The Origin and Antiquity of Syphilis: Paleopathological Diagnosis and Interpretation [and Comments and Reply] Author(s): Brenda J. Baker, George J. Armelagos, Marshall Joseph Becker, Don Brothwell, Andrea Drusini, Marie Clabeaux Geise, Marc A. Kelley, Iwataro Moritoto, Alan G. Morris, George T. Nurse, Mary Lucas Powell, Bruce M. Rothschild and Shelley R. Saunders Source: Current Anthropology , Dec., 1988, Vol. 29, No. 5 (Dec., 1988), pp. 703-737 Published by: The University of Chicago Press on behalf of Wenner-Gren Foundation for Anthropological Research Stable URL: https://www.jstor.org/stable/2743609

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This content downloaded from 206.253.207.235 on Sun, 08 Nov 2020 20:29:57 UTC All use subject to https://about.jstor.org/terms CURRENT ANTHROPOLOGY Volume 29, Number 5, December I988 ? I988 by The Wenner-Gren Foundation for Anthropological Research. All nghts reserved OOII-3204/88/2905-OOOI$3.00

Despite Thomas Gann's I90I publication of "Recent Discoveries in Central America Proving the Pre-Co- The Origin and lumbian Existence of Syphilis in the New World," the controversy concerning the origin and antiquity of syphilis remains. As the Columbian quincentenary Antiquity of Syphilis draws near, it is appropriate to reassess the documentary and skeletal evidence regarding the origin of syphilis and its dispersion throughout the world in the light of Paleopathological Diagnosis and paleopathological diagnosis and interpretation. A review of the literature strongly suggests a New World origin of Interpretation the treponemal infections. Whereas the evidence for pre- Columbian treponematosis in the Old World is docu- mentary and equivocal, there is a vast array of skeletal evidence indicating the presence of a nonvenereal form by Brenda J. Baker and of treponemal infection in the Americas prior to Colum- George J. Armelagos bus's arrival.

A review of the literature regarding the origin of syphilis in the Hypotheses on the Origin of Syphilis light of paleopathological diagnosis and interpretation strongly suggests a New World origin. Whereas the evidence for pre-Co- Three hypotheses have been advanced to explain the ori- lumbian treponematosis in the Old World is documentary and gin and subsequent spread of venereal syphilis through- equivocal, abundant skeletal evidence indicates the presence of a out the world. nonvenereal form of treponemal infection in the Americas before Columbus. The Columbian hypothesis, proposed by Crosby (i969), Dennie (i962), Goff (i967), Harrison (i959), and BRENDA J. BAKER iS a Ph.D. candidate in anthropology at the Uni- others, is that syphilis originated in the Americas and versity of Massachusetts (Amherst, Mass. OI003, U.S.A.). Born in was carried to Europe by Columbus's crew in I493. Sub- I959, she received her B.A. from Northwestern University in sequently, a syphilis epidemic occurred in Europe about I98I. She has done archaeological fieldwork in Illinois, Arizona, i5oo. The rapid spread of syphilis throughout Europe at New England, and Egypt. Her research interests are nutrition and disease in prehistory and settlement patterns and demography; that time suggests the introduction of a virulent disease her current work involves analysis of bone collagen from human into a population that had not previously been exposed skeletal remains from the Wadi Halfa area of Sudanese Nubia. to it and had no immunity to it. GEORGE J. ARMELAGOS is Professor of Anthropology at the Uni- Proponents of the diametrically opposed pre-Colum- versity of Massachusetts. He was born in I936 and educated at the bian hypothesis (e.g., Hackett I963, I967; Holcomb University of Michigan (B.A., I958) and the University of Col- I934, I935) assert that venereal syphilis was present in orado (M.A., I963; Ph.D., I968). He taught at the University of Europe prior to Columbus's voyage but was not dis- Utah in I965-67, before joining the faculty at Massachusetts, and at the University of Colorado in the summers of I983-87. He has tinguished from "leprosy." The alleged epidemic re- done extensive research with human skeletal remains on diet, dis- sulted from the recognition of syphilis as a separate ease, and demography in prehistoric populations from Dickson disease in the I490s. Cockburn (i96i; i963:I53-59) pro- Mounds, Illinois, and from the Wadi Halfa area of Nubia. His pub- vides an evolutionary framework for the pre-Columbian lications include, with Alan C. Swedlund, Demographic An- origin of syphilis in which geographical isolation led to thropology (Dubuque: W. C. Brown, I987); with Peter Farb, Con- suming Passions: The Anthropology of Eating (Boston: Houghton speciation of Treponema. Throughout most of human Mifflin, I980); and, with coeditor M. N. Cohen, Paleopathology at history, treponemal infection (i.e., pinta, yaws, endemic the Origins of Agriculture (Orlando: Academic Press, I984). syphilis, and venereal syphilis) was mild and chronic because populations were small. As population size in- The present paper was submitted in final form 30 v 88. creased, more acute infections were selected for and spread by direct skin-to-skin contact among children. By I492, European living standards had improved to the point of differentially affecting the transmission of Treponema species. Those dependent upon skin contact were disadvantaged and replaced by a hardier strain that was sexually transmitted (Cockburn i96i:226). Thus in Cockburn's view the discovery of America and the ap- pearance of venereal syphilis are not cause and erfect; rather, both resulted from other social and economic events. A third, unitarian hypothesis is that the agent of

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syphilis has evolved with human populations and was Syphilis and Leprosy present in both the Old and the New World at the time of Columbus's discovery. Hudson (I963a, b, i965a, b, Because the pre-Columbian and unitarian hypotheses i968) maintains that pinta, yaws, endemic (nonvenereal) suggest that diseases such as yaws, endemic syphilis, syphilis, and venereal syphilis are four syndromes of venereal syphilis, and leprosy were confused from an- treponematosis, a single disease caused by Treponema cient times and grouped under the term "leprosy" (Hol- pallidum, which evolved simultaneously with humans. comb I935:277; I940:I77; Hudson i965a:896), before The syndromes form a biological gradient in which vari- examining the evidence it is necessary to discuss the ous social and environmental factors produce different differential diagnosis of these diseases. manifestations of treponematosis (Hudson i965a). Al- Venereal syphilis has an incubation period of IO-90 though Hudson and Cockburn agree on the role of im- days before the primary lesion appears in the anogenital proved hygiene in the appearance of venereal syphilis, region (Olansky i98i:299). Secondary lesions usually de- they disagree on several aspects of its etiology and velop on the skin and mucous membranes. Prior to the epidemiology. advent of penicillin treatment, the prevalence of syphilis According to Hudson (I963a, I965a), treponematosis was about 5% in mostly urban adult populations (Stein- originated during the Paleolithic period as a childhood bock I976: iio). Steinbock's survey of the clinical litera- disease (yaws) transmitted by skin-to-skin contact in ture predating penicillin use indicates skeletal involve- the hot, humid climate of sub-Saharan Africa. The infec- ment in IO-20% of cases (cf. Hackett I976:IO8, who tion accompanied gatherer-hunters in their migrations cites a single study in which osseous lesions developed throughout the world. As groups moved into drier zones in only i% of untreated patients). Since asymptomatic bordering the tropics, the focus of treponemal activity bone lesions often go undetected in early syphilis, skele- retreated to the moist areas of the body (mouth, armpits, tal involvement may be underestimated (Hansen et al. and crotch), as in endemic syphilis (Hudson i965a:89i). I984; Steinbock I976:io9). Following Steinbock's (p. Treponematosis in the form of endemic syphilis was car- iio) arithmetic, however, one obtains a frequency of ried into the New World by the earliest migrants from osseous involvement in i of every IOO-200 individuals the Old World. As the tropical zones of the Americas in a skeletal series representing an adult urban popula- were populated, the climatic change caused the shift tion (a prevalence of o.5-i% in skeletal populations). back to yaws (p. 893). The appearance of villages in the Hackett (I976:io8, II4) indicates that only i in i,ooo Neolithic period did not alter the nonvenereal nature of adults would develop syphilitic bone lesions. the infection; crowded, unsanitary conditions and in- Skeletal involvement in venereal syphilis most often creased frequency of child-to-child contact in village set- affects the cranial vault, the nasal area, and the tibia. tings facilitated its spread (i963a:IO42-43; I965a:892- Together, these three locations comprise 70% of all ter- 93). tiary syphilitic bone lesions (Ortner and Putschar Urbanization, beginning in Mesopotamia and Egypt by 1985:i82). The major diagnostic criterion of skeletal 4000 B.C., was accompanied by an improvement in per- syphilis is the caries sicca sequence, described in detail sonal and community hygiene (Hudson i963a: I043). Al- by Hackett (I976:30-49), which results in the "worm- though it seems counterintuitive for sanitation to have eaten" appearance of the outer table of the cranial vault, improved in cities, Hudson (i965a:895) points out that characterized by the formation of stellate scars. Caries "hygienic barriers do not have to be very high to prevent sicca is usually accompanied by naso-palatine destruc- the spread of touch-contact syphilis." Availability of wa- tion. This destruction, more extensive and rapid than in ter, washing and bathing with soap, separate sleeping leprosy, usually involves the nasal bones and is accom- quarters, and the like became adequate barriers to the panied by healing and sclerosis (Hackett I976:63-65; proliferation of treponematosis by casual contact among Ortner and Putschar I985:I92, I97; Steinbock I976:I45, children. As a result, individuals reached sexual matu- 208). Where there is gross destruction of the naso- rity without prior exposure to it. Hence, "coitus . . . palatine region, there is often maxillary alveolar damage became the only personal contact of sufficient intimacy as well (Hackett I976:65). to permit transmission of treponemas," and adults dis- Postcranially, formation of subperiosteal bone begins seminated the disease in a society in which there was in the metaphyses of the long bones, with the tibiae "promiscuity and prostitution" (p. 895). being most often involved. Inflammation of the entire Hudson (I965b:738) indicates that both venereal and periosteum initiates a subperiosteal response resulting nonvenereal forms of treponematosis may be present in thickening and possible bone deformation (Steinbock within a narrow geographical area, for example, where a I976:ii5). Hackett (I976:79-90) proposes a sequence for city characterized by venereal syphilis is surrounded by nongummatous periostitis that ranges from finely a rural area characterized by yaws. Despite identical cli- striated nodes and expansions to grossly rugose expan- mates, the higher hygienic level and different social cus- sions, which he tentatively considers diagnostic criteria toms in the city promote venereal transmission. Disso- of syphilis. Gummatous lesions-nodes/expansion with lution of urban life would result in a shift from venereal superficial cavitation-he regards as certainly diagnostic to nonvenereal forms of treponematosis (either endemic (PP. 93-97). Gumma formation may occur periosteally syphilis or yaws, depending upon the climate). or in the medullary cavity, resulting in both proliferative

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and degenerative changes. Syphilis lacks the smooth i96i). Although leprosy is best known as a skin disease, cloacae and the sequestrum and involucrum formation its effects on the nervous and skeletal systems are well of pyogenic osteomyelitis (Hackett I976:95; Steinbock known. Skin changes usually consist of rough, dry I976:I37). Generally, the affected bone appears macules, in which hypopigmentation may occur (Drutz roughened and irregular because of thickening and in- 198I, World Health Organization 1980). creased density. The medullary cavity, particularly in Skeletal manifestations of leprosy have been described the tibia, is greatly narrowed by cortical thickening in detail by M0ller-Christensen (i967), M0ller-Chris- (Steinbock I976:I7, I23). Hands and feet are rarely af- tensen and Faber (i952), M0ller-Christensen and Inkster fected. (i 965), and Paterson (i 959). The most reliable diagnostic Pinta, yaws, endemic (nonvenereal) syphilis, and ve- criterion of leprosy is the occurrence of facies leprosa in nereal syphilis have been thought to be caused by differ- the skull. This condition is characterized by atrophy of ent species of Treponema (respectively, T. carateum, T. the anterior nasal spine, atrophy of the maxillary alveo- pertenue, and two subspecies of T. pallidum). The causa- lar margin, mainly in the incisor region, and inflamma- tive organisms of each disease, however, cannot be dis- tory changes of the superior surface of the hard palate. tinguished from each other by any known test. In elec- Facies leprosa has been identified in 60-82% of mod- tron microscope studies, the "species" of Treponema ern leprosy patients (Steinbock I976:20i). Postcranial are morphologically identical (Hovind-Hougen i983:5). changes accompanying facies leprosa include atrophy Their antigenic structures differ only quantitatively and resorption of the phalanges in the hands, beginning (Hudson i965a:886). DNA sequence homology analysis distally, and at the metatarsophalangeal joints in the indicates that T. pertenue and the subspecies of T. pal- feet. At a medieval Danish leper cemetery (St. George's lidum are identical and "might be regarded as a single Hospital, Naestved), 7 I .3 % of i 85 adequately preserved species" (Fieldsteel i983:50). Partial cross-immunity skeletons exhibited both facies leprosa and changes in exists between the treponemal syndromes (Cannefax, the hands and feet (Weiss and M0ller-Christensen Norins, and Gillespie i967:473-74). Clinically, yaws I97I:262-6 3). Changes affecting only the hands and feet and endemic and venereal syphilis closely resemble occurred in 26.5% and changes in the skull alone in each other in the prolonged course of the disease, with 2.2% (Weiss and M0ller-Christensen I97I:262-63). Ex- early and late manifestations. Primary yaws is similar to amination of the hands and feet is therefore important primary syphilis; secondary yaws resembles secondary in differentiating other diseases, such as syphilis, from syphilis, although the skin lesions of the former are of- leprosy. Subperiosteal bone deposits occur occasionally ten larger and more exuberant; and lesions of tertiary in the tibia and fibula in leprosy, but other long bones yaws, characterized by gummatous lesions of the skin, remain uninvolved. In contrast to the situation in soft tissue, bones, and naso-palatine area, are indistin- syphilis, where extensive bone destruction is always guishable from those of tertiary syphilis (Musher and accompanied by reactive new bone formation (M0ller- Knox i983:II4-I5). Where (as in all forms except pinta) Christensen I952: 1o6-7), bone resorption is not accom- bone lesions result from the treponemal syndromes, panied by proliferation. they are also indistinguishable from each other (Hackett I976:I13). Except for the dental stigmata and osteochon- dritis found only in congenital syphilis, the bone lesions found in one disease are identical to those found in the Documentary Evidence others (Steinbock I976:I39, I43). Steinbock stresses that the differences in skeletal involvement are merely quan- In the absence of extensive skeletal evidence for syphi- titative. For example, in endemic syphilis and yaws, the lis, medical historians have turned to ancient and medi- cranial vault is infrequently affected in comparison with eval documents in an effort to establish the antiquity venereal syphilis, whereas tibial lesions are much more of syphilis in the Old World (Baker i985). Supporters of common. the pre-Columbian and unitarian hypotheses argue that Skeletal series in areas in which either endemic syphi- syphilis was confused with leprosy in the ancient lit- lis or yaws occurs are expected to reveal bone lesions erature and have sought passages purported to delineate in approximately I-5% of the entire series (Steinbock the venereal communication of the disease. Columbian- I976:I39, I43). ists discount such descriptions and point to accounts of Leprosy (now known as Hansen's disease) is a chronic a new disease of foreign origin at the close of the i sth infectious disease caused by the bacillus Mycobac- century. terium leprae. The incubation period averages at least three to five years (World Health Organization i980: i6). BIBLICAL REFERENCES TO "LEPROSY" A prevalence of about o.5% (4.6 per i,ooo) is found in modern Africa, where leprosy is endemic (p. io). In clini- The Old Testament (written between the 8th and 2d cal studies, skeletal manifestations occur in i5-68% of centuries B.C.) iS the most frequently cited text in refer- leprosarium patients (Chamberlain, Wayson, and Gar- ence to leprosy. The Hebrew word tsara'at, which is land I93I, Esguerra-Gomez and Acosta I948, Faget and translated into Greek as lepra, "scaly," denotes ritual Mayoral I944, Murdock and Hutter I932, Paterson uncleanliness and probably refers to a wide range of dis-

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eases with dermatological manifestations (Cochrane OTHER ANCIENT REFERENCES I959:viii; Hulse I975; M0ller-Christensen i967:304-5). SUGGESTIVE OF SYPHILIS Lepromatous leprosy, originally described by the Alex- Several Greek and Roman physicians and historians in- andrian medical school about 300 B.C., is referred to as cluding Hippocrates, Martial, Pliny, and Celsus- de- elephantiasis because of the thickening and corrugation scribed genital lesions following sexual activity (Brown of the skin (Dols I979:3I5). As a result of inexact trans- et al. I970:3; Hudson i96I; I963b:646; Kampmeier lation, the biblical term "leprosy" could, therefore, refer I984:22-23; Rosebury I97I:Io5-7). During the ist cen- to syphilis. tury A.D., Celsus described hard and soft genital sores, Biblical passages suggesting syphilis have been re- reporting that the latter exuded a malodorous discharge viewed at length by Willcox (I949; see also Hudson (Hudson 196I:555). Galen (born in A.D. I 3 I) differ- I96I:552-54 and Rosebury I97I:98-iO4). Moses de- entiated dry ulcers from moist ulcerating tubercles, scribes punishment for disobedience as manifesting "emerods," scabs, itches that cannot be healed, mad- analogous to mucous patches (Kampmeier I984:22). Such lesions were described by both Greeks and Romans ness, and blindness (Deuteronomy 28:27-28). Job (Job as resembling mulberries or figs, which Hudson (I96I) I6, I9, 30) suffered from a genital lesion, and boils cov- and others (see Kampmeier I984:22) interpret as genital ered his body; iritis is suspected from his failing sight condylomata diagnostic of syphilis. Martial and Pliny and mucous patches from his corrupt breath. David's (Ist century A.D.) refer to mentagra, a term derived from illness (Psalms 38:i-ii) is also cited as a case of pre- the Latin mentum, "chin," from which mentula, Columbian syphilis masquerading as "leprosy." David "little chin," also originated. Hudson (I96I:554-55; suffered from shooting pains and odoriferous lesions, i963b:646) points out that the latter term was euphe- and his "loins are filled with a loathsome disease." Like mistic for the pubic area and concludes that the lesions Job, he had failing vision and recovered from his illness. and contagious nature of mentagra were venereal. By- David believed his condition to have resulted from zantine physicians of the 3d through 7th centuries docu- sleeping with Bathsheba, who was "unclean" at the time mented several types of genital lesions that have (2 Samuel 2-5). been attributed to gonorrhea and syphilis (Kampmeier Leviticus I3 and 22:4 and Numbers 5:2 are among I984:23). Finally, Hudson (I96I:55I), in his thorough passages discussing the skin lesions of "leprosy" and the etymological treatise, links the term bubas to Greek and restrictions placed upon the "unclean" in great detail Latin terms denoting "serpent." Diaz de Isla employed (see Brody I974:I08-I4 for further explication of bibli- cal references to leprosy). Depigmentation and discolora- this term to describe syphilis in I 539, noting that it was previously used in Spain to describe "leprosy" and the tion characterize the lesions reported. The lengthy de- Romans' mentagra. scription in Leviticus is actually a list used by priests to The ancient literatures of India and China have also differentiate among diseases that may or may not result been cited as containing "unmistakable proofs" that in ritual impurity (Hulse I975; Sussman i967:2II). genital lesions were associated with sexual activity If the foregoing passages are references to venereal (Hyde I89I:II7). Kampmeier (I984:22) indicates that syphilis, one would also expect biblical descriptions of the Sanskrit Veda contains several references to genital congenital syphilis. In Jeremiah 3I:29, where "the disease, which some have interpreted as syphilis. Lu and fathers have eaten sour grapes and the children's teeth Needham (i967) mention no disease resembling syphilis are set on edge," the dental condition is suggestive of in ancient China, and Crosby (i969:2i9) quotes Wong Hutchinson's teeth, a sign of congenital syphilis (Will- and Wu (I936:2i8) as saying that no Chinese writer "has cOx I949:32). Willcox also points to Exodus 2o:5, where ever described syphilis as being mentioned in ancient "the iniquity of the fathers" is visited "upon the chil- literature." Wong and Wu, however, assert in the follow- dren to the third and fourth generation." Although ing sentence that these writers "did not know the con- syphilis can be inherited only by the second generation, nection between chancres and syphilides, for the former Brown et al. (I970:2) find this passage significant be- were mentioned as early as the 7th century A.D." As to cause "syphilis is one of the few known communicable whether these chancres are syphilitic, they indicate (p. diseases that can be passed from one generation to an- 2i9) that "the original texts are too brief to enable us to other." form any definite conclusion." Clinical descriptions of Miriam's "leprosy" is described in Numbers (I2:9- leprosy in China and India from as early as 600 B.C. are, i5). A possible macerated syphilitic fetus is suggested by in contrast, quite clear (Browne I970:64I; Lu and Aaron's statement, "Let her not be as one dead, of whom Needham I967:226, 236-37; Steinbock I976:i92). the flesh is half consumed when he cometh out of his mother's womb." Leviticus (2i:i6-20) states that "he who hath a flat nose," perhaps indicative of congenital MEDIEVAL ''LEPROSY"1 saddle nose, was ostracized. Similarly, in 2 Samuel i2 it is said that the child conceived from the adulterous and Medieval texts have also been studied for evidence that unclean union of David and Bathsheba died seven days syphilis was included with other diseases under the term after birth. If David's subsequent disease was syphilis, "leprosy." True leprosy was apparently unknown in the baby may also have been afflicted. the Mediterranean region prior to 300 B.C. Andersen

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(i 969: I 23) has proposed an introduction from India after myth of the Trojan lovers, Troilus and Cressida, depicts Alexander the Great's campaign in 327-326 B.C. Celsus, a fallen woman who acquired an "incurable disease" and Pliny the Elder, Galen, and Aretaeus were the first to died "a leper" (Hudson I972:I46). Cresseid's face be- describe the disease, which they called elephantiasis, in came "o'erspread with black boils," her "clear voice" the first two centuries A.D. (Dols I979:3I5; see also Pat- became "hoarse, " "rough and raucous" (quoted in rick i967:245). The generic term lepra was not applied Richards I977:6-7). Cresseid's condition resulted from to true leprosy until the 8th century A.D. (Steinbock her lustful life. She was confined to a leper house to I976:i92-93) in the translation of Arab medical texts prevent the spread of her infection to others. Her life as a into Latin (Richards I977:9). Thus, a previously distinct leper is detailed, including the last will and testament and well-defined disease of no religious significance was required for entrance into the leper hospital, her wander- blended with the biblical concept of impurity and ac- ing with cup and clapper, and her diet of "mouldy bread, quired the stigma still attached to the word "leper" perry, and cider sour" (quoted in Richards I977:6-8). (Richards I977:9-io). As a result, the medieval diag- Henryson called Cresseid's disease leprosy, but Hudson nosis of leprosy may have incorporated several afflic- (I972:I49) suggests that because it is associated with tions, including true leprosy and syphilis. immorality and sex it is venereal syphilis. Richards The mode of transmission of medieval leprosy is con- (I977:6) finds Henryson so compassionate in his por- fused. Bartholomeus Anglicus (ca. I230-50) wrote that trayal of the "leper" that he must have had firsthand leprosy was caused by "intercourse with a woman after knowledge of leprosy and "of lives broken by it." she had been with a leprous man, heredity, and feeding a child with the milk of a leprous nurse" (Rubin I 974: I 5 3; THE EPIDEMIC OF I500 see also Gordon I959:493-94). Theodoric of Cervia (i205-98) provides one of the more detailed descriptions By I500, a "new" disease, which we know as syphilis, of the disease within the prevailing humoral theory (7 of was being described in Europe (see Crosby I969, Dennie his i2 common signs of leprosy correspond to those i962, Holcomb I934, Williams, Rice, and Renato Lacayo found by modern diagnosticians), but he also insists that I927). As syphilis became widely recognized and de- those "lying with a woman with whom a leper has lain" scribed, "leprosy" became less common. Historical will be infected (Brody I974:34-4I). Numerous me- events unrelated to the return of Columbus may explain dieval scholars refer to "venereal leprosy," "heredi- this trend. For example, the invention of the printing tary leprosy," and "leper whore" and describe genital press in the mid- i5th century led to rapid diffusion of lesions (Brody I974:54-56: Holcomb I935:297-303; information. By I566, 58 books had been published on Hudson i96i:548; I972:I50-5i; Kampmeier i984:23- the subject of syphilis. Kampmeier (i984:24) argues that 24). Leprosy is neither hereditary nor sexually transmit- the proliferation of such publications led to the wide- ted. It does show a strong family incidence (4.4-I2% of spread recognition of the disease at this time, making it household contacts of lepromatous leprosy patients appear as if it were a new disease of epidemic propor- show signs of the disease within five years [World tions. This dissemination of knowledge was accom- Health Organization ig80o), but both husband and panied wife by historical events that caused the displacement are affected in less than 5% of couples (Richards of people throughout Europe. I977 :xvi). Papal proclamations in I490 and I505 abolished all Leper hospitals were established throughout Europe leper houses (Holcomb I935:282), allowing the dispersal prior to the Crusades (A.D. io96-2.2i) in an effort to of thousands with "leprosy." Holcomb notes (p. 278) separate lepers from society. "Leprosy" reached its peak that Matthew Paris, an English monk who died in 1259, prevalence in Europe in the iith through I 3th centuries records "in somewhat ambiguous terms" the existence (Rubin I974:I5I), coinciding with the Crusades. Hudson of I9,000 leper houses in Europe. While this figure may (i963b) has outlined the importance of concurrent pil- be exaggerated, Gordon (I959:493) indicates that grimage to the Middle East in disseminating disease, "France and Germany alone had nearly io,ooo lep- which he contends included treponemal infection dis- rosaria" in I400, and Richards (I977:ii) notes approxi- guised as "leprosy." As supporting evidence he cites the mately 2oo leper hospitals "in their thirteenth- and four- use of "Saracen ointment," which contained mercury, teenth-century heyday" in Britain. It should be by the returning lepers (i96i:548; i963b:648; see also cautioned, however, that most leper hospitals were ec- Hackett i967:i63-64). Mercury has no effect on true clesiastical foundations that accommodated only about leprosy but was the mainstay in treating syphilis until ten lepers and at least as many chaplains and sisters the early 2oth century (Steinbock I976:88). (Richards I977:Ii). Richards (see also Creighton I965 Perhaps the most explicit description of medieval [i8941:86-ioo) concludes that the number of hospitals is "leprosy" is found in Robert Henryson's poem "The Tes- not a reliable estimate of the number of lepers because of tament of Cresseid." Written in Scotland prior to I492, the propensity of the church to establish the institutions the poem has been variously claimed as a delineation of to garner perpetual charity. Whatever the motive for es- venereal syphilis (Hudson I972) and as a sensitive por- tablishing the hospitals, they did house thousands trayal of an individual afflicted with leprosy (Richards throughout Europe. If the diseases were confused, it is I977:6-8). The poem, a contemporary version of the possible that some of the inhabitants were syphilitic and

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therefore that when the hospitals were closed syphilis in Temkin i966:33). A thorough search of the French was dispersed. archives revealed that the earliest Parisian reference to Hudson (1 964; i968:ii) claims that treponemal infec- the disease was contained in an edict promulgated by the tion existed in venereal and nonvenereal forms in pre- Paris parliament on March 6, I497 (Harrison I959:4-6; Columbian Spain and Portugal because of the Moorish see also Creighton i965:[i8941:436), nearly four years occupation and the importation of slaves from sub- after Columbus's crew returned from the first voyage. Saharan Africa. When an estimated i6o,000 to 400,000 Holcomb (I934:428) misdates this edict as well, stating Jews were expelled from Spain in I492, they allegedly that it was issued on March i6, I496. carried syphilis throughout Europe (Holcomb I935:284). Several edicts ostracizing people infected with syphilis The expulsion of Jews and lepers coincided with the dis- were issued elsewhere in Europe beginning in I496. In covery of America and the apparent epidemic of syphilis. that year, I12 such ordinances were passed at Nuremberg, In late I494, Charles VIII of France conducted a cam- and syphilitics were barred from the baths of Zurich and paign against Naples. The city fell in February of I495 as other municipalities throughout Switzerland and Ger- a plague broke out among the mercenary troops. They many (Holcomb I934:428; Kampmeier i984:24-25). subsequently disbanded, carrying their disease through- Ten persons with "the Neapolitan disease" were ex- out Europe (Brown et al. I970:5; Williams, Rice, and pelled from Besancon, France, in April of I496, while an Renato Lacayo I927:683). It is generally agreed that this edict at Lyon, dated August i2, I497, required those disease was syphilis; the controversy concerns the time with the disease to report within ten days or be ap- of arrival of Spanish troops purported to have contracted prehended (Harrison I959:4, 6). Early reference to the disease from Columbian contacts and the issue syphilis in Britain is from an ordinance of Aber- of several edicts regarding the disease elsewhere in Eu- deen dated April 2i, I497, in which it is stated that rope. Holcomb (I934:4I9; see also Hudson I968:5-6; "the infirmity came out of France" (Creighton I965 I972:I52) claims that Charles's army left Naples on May [i8941:4I7). A proclamation issued in Edinburgh by 20, 1I495, and the Spaniards did not arrive until June. James IV on September 22, I497, requires those with Although Charles did not reach France until October 27, "Grandgor" (syphilis) to go to the island of Inch Keith in I495, an edict had been issued by the Diet of Worms the Firth of Forth, "there to remain until God provide for more than two months earlier (August 7, I495), indicat- their health" (Creighton i965 [i8941:4I7-i8). Hospitals ing that syphilis was already widespread in Germany for the syphilitic such as St. Jobsgasthuis, founded in (Gordon I959:536; Holcomb I935:289, 427; see also Utrecht in I504 (Fuldauer, Bracht, and Perizonius I984), Harrison I959:4). While this would seem to vindicate were established throughout Europe by the beginning of Charles VIII, Waugh (i982:92) has pointed to problems the i6th century. in dating events of the time due to the variety of calen- It would appear from the dates of European edicts that dars in use (e.g., Gregorian vs. French). a new disease swept the continent within three or four Further confusion in the dates of early edicts on years of the return of the first Columbian voyagers. The syphilis has resulted from modern errors. Holcomb concurrence of these events has been challenged, how- (I935:293) laments the penchant of some writers (Co- ever, by those who point out that edicts after I493 lumbianists) for accepting ideas "without first assuring closely resemble those previously issued to isolate lep- themselves of the correctness of the historical data that ers. For example, a Parisian edict of I488 is directed they introduce." Reliance upon Sudhoff's archival work, against les lepreux, while those following the papal proc- however, has led to wide acceptance of the I495 date of lamation of I490 refer to syphilis (Creighton i965 the aforementioned edict of the Diet of Worms. Sudhoff [I8941:73; Holcomb I934:4I6: I935 :282). Creightonques- later amended the date to August 8, I496, and subse- tions the sudden reappearance of leprosy in the late I 5th quent research by Haustein revealed that the text was century, especially since the Paris edict is so close in actually drafted by the Diet of Lindau on January i.2, date to those concerning syphilis. Thus, one is left to I497 (cited in Temkin i966:32-33). Thus, it is possible wonder whether these ordinances were issued as a con- that the passage regarding syphilis was a response to its sequence of the importation of syphilis or if the discov- dissemination by soldiers returning from Italy. ery of America was merely coincidental with the recog- Holcomb's pre-Columbian thesis hinges largely upon nition and renaming of the disease as it was differ- an edict issued in Paris that bars those with grosse verole entiated from "leprosy." (syphilis) from the city. Holcomb (I934:4I6, 42I; I935:2 93) dates this edict to March 25, I493, or ten days LATE I5TH- AND EARLY i6TH-CENTURY after Columbus returned to Spain from his first voyage. TREATISES ON SYPHILIS This would render it impossible for the disease to have been imported from America. In an attempt to verify Treatises on syphilis proliferated in the late I490s and this date, Harrison (I959:4-6) followed a series of errors early iSoos (for reviews see, e.g., Crosby i969, Dennie in later compilations of ancient French laws (one of I 9 6.2, Holcomb I 9 34, Hudson I 9 6 I). Williams, Rice, and which was cited by Holcomb) and discovered that the Renato Lacayo (I 927) provide translations of large por- ordinance with the text in question was actually issued tions of early Spanish works, the most important of on June 25, I498 (verified by Haustein's research, cited which is Ruy Diaz de Isla's "Treatise on the Serpentine

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Malady, Which in Spain is Commonly Called Bubas, ten prior to that event. Furthermore, Diaz de Isla states which was drawn up in the Hospital of All Saints in that "in the year I 504 there were given me in writing all Lisbon," first printed in I539. In it, he claims that the the remedies that the Indians used for this disease," indi- serpentine disease (syphilis) appeared in Barcelona in cating that his belief in its American origin dated to I493, originated on the island of Espaiiola (Haiti), and within ii years of its alleged importation. Thus, the was brought to Europe by Columbus's crew (p. 693). He manuscript, usually ascribed to the period i5io-.10o, goes on to say that in the following year Charles VIII would appear more likely to have been written in i 505 entered Italy with "many Spaniards infected with this or I5o6. Holcomb (I934:4I2-I3), however, asserts that disease." Not knowing what it was, "the French called it Diaz de Isla "frequently states he had 40 years' experi- the disease of Naples," and the Italians, "as they had ence in the treatment of the disease" and therefore ac- never had acquaintance with a like disease, called it the ceptance of such dates would place his treatment well French disease." This portion of Diaz de Isla's account is before the discovery of America. Holcomb's observation confirmed by Gonzalo Fernandez Oviedo y Valdes is not apparent in the translation provided by Williams (I478-I557): "Many times in Italy I did laugh, hearing et al. (I927:694), in which Diaz de Isla writes only that the Italians say the French disease and the French calling he has had "long experience." It seems that a decade or it the disease of Naples; and in truth both would have hit more would qualify as such. on the right name if they had called it the disease from Several i 6th-century tracts written by European schol- the Indies." Oviedo also verifies that among Charles ars in the New World document the lifeways, languages, VIlII's army were Spaniards "touched with this disease," and mythologies of various native groups and refer to a but he indicates that they did not join the French until disease much like syphilis among them. These docu- I496 (see Williams et al. I927:687-89 and Crosby ments have been employed to support the Columbian i969:222). Much has been made of this discrepancy hypothesis in in publications of the past century (e.g., dates (e.g., Holcomb [I935:292] uses it to dismiss Bruhl I890, Crosby i969, Williams et al. I927), while Oviedo's entire account); Waugh's (i982:92) caution re- others (e.g., Holcomb I 934:4I 7-I 8) attribute such refer- garding the difficulty in dating such events must be ences to the introduction of the disease by Europeans. borne in mind. The biography of Christopher Columbus, by his son Fer- Critics of the i 6th-century treatises, such as Holcomb dinand, includes a I495 manuscript by Fray Roman Pane (I934, I935), point out that no mention is made of an recording an Arawak myth in which the hero, American origin of syphilis for more than 30 years after Guagagiona, "saw a woman ... from whom he had great the discovery of the New World. Earlier texts attribute pleasure, and immediately he sought many lotions to the disease to divine wrath visited upon a sinful cleanse himself, on account of being plagued with the populace, astrologic convergences, and the weather; disease that we call French," and afterwards went to a Oviedo's work is among the first to mention an Ameri- secluded place "where he recovered from his ulcers" can origin. His "Summaria of the Natural History of the (Williams et al. I927:687; see also Bruhl i890:276 and Indies" was published in i526 and is purported to have Crosby I 969: 22-22). Crosby, reminding the reader that been written from memory. His larger work, "General folklore is very slow to change, finds it unlikely that the and Natural History of the Indies," was first printed in Arawaks would have altered their legend to give the I535 (Holcomb I934:406-7; Williams et al. I927:687). hero a new disease, thus implying that the malady was In it he says that, while he is writing from memory, he is extant among the natives long before the Europeans ar- referring to "notes which were written at the time when rived. This is corroborated by Bartolome de las Casas, the things described in them happened." Holcomb who questioned the natives as to the origin of the disease (I934:407) points out that taking such notes is not the and was told they had had it from time immemorial usual activity of a teenager (Oviedo was only i5 when (Crosby i969:222; Williams et al. I927:69o). Further ex- Columbus returned from his first voyage). Crosby amples of "syphilis" in native mythology, as well as dif- (i969:222) maintains that Oviedo was quite friendly ferential burial treatment of those afflicted, were docu- with the explorer's sons and cites a passage in which mented by Bernardino de Sahagun, who lived in Mexico Oviedo asked several of his friends sailing with Colum- from I5.29 to 1590 (Bruihl I890: 275-76; Williams et al. bus in I493 (second voyage) to provide him with detailed I927:69-9oi). reports (his affiliation with several crew members is also Linguistic evidence compiled by Montejo y Robledo recorded in the translation by Williams et al. I927:688). from i 6th- and I 7th-century dictionaries of native Mexi- The original manuscript of Diaz de Isla's account is can and Central and South American languages reveals dedicated to King Manuel of Portugal, who died in i52i indigenous terms for bubas and related European expres- (Williams et al. I927:695). In a paragraph omitted from sions (Williams et al. I927:685-86). Bruhl (i890:278-80) the printed versions, he writes of an island "discovered counters the view that these terms were invented after and found by the Admiral Dom Cristoual Colon at pres- the arrival of Europeans by reviewing the ways in which ent holding intercourse and communication with the names were assigned to previously unknown things- Indies" (Williams et al. I927:695). Since Columbus's last adopting the European word with little or no change or voyage culminated in his death in the New World in deriving the name from a conspicuous feature of the ob- I5 o6, it seems that the manuscript must have been writ- ject. While the terms for previously unknown diseases

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described a prominent symptom, the words synonymous ting of the occipital and parietals, and "the relative de- with European appellations for syphilis were "formed at pression of the bridge of the nose" in both children and the development of the respective 'languages" and, in adults. Worn taurodont molars are suggested to resemble many cases, associated with chieftains and gods (Bruhl the mulberry molars of congenital syphilis. Bowing of I890: 279). the femur is attributed to syphilitic osteitis, also hy- pothesized to "account for Neanderthal long bones being so short and stout." Many of the lesions Wright Skeletal Evidence describes are diagnostic of rickets, while the general skeletal variations he attributes to syphilis are the The preceding review of ancient and medieval documen- consequence of genetic and biomechanical differences tary sources reveals many ambiguities in disease de- between Neanderthal and modern populations. scription and the dating of events. The ensuing interpre- The alleged skeletal evidence of pre-Columbian tations of these passages remain controversial. Skeletal syphilis was thoroughly reviewed by Williams in I932. evidence of pre-Columbian syphilis is subject to similar Prior to investigating archaeological specimens, he ex- disagreement. As Williams (I932:780) states, "one must amined the bones of over 500 modern individuals known have proof that a bone is ancient and that it is syphilitic. to be syphilitic in order to establish diagnostic criteria. It is owing to a difference of opinion as to what consti- Various specimens described in the early literature as tutes proof that the controversy continues." Unfortu- syphilitic had apparently been lost by the time of his nately, many of the remains thought to be syphilitic research, and others were too incomplete for diagnosis to (primarily those recovered prior to Williams's review) be attempted. In many of the remaining cases, the sup- lack archaeological provenience and cannot, therefore, posedly syphilitic lesions could be attributed to other be assumed pre-Columbian. Further difficulties arise in causes. For example, several Egyptian cases had actually interpreting many late igth- and early 2oth-century de- suffered postmortem damage by rodents or insects (pp. scriptions of syphilitic specimens. These reports often 802-3), and the lesions on Parrot's (i879:698) Peruvian present descriptions of an isolated skeletal element. crania were attributable to porotic hyperostosis (Wil- Since skeletal lesions resulting from yaws, endemic liams i929:852; I932:97I). Williams considered five syphilis, and venereal syphilis are identical, speculation cases of reputed Old World syphilis "suspicious." In the regarding the mode of transmission of the treponeme in case of a tibia and fibula from Japanese shell middens, a single individual is impossible (i.e., an isolated case of said to be more than 2,500 years old, he thought trauma treponematosis cannot be assumed to have resulted or healed osteomyelitis with periostitis the cause of the from venereal transmission). Reliable conclusions re- lesions described (p. 802) and judged the antiquity of the garding the prehistoric distribution of treponemal dis- remains questionable in any event (p. 974). For a Nubian ease may, however, be drawn from skeletal evidence. femur and tibia dated to Iooo B.C., insofar as his exami- The pattern of treponemal infection discerned in entire nation of the published illustrations permitted, he found skeletal series, viewed in conjunction with social and the diagnosis of syphilis plausible, although "other climatological factors, may permit epidemiological in- causes of periostitis would be equally probable" (pp. 803, ferences. 975). For the remaining "suspicious" instances, all from France-a tibia from Solutre, a humerus and ulna from the Marne Valley, and an ulna, femur, and femur frag- OLD WORLD REMAINS ment from the museum at Saint-Germain (pp. 805-9, Although numerous cases of alleged pre-Columbian Old 975)-he found the diagnosis of syphilis equivocal. The World syphilis have been described in the literature of few possible instances of pre-Columbian syphilis consist the past century, few have withstood reexamination. of isolated long bones with inadequate archaeological Once Parrot (i 879) had aroused European interest in the provenience (Sigerist I95 I:56; Williams I932:974). Jean- paleopathological identification of syphilis, nearly every selme, Pales, and others concur that the Old World evi- French anthropologist discovered syphilitic specimens dence presented prior to I930 is inconclusive or negative (Sigerist i95i:56). Parrot, however, confused the mani- (Williams I932:975-76; see also Sigerist I95I:56 and festations of congenital syphilis and rickets, delineating Steinbock I976:97). a "rachitic period" of congenital syphilis for which Possible skeletal evidence accumulated since I930 is "swelling . . . of the articular ends of the bones" and sparse. Steinbock (I976:97) regards Siberian material "cranial osteophytes" resulting in "the form of a cross" consisting of several tibiae, a radius, and an ulna dated on the skull vault were diagnostic (i879:697-98). Thus iooo-800 B.C. as the earliest indication of possible Old he reported syphilis in prehistoric Ecuador, Peru, and World syphilis. In addition, two tibiae dated 5o00-200 France solely on the basis of cranial vaults exhibiting B.C. and three crania dated A.D. I00-700 are reported to circumscribed areas of bone deposition (i.e., cranial boss- show syphilitic lesions (cf. Hackett I976:I8, who indi- ing) that were more likely due to rickets, iron deficiency cates that the dates may be unacceptable). Evidence of anemia, or congenital anemia (Steinbock I976:ioi). Re- pre-Columbian syphilis reported since I930 in Europe is liance on Parrot's diagnostic criteria underlies Wright's tantalizing but inconclusive. The skull of an adult fe- (I9 7I) contention that syphilis is evident in Neanderthal male from Spitalfields Market in London presents the remains in the form of cranial bossing, thinning and pit- diagnostic stellate scars of caries sicca (Brothwell

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i96i:324-25; Morant and Hoadley I93I:222, pl. 3; cavitation (Stewart and Spoehr i967[19521:3II-I7; see Steinbock I976:97). Historical records indicate that the also Steinbock I976:I53, i58). The site is radiocarbon- site was part of the cemetery at the church of St. Mary dated to A.D. 854 + I45, thus predating European con- Spittle, used A.D. II97-I537 (Morant and Hoadley tact by a considerable margin (Stewart and Spoehr I93I:202). Brothwell (i96i:324-25) finds it a "remark- i967[I9521:3II). Yaws has also been described in a pre- able coincidence" that the woman succumbed to contact skeletal series from Tonga (Steinbock I976:i59). syphilis within 35 years of its supposed appearance in London, but the possibility cannot be dismissed. Simi- NEW WORLD REMAINS larly, excavations at the Helgeandsholmen cemetery in Stockholm, used from A.D. I300 to I53I, have yielded Interest in prehistoric skeletal evidence of syphilis de- syphilitic remains (Madrid i986). veloped in America at about the same time as in Europe. Hudson (i96i:547-48) contends that "syphilitic The earliest discussion is usually attributed to Jones skulls and other bones have been found in 'leper cem- (i876), although Williams (I932:93I) cites an I875 ac- eteries' and doubtless many a European 'leper' lost his count, by R. J. Farquharson, of syphilitic lesions in skele- nose and his voice, or was covered with purulent tal remains from mounds near Davenport, Iowa. Jones's crusts, as a result of treponemal infection." If he is cor- (i876:49, 65-67, 7I-72, 85) detailed descriptions of skel- rect, then excavations of cemeteries associated with etal lesions in ancient inhabitants of Tennessee and medieval leprosaria should reveal skeletons of syphilit- Kentucky support his conclusion that syphilis (i.e., a ics in addition to lepers (his citations are to publications treponemal infection) was the cause of pathology ob- of i868 and I89I, prior to the establishment of diag- served in several individuals. Jones remarks (p. 66) that nostic criteria for syphilis and leprosy). Excavations at the tibiae are, in many cases, "thoroughly diseased, en- Danish leper hospitals and medieval churchyards and larged, and thickened, with the medullary cavity com- extensive examination of European skeletal collections pletely obliterated by the effects of inflammatory action, reveal no evidence of pre-Columbian treponemal disease and with the surface eroded in many places." Skeletal (e.g., M0ller-Christensen i952, I967; M0ller-Christen- involvement was not confined to the tibial shafts but sen and Faber i952; Weiss and M0ller-Christensen included the cranium, clavicle, sternum, and other long I97'). bones. Significantly, Jones notes the symmetrical distri- Yaws and/or endemic syphilis have occasionally been bution of the skeletal lesions. The crania are described reported in skeletal material from the Old World. An (p. 66) as exhibiting lesions "in which a network of isolated skull from Iraq, dated prior to A.D. 500, exhibits periosteal deposit had been formed, and which had been a large crater-like depression on the mid-frontal and a perforated by ulcers, subsequently forming and assum- smaller, slightly depressed area on the right side of the ing the annular type." Williams (I932:966) examined frontal bone that have been attributed to treponematosis some of the skulls in the Jones collection and verified (Guthe and Willcox I954:fig. 2; Steinbock I976:I41). An the presence of stellate scars in one specimen that he elliptical area of porosity on the occipital of an eight- also attributed to syphilis. Soon after Jones's disclosure, year-old child (INM i96) from the Chalcolithic site of claims of pre-Columbian syphilis in the Americas pro- Inamgaon in western India (dated I000-700 B.C.) is in- liferated (e.g., Gann I9OI, Lamb I898, Langdon i88i, terpreted as evidence of yaws (Lukacs and Walimbe Orton I905, Parrot i879), although much of the pur- i984:I23-24, fig. 7). This attribution is tenuous, how- ported evidence was deemed inconclusive by others (e.g., ever, since there is no other skeletal involvement and Hyde I89I; Putnam I878:305; Whitney i883). As with treponemal lesions are infrequent on the occipital. the European material, difficulty in differentiating dis- Australia and the Pacific islands have yielded many ease processes, incomplete skeletons, and absence of ar- examples of treponematosis in skeletal remains. Hack- chaeological context precluded reliable diagnoses in ett (I976:io9, II4) found treponemal changes in i% of most cases. Even the most conservative, however, de- the 4,500 Australian Aboriginal crania he examined and scribed skeletal lesions in ancient American remains argues that treponemal infection has probably existed in that they admitted might have been due to syphilis Australia "for some thousands of years." Unfortunately, (e.g., Hyde i89i:i28; Whitney i883:366). Williams no information regarding the antiquity of these remains (I932:976-77) considered reported cases of syphilis from is furnished, and it is uncertain if they predate European several areas in North and South America "as nearly free contact (see Steinbock I976:I4I, i58). Two subadults from suspicion as any that can be found." from Tinian, in the Mariana Islands, display treponemal In the Southeastern United States, reported evidence lesions thought to result from yaws (Stewart and Spoehr of pre-Columbian treponematosis abounds. Following i967[I95.2). Pathological changes consist of a crater-like Jones's (i876) report, Lamb (i898) described syphilitic depression surrounded by an irregular zone of porosity lesions in a skeleton excavated by Clarence B. Moore at on the frontal bone of one individual and similar lesions Lighthouse Mound, in northeastern Florida. Moore on the parietals. Parts of a femur, humerus, and radius (quoted in Bullen I972:I57) found the percentage of from the same individual exhibit periostitis with cavita- pathological specimens and degree of skeletal involve- tion. The incomplete tibia from the second subadult ment in the 74 individuals recovered remarkable and shows prominent thickening of the cortex along the an- indicated that "cranial nodes" were apparent. The skele- terior aspect (saber shin) accompanied by pitting and ton examined by Lamb (i898:63-64) was not accom-

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panied by the skull but exhibited "lesions of osteoperios- and in Australian anthropological collections." Two tib- titis, both hyperostotic and ulcerative," on the shafts of iae from another individual present thickening due to the long bones. Williams (I932:968) also examined this osteoperiostitis, probably a result of treponemal infec- individual and agreed that the lesions "were in all proba- tion (Williams I936:786). bility syphilitic." In an examination of over soo individuals at Mound- Bullen's (I972) survey of prehistoric skeletal material ville, Powell (i988a) observed a "high prevalence of sub- from Florida reveals considerable evidence suggestive of periosteal apposition on lower limb long bone shafts and treponematosis. Enlarged long bones exhibiting en- moderate prevalence of cranial stellate lesions." Perios- croachment upon the medullary cavity have been re- titis of major long bones is reported in 207 cases, of covered from the Tick Island Archaic site, radiocarbon- which 72% appear minor in extent and well-healed at dated to 3300 B.C. (p. i66). Burial 352 from Palmer death (Powell i988b). The absence of the dental stigmata Mound (FSM 97527) presents the most convincing case associated with congenital syphilis and the frequency of of pre-Columbian treponemal infection in Florida (pp. healed tibial lesions have led Powell (i988a,b) to attrib- I38-50). The site belongs to the Weeden Island period ute the observed pathology to a nonvenereal treponemal and dates to A.D. 850. The nearlry complete skeleton of syndrome (yaws or endemic syphilis). an adult female displays cranial caries sicca (see also A possible case of treponematosis from the Late Hackett I976:iio) and lesions on several long bones. Woodland Hardin site in the North Carolina piedmont The right humerus shows focal areas of destruction sur- has been described by Reichs (i987). The skeleton exhib- rounded by diffuse osteitis and dense reparative bone, its destructive and proliferative changes resulting in the radii and left fibula are slightly thickened with some node formation, expansion and cortical thickening of periosteal new bone formation, and the left tibia is ex- long bone shafts, medullary encroachment, and patho- panded and irregular. A radiograph of the left tibia re- logical fracture, with both cranial and postcranial in- veals multiple lytic areas surrounded by sclerotic bone volvement. Although the lesions are suggestive of trepo- that Hackett (I976:iio) has identified as superficial nematosis, Reichs recognizes that the overall pattern of cavitation of nodes-diagnostic of syphilis. Additional pathology in this individual may be due to the syner- remains from Palmer and several other prehistoric sites gistic effects of multiple diseases. (mostly Weeden Island, A.D. 850-I350) exhibit trepo- An apparent case of congenital syphilis in a six-to- nemal lesions (Brothwell and Burleigh I975:394; Bullen seven-year-old child (U.S. National Museum of Natural I972:i50-62; Iscan and Miller-Shaivitz i985), indicat- History, Smithsonian Institution collection [hereafter ing that the Palmer burial is by no means an isolated NMNHI, No. 379I77) from Virginia dates prior to A.D. case. I400 (Ortner and Putschar i985:207-io). Abnormal Treponematosis has also been identified in a prehis- reactive bone is evident in a frontal lesion, and the sur- toric skeletal series from Georgia. The remains of 265 face of the nasal aperture displays thickened, porous, individuals from Irene Mound (A.D. I200-I450), near periosteal bone. The extant deciduous incisors have hy- Savannah, reveal widespread inflammatory response poplastic defects so severe that, in three, the superior with marked diaphyseal expansion in the lower legs and portion of the crown had broken off before death. The arms (Powell i988c). Few cranial and naso-palatine le- deciduous and first permanent molars are unaffected, as sions are noted, but in some cases focal lytic lesions of is an observable unerupted permanent incisor. Postcra- the skull vault are apparent. The demographic and ana- nial skeletal involvement is extensive. The shafts of tomical patterning of skeletal lesions suggests endemic- both tibiae are thickened, with periosteal expansion oc- ity rather than venereal transmission. curring primarily on the anterior aspect. The other long Syphilis is proposed as the cause of bone pathology in bones also exhibit periosteal apposition and diaphyseal several specimens from northern Alabama, including a expansion, although to a lesser degree. A similar process cranium in which the palate has been almost completely is apparent in several metacarpals and metatarsals. Dac- eroded and only the remodeled edges remain (Rabkin tylitis is more common in yaws than in syphilis (Stein- I942:220-2 I, fig. 6). No specific provenience is provided bock I976:I43); however, a congenital disease is indi- for the syphilitic remains, but the sample includes mate- cated by the development of hypoplastic dental defects rial from as late as A.D. I400-i600 (p. 2i8). Prehistoric at about the seventh fetal month (Ortner and Putschar pathological remains suggestive of syphilis at Mound- 198 S:2 io). Thus, a pattern in which the bones with min- ville, Alabama, were first noted by Moore (I907:339- imal overlying tissue are most severely affected, as is 40). One skull that has received considerable attention commonly observed in treponematosis, accompanied by in the literature (e.g., Bullen I972:i63-64; Hackett congenital dental defects suggestive of Hutchinson's I976:I09-I0; Haltom and Shands I938; Williams teeth is strong evidence of congenital syphilis. Although I936:785-86) displays extensive erosion and new bone such dental stigmata are not pathognomonic of con- formation on the frontal, resulting in the stellate scars genital syphilis, they are associated with characteristic characteristic of caries sicca. Hackett (I976:iio) indi- bone lesions in about 50% of all cases, and the diagno- cates that although the changes in this skull are not sis in such instances is "very reliable" (Steinbock typical caries sicca, "in which the nodules are smaller I976:io6). and of more regular size," the diagnosis of trepo- The skeleton of a 25-35-year-old male (NMNH nematosis is "fully supported by the presence of similar 385788) from a site radiocarbon-dated to A.D. 925 pro- changes in [crania found inl European medical museums vides additional evidence of treponematosis in prehis-

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toric Virginia (Ortner i986). Remains from tidewater vault changes suggestive of treponematosis (Broth- and piedmont sites in Delaware, Maryland, and Virginia well and Burleigh I975:394). At least two skeletons that exhibit inflammatory lesions on the frontal and as- from Indian Knoll, Kentucky (radiocarbon-dated ca. sociated long bones are in some cases suggestive of 3350 B.C.), exhibit such lesions (Brothwell and Burleigh syphilis (Stewart and Quade i969). Hackett (I976:iio) I975:393; Steinbock I976:96), thus extending the evi- indicates that the skull from Accokeek, Maryland dence in the Ohio Valley region to the Archaic period. (NMNH 378I96 [Stewart and Quade I969:pl. i-CI), ex- Cassidy (ig80:I36-38; i984:325, 330-32) has identified hibits serpiginous cavitation (diagnostic of trepo- a "syndrome of disseminated periosteal reactions," dis- nematosis). Although the piedmont sites are late prehis- tinct from localized inflammatory lesions, in skeletal toric, the tidewater sites discussed by Stewart and series from Indian Knoll and the late Fort Ancient- Quade (i969:92-93), including Accokeek, date from A.D. period Hardin Village (ca. A.D. i525-i675). This syn- i2oo-i600; it is therefore uncertain if the remains are drome is characterized by thickening of the long bones, pre-Columbian. particularly those of the legs; development of "stripes of A possible case of pre-Columbian treponematosis smooth billowed material or patches of rough porous from the Veddar site (Cnj 43-2, also known as the material on the surfaces; and some diminution of the Palatine Bridge site) in the Mohawk Valley of New York medullary canals in severe cases" (Cassidy ig80:I36- is the only evidence reported in northeastern North 37). Such lesions are indicative of a nonvenereal trepo- America (Elting and Starna i984). The remains in ques- nematosis that affected 2.4% of the Indian Knoll popula- tion are thought to date to the Early Woodland compo- tion and 3I.4% of the Hardin Village series, where eight nent of the site (500 B.C.) and are undoubtedly pre- individuals display severe manifestations (Cassidy Columbian. The tibiae and fibulae of one individual i984:325, 330). The increase in incidence of this syn- exhibit diffuse periosteal inflammation and new bone drome in the post-Columbian group is postulated to be a formation with narrowing of the medullary canals. result of increased population size and sedentism (Cas- Coarse striations and nodes with superficial cavitation sidy ig80:I37). are described, and the latter is noted to be one of Hack- A considerable amount of purported treponematosis ett's (I976) diagnostic criteria. The changes evident from has been discovered in Woodland and Mississippian re- the photographs (Elting and Starna i984:270-7I, figs. 2 mains in Illinois. The material is from the lower Illinois and 3) may more closely correspond to Hackett's River valley, in the west-central portion of the state. A (I976:82-83) coarsely striated and pitted expansions, high incidence of cranial lesions (attributed to various only tentatively considered diagnostic. The absence of causes) in a skeletal series from the Jersey County Bluff sequestrum and cloaca formation, however, rules out os- mounds (A.D. 400-I400) is noted by Stewart and Quade teomyelitis, and the changes apparent in the medullary (i969:95-96). Of 122 relatively complete skeletons, 4 canals indicate that "a diagnosis of treponematosis is (3.3%) exhibit both frontal and long bone lesions. Hack- reasonably secure" (Elting and Starna i984:272). ett (I976:iio) indicates that one skull (NMNH 380044 Syphilis was reported in remains from the Ohio Valley [Stewart and Quade I969:pl. i-Al) from this series exhib- as early as i88i (Landgon i88i:254-56). William C. its serpiginous cavitation and another (NMNH 379875 Mills's excavations at several Ohio sites in the early [Stewart and Quade I969:pl. 2-Cl) "a rather atypical I9OOS revealed a large number of burials, many of which caries sicca." The cranium and left tibia of an individual were pathological. For example, of I27 individuals from from the Middle Woodland (ca. IOO B.C.-A.D. 400) com- the Baum site (A.D. 950-i250), 2i were diseased, and ponent of the Carter Mound Group (Burial 7, Mound i) at least i.2 were deemed syphilitic by Orton (Mills in adjacent Greene County illustrates the pathology usu- i906:i26-35; Orton i905). Williams (I932:954-62) ex- ally reported in the literature as "syphilis" (Buikstra amined much of the prehistoric skeletal material from I979: 233). A 40-year-old Middle Woodland male from the Ohio State Museum and found long bones with pos- the Klunk site (C4o, Burial 2i) in Calhoun County also sible syphilitic lesions in i5 individuals (at least one of exhibits cranial and long bone lesions suggestive of which had been previously described by Means [i9251). treponematosis (Morse I978:I36-37, pl. iS A-C). In 9 cases, three different roentgenologists agreed that Additional cases have been reported somewhat farther the proliferative bone changes resulted from syphilis. Six up the Illinois River in Schuyler and Fulton Counties. tibiae from 4 different individuals are depicted and de- The skeleton of a 30-40-year-old male from the Rose scribed in detail. In general, they display thickening of Mound Group (Middle Mississippian, A.D. I1200-I400) the anterior aspect, with a slightly nodular surface per- in Schuyler County displays cranial and postcranial forated by small openings. Where both tibiae are pre- pathology suggestive of treponematosis (Morse i967:48- sented, the involvement is bilateral. Hackett (I976:io9) 52; I978:53-55, i66-69, pls. 30 A and B, 3i A-E). The indicates that these specimens do not exhibit diagnostic naso-palatine destruction is extensive, including the al- criteria of treponematosis. Williams (I 932:955), how- veolar area, intranasal structures, and nasal bones. The ever, states that the bones he described were "only a maxillary incisors have been lost antemortem. Some portion of the ancient diseased, probably syphilitic, healing is evident along the perimeter of the nasal cav- bones that have been disclosed by the investigations of ity. There is slight involvement of the frontal bone. The the Ohio State Museum." anterior portions of both tibiae show periostitis and os- Nine individuals from May's Lick, Kentucky, radio- teitis with cavitation, as do the distal portions of the carbon-dated to A.D.1325 (58o ? Io8 B.P.), show cranial humeri, the upper third of the right ulna, and the left

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clavicle. Hackett (I976:97) categorizes the long bone le- cortical enlargement with porosity. The anterior sur- sions as nodes/expansions with superficial cavitation faces consist of raised plaques and spicules. The remains and therefore diagnostic of treponematosis. A case de- are thought to be pre-Columbian. scribed by Morse (i967:52-58; I978:55-57, I66-69, pls. Remains from the Late Mississippian Nodena culture 30 C-E, 3 I W-Z) in Fulton County consists of the fairly (ca. A.D. I400-I700 [D. F. Morse I973:831) are reported complete skeleton (T-6) of a 35-year-old male. The re- to display evidence of treponematosis. Typical lesions mains are from the Thompson site and date to the Early are described in six skeletons and additional isolated Mississippian period, approximately A.D. iooo. The an- bones from the "vicinity" of the mounds in Crittenden terior portion of the frontal displays subperiosteal thick- and Mississippi Counties in northeastern Arkansas ening with cavitation of the outer table surrounded by (Wakefield, Dellinger, and Camp i937). The tibial shaft slight erosion. Postcranial lesions are evident on the is most often affected, and in some cases "the sharp an- right tibia, radius, ulna, and humerus, both femora, and terior crest was replaced by a rounded surface and this the right clavicle. Generally, they exhibit cortical thick- thickening gave the shaft the appearance of having been ening and sclerosis, with some focal destruction (pitting bowed anteriorly" (p. 491, fig. 4). Fibulae, radii, ulnae, and sinus formation) and encroachment on the medul- and clavicles show a similar "deforming osteitis." Ero- lary cavity. Lesions on the sacrum and greater trochanter sion of the palate and nasal bones is evident in one skull. of the right femur are of a different nature and are attrib- Extensive cranial and postcranial involvement in one uted to bed sores. The skeleton of a Middle Woodland skeleton (pp. 491-92, fig. 3) provides a convincing case. resident of Fulton County (originally described by The cranial vault of this individual (No. 6) has a nodular Denninger) exhibits osteoperiostitis that Williams surface typical of caries sicca, and the long bone X-rays (1936:787) diagnoses as syphilis. Both tibiae and fibulae reveal cortical thickening with encroachment upon the present bone proliferation of periosteal origin with some medullary canals. Although no European trade items narrowing of the medullary cavity. Hackett (1976:97) were found with these burials, their apparent Nodena notes the similarity of the "pronounced periostitis" on affiliation indicates that they may postdate 1492. the anterior surfaces of the femora, tibiae, and fibulae in Morse (1973:50-52, 54-55) has also described Nodena a Late Archaic Red Ocher burial (I500-1000 B.C.) from material from Mississippi County with lesions sugges- Fulton County to that in yaws patients in Uganda and in tive of treponematosis. HM 9I6, an isolated skull of a Australian Aboriginal bones. The skeleton of this 22- 26-year-old female, displays "an area of sclerotic peri- year-old female from the Morse site (F772, Burial I2) is osteal reaction with pitting over almost the entire left described and illustrated by Morse (1978:I7, 13 2-33, pl. half of the frontal bone," substantial involvement occur- 13 A and B). According to Hackett (1976:97), the long ring above the left orbit (fig. 27a). Steinbock (1976:96) bones depicted exemplify the diagnostic nodes/ex- agrees that this "closely resembles syphilis." An X-ray pansions with superficial cavitation. (Morse 1973: fig. 27b), however, reveals the presence of a In an epidemiological study of Illinois Woodland popu- mud-dauber nest inside the skull. In our opinion, the lations, Cook (1976, i984) observes a pattern of osteitis lesions are not diagnostic of treponematosis and are far and periostitis suggestive of treponematosis. In the Late more likely to have resulted from destruction by the Archaic Klunk skeletal series, 3' of 123 individuals wasps. HM goo consists of the skull of a female aged 22 (25%) exhibit treponemal lesions, whereas Middle and and exhibits cicatrization of the nasal aperture, with loss Late Woodland populations show an overall prevalence of the anterior nasal spine and nasal septum and involve- of approximately So% (Cook i984:259). The Mississip- ment of the nasal bones. The entire palate is eroded, pian Schild site reveals a prevalence similar to that of with healed sclerotic borders remaining. The maxillary the Woodland groups. The prevalence of the treponemal sinuses have large eroded openings, and the involvement disease and absence of indicators of congenital infection, extends to the ethmoid and orbits. Morse (1973:54) at- while atypical of venereal syphilis, are characteristic of tributes the observed pathology to a malignant tumor nonvenereal treponematosis (Cook 1976, i984). Thus, but does not rule out the possibility of treponematosis or yaws or endemic syphilis seems to have existed in Il- leprosy. The lack of alveolar involvement would elimi- linois for nearly 3,000 years. nate leprosy, and healing is not found in neoplasm In Arkansas, the incomplete skeleton of an adult fe- (Hackett 1976:65). The absence of frontal pathology does male (NMNH 258778) discovered during Moore's exca- not preclude the possibility of a treponemal lesion simi- vations on the St. Francis, White, and Black Rivers in the lar to the gangosa of yaws. Hackett (1976:63; see also early part of the century includes several pathological Ortner and Putschar i985:ig2, figs. 274-79, and Stein- bones (Ortner and Putschar i985:210-14, figs. 329-32). bock 1976:145, i5i) indicates that such naso-palatine The external table of the skull vault exhibits an "irregu- destruction is characterized by "an empty nasal cavity lar lumpy appearance" with "typical gummatous lesions . . . presenting a smooth, 'bored out' tunnel-like passage- characterized by a mixture of bone formation and de- way" and may be accompanied by opening of the eth- struction" (Ortner and Putschar i985:2i2). There is moid sinuses and partial or complete destruction of the some involvement of the inner table. The proximal palate and maxillary alveolus. Thus, "when extensive metaphysis of the left ulna and the proximal shaft of andthe healed," this type of naso-palatine destruction "is a left femur show expansion of the cortex. The entire shaft diagnostic criterion of syphilis" (p. 65). of the right femur and the left proximal tibia exhibit Despite excavation of nearly 2,ooo Nodena burials,

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few complete skeletons are extant. Early excavators did (Walker i983:499). The site, radiocarbon-dated to 515 not consistently save skeletal material, and the majority B.C., is affiliated with the Pelican Lake phase of the Late of the collection consists of crania and pathological Archaic period. Resorptive lesions appear on the right specimens. Thus, of 43 relatively complete individuals margin of the manubrium, the sternal end of the right from the Upper Nodena site, 37 (86%) display inflam- clavicle, and the left side of the centra of the second matory lesions, as do 9 of i6 such individuals (56.3%) and third thoracic vertebrae of a 36-46-year-old male. from the Middle Nodena site (Powell I988d). Powell re- Walker suggests (pp. 50i-2) that the erosion is due to ports that the lower long bones show "localized patches pulsation of an aneurysm. Clinical descriptions indicate of mild to moderate periostitis, well-healed at death, that syphilitic aneurysms typically occur on the ascend- most typically affecting the anterior crests and lateral ing aorta and cause pulsation of the right sternoclavicu- aspects of . . . tibia shafts." Several tibiae are noted to lar joint. In contrast, aneurysms due to atherosclerosis display "saber shin." Five of the individuals with mild to are very rare in the aortic arch and in the age-group of moderate tibial periostitis exhibit remodeled cranial le- this individual. sions. Six isolated crania (one identified as HM goo) also Evidence of pre-Columbian treponematosis is lacking present focal lytic lesions, in one case described as "le- in northwestern North America. Syphilitic skeletal ma- sions of the distinctive 'stellate' configuration associ- terial abounds, however, in i8th- and i 9th-century Alas- ated with the gummateous skin ulcers of treponemal kan material (see Cook i 985; Holcomb 1940; Meer infection" (Alabama Museum of Natural History, Nod i985; Ortner and Putschar i985:214-i8, figs. 333-40), 432 [Powell i988d:pl. i]). The lesions evident in the pho- where venereal syphilis was apparently introduced after tograph correspond to Hackett's (1976:36) confluent Russian contact. In California, nine individuals exhib- clustered pits, diagnostic of treponematosis when ac- iting periostitis suggestive of treponematosis were re- companied by healing. From this evidence Powell con- covered from a Middle Horizon (500-200 B.C.) site in cludes that an endemic treponematosis was present in Sonoma County (Son 299; Roney i966:ioi-2). A Late the Nodena population. A high frequency of generalized Horizon specimen (Scr.I.83.4434) has been radiocarbon- periostitis, noted by several investigators (see Rose et al. dated to A.D. 1105 (Brothwell and Burleigh 1975:394). i984:414-1 5), is evident in skeletal series from Baytown Tenney's (i986) survey of osteological material in the (A.D. 300-700), Coles Creek (A.D. 700-12oo), and Missis- Lowie Museum of Anthropology disclosed many indi- sippian (A.D. i2oo-i680) sites in eastern Arkansas and viduals with generalized skeletal lesions like those Louisiana, providing support for the long-standing oc- expected in treponematosis. Nasal destruction, palatal currence of treponematosis in the lower Mississippi Val- perforation, cranial sclerotic new bone formation, and ley. fusiform tibial lesions without cloacae are noted. Stewart and Quade (i969:9i) describe frontal lesions In the Southwestern United States, additional evi- in a Hopewellian skull (NMNH 379109) found near Kan- dence of pre-Columbian treponematosis has ac- sas City, Missouri, as possibly due to treponematosis. cumulated. Hyde (i89i:ii9-2o, 124-28, fig. 6) reported The skull has three depressed scars on the middle of the two pathological tibiae from a prehistoric (Basket- frontal and similar scars around each parietal boss. At maker?) burial found near the Animas River, about 45 the precontact Morris site in southeastern Oklahoma, miles from Durango, Colorado. The tibiae are enlarged, over a third of the adults exhibit "osteitis with tremen- and the surfaces of both shafts are roughened and porous, dous swelling," primarily in the tibiae (Brues I966:io8- with apparent striations and "superficial erosions" re- 9). Brues describes a sequence of long bone lesions very sulting from a "chronic inflammatory process." The left similar to Hackett's (1976), culminating in the forma- tibia appears bowed. While syphilis is not ruled out as tion of pits. Cranial lesions similar to those illustrating the cause of this "chronic rarefying and formative os- syphilis are also noted. Two precontact skulls with teitis, with osteomyelitis and chronic formative perios- "gnarled and pitted" surfaces are described by Goldstein titis," it is indicated that such a diagnosis may not be (1957:302, pl. i b-d) as suggestive of syphilis. One skull justified (pp. 127-28). At Mesa Verde National Park, the (Cat. No. 411, Sanders Site, Lamar County) is accom- remains of a 24-year-old male from the Pueblo III (A.D. panied by pathological tibiae, fibulae, and a femur 1100-1300) Mug House exhibits bilateral symmetrical (Goldstein 1957:pl. i c and d). The other (Cat. No. 66oB, enlargement and bowing of the tibiae in the ante- Willison Farm, Bell County) does not appear to be ac- rior-posterior plane (Miles i966:96; 1975:.28, fig. 33). companied by postcranial remains. In South Dakota, Although treponematosis is possible, the smooth several bones from the 14th-century Crow Creek site periosteal surface does not support such a diagnosis (39BF1 i ) display varying degrees of periostitis, with con- (Miles 1975:28). siderable new bone formation and narrowing of the The skull and right femur of an adult female (Case medullary cavity in some tibiae, resulting in a saber-shin 60455) from Pecos Pueblo, New Mexico, excavated by appearance (Gregg, Allison, and Zimmerman i98i). Kidder and originally described by Hooton (1930), show Osseous lesions from a possible syphilitic aortic aneu- caries sicca on the frontal and parietals, partial destruc- rysm provide the only evidence of treponemal disease in tion of the nasal bones, with subsequent healing, and a gatherer-hunter group from the northern Plains. The dense periosteal bone apposition on the femur (Williams remains are from one of five individuals interred in the 1932:932-34). Hackett (1976:IO9) concurs with Wil- Bracken Cairn (DhOb-3) in southwestern Saskatchewan liams's diagnosis of syphilis in this individual. Two

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other crania from Pecos Pueblo (Cases 59864 and 59814) an active lesion surrounded by serpiginous and nodular exhibit cicatrization of the nasal and palatal areas (Wil- cavitation is apparent. The long bones illustrated (figs. liams 1932:934-37) similar to that described in the Ar- 9-I I) present fusiform expansion of the shafts. Dating of kansas HM goo skull. Ceramics associated with these the site does not seem well established and ranges from remains indicate that they date to the Pueblo IV period the 6th to the i6th century (p. 289). Williams (1936:784- (A.D. 1300-1540). Case 59814 dates to the latter portion 85, fig. i) reports that a pre-Hispanic Aztec skull from of this period and may not be pre-Columbian. Elsewhere Santiago Tlaltelolco (near Mexico City) exhibits two in New Mexico, an isolated tibia (SM 56A) recovered lesions, one of which has destroyed nearly half of the from Smokey Bear Ruin exhibits periostitis and defor- frontal. This defect is accompanied by reactive bone for- mation due to considerable subperiosteal bone apposi- mation at the perimeter, resulting in "the characteristic tion (El-Najjar 1979:604, fig. 3b and c). Sequestra and worm-eaten appearance seen on some syphilitic skulls," cloacae are absent. Ceramics indicate that the site was and resembles the active lesion described in the Can- used around A.D. 1250-1350. delaria skull. The skull of an adult male, dated to 300 Scattered sites in Arizona have yielded further evi- B.C., from the Tehuacain Valley in Puebla exhibits simi- dence of treponematosis. Williams (1936:786-87) re- lar destruction of the cranial vault (Anderson i965). ports that a skeleton from the Basketmaker period (ca. Mayan remains from Central America also include in- 200 B.C.-A.D. 700) exhibits lesions in four long bones dividuals with apparent treponemal disease. Goff (i967: accompanied by a stellate scar on the skull, which he 288-89, fig. 7) refers to two crania from Zaculeu, attributes to syphilis. Of some 400 burials from Guatemala (A.D. 900-IOOO), as syphilitic. One shows ap- Tuzigoot Ruin, near Clarkdale (south of Flagstaff), one parent caries sicca on the frontal, while the other dis- skull shows extensive destruction of the frontal and na- plays a large parietal defect with no evident healing and sal bones and perforation of the palate (Denninger 1938). periostitis on the frontal. Inflammatory lesions in ten Tuzigoot was inhabited from about A.D. 1000-135o. A individuals (I5.9% of adults) buried at Altar de 2o-25-year-old female (CdC No. 2) from a Pueblo II (A.D. Sacrificios, Guatemala, before A.D. 950 exhibit osteitis 900-Iioo) site at Canyon de Chelly displays gumma- suggestive of treponematosis (Saul 1972). Cranial lesions tous destruction and bone necrosis producing a "worm- alone are evident in two individuals (table 8). Burial No. eaten" appearance of the cranial vault (El-Najjar 96 (fig. io) exhibits periostitis, which is not diagnostic. 1979:604-5, fig. 4 a and b). The photographs are illustra- Cranial lesions of Burial No. 129 (p. 42, fig. 7) may actu- tive of Hackett's (1976:43-45) diagnostic criteria of ser- ally be due to postmortem insect damage. Six individ- piginous and nodular cavitation. South of Canyon de uals show only postcranial involvement, while two have Chelly, near Fort Apache, 2 of 57 individuals excavated both cranial and postcranial lesions (table 8). Postcranial at Kinishba and Vandal Cave are suspected of suffering lesions consist of cortical thickening and enlargement of from treponematosis. Tree-ring dates at Kinishba range the long bone shafts, resulting in the saber-shin tibia from A.D. 1233 to 1306, while the Basketmaker II and evident in Burial No. 112 (figs. 22-24). In Belize, a Pueblo III occupations at Vandal Cave date from A.D. 6o8 Mayan tomb revealed the remains of an adult male with to 683 and prior to A.D. 1300 respectively (Cole et al. enlarged tibiae presenting a surface "covered with a 195 5:23 i). Pronounced fusiform expansion and focal pit- number of small nodular outgrowths, between which ting of the cortex of the right tibia shaft accompany were small pits or depressions" (Gann I9OI:969). With periosteal bone proliferation in the skull of A-17-0-17 this skeleton were three clay figures of men performing from Kinishba (pp. 232-35, figs. 1-3). An isolated right an operation with a pointed implement on the head of tibia from Vandal Cave (VI-B-s) has a saber-shin appear- the disproportionately large penis and "a natural-sized ance caused by deposition of new periosteal bone on the model of the human penis in a state of semi-erection" on anterior aspect of the shaft (pp. 23 5-36, fig. 4). In the Salt which "three longitudinal incisions" were made on the River Valley, near Phoenix, excavations conducted at glans (p. 969). Gann takes this as evidence that the Los Muertos in the late I89os revealed several skeletons buried individual suffered from a venereal disease and that suggest the possibility of treponematosis. Mat- that this disease, as indicated by osseous involvement of thews, Wortman, and Billings (i893:172) describe one the tibiae, was syphilis. individual with "irregular nodular hypertrophy" of the South American evidence of pre-Columbian trepo- shafts of both tibiae, both ulnae, and the distal right nematosis comes primarily from Peru. At Paracas, two fibula and other individuals with involvement of the tib- individuals from tombs excavated by Julio Tello in 1929 ial shafts alone. Los Muertos is a Classic Hohokam site, are considered by Williams (1932:937-46) to be syphi- dating between A.D. IIOO and 1450 (Gumerman and litic. The remains are affiliated with the early Nazca Haury 1979). culture, approximately 200 B.C. (Lanning i967:25-27, Mexican remains also provide evidence of pre- 122; Williams 1932:938). The first individual displays Columbian treponematosis. Goff (i963; i967:289-9i, stellate scars (caries sicca) over much of the cranium. figs. 2-6, 9-Ii) attributes pathological changes in 2o The accompanying long bones (both femurs and the left skulls and several long bones from Cueva de la Can- tibia, humerus, and ulna) show marked periosteal bone delaria, Coahuila, northeastern Mexico, to treponemal apposition with some encroachment upon the medul- infection. The skulls exhibit osteitis and periostitis re- lary canal and present nodular surfaces with small open- sulting in a nodular appearance. In one case (i967: fig. 3), ings. The second, mummified individual suffered from a

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large ulcer on the roof of the mouth that had perforated syphilitic by Broca and other European authorities. From the hard palate. The lower portion of the body was the Chubut River valley, a probably pre-Columbian poorly preserved. Hackett (1976:Iog), referring to skullthe shows gummatous lesions (p. 973). Another skull, photographs of the Paracas crania, indicates that the from Calchaqui, exhibits a mass of smooth-edged scars, diagnosis of syphilis in both cases "may not be accept- with thickening of adjacent areas and nasal destruction able." Although his caution is justified, the photographs accompanied by healing (pp. 973-74). and description do lend credence to a diagnosis of trepo- nemal infection in the first case. A burial excavated by Kroeber in the Cafiete Valley, Discussion Peru, dated about A.D. 500, is also described as syphilitic (Williams 1932:948-54). Although the skull is normal, a Review of the documentary and skeletal evidence for chronic inflammatory osteoperiostitis produced "dense, pre-Columbian syphilis reveals many ambiguities in ivory-like bone" over the entire shaft of the left femur dates and differential diagnosis. What, then, can be de- and both tibiae, with some encroachment upon the termined from this evidence? medullary canal. The left fibula is involved to a lesser Is it possible that syphilis and leprosy were confused extent. The lateral view of the right tibia indicates con- before the 149os? Ancient and medieval texts portray siderable bone apposition on the anterior aspect. Hack- leprosy as a highly contagious disease with a short incu- ett (I976:Iog) states that these long bones do not exhibit bation period, associated with immorality, sexually and lesions diagnostic of treponemal disease, but according congenitally transmitted, and responding to mercury to Williams (1932:948) "the absence of sequestrums and treatment (Holcomb 1935:297-303; Hudson 1972:149). of deep sinuses tends to exclude nonsyphilitic periostitis Leprosy has none of these characteristics. Syphilis, and osteomyelitis." however, is not the only disease that manifests such An eight-year-old child from Machu Picchu (Peabody features. It is just as likely that such descriptions refer to Museum, New Haven, No. 5 i-92io) dated ca. A.D. other venereal or skin diseases. Drawing diagnostic con- iioo-i2oo allegedly exhibits congenital syphilis (Goff clusions from these accounts is "unconscionable," as i967:293, fig. I2; Williams 1932:972) Lesions are evi- one is "faced with a spectrum of dermatologic diseases, dent on the frontal and are accompanied by saber-shin exanthems, leprosy, tuberculosis, and epidemics in the tibiae. No reference is made to the dentition. Other tib- Middle Ages of louse-borne typhus, bubonic plague, and iae in this series exhibit similar enlargement (Williams widespread ergotism" (Kampmeier i984:28). 1932:972). MacCurdy (1932:264, pls. 38, 41) reports Many authorities (e.g., Brown et al. 1970:82; Harrison three cases of possible syphilis at sites in the Urubamba I986:5I; Kampmeier I984:19, 2i, 28; Sussman Valley near Cuzco. The cranium of a six-year-old from i967:214; see also Rosebury 197 1:20-2i) attribute bibli- Paucarcancha (Cat. No. 5i) exhibits considerable necro- cal and other ancient disease descriptions such as those sis of the left parietal and frontal. At Patallacta, the left previously summarized to gonorrhea rather than parietal of an eight-year-old child (Cat. No. 938) has a syphilis. Galen, in the 2d century A.D., invented the circular area of necrosis 4.2 cm in diameter, and the term "gonorrhea" (seed flow) to describe the discharge cranium of a 26-year-old male (Cat. No. 635) displays an associated with the disease (Brown et al. I970:82; Kamp- area of necrosis nearly 5 cm in diameter that has a large meier i984:28). The hard and soft genital sores described perforation at its center. In none of these cases is reac- by Galen and Celsus may have been not syphilitic con- tive new bone formation apparent; therefore treponema- dylomata but evidence of chancroid, genital herpes, ve- tosis is probably not the cause. Williams (1932:972) nereal warts, granuloma inguinale of leishmaniasis, or agrees with this assessment in the first two cases but other nonvenereal skin diseases (Kampmeier i984:26- considers the adult male a possible example of syphilis. 27). Along with cutaneous lesions and granuloma in- The apparent Inca affiliation of these sites indicates that guinale, leishmaniasis may also cause destruction of the they may be post-Columbian. nasopharynx (Steinbock 1976:I5I). In addition to At Aguazuque, a preceramic site in central Colombia, syphilis, several other diseases causing skin lesions can i 3 of 40 individuals (32.5% ) demonstrate lesions associ- cross the placenta to infect the fetus. Among these are ated with treponematosis, particularly in the tibia, in rubella (German measles), measles, smallpox (variola), some resulting in a saber-shin deformity (Correal Urrego chickenpox and shingles (varicella-zoster virus), genital i987). Three of these individuals also display caries herpes, and gonorrhea (Rosebury 1971:55-56). All of sicca. A skeleton with both cranial and postcranial le- these are highly contagious diseases with short incuba- sions is radiocarbon-dated to 2o80 B.C. (4030 ? 80 B.P.). tion periods, and the latter two are acquired through Correal Urrego suggests that since yaws is rare in this sexual intercourse. part of modern Colombia the pathology stems from ve- Mercury treatment has been cited by proponents of nereal syphilis. the pre-Columbian hypothesis as proof that ancient In Argentina, a pre-Columbian skull from Rio Negro is "leprosy" was syphilis. Mercury, however, was com- regarded as above suspicion by Williams (1932:946-48, monly prescribed for many disorders. In his medical 976) although he did not personally examine it. It had treatise of I546, Fracastor advocates rubbing mercurial previously been described as exhibiting "little elevations ointment on the inner arms to cure a severe headache and depressions that were like scars" and pronounced (Rosebury 1971:47). Although application of mercury is

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known to have an effect on syphilis, it also results in a creasingly being transmitted sexually in the more ad- rapid reduction in gonorrheal discharge and probably re- vanced areas, culminating in the identification of lieved symptoms of several other diseases (Harrison syphilis at the end of the i5th century. Endemic 1959:6-7; cf. Hudson i96i:548-49). syphilis, associated with poor hygiene and primitive liv- Did an epidemic of syphilis begin in the late 149oS? ing conditions, did exist in Europe until the mid-i 8oos- The documentary evidence regarding the appearance of a as sibbens in Scotland, button scurvy in Ireland, new disease is ambiguous in terms of symptoms de- radesyge in Norway, saltfluss in Sweden, and spirocolon scribed, but the numerous ordinances passed throughout in Greece and Russia-but was not recognized until the Europe in the late 1490S in an effort to control the dis- middle of the 17th century (Morton I967:374; Steinbock ease and the proliferation of publications regarding it I976:I38). In Scotland, the introduction of endemic indicate that a highly contagious infection that caused syphilis was blamed on Cromwell's army in I650 (Mor- genital and cutaneous lesions was raging at that time. ton I967:374-75). In contrast, edicts concerning ve- Was this epidemic the result of differentiation of nereal syphilis were issued in Aberdeen and Edinburgh syphilis and its widespread recognition as a disease dis- in 1497. Thus, while the cities and towns were ravaged tinct from "leprosy"? In support of the pre-Columbian by a venereal disease, treponemal infection seems to hypothesis, it has been noted that leprosy declined at have spread slowly to the countryside, where social con- this time and that edicts regarding the new disease were ditions allowed nonvenereal transmission to prevail. quite similar to those previously issued to isolate lepers. The epidemiological aspects of the unitarian hypothesis The characteristic hard chancre of syphilis was first de- are supported. However, if syphilis was recognized as a scribed in 1514 by de Vigo, and syphilitic and non- distinct disease at the end of i 5 th century, documentary syphilitic condylomata were differentiated in i563 evidence indicates that the venereal form of trepo- (Brown et al. 1970:82; Kampmeier i984:26-27). It is pos- nematosis was the first to appear, followed by reversion sible, however, that these lesions were not described to an endemic form in rural areas. Again, rather than prior to I500 because they did not previously exist in the supporting the pre-Columbian existence of trepo- Old World. Holcomb (1934, 1935) has explained the de- nematosis, a case can be made for the appearance of a cline in "leprosy" as a transference of the symptoms new disease which was subsequently included in a cate- associated with that disease to syphilis. If the two dis- gory of maladies manifesting similar lesions. eases were differentiated by the late 1490S, why do i6th- As Hudson (I968:6) indicates, "by selecting the 'right' century descriptions continue to apply the term "lep- witnesses and dates and discarding the rest, it is possible rosy" to syphilis? Paracelsus (1493-1541), for example, to build a case for either view, depending on the credibil- thought that "leprosy and venereal bubas" (quoted by ity of the witnesses and the credulity of the reader." On Brody [1974:56-571) were the first stage of syphilis. theHis basis of the documentary evidence prior to 1492, description is usually explained as confusion of syphilis syphilis cannot be excluded from the list of diseases that with gonorrhea (Brown et al. 1970:82; Kampmeier may have been grouped under the term "leprosy." The i984:.26). Similar diagnostic difficulties plagued scholars lack of syphilitic skeletal material in European leper of the i6th through igth centuries until syphilis and cemeteries, combined with the dearth of Old World gonorrhea were finally differentiated (Brown et al. remains that have even been suggested to exhibit trepo- 1970:82-83; Hackett i963:29; Kampmeier i984:26-28; nemal lesions, however, precludes this possibility. If Rosebury 1971:i8i). By the end of the isth century, treponematosis evolved with Homo, as postulated in the "leprosy" had become identified with syphilis to the ex- unitarian hypothesis, and was among the diseases de- tent that Job, once the patron saint of lepers, became the scribed in biblical, Greek, Roman, and medieval texts, patron saint of syphilitics (Brody 1974:56-58, igi-92; then skeletal evidence suggestive of treponematosis Creighton i965 [i8941:io2). Although the symptoms should be abundant in the materials recovered from Old were being transferred from one disease to another, it World sites. The case for pre-Columbian syphilis in the appears that syphilis was being grouped with ailments Old World rests solely on vague and ambiguous disease having similar symptoms rather than being differ- descriptions and must, therefore, be rejected. entiated from them. This would seem to indicate that Was syphilis present in the New World before 1492? A syphilis was a new disease. substantial amount of documentary evidence from the Was the epidemic of venereal syphilis due to increas- early i6th century indicates that it was. These docu- ing urbanization and improved hygiene in late isth- ments, as previously discussed, present ambiguous de- century Europe? The decline in the incidence of leprosy scriptions and inconsistencies in dates. Williams and co- actually began in the 14th century and has been at- workers (1927:686) find the Native American linguistic tributed to improved living conditions (Clay i966 evidence tenuous because of possible confusion of [19091:41-43; Rubin 1974:151-53). The incidence of syphilis and yaws. The absence of the dental stigmata nonvenereal treponematosis, if it had been present in associated with congenital syphilis (with the possible Europe, would also have decreased with such improve- exception of the child from Virginia) has been cited as ments. Hudson (i96i:548; I965a:897) postulates that proof that venereal syphilis did not exist in the New endemic syphilis was present in Europe from Roman World. The etiological unity of the treponemal syn- times and retreated to rural areas in the Balkans, Russia, dromes, however, renders such objections moot. and Scandinavia as standards of living rose during the Despite Williams's (1932:977) assertion that the Middle Ages. In the meantime, the treponeme was in- amount of New World skeletal evidence of trepo-

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nematosis is "almost embarrassing" in comparison with the New necessitates revision of Hudson's thesis that the Old World data, Hackett (I976:III) is alarmed that treponematosis originated in Africa and was subse- few pre-Columbian American bones (about i in 500) ex- quently carried throughout the world in the course of hibit the diagnostic criteria of treponematosis. It must human migrations. It appears, instead, that trepo- be reiterated that bone lesions are expected in only i - nematosis is a relatively new disease that originated in 5% of individuals in skeletal series from areas in which the tropical or temperate zone of the Americas and was yaws or endemic syphilis occurred. Furthermore, a con- spread by casual contact. This nonvenereal infection is siderable amount of material has come to light since the disease that was initially contracted by Columbus's Hackett's review. Investigations in the Midwestern and crew, but social and environmental conditions in Europe Southeastern United States (e.g., Cassidy I980, I984; at that time were conducive to its venereal dissemina- Cook 1976, I984; Powell i988a, b) reveal treponemal tion in urban areas. The transition of one treponemal infections involving up to half of the population. While syndrome to another under differing environmental and these reports differentiate localized inflammatory le- social circumstances has been frequently documented in sions from the syndrome of diffuse periostitis suggestive modern populations (e.g., Grin I96I; Hudson I965a:889; of treponematosis, the reported frequencies are so high 965sb:743-44; Willcox 1974:174). that attribution to a single infectious disease may be This contention will undoubtedly meet with much questionable. Hill (I986) cautions that "postcranial mar- dissent. Although there is universal agreement that Na- row hypertrophy associated with acute and chronic tive American populations were decimated by diseases anemia in children is virtually indistinguishable from introduced by Europeans to which they had no immu- generalized periostitis indicative of infection" and that nity, the possibility of a parallel introduction of Ameri- "postcranial periosteal lesions associated with cranial can diseases into Europe is rejected. Nearly 30 years ago, porotic hyperostosis have been treated as a separate en- Harrison (I 959:7) suggested that "if one could test mum- tity, i.e., infection." While the synergism of infection mies for antibodies to T. pallidum ... one might perhaps and nutritional deficiencies (such as iron deficiency settle this eternal question of the birth-place of anemia) cannot be overlooked, the appearance of diag- syphilis." He thought his suggestion far-fetched, but im- nostic changes in some individuals from these skeletal munological tests have recently been attempted on skel- populations indicates that a treponemal infection was etal materials. An effort to inoculate rabbits with an undoubtedly present in the eastern half of the United extract from a pathological Crow Creek specimen to pro- States from Late Archaic times (as early as 3000 B.C.) and duce an antibody titre indicative of the presence of contributed to the generalized periosteal involvement treponematosis ended with the animals' death (due to evident in these remains. Clostridium contamination) before any results could be The nature of the skeletal evidence found in North obtained (Gregg et al. I98I). A method developed in and South America is explained by treponemal epi- Czechoslovakia has proved capable of determining the demiology. The apparent absence of congenital syphilis presence of Treponema in a recent case of yaws from an is not surprising, considering that most of the popula- Australian bone sample and in European cases of tions in pre-Columbian times were gatherer-hunters or syphilis from the i6th and igth centuries (Smrcka I985). horticulturalists residing in small camps or villages The most recent and significant immunological test has rather than large cities. The prevailing hygienic condi- demonstrated the presence of treponemal antigen in the tions would be insufficient to prohibit transmission of remains of a Pleistocene bear from Indiana radiocarbon- the treponeme by casual contact among children. Such a dated to II,500 + 520 B.P. (Rothschild and Tumbull pattern probably characterized more populous areas I987). Skeletal lesions include gumma formation and prior to European contact as well. The high frequency of periosteal reaction in the mandible, humeri, radii, and treponemal lesions reported in some skeletal series may ulna and in three thoracic vertebrae. Immunofluores- reflect population nucleation, particularly where cence analysis of histological sections revealed the pres- sociopolitical organization allowed for widespread ex- ence of treponemal antigens, while tests for Neisseria change of material goods and infectious diseases, as gonorrhea, Streptococcus, and Legionella pneumophilia among Middle Woodland and Mississippian groups (cf. were negative. The pursuit of similar immunological Buikstra i984:229-30; Cassidy I980:137; I984:334-35; analyses in pre-Columbian remains with skeletal lesions Cook i984:26i-62; Larsen I984:379-80; Perzigian, suggestive of treponemal infection should eventually re- Tench, and Braun I984:356-58; Rose et al. I984:4I5- solve the controversy. i8). Skeletal series in the pre-Columbian New World would therefore be expected to display a pattern of pathological involvement more typical of nonvenereal Conclusion than of venereal syphilis-a situation encountered in several large skeletal series from the eastern half of the Current attention is focused on the epidemic of AIDS, United States. As Buikstra (1979:232) has indicated, "it which is similar in some respects to the epidemic of appears that certain forms of intercourse are less impor- syphilis nearly soo years ago. Because of disease syner- tant in explaining the archaeological record than previ- gism and the numerous complications that may finally ously suggested." cause the death of an AIDS patient, the question arises The absence of skeletal evidence of treponematosis in how long AIDS was present in human populations be- the Old World and the abundance of such evidence in fore it was recognized as a distinct disease. The AIDS

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virus has been recently discovered in tissue saved after lems that continue to face me regarding this conclusion the puzzling death of a St. Louis teenager in I969, a and that are not covered by Baker and Armelagos are as decade before AIDS was recognized elsewhere in the follows: United States (Associated Press I987). As with syphilis, T. pallidum appears to be the agent responsible for it could be argued that the "epidemic" of AIDS is a re- syphilis, yaws, and related treponemal infections mani- sult of its differentiation from an array of complications festing diverse symptomatology (cf. Hudson I965 a). with which it was previously confused. Arguments as to The variations in the symptoms appear to be the result its point of origin (e.g., African green monkeys, Haitians, of differing expressions of the disease resulting from the homosexual males, etc.) have ensued. pathogen's operating in different environments, a phe- Recent research reveals that a positive serological test nomenon known widely in biology. for syphilis in men, a history of syphilis in men, and a If, however, this is the case, what is the evidence that history of genital warts in women are significantly asso- supports the Columbian hypothesis rather than Hud- ciated with seropositivity for human immunodeficiency son's unitarian one? virus (HIV), which causes AIDS (Quinn et al. I988). If a New World disorder (venereal syphilis) spread with Thus, sexually transmitted diseases which disrupt unusual virulence into the Old World, was it because the epithelial surfaces (particularly syphilis) may increase urban environment into which it was introduced pro- the efficiency of HIV transmission (Quinn et al. vided the circumstances under which it would flourish? i988:21i-2). In light of these findings and the recent If so, then one would expect that the original New World report that syphilis is at its highest level in the United distribution of the disease would correlate with urban States since I950 (NBC News, January 28, I988), it is populations. The skeletal record does not appear to sug- apparent that the attention accorded syphilis in the past gest this but rather may reflect a random distribution. is likely to be renewed. Conversely, if the disorder were a transformation of an This review of the documentary and skeletal evidence infection already existing in the Old World, as Hudson of treponematosis supports the Columbian hypothesis. suggests, one would expect that increases in the mani- The abundance of New World human skeletal material festation of syphilis would parallel the growth of post- exhibiting lesions suggestive of treponemal infection, medieval cities. The spread of what Baker and Armel- particularly when encountered in large skeletal popula- agos demonstrate to have been a new disease simply tions, and the discovery of treponemal antigens in the appears to be strongly correlated with the years after remains of a Pleistocene bear from the Midwestern I492. On the other hand, if the disease were transformed United States clearly demonstrate the presence of the only after arriving in the Old World, then the skeletal disease prior to I492. The paucity of possible treponemal evidence from the preceding period in the two hemi- lesions in the vast collections of pre-Columbian Old spheres might not differ at all. In fact, while Baker and World skeletal remains is a telling contrast to the New Armelagos note how infrequently one might expect to World situation. Newly developed immunological anal- find skeletal evidence for syphilis, we are not told how ysis should finally lay the controversy regarding the ori- frequently it actually appears in the many collections in gin of syphilis to rest. which they have found it. The rate appears to me to be extraordinarily high. Several general matters noted in this paper should also be discussed further. Although the belief that European- Comments introduced diseases ca. I500 sharply reduced Native American populations has nearly "universal agreement" in the popular literature, a growing number of scholars MARSHALL JOSEPH BECKER (Ramenofsky i982, Becker I988) have noted situations Department of Anthropology and Sociology, West in which this was certainly not the case. Such examples Chester University, West Chester, Pa. 19383, U.S.A. call into question the application of this idea to all of the 2I VI 88 New World. The idea of European diseases' devastating New World populations ignores contacts stretching back Baker and Armelagos provided us with an extremely to the Norse settlements and continuing with the long useful updated review of the literature on the origins and i 5th-century contacts by whaling and fishing fleets from antiquity of venereal syphilis in the Old World. By ad- England, France, and so on. These contacts, rapidly ac- dressing specific problems concerned with the three celerating before i500, would be just as likely to have dominant hypotheses and reviewing the evidence as it served as disease vectors in both directions, a point that now stands, they conclude that the Columbian hy- Cockburn (i96i) has noted. Also of note in this same pothesis best fits these data. This is approximately the period is the not so coincidental expulsion of the Mus- view that I take-that in some way the voyages of Co- lim and Jewish populations from Iberia in I492, after lumbus brought to Europe the pathogen that became what some people might call the last great barbarian manifest as venereal syphilis. The crux of their argu- invasion. The dispersal of these peoples, both of which ment is that the "transition of one treponemal syndrome are considered to have been considerably more cleanly to another under differing environmental and social cir- than their neighbors, may be a still unexplored factor in cumstances" is the explanation for the sudden rise in the this matter. Old World of a disease not previously known. The prob- While Hudson's thesis is attractive, the situations that

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he suggests developed during the process of late- and (Brothwell I970). It is interesting to recollect that Bald- post-medieval urbanization are too poorly documented to win IV, king of Jerusalem in the i2th century A.D., provide any reliable support for it. We simply do not is regarded as having had a fast-developing form of know if the cities of that period were growing at an un- "leprosy," perhaps now to be considered as possible en- usual rate or if hygiene actually was changing at that demic syphilis. In northern Europe, there appears to time. One of the basic problems with Hudson's argu- be a definite case of treponematosis from medieval ment lies in speculation concerning improvements in York (Dawes and Magilton i980), confirmed as pre- personal and community hygiene in antiquity and his Columbian by radiocarbon dating. There is also a claim apparent ignorance (i965a:895) of the late invention of of endemic syphilis from late medieval Trondheim in soap. To infer that child-to-child contacts may be re- Norway, suggesting that the medieval period really was duced with improvements in hygiene suggests ignorance critical to the northward movement of the condition of present vectors for head lice, chickenpox, etc., among (Anderson et al. i986). some well-washed modern groups. We do, then, have a small amount of Old World evi- The availability of extensive evidence for pre-Colum- dence, spread widely from South-East Asia to northern bian treponemiasis in the New World may also reflect Europe and of pre-Columbian date, and it simply can't be the concerns of Americanist archaeology. Careful recov- ignored. My feeling is that Asia may still turn out to be ery of skeletons, outstanding curation, and concern for the original homeland for the evolution of the patho- analysis developed early in the New World. These efforts genic human treponemes and that the scheme of differ- have been matched in England, Denmark, and other entiation I have discussed elsewhere still seems to fit all areas, but the regions of Europe in which the reports of the archaeological and historical facts most satisfacto- syphilis first appeared are just those in which skeletal rily (Brothwell I98I). studies have become important more recently. As such studies become increasingly available, the additional in- formation may give us new perspectives on this topic. ANDREA DRUSINI At this point Baker and Armelagos's paper is a most Department of Biology, University of Padua, Padua, welcome contribution. Italy. 47 VI 88

This article contains all the necessary ingredients for a DON BROTHWELL modern view of the history of disease: historical back- Institute of Archaeology, University of London, 3 I-34, ground, palaeoepidemiology, a review of the osteological Gordon Square, London WCiH oPY, England. 24 vi 88 specimens, and the inevitable parallel between syph- ilis and AIDS. There are, however, some remarks to be It was good to read of current New World thinking on made. ancient treponematoses. I have pondered this problem First, scant importance is attributed to Sudhoff's con- for some years and have the following reactions: tribution to the history of syphilis. Against the hypoth- i. While the mind boggles at potential treponeme eses of Iwan Bloch (i9oi- i), one of the principal advo- transmission by Paleo-Indian bestiality (with bears!), I cates of the New World origin of syphilis, Sudhoff noted like the idea of the human treponematoses' being ini- that beginning in the i2th century, Italian surgeons es- tially a mammal zoonosis. However, I confess to serious pecially used metallic mercury as an ointment to cure doubts about the reported immunological findings. At chronic diseases of the skin such as leprosy and scabies. least the results emphasize again the need for a careful Some varieties of scabies (scabies grossa or, in French, and critical appraisal of the treponemes in other verte- grosse verole, gros mal) healed completely with mercu- brates, especially as regards the emergence of our own rial treatment. The proceedings of the trial of Dijon in pathogens. 1463 clearly show that such a disease was transmitted 2. Regarding possible human treponemal material by sexual contagion. from Mexico, the list has grown somewhat beyond that Meanwhile, about I440 the term mal franzoso ap- detailed by the authors (Brothwell I978). peared in Italy, and in I489 some Swiss mercenaries 3. There is indeed remarkably little evidence of Old were insulted as Kriegsbuben und Frankricher, meaning World treponematoses, but there are a tantalizing few ill of mal franzoso. The idea that a disease that presents data, and the dating is not shaky on all of them. While cutaneous symptoms, transmitted by sexual contagion the New World origin is a hypothesis one can nearly and curable with mercury, could be considered syphilis embrace, it simply doesn't fit all the facts. There is, for therefore seems justified (Sigerist I923, with a complete instance, the pre-European material from Borneo (Broth- bibliography of and comment on Sudhoff's works). well I976), and new material from Australia (Prokopec Also, the Veronese physicians of the Renaissance and Pretty, unpub.) can be added to the Marianas Island Giorgio Sommariva and Natale Montesauro stated that data (Stewart and Spoehr I967 [i9521) to establish trepo- the "new" disease was already known as mal franzoso; nematoses in early South-East Asia. Trithenius detected the contagion on the banks of the Europe is indeed a puzzle, but the rarity of finds may Rhine in I493; Jeronymus Braunschweig (or Brun- be related to the possible late adaptation and survival of schwig) recognized it in I493-94; the Sicilian physician endemic syphilis in northern climates following greater Niccolo Scillacio (I5th-I 6th century) found it in Barce- contact with the Palestinian area during the Crusades lona and called it "morbus novus, qui nuper a Gallia

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defluxit" (Sigerist I923). It is important that these Re- MARIE CLABEAUX GEISE naissance physicians did not for the most part link Department of Anthropology, State University College syphilis with the discovery of the New World. at Buffalo, Buffalo, N.Y. 14222, U.S.A. 23 VI 88 Another important omission regards a basic work of Guerra (I978), who says (p. 40) that "new understanding As researchers attempt to trace the origins of the newest about the evolution of treponematoses, the clinical syn- of the sexually transmitted diseases, AIDS, it is appro- dromes of human infection, and a much clearer view of priate to assess our progress in tracking the history of an the effect of the environment upon the disease have older one. It is also appropriate to remember that syph- made obsolete the traditional setting for the discussion ilis once caused the same fear of the disease itself and of of the role of America in the history of syphilis." To- its victims that AIDS is producing today. AIDS has gether with the most important debates among the Re- emerged (apparently) within our lifetime, a time of highly naissance physicians, Guerra cites two interesting Re- developed medical technology, rapid and widespread naissance documents: the opera "Sylva in Scabiem," scientific communication, and a sophisticated frame- written by Angelo Poliziano (I450-94) about I475, in work of theory, yet we do not know where, when, or which he described a disease called lues or morbo gal- how it developed. To try to answer these questions for a lico, and an epistle to "Ario Lusitano grecas literas Sal- disease whose origins date far back into antiquity is an manticae" from Pietro Martire d'Anghiera (I455-i526), ambitious undertaking. As Baker and Armelagos note, dated April 9, I489, that gives a good description of a the debate on the origins of syphilis is virtually as old as diseased called bubas by the Spaniards, morbo gallico by its recognition as a separate disease. the Italians, and elephantiasis by some physicians. Those familiar with the paleopathological literature Guerra (I978:44) also emphasizes the words of Ruy know that there is even more evidence for the occur- Diaz de Isla (I539) at the close of his book: "ten years rence of treponemal infection in the pre-Columbian before the [venereal] disease appeared, women did not New World than Baker and Armelagos have chosen to know a better way of cursing their children, stepchildren include. Although they say that such evidence is lacking and servants than by saying 'May you die of nasty for northwestern North America, this is not the case. bubas.' . . . This indeed shows that 'bubas' were com- Jerome S. Cybulski has found evidence of treponemal mon in Spain before the discovery of the New World." infection at two Northwest Coast sites: the Boardwalk Finally (p. 56), he states that "the import into Europe of site on Prince Rupert Harbour and the Duke Point site in new tropical treponematoses, such as yaws from the Gulf of Georgia region. The Boardwalk site yielded America, does not affect the truth of Sudhoff's thesis an adult female with a radiocarbon date of 2,325 ? 90 about the existence of urban treponematoses in Europe, B.P. with cranial lesions of caries sicca. The Duke Point such as venereal syphilis, during the medieval period." site dates to 3,490 + I25 B.P. and has produced four We must bear in mind that the European explorers of individuals with signs of treponemal infection and as Southeast Asia and the Pacific Islands from the Renais- many as six affected. The burials include a female with sance to the modem age have found yaws among natives node lesions on the tibial shaft. Situated in her pelvis of humid and hot areas (see, for example, Dampier I703). was a fetus with cortical osteoporosis. One of the Another work of Holcomb (I 94I:i67) could have been juveniles has a mulberry molar. Cybulski suggests that quoted: "The description of leprosy given by Bernard de these cases represent an endemic nonvenereal syphilis Gordon about I308 A.D. is not modern leprosy, but a which was stimulated to venereal syphilis in the contact circumstantial description of congenital and venereally situation of fur trading (Cybulski, personal communica- acquired modern syphilis.... Syphilis in a congenital tion and n.d.). and acquired form certainly prevailed in Europe long be- I am in strong agreement with Baker and Armelagos's fore the discovery of America." But perhaps, as Acker- conclusions, in part because their arguments are persua- necht (i9SS, I965) has pointed out, the question will sive and in larger part because I have encountered evi- remain controversial from both the historical and the dence suggestive of treponemal infection in skeletons palaeopathological point of view. from the Northeast. If "seeing is believing," I have seen As far as the osteological evidence is concerned, there and I do believe. The existence of treponemal infection is great disproportion in the amount of documentation in Europe prior to Columbus's voyages is problematic. It between Europe and America. Two other Old World dis- is extremely difficult to prove a negative-that syphilis coveries are perhaps to be mentioned: Vorberg (i896) and did not exist in Europe prior to contact. Baker and Ar- Rokhlin (i965), the latter concerning syphilitic bones melagos have come as close to doing so as is possible. dated 3000-2000 B.C. in the trans-Baikal area of Siberia. While they feel that new immunological analyses will The absence of evidence of pre-Columbian syphilis in end this controversy, I do not think this will be so. The Europe may simply mean that research in the area is still results, either negative or positive, will be questioned. incomplete. The bear evidence is already being disputed. Western Only one certainty emerges from this debate: in an- scientists see the origins of AIDS in Africa, African sci- cient times urbanism, migrations, and travels created a entists in the Western world, especially the United "common market" for syphilis (Dubos i965).' States. Our attitudes towards diseases are deeply embed- ded in the culture and have an emotional context. We i. I am deeply indebted to Maurizio Rippa Bonati, Institute of the still remember the Black Plague, but the influenza pan- History of Medicine, University of Padua, for his kind suggestions. demic that was responsible for more deaths than the

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First World War during which it occurred is dismissed. i5th century. I am greatly inclined to agree with Baker People still die from flu and no longer die from syphilis, and Armelagos. but a diagnosis of syphilis carries much more emotional impact. Syphilis is still a disease with a high level of cultural meaning. A dispassionate assessment of the ALAN G. MORRIS data such as that presented here will probably not end Department of Anatomy and Cell Biology, the debate. University of Cape Town, Observatory 7925, Cape Town, South Africa. 22 VI 88

MARC A. KELLEY Baker and Armelagos have done an excellent job in their Department of Sociology and Anthropology, University expert collation and consideration of the confusing mass of Rhode Island, Kingston, R.I. 0288I, U.S.A. 28 vi 88 of data about the origins of syphilis. The impact of syphilis on the European populations of the i 6th century Baker and Armelagos have presented an energetic review is well known, and speculations on the origin of the of the syphilis controversy. While it is quite similar in disease have occupied learned circles for generations. content and structure to Steinbock's (1976), it does aug- The evidence for the presence of the treponemal infec- ment the debate with the latest developments in im- tion in the New World now seems beyond doubt, and the munological testing for the treponemal antigen. This focus of research, as Baker and Armelagos suggest, must tool will indeed probably lead to the resolution of this shift to the skeletal remains of the inhabitants of the Old tired controversy. Continued attempts to interpret the World. voluminous and contradictory literature on the history Southern Africa might present an interesting test re- of syphilis can only lead to speculative conclusions. As gion for the prehistoric presence of treponemal infec- far as such speculation is concerned, the view outlined tion. Of the four clinical variants of treponemal disease, by Baker and Armelagos is nearly identical to the one I all but pinta are currently found in the region. The have advocated in the classroom and among my col- ecological model clearly explains the modern distribu- leagues for the last five years. tion of the disease-yaws in the humid north and east, The comparison of AIDS to syphilis is in my opinion endemic syphilis in the arid centre and south, and ve- superficial and appears "tacked on." nereal syphilis in the urban situation. The argument against the introduction of treponemal sicknesses to southern Africa is primarily based on the IWATARO MORIMOTO pattern of endemic syphilis. Researchers who have ex- Department of Anatomy, St. Marianna University amined endemic syphilis in trans-Kalahari populations School of Medicine, 2-I6-I Sugao, Miyamae, Kawasaki, (Nurse and Jenkins I977, Nurse et al. I973, Truswell and Kanagawa 213, Japan. I7 VI 88 Hansen i968) have concluded that the disease has been present for a considerable length of time. One paper Baker and Armelagos's attention to syphilis in their in- (Nurse et al. I973) goes so far as to suggest that the valuable paper is timely because the recent epidemic of desert dwellers represent the reservoir from which the AIDS seems similar in some respects to that of syphilis disease filters to the settled agricultural populations to nearly 500 years ago and because sexually transmitted the east. Maingard (I937) has described a root that the syphilis, which disrupts epithelial surfaces, may in- southern San used for the curing of the vuilsiekte (en- crease the efficiency of AIDS virus transmission to those demic syphilis). This suggests a knowledge of the disease who have not previously been exposed to this fright- that has had some time in which to accumulate. ening disease and have no effective immunity against it. Despite this, historical reports are adamant that On the basis of a great abundance of documentary and syphilis was introduced to southern Africa, especially in skeletal evidence they advocate the hypothesis that the arid regions of the southern Kalahari and the western syphilis originated in the Americas and was carried to Highveld. Wikar in I775 (Mossop and van der Horst Europe by the crew of Columbus in I493. In Japan, it I935) is a Somerville in 1799 (Bradlow and Bradlow I979), matter of record that the first epidemic of venereal and Smith in I835 (Kirby 1940) specifically state that the syphilis occurred at Kyoto in I 5 I2, about 30 years before venereal form of the disease is not present in the native the first European sailors came to this country. The new populations, and their lists of common disorders of the venereal disease swept the Japanese islands within sev- people do not include symptoms that resemble the en- eral years of the first epidemic, much as it did in Europe demic treponemal infection. Yet some of the towns that during the final decade of the I5th century. Suzuki they visited contained upwards of io,ooo people in con- (i984a), from the viewpoint of paleoepidemiology, has es- ditions epidemiologically perfect for the spread of the timated the prevalence of syphilis in the adult citizens of venereal treponeme. The venereal form of the disease Edo (Tokyo) from the 17th to the igth century at as was present in the Cape Colony from at least the i69os much as 54.4% on the average. Since the occurrence of (Grevenbroek I695 in Schapera 1933) and was rampant bone changes is clinically scanty in venereal syphilis, he amongst slaves, sailors, and soldiers by the 1730S (Ment- estimates the incidence of cranial syphilis in the same zel I944). citizens at 7.9%. There seems to be no evidence of In common with other parts of the Old World, south- syphilitic lesions in Japanese skulls dated before the ern Mfrica has not produced archaeological specimens

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which show clear signs of treponemal disease. Periostitis purely epidemiological. Some immunity against T. pal- occurs at regular intervals but not in patterns suggestive lidum does develop; if this happens in childhood, it of yaws or endemic or venereal syphilis. Since we have a could prevent the venereal form of the disease from good idea of the frequency of endemic syphilis infection emerging later. When children are more effectively in modern Kalahari populations, perhaps the new im- shielded from infection by clothing and hygiene, the op- munological techniques referred to by Baker and Ar- portunity for the disease to spread may not come until melagos might be used on archaeological samples from the apposition of infected with uninfected mucous mem- the same region to indicate infection in individuals who brane happens during sexual activity in adults. It is not do not show signs of osteological involvement. This not at all rare for an infectious disease occurring for the only would test the presence of treponemal infection in first time in adulthood to manifest itself differently from a pre-Columbian Old World population but could also the same infection acquired in childhood: good exam- indicate the presence of a specifically endemic pattern ofples of this are mumps and hepatitis A. Here, the argu- the disease. ment from the absence of congenital syphilitic stigmata in Amerindian skeletal remains is a powerful one. It has proved impossible to distinguish microbiologically be- GEORGE T. NURSE tween the causative organism of venereal syphilis and Department of Community Medicine, University of that of its non-venereal counterpart. The two are almost Papua New Guinea, P.O. Box 5623, Boroko NCD, certainly the same disease. Papua New Guinea. 2 VI 88 One or two historical points may be mentioned: Bon- ser (i963), in his comprehensive description of medical This satisfyingly up-to-date account of what is known knowledge in England before the Norman Conquest, about the ecogenesis of the treponematoses answers does not describe any disease which could possibly be a many outstanding questions and provokes some further treponematosis, and this gives at least some negative speculation, particularly in the context of non-venereal support to the Columbian hypothesis. He does not men- syphilis. tion scabies, either, which somewhat inhibits my suspi- Even syphilis acknowledged to be venereal is occa- cion that anything called "button scurvy" is more likely sionally transmitted by other than the venereal route. to be that than endemic syphilis. Baker and Armelagos Weeping secondary rashes and especially condylomata probably derive their interpretation of the term from lata teem with treponemata, and casual skin contact Lancereux (i868), to whom, however, they do not refer. with them not infrequently results in the development Lancereux also talks of radesyge (?rosary or necklace dis- of chancre. This could account for the cases reported ease), as they do, and of "sibbens." The last-named, more from Vienna as "endemic syphilis" by Luger (1972). The properly "sivvens," derives from the Gaelic suibhean, usual characterization of non-venereal syphilis as a dis- "raspberry" (Latin framboesia), which of course recalls ease of hot, dry rural areas makes it hard to agree with yaws. The descriptions quoted in the Oxford English the ascription of its spread to overcrowding as well as Dictionary (1933) are more suggestive of yaws than of imperfect hygiene. Overcrowding is more a feature of endemic syphilis; but could yaws as we know it ever urban than of rural life, and the majority of urban popu- have survived in Scotland or Scandinavia? Or could this lations, at least in developing countries, are not notably have been another treponematosis, now extinct? It may more cleanly. This disease is more likely to be per- not even have been a treponematosis at all, though Pen- petuated by the huddling together of scantily clad chil- nant in his Tour in Scotland of I776, cited in the OED, dren outside the dwellings than within them. I have ob- calls it a venereal disease. Perhaps we see here again the served this in the Kalahari (Nurse et al. I973) and in the lubricious tendency to classify any disease which can Nafud Desert, in which the disease has lately been re- have such a mode of spread as venereal, irrespective of corded (Pace and Csonka I984). It probably was largely the other, commoner routes by which it may also propa- responsible for the spread and persistence of trepo- gate itself. nematosis in pre-Columbian North America. In all three environments the winters can be remarkably cold, and young children are or could have been dependent on the MARY LUCAS POWELL warmth of the bodies of their playmates. This may have Museum of Anthropology, University of Kentucky, played a part also in the long-standing endemicity in Lexington, Ky. 405o6, U.S.A. 24 vi 88 Bosnia and Hercegovina, where the successful eradica- tion campaign coincided with an improvement in the In their provocative reconsideration of the centuries-old standard of living (Grin and Guthe I973). In the question of whether venereal syphilis originated in the Kalahari, where a similar campaign was unsuccessful Eastern or the Western Hemisphere, Baker and Armel- (Murray, Merriweather, and Freedman I956), no change agos marshal an impressive array of historical, epi- in the life-style of the San occurred at or around the time demiological, and paleopathological evidence that this of the treatment. deadly form of treponemal disease was America's gift to It is certainly legitimate to suggest, as Baker and Ar- Europe's invading conquerers. Skeletal specimens from a melagos do and as Hudson (I958) came close to doing, multitude of New World sites display lesions that meet that the difference between the two forms of syphilis is the key diagnostic criteria set forth for treponemal dis-

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ease by Hackett (1976). While some of these may date from each individual in a series, would include a broader from the early period of European contact and are there- range of lesser degrees of bone involvement. Admittedly, fore suspect in the present context, others (such as the many of these manifestations are nonspecific in nature cases cited from the Indian Knoll site in Kentucky) se- and could not be used alone to diagnose treponematosis curely establish the existence of treponematosis on this in the absence of other, more clearly pathognomonic le- side of the Atlantic Ocean several millennia before the sions. Nonetheless, a close reading of Hackett's (I95i) voyages of Columbus. No human cases have been docu- masterful discussion of bone lesions of yaws and Hud- mented that rival in antiquity the supposedly syphilitic son's detailed descriptions of bone involvement in en- Pleistocene bear reported by Rothschild and Turnbull demic syphilis (I958, I965a) gives a vivid impression of (i987). This absence is not surprising, given the lack of the full range of associated pathology. Clinical and human remains from that early time, but the pathologic paleopathological studies alike that emphasize only the lesions in the animal skeleton could be more reasonably "classic" treponemal lesions will invariably overlook diagnosed as representing nonspecific osteomyelitis the less spectacular evidence that is more abundant in compounded by an opportunistic fungal infection. The both living and skeletal populations afflicted by trepo- possibility that the results of the immunofluorescence nemal disease. The soundest approach from an epidemi- analysis in that case represent a "false positive" reaction ological perspective is to focus upon the "classic" le- to related saprophytic or free-living spirochetes im- sions for the initial diagnosis of the disease in a munologically similar to the genus Treponema (Cock- particular specimen or population and then describe the burn i963:15 3) should also be kept in mind. lesser forms of involvement to document the specific Given the abundance of pre-Columbian New World gradient of pathological involvement observed in that skeletal evidence for treponemal disease as evaluated by particular context. In the skeletal series from Mound- modern paleoepidemiological standards, as compared ville, Irene Mound, and Nodena that I have observed, with the virtual absence of convincing contemporane- only a few cases could be presented as "classic exam- ous Old World cases, the authors' conclusion that the ples" of treponematosis, yet it would make no sense appearance of venereal syphilis in early i 6th-century epidemiologically to assume that those few cases were Europe represented the adaptive transmutation of an the only individuals affected in those populations. ancient New World nonvenereal disease in a novel Hence the "seeming contradiction" mentioned earlier epidemiological context does not seem unreasonable. stems more from differences in methodology of observa- The existence of anomalous cases of apparently con- tion and perspective of interpretation than from any real genital origin, such as the child from pre-A.D. I400 Vir- differences between the disease variants in question. ginia described by Ortner and Putschar (i98i:207-IO), Surely not all of the periostitis observed at Moundville, does not invalidate arguments for the essentially nonve- Irene Mound, and Nodena represents treponemal in- nereal nature of the New World treponematosis. Given volvement, but undoubtedly a great deal of it does even the profound similarities documented between the in cases that cannot be securely diagnosed. However, nonvenereal and venereal treponema strains (Hudson any comprehensive assessment of the biological costs of I958, i965a), Grin (i956) has noted that transplacental chronic endemic disease in a population must take into infection should theoretically be possible. He argues consideration not only the most severe cases but also the that the rarity of this occurrence in modern yaws and much larger number of minor cases that also exacted endemic syphilis probably results from the typically their toll in the form of pain, depleted energy, and de- very low levels of pathogenic treponemes in the mater- creased resistance to other diseases. nal bloodstream at the time of pregnancy because of the long period of time separating treponemal infection in childhood from the onset of pregnancy in adulthood. BRUCE M. ROTHSCHILD The remainder of my comments will address the Department of Medicine, Northeast Ohio Universities seeming contradiction noted by the authors between ex- College of Medicine and St. Elizabeth Hospital and pected frequencies of bone lesions from nonvenereal Department of Earth Sciences, The Carnegie Institute, treponematoses, based upon modern clinical studies (cf. Pittsburgh, Pa. I52I3, U.S.A. 24 v 88 Steinbock I976), and the frequencies of bone involve- ment in prehistoric skeletal series reported by myself Baker and Armelagos are to be congratulated for a mas- (Powell i988a, b, c, d) and other researchers (Cassidy terful review and analysis of the history of treponemal I980, I984; Cook I976, I984; Brues i966). The studies disease. Provenience of historical as well as skeletal in- cited by Steinbock (I976) relied upon radiographic or formation and the often nonspecific nature of the latter clinical evidence (e.g., descriptions of bone pain) of bone are well documented as previous sources of confusion. involvement, thereby insuring that only certain levels of While the idea of I9,000 leprosaria (Steinbock I976) bone involvement would be noted. Lesser levels (e.g., strains credulity, Baker and Armelagos appropriately cortical striations indicative of minor periosteal eleva- note skeletal pathologic confirmation of the diagnosis of tion) or, more important, remodeled lesions in older in- leprosy in a leper cemetery (Weiss and M0ller-Chris- dividuals would tend to be systematically excluded. tensen I97I) apparently associated with one such asy- Conversely, direct observation of dry bone specimens, lum. While a number of Old World venereal diseases with emphasis upon examination of all elements present were apparently called leprosy, the available skeletal re-

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mains provide no convincing evidence for treponemal Columbian skeletons are subjected to immunologic disease. Difficult to reconcile with the skeletal record is analysis. Even the specific treponemal disease respon- Holcomb's (I934) notation that one medieval physician sible may well be determinable by epidemiologic anal- changed the title of his chapter "Leprosy" to "Morbus ysis of such verified skeletal populations. Gallicus" (the i 6th-century European name for syphilis) without altering the text. Contemporary reporting of en- SHELLEY R. SAUNDERS demic syphilis as leprosy in Iraq (Hudson I958, Stein- Department of Anthropology, McMaster University, bock I976) further documents the challenge of decipher- Hamilton, Ont., Canada L8S 4L9. I 3 vi 88 ing pathology in historic records. The unitarian hypothesis of treponemal diseases as an The novice "syphilologist," sifting through a volumi- environmental adaptation or subspecies phenomenon nous literature on the origin of the disease, must feel (Hudson i965b) retains merit even if no pre-Columbian like the wind-blown sapling bending to each successive Old World treponemal disease is identifiable. While the argument, pre-Columbian, Columbian, or unitarian. organisms of venereal syphilis cannot be distinguished Hudson's charge that medical historians tend to choose immunologically or grossly, they can biologically. In the "right" witnesses and dates is apt. Baker and Ar- vivo cultures (natural infections) reveal distinguishable melagos's survey of the historical events surrounding dermatologic and osseous changes. Although the indi- the ca. I500 epidemic raises several questions: vidual skeletal lesions of the various treponemal dis- What evidence is there for Columbus's men's having eases cannot be distinguished, their differing skeletal contracted the disease in the Indies during the first and/ distributions afford an epidemiologic approach (Hudson or second voyages? i928, Hunt and Johnson I923). Examination of a single Were there Spanish troops in Charles VIII's army, and, bone or individual does not allow epidemiologic assess- if so, was there time for them to have picked up the ment, but examination of well-defined skeletal popula- disease from Columbus's Indian captives in Barcelona or tions for population frequency and skeletal distribution through infected crewmen and transmitted it to Naples? of lesions provides samples that can be statistically com- Do the several European edicts issued regarding the pared with known "modern" afflicted populations disease really postdate Columbus's return from the first (Woods and Rothschild n.d.). As treatment may affect and/or second voyages? skeletal manifestations and distribution, the compari- Baker and Armelagos mention possible ambiguities in son "modern" populations should be drawn from the dating Charles's Naples campaign because of the use of prepenicillin era. different calendars. Since the difference is on the order of Evidence of congenital lesions would be expected on three months, this might put Charles's arrival in France sampling a population affected by venereal syphilis. The about a month before the Worms edict. One wonders diseases therefore remaining to be distinguished are that the disease would have become widespread in Ger- nonvenereal syphilis and yaws. Bone lesions are noted in many in such a short time. Morison (I942) indicates that 9-24% of venereal syphilis, 3-5% of endemic syphilis, there is no evidence in any of the local chronicles of the and IO-I5% of yaws (Hudson I958, Moss and Bigelow time of an outbreak of syphilis in Naples during i922, Steinbock I976, Whitney i915). While venereal Charles's campaign. He also notes that the presence of and endemic syphilis predominantly affect the lower ex- Spanish troops in Charles's army is debated by histo- tremities (Steinbock I976), yaws has a predilection for rians. He finds no evidence for Columbus's men's having the upper (Moss and Bigelow i922, Steinbock I976, become severely ill during the first or second voyages Whitney i9i5). Digits are commonly involved in yaws either in Columbus's joumal or in other contemporary but only rarely in syphilis. Cranial involvement in yaws accounts by observers less likely than Columbus, writ- is much less severe than in syphilis (though more gener- ing for Isabella, to be biased in this regard. Baker and alized when it does occur). Syphilis, producing saddle- Armelagos's comments on the date of publication nose deformity, more commonly affects the nasal bone of Diaz de Isla's account confirm what seems to me than does yaws, which more commonly affects the pal- the near futility of attempting to unravel the documen- ate and maxillary bones. Examination of the epidemiol- tary history. Morison (though himself a Columbian sup- ogy of the Hippelates pallipes fly, the insect vector of porter) agrees with Holcomb's translation of Diaz de yaws (Sanchez, Mazzotti, and Salensas I96I, Turner Isla's "al presente" to mean the idiomatic "at that I937), may also provide diagnostic insight for a given time" rather than "at present," which would weaken the population. This approach is of course premised on the argument that the treatise was written before i 506. diseases' having retained their characteristics through As Baker and Armelagos point out, most telling is the the millennia. Although that premise is of course sub- apparent absence of skeletal evidence of syphilis in the ject to scrutiny, correlation of pre-Columbian skeletal Old World. I agree that the lack of syphilitic bones in distribution with that observed in the preantibiotic era pre-I492 leper cemeteries and the weakness of the pro- would strongly suggest the identity of the disease. posed Old World skeletal cases are convincing, but, Treponemal disease can now be immunologically con- again, I have some questions and comments: firmed (Rothschild and Turnbull i987). The controversy That 80-90% of European skeletal collections are regarding the origin of treponemal disease should be re- skulls alone compromises attempts at conclusive skele- solved as the gummatous lesions from all suspected pre- tal diagnoses.

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There is no mention here of evidence, or lack thereof, could be diagnosed as syphilis have been found. The dif- of pathological skeletal material from Africa. Is there ferential diagnosis of types of treponematosis, though any? certainly a problem, is unimportant in this connection The exceedingly rapid geographic spread of the disease because in these medieval collections it is simply out of to different populations in the Old World so soon after the question. the proposed I493 date is incredible. Suzuki (i984a) re- The number of modem skeletons available for study is ports the entry of syphilis into Japan from the east coast much smaller. Because cemeteries from the i6th-i8th of China at about A.D. I 5 .12. Can this be attributed solely century are less attractive to archaeologists, the discov- to European sea exploration? ery of such skeletons is exceptional. In spite of this, a Although Baker and Armelagos's discussion of the number of them have been anthropologically studied New World skeletal evidence is extensive, there is only and published, and in addition we have bones from os- one reference to samples in Canada. Hartney (I978) has suaries, as a rule of the same date. Here, in contrast, identified potential pre-Columbian and early historic wherever we have a sizable set of remains at our disposal cases (admittedly not thoroughly discussed in the litera- we almost always find traces of lesions on tibiae, fibulae, ture) of treponemal disease amongst southern Ontario and skulls, some certainly of syphilitic origin and the Iroquois. Recently, the recovery of a potential case of rest possibly so. This contrast between the collections osseous syphilis in a skeleton from a i6th-century vil- from before the end of the i 5th century and those from lage has prompted me to reexamine the southern On- later centuries is striking indeed. tario evidence. It is possible that treponemal disease be- Increasing urbanization and improved hygiene need came prevalent in this region as settlement intensified not, I think, be closely connected. On the contrary, con- and population increased in the I 5th century. centration of great numbers in medieval towns evidently Finally, why the persistent fascination with the origin produced a change for the worse in both hygiene and of syphilis? Certainly the unitarian theory was attractive nutrition. But this fundamental change, with its in- when formulated because it made sense in terms of evo- creased potential for the diffusion of various epidemics, lutionary biology (see also Hollander i98i). The opposi- occurred earlier in Central Europe, very probably in the tion of Columbian and unitarian theories reflects a I3th century. The improvement of medicine at the end deeper dissension between logical determinism and of the Middle Ages may not have been so important as to chance. A hypothesis that postulates a unique past event play a substantial role in the health of whole popula- as its basis should have some observable consequences tions. Is it not possible to see the reason for the reduc- for the present, and I don't see what these are from the tion in frequency of leprosy in the fact that it had passed Columbian theory. If it prompts researchers to explore its zenith and struck an immunological barrier in Euro- the immunological testing of exhumed bone, so much pean populations? Moreover, traces of leprosy are rather the better, but I doubt that the controversy will be re- rare in bone material, and therefore we can only rely on solved to everyone's satisfacion in the near future. The historical sources, untrustworthy with regard to diag- current epidemic levels of syphilis and its association nosis as they are. with AIDS emphasize the fact that infectious diseases are complex bioecological puzzles reflecting a range of interactions among biological, environmental, and so- REBECCA STOREY cial forces. Herein, and not in origins alone, lie the Department of Anthropology, University of Houston, intriguing problems for experimental and historical re- Houston, Tex. 77004, U.S.A. 22 vi 88 searchers alike. The effects of European contact with the New World were profound for both worlds, but the brunt of its dis- MILAN STLOUKAL ease and cultural disruption has fallen upon the Native Narodni Muzeum v Praze, ti. Vitezneho utnora 74, II I American (Crosby I972, Dobyns I984, Denevan I976). 79 Prague i, Czechoslovakia. 2i VI 88 The idea that the Americas gave venereal syphilis to Europe has always seemed like a kind of rough justice. This paper presents an interesting survey of the litera- Because we are interested in the epidemiological aspects ture and arrives at a conclusion essentially expressing of the Columbian era, however, syphilis needs to be put my long-time conviction. Baker and Armelagos weaken in its proper place, at least as much as the evidence will their conclusion that syphilis was brought to Europe by allow. the participants in the Columbian expeditions, however, It is in marshalling this evidence, both documentary with the statement that European evidence authorizing and skeletal, that this article by Baker and Armelagos this conclusion is lacking. Surprisingly, they seem not to makes a real contribution. The development of paleo- be acquainted with the European literature on the sub- pathological methods has made it finally possible for re- ject. In the last 20 to 30 years over io,ooo skeletons from searchers, instead of depending on documentary sources, medieval cemeteries in Czechoslovakia have been to look at the skeletal evidence that is the best we have studied and published; the majority date to the 7th-I ith for the origin of syphilis. Baker and Armelagos's review century, but skeletons from the late Middle Ages are indicates that there is no good evidence of treponemal also available. In this very large collection no cases that lesions on pre-Columbian skeletons in Europe and con-

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siderable such evidence from pre-Columbian times in largely based on a lack of clear evidence, is well made. the New World. Particularly since various publications by Cook, Powell, While I understand that one of the objectives of the and others, the skeletal evidence for pre-Columbian article was a complete listing of the skeletons ever con- New World treponemal conditions has been accumulat- sidered in the syphilis controversy, it would have been ing rapidly. We have observed skeletal conditions con- clearer if doubtful specimens had been grouped together sistent with a treponemal syndrome in our ongoing stud- and skeletons whose lesions are good evidence for trepo- ies of ossuary material from coastal North Carolina nematosis presented more forcefully. The listing of (Bogdan and Weaver i988) and since have seen similar skeleton after skeleton, many with questionable dates or and even more characteristic skeletal signs, including lesions, tends to diffuse the argument that New World stellate bone lesions, cavitation, and radial scars, in specimens are plentiful. other coastal ossuary material. The debate will soon be I agree that individuals with bone lesions will likely be settled in favor of a New World Syndrome by skeletal rare. In my own work with the skeletons from an apart- evidence from a number of quarters. ment compound in the preindustrial city of Teotihuacan Baker and Armelagos could clarify the theoretical im- (ca. A.D. 300-700) and the skeletal population from the plications of at least two epidemiological points: why a Late Classic Maya center of Copan (ca. A.D. 700-IIOO), high frequency of skeletal signs of infection per se would lesions diagnostic of treponematosis on skulls and espe- be useful to exclude syphilis as a diagnosis and how they cially tibiae are found in about I% of individuals. Fur- would have us distinguish venereal from nonvenereal thermore, there are no clear cases of congenital syphilis treponemal infections. This last point may prove intrac- in these populations. The individuals affected are mid- table. dle-aged to older adults. While postcranial periosteal le- A final aside may be of some interest. Since the sions are common, they cannot necessarily be attributed zoonotic origin of the human HIV's (AIDS viruses), prob- to treponematosis, even "on trial." ably in African green monkeys, was proposed by Kanki Nevertheless, the lack of clear Old World pre-Co- et al. (i986), many of us have been confused by the lack lumbian skeletal lesions of treponematosis should dis- of overt symptoms in most apparently infected nonhu- credit the pre-Columbian hypothesis. I agree with Baker man primates (especially African green monkeys) and by and Armelagos that, no matter what one feels about the the lack of a clear mode of transmission for the virus. It documentary evidence, enough skeletal material is now seems likely that the proposed HTLV-4 is a labora- available from Europe alone to produce evidence of these tory contaminant (STLV-IIImac) and not a strain or vari- lesions if the disease was present, and the fact that not ety that is communicable to humans (Kestler et al. even leper-colony material has yielded any such evi- i988). Of course, this does not alter the general points dence is telling. The only controversy that may remain about disease/host coadaptation made by Baker and Ar- has to do with the transmission of nonvenereal and ve- melagos, but it eventually may turn out to be of some nereal treponematosis. Baker and Armelagos's epi- comfort to those of us working with nonhuman pri- demiological hypothesis may not explain everything. mates on a daily basis. Preindustrial cities or other types of population nuclea- tion are notorious centers of disease, where infections tend to cycle continually through the population (McNeill I976). Hygiene may not have been much better AL B. WESOLOWSKY in large population nucleations than in rural areas before Journal of Field Archaeology, Boston University, 675 modern sanitation systems, and water contamination is Commonwealth Ave., Boston, Mass. 022I5, U. S.A. a health hazard even today. Better understanding of the 22 vi 88 epidemiology of treponematosis, especially the nonve- nereal forms, will finally allow us to explain what hap- When I was an undergraduate, one of the first series of pened at the Columbian contact and how syphilis was prehistoric New World skeletons I was shown had a transferred from one world to another. number of instances of "cortical swelling" on the tibiae. In subsequent years I noticed similar, characteristic oc- currences in other series and wondered if perhaps trepo- DAVID S. WEAVER nematosis might be the culprit. I suspect that anyone Departments of Anthropology and Comparative with any amount of experience with New World materi- Medicine, Wake Forest University, Winston-Salem, als has harbored similar thoughts. N.C. 27I09, U.S.A. 23 vi 88 Now we have this important and timely contribution to the debate on the origins of the treponematoses, and it Baker and Armelagos have compiled an impressive and should be read with care by historians of disease, his- very useful review of the propositions and data concern- toriographers, and archaeologists. It brings together an ing the origin and antiquity of syphilis. In fact, they updated synthesis of several theories and strands of re- properly do not restrict the paper to syphilis, reflecting search and includes recent and older scholarship on an the likelihood that treponemal conditions have had a epidemic that, as the authors point out, has implications complex and convoluted evolutionary history. Their for the current concern with the spread of Acquired Im- case against European pre-Columbian syphilis, although mune Deficiency Syndrome.

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The article is somewhat ambitious in its scope and cise and reliable methods whereby the organisms caus- tries to do several things, only one of which it does well. ing lesions in ancient bones can be identified." The necessary review of theories regarding the introduc- tion of syphilis into Europe is less effective than it could have been. Its organization, so promising at first, be- JOHN A. WILLIAMS comes, finally, an obstacle to an appreciation of the Department of Anthropology, University of North wealth of information that the authors are trying to Dakota, Grand Forks, N.D. 58201, U.S.A. 23 VI 88 bring together. The political and medical status of Europe from I494 through the first half of the i6th cen- Like the question of the origin of New World tuber- tury is complex but explicable; this article does little to culosis (Buikstra I98I, Clark et al. I987), that of syphilis clarify matters. The putative role of the army of Charles has not been conclusively answered. As Baker and Ar- VIII of France in the spread of syphilis is crucial to the melagos point out, it is beneficial from time to time to Columbian hypothesis, but we are presented with only a summarize the evidence on such complex issues. While patchy account of both the campaign and the chronology the reader unversed in diagnosis and interpretation may of the various edicts and proclamations that seem to have difficulty understanding some sections of their arti- have been issued in the wake of the siege of Naples. cle, they should be commended for their concise presen- The use of the early accounts of Columbus's voyages tation of the wide range of information on the subject of is heartening, and it is here, I think, that Baker and Ar- syphilis. Although they favor a New World origin for melagos are in more familiar surroundings and begin to venereal syphilis, they maintain an even hand in pre- speak with greater authority. The principal contribution senting all sides of the argument. of this article is its use of excavated skeletal remains to The conjecture that New World treponematoses, like demonstrate the existence of treponematosis in the New tuberculosis, may have experienced an expansion with World long before the European discovery of America. I the appearance of sedentary agriculture, as opposed to think that the authors have demonstrated their main urbanization, is intriguing (Hudson I965 a). It is unfortu- contention, but I am frustrated by three aspects of their nate that Baker and Armelagos do not expand on this presentation. (i) Since several direct quotations from ar- hypothesis, probably one of the more important contri- ticles that discuss skeletal materials are used, one sur- butions of their synthesis. To a certain extent, the evi- mises that the descriptions and diagnoses of the remain- dence for syphilis and tuberculosis in the New World is der are paraphrases of the original publications, but one similarly ambiguous and equivocal. For example, an ex- cannot be certain. Also, it is not clear which, if any, of amination of several hundred prehorticulture Plains In- these materials the authors have themselves examined. dian skeletons ranging in age from Archaic to Late (2) The review consists of an east-to-west, north-to- Woodland has yet to turn up a single case of treponemal south presentation that has no bearing on the problem at infection (Gregg and Gregg I987). To date only two cases hand. It merely forces the reader to construct a personal of skeletal tuberculosis have been identified in this same chart of the chronology and incidence, as seen in the series of samples (Williams i985). Yet both diseases are excavated remains, of the disease in the Americas. (3) documented on the Northern Plains by the early igth The most serious shortcoming in this otherwise most century, prior to any significant Euro-American contact useful survey is the utter lack of illustrations of speci- but after the adoption of a sedentary subsistence pattern mens. There are frequent citations to figures that appear (Reid I947-48, Thwaites I905). in the original publications, so one may be assured that Although this article does not end the controversy sur- the specimens are shown in print, but how is the special- rounding the origins of venereal syphilis, it brings us ist to judge the accuracy of these observations and the closer to formulating a more appropriate hypothesis. resultant diagnoses? The importance of this survey of excavated remains is not to be underestimated. It does appear that while Europe has no convincing evidence of syphilis prior to Reply I493, America has plenty. If we accept these diagnoses of treponemal infections in New World skeletons, and I see no reason we should not, it is clear that this disease BRENDA J. BAKER AND GEORGE J. ARMELAGOS (or diseases) developed in the New World long before Amherst, Mass., U.S.A. 30 VII 88 I492 and that the crews of Columbus's voyage are his- torically and epidemiologically the most likely vector It is gratifying to receive such a positive response to our for the introduction of syphilis into Europe. paper. Our position that nonvenereal treponemal infec- It is a disappointment that no mention is made of tion is a New World disease that spread to the Old World McNeill's Plagues and Peoples (I976), especially since and became a venereal disease following European con- Baker and Armelagos, correctly, I am sure, point out in tact is accepted by most of the commentators. Kelley, their closing argument that immunological analyses of however, sees the evolution of the syphilis as a "tired" diseased bone material should resolve the controversy. topic and considers our paper similar in structure and More than a decade ago, McNeill pointed out (p. I94) that content to Steinbock's (I976). We feel that active inves- "proof, one way or the other, awaits development of pre- tigation of even a "tired" topic is likely to illuminate

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new facets of it. We did in fact rely extensively on Stein- There were in America the four types of human bock, as the frequency of citations indicates. He provides pathogenic treponematoses, pinta, yaws, venereal an exceptional analysis of the differential diagnosis of syphilis and probably endemic syphilis, in pre-Colum- the treponemal infections and extensive discussion of bian times, while there existed in Europe at the same the skeletal evidence of treponemal infection in the time venereal and endemic syphilis. The discovery of New and Old Worlds. Even with his thorough study, America brought the spread to Europe of American however, he sees a need for additional work: "The pau- bubas or yaws, a new rural and tropical treponemato- city of lesions and questionable dating and diagnosis of sis; after several generations, yaws adapted itself to specimens has caused some authorities to doubt the the temperate urban environment of venereal presence of syphilis in the New World before European syphilis, changing the original violent epidemiolog- contact." He agrees with T. Dale Stewart's call for "a ical character, as corresponding to a new mutant of general survey of the New World material, particularly treponematoses. newly excavated material, to establish the prevalence and distribution of venereal and nonvenereal syphilis in We believe that our analysis of the documentary evi- well-dated specimens" (Steinbock I976:96-97). Our pa- dence is fair and evenhanded. Nurse cites additional (al- per is a response to this call. though negative) evidence that supports it. The material Only Drusini strongly objects to our position, while cited by Drusini does not alter the case. We do wish that Brothwell says that the hypothesis we offer is one that there were more clear-cut evidence concerning the ac- can nearly be embraced but suggests that there is tan- tual vector of transmission. Saunders asks if there is evi- talizing evidence of pre-Columbian treponemal infec- dence that Columbus's sailors were infected with the tion in the Old World that does not fit it. Others, while treponemal pathogen. In the paragraph of Diaz de Isla's in general agreement, question or comment on aspects original manuscript cited earlier, Williams et al. (I927: of our interpretation. 695) point to a report that the disease "was seen in the Drusini believes that our analysis of the documentary armada itself in a pilot of Palos who was called Pincon evidence is skewed toward a New World origin and that and others." Saunders is also concerned about the timing we have not considered the osteological evidence from of the transmission by Charles VIII's troops, but while the Old World that supports the pre-Columbian origin of the time is short there is no evidence that this rapid syphilis. He places great emphasis on the documentary transmission could not have occurred. evidence, arguing among other things that some variet- As for the osteological evidence, Drusini would add ies of scabies healed completely after mercury ointment Rokhlin (i965) on syphilitic bones from the trans-Baikal treatment and that in the proceedings of a I493 trial region of Siberia dated 3000-2000 B.C. We have in fact evidence was presented that showed the disease to be cited this material, but with the iooo-800 B.C. date for it sexually transmitted. We do not dispute this interpre- reported by Steinbock. Drusini suggests that the absence tation and have presented similar ones of others. In of other European examples is simply the result of a lack fact, as we have reported, mercury ointment was pre- of research in the area. Becker, Saunders, and Brothwell scribed for a variety of ailments, including headaches raise similar issues of sampling. (for which it was rubbed on the inner arm). We do not Brothwell states that we cannot ignore the osteolog- find this or Drusini's other documentary evidence very ical evidence for pre-Columbian Old World treponemal compelling. The fact that Italian, Sicilian, and German infection. In addition to the reports he cites from the physicians recognized a venereal disease before I493 and Marianas, Borneo, and Australia, we have since un- made no link to the New World at the time is not covered Pietrusewsky's (I97I) publication of a possible sufficient to warrant the identification of the disease as case of yaws in precontact Tonga. Brothwell also points syphilis. to reports of syphilis in medieval York and Trondheim. Drusini considers our failure to cite Guerra (I978) a The evidence from Trondheim is provocative because major omission. We have since read Guerra's work, and the level from which it comes must be earlier than I 5 3 I, while it is an excellent treatment of the literary history the burial being covered by a deposit of wood ash from a of the controversy, it has significant shortcomings. It fire recorded at that time. There is no other evidence of does not, for example, consider the osteological evidence treponemal infection from this period, but there is indi- that is essential for understanding the origin of trepo- cation of it in the subsequent periods of occupation. The nemal infection, and we find little that is new in the possibility that the disease was brought back by earlier interpretation of the documentary evidence. Guerra's Norse explorers of the New World ought to be consid- case for pre-Columbian syphilis in the Old World is ered. based on the argument that diseases described in the Contrary to the impression conveyed in our paper, literature prior to I493 are in fact syphilis. We continue Steinbock, while recognizing problems with the dating to view these reports as ambiguous. Drusini quotes of the Australian specimens, does state that there is a Guerra as saying that current understanding of the envi- strong suggestion of precontact syphilis in Australia. ronmental effects on the disease has altered the context While we do not deny the importance of this osteolog- for discussion of the role of America in the history of ical evidence, pre-Columbian examples from the Old syphilis. Guerra's approach (p. 57) is reminiscent of World are sparse compared with those found in the New Hackett's: World. In addition, if the alleged venereal disease in pre-

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Columbian Europe had in fact been syphilis, then we to sort through all the material and present it as we would expect to find widespread skeletal evidence of it. resurrected the hypothesis of a New World origin. Geise, Even in those instances in which the dating of the os- Saunders, Weaver, and Storey provide additional data teological specimen is not in dispute, the evidence is on pre-Columbian treponemal infections in the New meager; for example, on the York specimen the classic World. Storey points out, further, that there is no evi- stellate scars are found on the fragmentary cranium of dence of congenital syphilis at either Teotihuacan or Co- one individual, and there is diffuse osteitis on a tibia and pan. Nor would we expect it, since venereal syphilis a fibula of another. need not be present wherever there is urbanization. Are these differences a matter of sampling? Becker While not all periosteal involvement need be trepo- suggests that the interest shown by Americans has been nemal, Story might find it fruitful to reevaluate the pro- matched only in England and Denmark, and Saunders portion that is the result of treponemal infection. Alli- points out that European museum collections are son et al. (i982) have reported evidence of treponemal mostly skulls, perhaps not the best part for identifying infection in South America that is dated at 7,000 years treponemal infection. Brothwell, who suggests that the ago. If the diagnosis and dating are confirmed, this dis- original homeland of the treponemes may be Asia, im- covery would suggest great antiquity for the treponemes plies a similar concern for sampling in that area. To in the New World. prove that treponemal infection did not occur in pre- Wesolowsky asks if we have seen the material that we Columbian Europe is extremely difficult, since we are report in the paper. Unfortunately, we have not seen arguing from negative evidence. It is not that we were much of the material discussed but have relied on the not familiar with the European evidence, as Stloukal im- primary investigators' descriptions and illustrations. We plies, but that we were unwilling to report an absence of apologize for the absence of illustrations here but have evidence unless this was specifically stated. been careful to cite the relevant ones in the published In responding to the question of sampling we should material reviewed. examine the areas in which there has been extensive Our presenting this synthesis was made possible by excavation. The work on leper cemeteries in Denmark is the agreement that has developed among skeletal biolo- especially critical, since many of those who claim that gists as a result of the work of Hackett and others in syphilis existed in pre-Columbian Europe believe that defining the criteria for diagnosis. Workshops held at the many individuals who were diagnosed as lepers were in annual meetings of the Paleopathology Association have fact suffering from syphilis. Examination of cemeteries been very effective in developing consensus on diag- associated with leprosaria has not revealed individuals nostic criteria. In addition, Powell, Cook, and others with treponemal lesions. Furthermore, Stloukal notes have undertaken excellent studies using the most up-to- that in the last 20-30 years over io,ooo skeletons have date methods of diagnosis and provided the epidemiolog- been excavated and studied from medieval Czechoslo- ical model for others to use in examining their material vakian cemeteries without producing any evidence of for evidence of treponemal infections. syphilis, whereas in the i6th-i8th century cemeteries Hackett (I 976) was concerned that few pre-Columbian there is ample such evidence. American bones exhibited diagnostic features of trepo- Saunders asks about the evidence from Africa. Stein- nematosis, and we calculated that we would expect to bock (I976:97) states that Smith and Jones (i9io) exam- find lesions in I-5% of the individual skeletons if the ined 25,000 Egyptian skeletons and found no indication disease were endemic. In contrast, researchers such as of syphilis. A reexamination by Hussein (I 949) describes Powell, Cook, and others working in the East and Mid- two possible cases. Armelagos and colleagues found no west find half of their populations showing the disease. evidence in an examination of I,OOO Meroitic, X-group, Powell provides a reasonable resolution of this riddle in and Christian burials from the Republic of the Sudan. pointing to the difference between the earlier radio- Morris confirms that there are no reports of treponemal graphic assessments and the most recent assessments infection in South Africa prior to European contact. based on the direct observation of dry bones. Powell also Morimoto points out that the first evidence of ve- solves another problem of interpretation-that of the nereal syphilis in Japan comes from Kyoto in I5 .12, and evidence for transplacental infection-by citing Grin Saunders inquires about the relationship of this date to (i956) to the effect that transplacental transmission is the earliest arrival of Europeans in Japan. This occur- possible. Its rarity in modern yaws and endemic syphilis rence pre-dates the arrival of European sailors by 30 reflects the generally low level of pathogenic trepo- years. Suzuki (i984b) states that shortly after that first nemes in the maternal bloodstream because of the occurrence there was a virulent outbreak. He also cites length of time separating the onset of the treponemal Koganei's (i894) description of a case of syphilis in an infection and the occurrence of pregnancy. Ainu skeleton and his own i963 report of evidence of Weaver asks if distinction between nonvenereal and syphilis in 3 of 23 skulls from the Muromachi period. He venereal syphilis is intractable. As we have pointed out, describes another case of syphilis from a burial associ- the skeletal symptoms are similar, but the pattern of ated with a medieval castle from Hokkaido (i984c). infection in the population is likely to be different. For Storey claims that the inclusion of doubtful specimens example, nonvenereal syphilis is likely to infect younger from the New World diffuses the argument that the New individuals prior to reaching sexual maturity. If a popu- World specimens are plentiful. We saw a need, however, lation is exposed to nonvenereal syphilis, we would not

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expect to find any individuals with evidence of con- goes beyond history is an important aspect of paleopa- genital transmission. thology as a science. We see our discussion of the trepo- Rothschild suggests that immunological testing can nemal infections in a broader context that considers confirm treponemal infection in prehistoric bone. He ar- methods of analysis, use of skeletal and documentary gues that once all the pre-Columbian bones with sus- evidence, ecology, and the evolution of pathogen and pected treponemal infections have been analysed in this host. way, the controversy will be resolved, and Kelley echoes One of the pleasing aspects of presenting a review such this view. Geise questions it, noting that doubts have as this is eliciting responses that suggest future research. already been raised about the immunological evidence of Morris notes that yaws, endemic syphilis, and venereal the treponemal infection in the Pleistocene bear. Powell syphilis coexist today in southern Africa. As he points suggests that it may represent a nonspecific osteomy- out, this would be an ideal region in which to examine elitis with an opportunistic fungal infection that gives a the ecological relationships between the pathogen and false positive result. On reflection, while we see tremen- its physical and social environment in historical con- dous possibilities for immunological testing, we agree text. that it will not present a quick solution. As Brothwell While we realize that we have not had the last word in notes, the analysis of the treponemes in other verte- this interesting controversy, we hope that we have brates will be necessary to see if this is in fact a zoonosis. clarified the issues for the continuing debate. Becker states that the crux of our argument is the transformation of the treponemal pathogen under differ- ing environmental and social circumstances. While gen- References Cited erally agreeing with our position, he asks if venereal syphilis spread with unusual virulence into the Old ACKERNECHT, ERWIN H. I95s. A short history of medicine. New World from the New because the urban environment York: Ronald Press. [AD] conduced to it and, if so, why the New World distribu- . I965. History and geography of the most important dis- tion is not associated with urban centers. We do not eases. New York: Hafner. [AD] claim that venereal syphilis existed in the New World; ALLISON, M. J., G. FOCACCI, E. GERSZETEN, M. FOUANT, AND M. CEBELIN. I982. La sifilis: iUna enfermedad americana? rather, we argue that the endemic nonvenereal trepo- Chungara 9:27 5-83. nemal infection was present and was transformed into a ANDERSEN, J. G. I969. Studies in the mediaeval diagnosis of lep- sexually transmitted disease following its spread to rosy in Denmark. Danish Medical Bulletin I6(suppl. 9):I-I42. Europe. We do not see a need for urban centers for the ANDERSON, JAMES E. I965. Human skeletons of Tehuacan. Sci- ence I48:496-97. transmission of endemic treponemal infections. As ANDERSON, T., C. ARCINI, S. ANDA, A. TANGERUD, AND G. Nurse points out, it is "the huddling together of scantily ROBERTSEN. I986. Suspected endemic syphilis (treponarid) in clad children" that is the most likely avenue for the sixteenth-century Norway. Medical History 30: 34I-50. [DB] transmission of the pathogen. We do agree with Hudson ARMELAGOS, G. J., J. H. MIELKE, AND J. WINTER. I97I. Bibliog- raphy of human paleopathology. Department of Anthropology, that urban centers are an ideal environment for the sex- University of Massachusetts, Research Reports 8. ual transmission of treponemal disease. Hudson argues, ASSOCIATED PRESS. I987. Report says AIDS surfaced in I969. however, that this is because of improved hygiene that Boston Globe, October 25, p. 2i. delayed the transmission until it was spread sexually. 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Sandison, pp. 279-93. Springfield: Thomas. proach. Ph.D. diss., University of Chicago, Chicago, Ill. G O L D S T E I N, M A R C U S S. I 9 57. Skeletal pathology of early Indi- . I984. "Subsistence and health in the lower Illinois Valley: ans in Texas. American Journal of Physical Anthropology Osteological evidence," in Paleopathology at the origins of ag- I5: 299-3II. riculture. Edited by Mark N. Cohen and George J. Armelagos, GORDON, BENJAMIN L. I959. Medieval and Renaissance medi- pp. 235-69. Orlando: Academic Press. cine. New York: Philosophical Library. 1985. Treponematosis in the Chirikof Island population. GREGG, JOHN B., MARVIN J. ALLISON, AND LARRY J. ZIMMER-

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MAN. I98I. Possible treponematosis in fourteenth-century Bedouin Arabs of the Syrian desert. United States Naval Med- Dakota Territory: A progress report. Paleopathology Newslet- ical Bulletin 26:8I7-24. [BMR] ter, no. 34, pp. 5-6. .I 958. Non-venereal syphilis: A sociological and medical GREGG, JOHN B., AND P. S. GREGG. i987. Dry bones: Dakota study of be/el. Edinburgh: E. and S. Livington. [MLP, BMR] Territory reflected. Sioux Falls: Sioux Printing. [JAW] HUDSON, ELLIS HERNDON. I96I. Historical approach to the ter- GRIN, E. j. i956. Endemic syphilis and yaws. Bulletin of the minology of syphilis. Archives of Dermatology 84:545-62. World Health Organization I5:959-73. [MLP] . I963a. Treponematosis and anthropology. Annals of Inter- . i96i. Endemic treponematoses in the Sudan. Bulletin of nal Medicine 5 8:I037-49. the World Health Organization 24:229-38. . I963b. Treponematosis and pilgrimage. American Journal GRIN, E., AND T. GUTHE. I973. Evaluation of a previous mass of the Medical Sciences 246:645-56. campaign against endemic syphilis in Bosnia and Herzegovina. .I 964. Treponematosis and African slavery. British Journal British Journal of Venereal Diseases 49: I-I9. [GTN] of Venereal Diseases 40:43-5 2. GUERRA, FRANCISCO. I978. The dispute over syphilis: Europe . I965 a. Treponematosis and man's social evolution. Amer- versus America. Clio Medica I3:39-6I. [AD] ican Anthropologist 67:885-9OI. GUMERMAN, GEORGE J., AND EMIL W. HAURY. I979. "Prehis- .I 965 b. Treponematosis in perspective. Bulletin of the tory: Hohokam," in Handbook of North American Indians, vol. World Health Organization 32:735-48. 9, Southwest. Edited by Alfonso Ortiz. Washington, D.C.: .I968. Christopher Columbus and the history of syphilis. Smithsonian Institution. Acta Tropica 25:i-i6. GUTHE, T, AND R. R. WILLCOX. I954. Treponematoses: A world .I972. Diagnosing a case of venereal disease in fifteenth- problem. Chronicle of the World Health Organization 8:37- century Scotland. British Journal of Venereal Diseases 48: I I3. I46-53. HACKETT, C. j. I95 I. Bone lesions of yaws in Uganda. Oxford: HULSE, E. v. I975. The nature of biblical "leprosy" and the use of Blackwell Scientific Publications. alternative medical terms in modern translations of the Bible. . i963. On the origin of the human treponematoses. Bulle- Palestine Exploration Quarterly I07:87-I05. tin of the World Health Organization 29:7-4I. HUNT, D., AND A. L. JOHNSON. I923. Yaws: A study based on . i967. "The human treponematoses," in Diseases in antiq- over 2,ooo cases treated on American Samoa. United States uity. Edited by Don Brothwell and A. T. Sandison, pp. I 5 2-69. Naval Medical Bulletin I8:599-607. [BMR] Springfield: Thomas. H U SS EI N, M. K. I949. Quelques specimens de pathologie osseou- . I976. Diagnostic criteria of syphilis, yaws, and treponarid ses chez les anciens egyptiens. Bulletin de l'Institut d'Egypte (treponematoses) and of some other diseases in dry bones. Ber- 32:II-I7. lin: Springer-Verlag. HYDE, JAMES N. I89I. A contribution to the study of pre-Colum- HALTOM, W. L., AND A. R. SHANDS, JR. I938. Evidences of bian syphilis in America. American Journal of the Medical Sci- syphilis in Mound Builders' bones. Archives of Pathology ences I02:II7-3I. 25:228-42. ISCAN, M. YASAR, AND PATRICIA MILLER-SHAIVITZ. I985.

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MOSSOP, E. E., AND A. W. VAN DER HORST. I935. The journal of MAC CURDY, GEORGE G. I923. Human skeletal remains from the Hendrik Jacob Wikar (1779). Van Riebeeck Society IS. [AGM] highlands of Peru. American Journal of Physical Anthropology MURDOCK, J. R., AND H. J. HUTTER. I932. Leprosy: Aroentgeno- 6:2I7-329. logical survey. American Journal of Roentgenology 28:598-62i. MC NEILL, W. H. I976. Plagues and peoples. Garden City: MURRAY, J. F., A. M. MERRIWEATHER, AND M. L. FREEDMAN. Doubleday Anchor. [RS, ABW] I956. Endemic syphilis in the Bakwena Reserve of the MA D RI D, AL F O N S O. I 9 86. Work in historical osteology at theBechuanaland Protectorate: A report on mass examination and National Museum of Antiquities in Sweden. Museum 38(3): treatment. Bulletin of the World Health Organization I 5: I975. I55-57. [GTNj MAINGARD, J. F. I937. Some notes on health and disease among MUSHER, DANIEL M., AND JOHN M. KNOX. i983. "Syphilis and the Bushmen of the southern Kalahari. Bantu Studies I i:285 - yaws," in Pathogenesis and immunology of treponemal infec- 94. [AGM] tion. (Immunology Series 2o.) Edited by Ronald F. Schell and MATTHEWS, WASHINGTON, J. L. WORTMAN, AND JOHN S. BIL- Daniel M. Musher, pp. ioi-2o. New York: Marcel Dekker. LINGS. I893. Human bones of the Hemenway collection in the NURSE, G. T., AND T. JENKINS. I977. Health and the hunter- United States Army Medical Museum. Memoirs of the National gatherer. Basel: Karger. [AGM] Academy of Sciences 6: I4i-286. NURSE, G. T., N. TANAKA, G. MACNAB, AND T. JENKINS. I973. MEANS, H. J. I925. A roentgenological study of the skeletal re- Non-venereal syphilis and Australia antigen among the G/wi mains of the prehistoric Mound Builder Indians of Ohio. Ameri- and G//ana San of the Central Kalahari Reserve, Botswana. Cen- can Journal of Roentgenology I3:359-67. tral African Journal of Medicine I 9:207-I 3. [AGM, GTN]. M E E R, R. M. I 9 85. Health and disease in protohistoric Alaska. Pa- OLANSKY, SYDNEY. i98i. "Treponematosis," in The science and per presented at the 84th annual meeting of the American An- practice of clinical medicine, vol. 8, Infectious diseases. Edited thropological Association, Washington, D.C. by Jay P. Sanford and James P. Luby, pp. 298-305. New York: MILES, JAMES S. I966. "Diseases encountered at Mesa Verde, Grune and Stratton. Colorado. II: Evidences of disease," in Human palaeopathology. ORTNER, DONALD j. i986. Skeletal evidence of pre-Columbian Edited by Saul Jarcho, pp. 9I-97. New Haven: Yale University treponemal disease in North America. Paper presented at the Press. 6th European Members' Meeting of the Paleopathology Associa- . 1975. Orthopedic problems of the Wetherill Mesa popula- tion, Madrid. tions, Mesa Verde National Park, Colorado. National Park Ser- ORTNER, DONALD J., AND WALTER G. J. PUTSCHAR. i985. Re- vice Publications in Archeology 7G. print edition. Identification of pathological conditions in hu- M I L L S, W I L L I A M C. I 906. Baum prehistoric village. Ohio man skeletal remains. Washington, D.C.: Smithsonian Institu- Archaeological and Historical Publications I 5:45-I 36. tion Press. MENTZEL, O. F. I944. A geographical and topographical descrip- ORTON, S. T. I9o5. A study of the pathological changes in some tion of the Cape of Good Hope. Van Riebeeck Society 25. [AGM] Mound Builder's bones from the Ohio Valley, with especial ref- M0LLER-CHRISTENSEN, VILHELM. i952. Case of leprosy from erence to syphilis. University of Pennsylvania Medical Bulletin the Middle Ages of Denmark. Acta Medica Scandinavica I42 I8:36-44. (suppl. 266):IoI-8. PACE, J. L., AND G. W. CSONKA. i984. Endemic non-venereal . i967. "Evidence of leprosy in earlier peoples," in Diseases syphilis (bejel) in Saudi Arabia. British Journal of Venereal Dis- in antiquity. Edited by Don Brothwell and A. T. Sandison, pp. eases 60:293-97. [GTN] 295-306. Springfield: Thomas. PARROT, M. J. I879. The osseous lesions of hereditary syphilis. M0LLER-CHRISTENSEN, VILHELM, AND BORGE FABER. I952. Lancet i:696-98. Leprous changes in a material of mediaeval skeletons from the PATERSON, D. E. i959. "Radiographic appearances and bone St. George's Court, Naestved. Acta Radiologica 37:308-I7. changes in leprosy: Their cause, treatment, and practical appli- M0LLER-CHRISTENSEN, VILHELM, AND R. G. INKSTER. I965. cation," in Leprosy in theory and practice. Edited by R. G. Cases of leprosy and syphilis in the osteological collection of Cochrane, pp. 243-64. Bristol; John Wright. the Department of Anatomy, University of Edinburgh. Danish . i96I. Bone changes in leprosy: Their incidence, progress, Medical Bulletin I 2: I I-I 8. prevention, and arrest. International Journal of Leprosy 29: M OO R E, C L A R E N C E B. I 907. Moundville revisited. Journal of the 393-422. Academy of Natural Sciences of Philadelphia I3:337-405. PATRICK, ADAM. i967. "Disease in antiquity: Ancient Greece MORANT, G. M., AND M. F. HOADLEY. I93I. A study of the re- and Rome," in Diseases in antiquity. Edited by Don Brothwell cently excavated Spitalfields crania. Biometrika 23:I9I-248. and A. T. Sandison, pp. 238-46. Springfield: Thomas. MORISON, SAMUEL ELIOT. I942. Admiral of the ocean sea: A PERZIGIAN, ANTHONY J., PATRICIA A. TENCH, AND DONNA life of Christopher Columbus. Boston: Little, Brown. [SRS] J. BRAUN. i984. "Prehistoric health in the Ohio River valley," MORSE, DAN. I967. "Two cases of possible treponema infection in Paleopathology at the origins of agriculture. Edited by Mark in prehistoric America," in Miscellaneous papers in paleopa- N. Cohen and George J. Armelagos, pp. 347-66. Orlando: Aca- thology, vol. I. Edited by William D. Wade, pp. 48-60. Museum demic Press. of Northern Arizona, Technical Series 7. PIETRUSEWSKY, M. 197I. An osteological study of cranial and . I973. "Pathology and abnormalities of the Hampson skel- infracranial remains from Tonga. Records of the Auckland In- etal collection," in Nodena: An account of 75 years of archeo- stitute and Museum 6:287-402. logical investigation in southeast Mississippi County, Arkan- POWELL, MARY LUCAS. I988a. Status and health in prehistory: sas. Edited by Dan F. Morse, pp. 4I-60. Arkansas Archeological A case study of the Moundville chiefdom. Washington: Smith- Survey Research Series 4. sonian Institution Press. . I978. 2d revised edition. Ancient disease in the Midwest. . I988b. Endemic treponematosis and tuberculosis in the Illinois State Museum Reports of Investigations i 5. prehistoric southeastern United States: The biological costs of

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chronic endemic disease. Paper presented at the i2th Interna- STEINBOCK, R. TED. I976. Paleopathological diagnosis and in- tional Congress of Anthropological and Ethnological Sciences, terpretation. Springfield: Thomas. Zagreb, Yugoslavia. STEWART, T. D., AND LAWRENCE G. QUADE. i969. Lesions of . I988c. "On the eve of the conquest: Life and death at the frontal bone in American Indians. American Journal of Irene Mound, Georgia," in Postcontact biocultural adaptation Physical Anthropology 30:89-I IO. of Native American populations on St. Catherines Island, STEWART, T. D., AND ALEXANDER SPOEHR. i967 (I952). "Evi- Georgia. Edited by David Hurst Thomas and Clark Spencer dence on the palaeopathology of yaws," in Diseases in antiq- Larsen. New York: American Museum of Natural History. In uity. Edited by Don Brothwell and A. T. Sandison, pp. 307-I9. preparation. Springfield: Thomas. . I988d. "Health and disease at Nodena, a Late Mississip- SUSSMAN, MAX. i967. "Diseases in the Bible and the Talmud," pian community in northeast Arkansas," in Towns and temples in Diseases in antiquity. Edited by Don Brothwell and A. T. along the Mississippi. Edited by David Dye. Birmingham: Uni- Sandison, pp. 2o9-2i. Springfield: Thomas. versity of Alabama Press. In press. SUZUKI, TAKAO. i963. Human skeletal remains of the ancient PUTNAM, FREDERIC W. I878. Archaeological explorations in Japanese populations. Tokyo: Iwanami Shoten. Tennessee. Report of the Peabody Museum 2:305-60. . I984a. Paleopathological and paleoepidemiological study QUINN, THOMAS C., DAVID GLASSER, ROBERT 0. CANNON, of osseous syphilis in skulls of the Edo period. Tokyo: Univer- DIANE L. MATUSZAK, RICHARD W. DUNNING, RICHARD L. sity of Tokyo Press. [IM, SRS] KLINE, CARL H. CAMPBELL, EBENEZER ISRAEL, ANTHONY S. . I984b. Paleopathological study on osseous syphilis in FAUGI, AND EDWARD W. HOOK III. I988. Human immu- skulls of the Ainu skeletal remains. Ossa 9-I I: I 53-68. nodeficiency virus infection among patients attending clinics . i984c. Typical osseous syphilis in medieval skeletal re- for sexually transmitted diseases. New England Journal of mains from Hokkaido. Journal of the Anthropological Society Medicine 3i8:I97-203. of Nippon 92:23-32. RABKIN, SAMUEL. I942. Dental conditions among prehistoric In- TEMKIN, OWSEI. I966. "Discussion," in Human palaeopathol- dians of northern Alabama. Journal of Dental Research 2 i:2 2i- ogy. Edited by Saul Jarcho, pp. 30-3 5. New Haven: Yale Univer- 22. sity Press. RAMENOFSKY, ANN F. I982. The archaeology of population col- TENNEY, j. i986. Possible treponemal bone lesions among early lapse: Native American response to the introduction of infec- native Californians. Paper presented at the 6th European Mem- tious disease. Ann Arbor: University Microfilms. [MJB] bers' Meeting of the Paleopathology Association, Madrid. REICHS, KATHLEEN J. I987. Treponematosis: A possible case THWAITES, R. G. I9o5. Early Western travels, I748-I846. Vol. from the Late Woodland of North Carolina. Paper presented at I 5. Cleveland: Arthur Clark. [JAW] the I4th annual meeting of the Paleopathology Association, TRUSWELL, A. S., AND J. D. L. HANSEN. i968. Medicalandnutri- New York, N.Y. tional studies of the !Kung Bushmen in northwest Botswana. REID, R. I947-48. Lewis and Clark in North Dakota. North South African Medical Journal 28:I338-39. [AGM] Dakota History I4 and I 5. [JAW] T U R N E R, T. B. I 9 37. Studies on the relationship between syphilis RICHARDS, PETER. I977. The medieval leper. Cambridge: D. S. and yaws. American Journal of Hygiene 254:477-5o6. [BMR] Brewer. VORBERG, G. i896. Uber den Ursprung der Syphilis: Quellen ge- ROKHLIN, D. G. I965. Diseases of ancient men: Bones of the men schichtliche Untersuchungen. Stuttgart: J. Puttmann. [AD] of various epochs, normal and pathological changes. Moscow- WAKEFIELD, E.. G., SAMUEL C. DELLINGER, AND JOHN D. Leningrad: Nauka. [AD] CAMP. 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Institutions

* The European Anthropological Association was south, where a department of anthropology was estab- formed in I976 under the chairmanship of Georges lished in I983) has there gradually emerged a body of Olivier; its current chairman is 0. Eiben. It aims to locally based, permanently resident scholars in a posi- stimulate research in physical anthropology in Europe tion to take a sustained interest in the development of but also has many non-European members. It pub- anthropology in Ireland (see Kane et al. I988). Until re- lishes a newsletter and a journal, the International cently there have been relatively few opportunities for Journal of Anthropology, and holds a congress every these scholars to meet as a professional body. More- two years. The sixth congress took place in Budapest over, anthropologists in Ireland without an institu- in September of this year. The seventh congress, to be tional base and those visiting for the purposes of re- organized by T. Bielicki, will be held in Wroclaw in search often expressed a need for a forum to minimise I990. Inquiries about membership should be directed the academic isolation they sometimes felt. to Charles Susanne, Free University of Brussels, Plein- These views were expressed particularly clearly at a laan 2, I050 Brussels, Belgium. meeting of the Royal Irish Academy in Dublin in I986 which brought together for the first time anthropolo- m The Prehistoric Society disposes of limited resources gists from all over Ireland in an effort to identify their intended to further the development of prehistory as potential role in policy and development research (see an international discipline by assisting prehistorians Donnan I986). The success of this meeting made clear attending international conferences. Particular atten- that there was now a sufficient number of anthro- tion is paid to the needs of those prehistorians, partic- pologists resident in Ireland to sustain some kind of ularly from developing countries, who would other- association, and in order to discuss this further a wise have difficulty in acquiring funds to attend series of three conferences was organised, each at a dif- international meetings. Application forms and further ferent location, to which all anthropologists known to information are available from Frances Healy, Norfolk be in Ireland at the time were invited. These confer- Archaeological Unit, Union House, Gressenhall, East ences were well-attended and were invigorated by the Dereham, Norfolk NR.o 4DR, U.K. presence of several distinguished visiting scholars. In addition to providing an opportunity to discuss a draft * While professional anthropological research in Ire- constitution for an association, they allowed a glimpse land began almost a century ago with the work of of the range of anthropological expertise in Ireland; pa- Haddon and Browne (i89i)1 and a steady flow of re- pers were presented not only on Ireland itself (north searchers has visited Ireland ever since, anthropology and south) but also on New Guinea, Kenya, India, as a degree subject is relatively new to the country's Pakistan, and Malta and covered a variety of subjects universities. Only with the development of degree pro- including elite politics, symbolism, and computer ap- grammes (since i962 in the north but later in the plications in anthropology. At the most recent of these

I. References cited are as follows: meetings, in May I988, the association which is to be DONNAN, H. I986. Anthropology and its applications. Anthropol- known as the Anthropological Association of Ireland ogy Today 2(5):22-23. was formally inaugurated and the following officers HADDON, A. C., AND C. R. BROWNE. I89I. Ethnography of the elected: Chairperson, Hastings Donnan; Vice-Chairper- Aran Islands, Co. Galway. Proceedings of the Royal Irish son, Joe Ruane; Treasurer-Membership Secretary, Lee Academy I8:768-830. KANE, E., J. BLACKING, H. DONNAN, AND G. MCFARLANE. Komito; Secretary, Graham McFarlane; Committee I988. "A review of anthropological research in Ireland, North Members, May McCann, Shaun Ogle, Gearoid and South," in The state of social science research in Ireland. O Crualaoich, and Annette Sanger (co-opted). Edited by L. O'Dowd, pp. 95-I IO. Dublin: Royal Irish The Association aims to promote anthropology in Academy.

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