduced samples involved in these comparisons of CO may be a contributing to the observed differences for this indicator of stress.

The caries rate in the BRSSSSLS-CMG series (2.2%) is significantly lower than the one reported for the Oleaithe Saipan series (10.2%), while the rate of advanced calculus in the SSLS-

CMG series (15.1%) is significantly higher than the Saipan Oleai series (7.7%). These two dental pathologies will vary relative to betel nut chewing; since betel nut inhibits caries formation and contributes to an alkaline oral environment and hyper-salivation, thus increasing calculus formation (Lieverse 1999;, Chatrchaiwiwatana 2006). However, the frequency of betel stained teeth is about the same in both the SSLS-CMG and Oleai series. Two individuals from the Oleai site are responsible for 13 of the 37 carious teeth in this skeletal series.

Comparisons All Saipan and Guam

Previous research suggested that the precontact inhabitants of Saipan (N=101) were less healthy than the precontact inhabitants of Guam (N=245). With the addition of the BRSSSSLS

27 and CMG skeletal samples to the extant Saipan data, we can readdress this issue with slightly larger samples sizes (N=127). No significant inter-island differences are seen in the indicators of childhood stress: CO, LEH, and adult stature. Similar patterns of physical activity on the two islands are suggested by the rarity of long limb bone fractures in both series. Spondylolysis is slightly more common in the Guam series (6.7%) than the Saipan series (1.3%), perhaps reflecting the larger number and greater size of Latte structures on the larger island. Treponemal infection rates are similar on the two islands.

Betel stained teeth are significantly more common in skeletons from Saipan (75.3%) than those from Guam (53.3%), predictably affecting the incidence of other dental diseases.

Comparisons between Saipan and Guam respectively, show AMTL (6.9%:5.3%), alveolar resorption (58.6%:28.3%), and attrition (48.7%:26.3%) are all significantly higher in the Saipan series than in the Guam series. Further, Aas predicted, the caries rate is significantly lower

(7.1%:10.1%) and (contrary to expectations) the rate of advanced calculus is lower

(10.5%:15.6%). Although it has been shown that loss of periodontal attachment and calculus formation are greater in areca nut chewers (Ånerud et al. 1991), a recent WHO study on the effects of betel-quid and areca nut chewing (IARC 2004) found that there are a number of confounding variables, which may have a significant influence on periodontal status, and hence calculus build-up. According to the same report living Guamanians do not use slake lime during chewing areca nut (pugua) (Stich et al. 1986), a practice that may help to explain the lower incidence of dental calculus in the Saipan series.

28 The lower rate of calculus formation is a mystery!! We are unable to explain the lower rate of advanced calculus in the Saipan skeletal series but one cop-out is sample size, different scoring methods, or preservation issues…..

Conclusion

Two recently excavated small skeletal series from Saipan contribute new data for an examination of intra- and inter-island differences in skeletal indicators of stress. Although preservation and sample size issues require the results be interpreted interpretated with caution, increasing physiological stress over time on Saipan is consistent with archaeological evidence for increasing population size, changes in marine resource utilization, and contact with Europeans contact. The previously noted inter-island differences between Guam and Saipan are strengthened with the addition of these new skeletal series. Quite likely some of the differences between these two islands may be attributed to temporal differences in the skeletal series sampled as well as the cultural practice of chewing a mixture of areca nut and betel leaf with or without slaked lime.

It is heartening to see efforts at dating these skeletons so that in the future a fuller examination of change of time may be attempted.

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