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Syphilis was perceived to be a new disease in Europe in the late 15th century, igniting a debate about its origin that continues today in anthropological, historical, and medical circles. We move beyond this age-old debate using an interdisciplinary approach that tackles broader questions to advance the understanding of treponemal infection (syphilis, yaws, bejel, and pinta). How did the causative organism(s) and humans co-evolve? How did the related diseases caused by Treponema pallidum emerge in different parts of the world and affect people across both time and space? How are T. pallidum subspecies related to the treponeme causing pinta? The current state of scholarship in specific areas is reviewed with recommendations made to stimulate future work. Understanding treponemal biology, genetic relationships, epidemiology, and clinical manifestations is crucial for vaccine development today and for investigating the distribution of infection in both modern and past populations. Paleopathologists must improve diagnostic criteria and use a standard approach for recording skeletal lesions on archaeological human remains. Adequate contextualization of cultural and environmental conditions is necessary, including site dating and justification for any corrections made for marine or freshwater reservoir effects. Biogeochemical analyses may assess aquatic contributions to diet, physiological changes arising from treponemal disease and its treatments (e.g., mercury), or residential mobility of those affected. Shifting the focus from point of origin to investigating who is affected (e.g., by age/sex or socioeconomic status) and disease distribution (e.g., coastal/ inland, rural/urban) will advance our understanding of the treponemal disease and its impact on people through time., (© 2020 Wiley Periodicals, Inc.)

Treponematosis is a syndrome of chronic infectious diseases. There has been much debate on its origins and spread, particularly with regard to venereal syphilis, an unsightly and debilitating disease in preantibiotic populations. The osteological analysis of 5,387 individuals excavated by Museum of London Archaeology from the medieval burial ground of St. Mary Spital in London (dated c 1120-1539) provided an unprecedented opportunity to investigate the nature and prevalence of disease over a period of time. Twenty-five individuals were found with suspected treponematosis, originating from all but the earliest period of the burial ground. Descriptions of affected individuals from each period, together with supporting images, are provided. In this work, particular emphasis was given to the distribution of lesions on the skeleton and the variation in patterns by sex and over time. Little change was observed in the distribution of bony change between individuals dated to pre- and post-Columbian periods. However, a dramatic rise in the prevalence of the disease in the final period (c 1400-1539) may reflect documentary reports of a European epidemic from the late 15th century., (© 2014 Wiley Periodicals, Inc.)

Treponemal disease is known to be associated with the compromised community health of permanent village settlement. This association explains its high visibility in the village-based, arguably chiefdom level, agriculturalist societies of late prehistoric (AD 1300-1600) North America. Within chiefdom-level societies, health differences have often been demonstrated between mortuary-defined "elite" and "nonelite" individuals. This theoretically should predict status-based differences in treponemal disease visibility. The prediction is tested in a five-site osteological sample (N = 650) from the Dallas phase (AD 1300-1550), a simple mortuary-defined two-tiered presumptive chiefdom level maize agriculturalist socioeconomic context from lower east Tennessee. The Dallas phase results affirm a general pre-Colombian North American pattern of no sex differences and display comparable adult to subadult frequencies. The study also reveals that given a sufficient sample size, "elites" do indeed exhibit a significantly lower frequency of tertiary stage treponemal disease. This can be attributed to better baseline health, which has been previously demonstrated in this sample. It may also be affected by the mortuary inclusion of achieved status individuals whose good health may have facilitated sociopolitical advancement. Another pattern that emerged is an apparent young adult age bias in disease visibility. This suggests that tertiary treponemal disease morbidity may either directly or synergistically factor in early adult age at death. Future research will address the veracity of this association., (2010 Wiley-Liss, Inc.)

The origin and geographic distribution of syphilis, a form of treponemal infection, have long been regarded as among the most important medical riddles of prehistoric and historic disease evolution. In this study, we expand on previous discussions of the origin, evolution, and relationship of treponemal infections as they occur in the prehistoric southeastern United States. Individuals from 25 skeletal series (n = 2,410 individuals) were examined for cranial and dental lesions characteristic of treponemal infection. They lived between the Archaic period (8000-1000 BC) and protohistoric period (AD 1500-1600), and in physiographic zones from the coast to the mountains of Alabama, Florida, North Carolina, and Tennessee. Radial cranial scars were found for 47 individuals, but none of the four cases of dental lesions could be attributed to congenital syphilis. Differences in frequency of cranial lesions by region were minimal, with the least number of cases found for the mountains, but the frequency of positive cases tended to increase through time. It is suggested that increasing population density and changing behaviors, rather than novel strains of the treponemal pathogen, are responsible for the chronological increase in the frequency of positive cases., (Copyright 2006 Wiley-Liss, Inc.)

In 1912, 68 medieval crania were excavated from a cave at Safed in the eastern Mediterranean and brought to the United Kingdom. It is only recently that these skulls have been studied for evidence of disease. One adult individual demonstrates multiple lesions of the cranial vault, compatible with treponematosis. Radiocarbon dating suggests the year of death to be between 1290-1420 AD. This range equates to the mamluk period, just after the crusades. This is the oldest dated case of treponematosis in the Middle East, and the first to confirm its presence there before the epidemiologically important transatlantic voyage of Christopher Columbus. The finding has significant implications for our understanding of the introduction of the disease to the Middle East and of the medieval diagnosis of ulcerating skin conditions by medical practitioners in the Mediterranean world., (Copyright 2003 Wiley-Liss, Inc.)

An unusually high frequency of periosteal lesions of visceral rib surfaces was observed in a small, prehistoric skeletal series from southwestern Colorado. Lesions of this type have been concordant with pulmonary tuberculosis in three studies of human skeletal collections with known cause of death, and in a recent clinical investigation of rib dimensions in living patients with lung disorders. Diseases such as pneumonia and actinomycosis have also been found to cause these lesions, but in much lower frequencies. Archaeological evidence suggests that Puebloan farmers of Sleeping Ute Mountain's southern piedmont, from which the sample is drawn, endured unusually harsh environmental conditions punctuated by severe drought and exacerbated by escalating warfare. It is argued here that these environmental stressors increased susceptibility to an opportunistic respiratory infection reminiscent of tuberculosis, and possibly also some form of pneumonia, resulting in high rates of active disease previously noted only in historic Puebloan peoples., (Copyright 2002 Wiley-Liss, Inc.)

Descriptions of skeletal pathological conditions evident in the prehistoric Tchefuncte adolescent 16ST1-14883b are clarified. The basis is reaffirmed for assigning to the described pathological conditions a diagnostic perspective of juvenile rheumatoid arthritis or juvenile Lyme disease--a disease that mimics juvenile rheumatoid arthritis in its arthritic presentation--rather than of assigning them as representative of juvenile onset ankylosing spondylitis or other juvenile spondyloarthropathies. A hypothesis (Lewis [1994] Am. J. Phys. Anthropol. 93:455-475) is restated that 1) the spirochete Borrelia burgdorferi was the infectious agent responsible for prevalence of adult rheumatoid arthritis in prehistoric southeastern Native American populations, 2) that B. burgdorferi is a possible cause of the arthritis evident in individual 16ST1-14883b, and 3) that antibodies to B. burgdorferi provided partial immunity to the related spirochete Treponema pallidum for the 16ST1 precontact Tchefuncte population from Louisiana, protecting them from severe treponemal response. Given the probable widespread existence of Ixodid tick vectors for B. burgdorferi in prehistoric North America, coupled with the existence of treponematosis, it follows that the transition of Native American hunting-gathering economies to more sedentary economies would predictably be linked to an increased incidence of treponematosis due to the loss of benefits of the above-stated partial immunity. In other words, as prehistoric Native American exposure to tick vectors for B. burgdorferi decreased, susceptibility to treponematosis increased. Inferences regarding biological controls interacting with and influencing prehistoric Native American migration patterns are suggested from the link of B. burgdorferi to an Ixodid tick common to northeast Asia.

An Iron Age (megalithic) skull recovered from a cist burial complex at Agripalle, Andhra Pradesh, India, exhibits extensive erosion of the calvarium, areas of sclerotic diploe, irregular osteitic and periosteitic lesions, and deep ulcerations with a granulomatous appearance of nodular foci due to bone remodeling. These lesions are found over the entire surface, but are less severe in the temporal region and in the occipital region below lambda. There is extensive ulceration and destruction of the orbital roof and the nasopalatine region. A thick bony mass representing a healed lesion is present on the nasal margin. Comparison with the pathologic skeletal series of Ortner and Putschar ([1981] Smithson. Contrib. Anthropol. 28:180-218), Steinbock ([1976] Paleopathology: Diagnosis and Interpretation, pp.86-169), and Calvin ([1964] Bones and Disease: Evidence of Disease and Abnormality in Early Man) indicates that these findings warrant a diagnosis of an advanced stage of treponematosis. The material from Agripalle, together with similar specimens recovered from the sites of Bhimbetka (Iron Age) and Inamgaon (Chalcolithic), furnish additional evidence supporting the hypothesis of the prehistoric antiquity of treponemal disease in both the New and Old Worlds.

Examination of five central Gulf Coast Florida archaeological skeletal series (n = 547) from the late prehistoric and early historic periods reveals the presence of pathological lesions characteristic of treponemal infection. These skeletal remains of native American populations represent a crucial time regarding hypotheses about the exchange of syphilis between the Old and New World or the mutation of one treponemal infection into another. Comparison of the lesions with those observed in modern studies of treponemal infection does not support an interpretation of venereal syphilis. The data from this study and from other archaeological skeletal series indicate the presence of a treponemal disease prior to European contact. The skeletal elements from Florida do not suggest that the disease changed dramatically following contact with Europeans. It is possible that cases of nonspecific postcranial pathology can be explained by the presence of this disease in the Florida populations. This study indicates that a treponemal disease was endemic throughout the region by at least A.D. 1000.