Advan ces in Anthropology
2011. Vol.1, No.2, 15-18
Copyright © 2011 SciRes. DOI:10.4236/aa.2011.12003
Virgin Texas: Treponematosis-Associated Periosteal Reaction
6 Millenia in the Past
Bruce M. Rothschild1, Christine Rothschild2, Glen Doran2
1Northeastern Ohio Medical School, Rootstown, USA;
2Florida State University, Tallahassee, USA.
Received August 21st, 2011; revised October 7th, 2011; accepted October 18th, 2011.
In bioarchaeology, skeletal biology and paleopathology, periosteal reaction has been variably considered as a
non -speci fic sign of tra uma and alt ernat ively as ha vin g potenti ally dia gnostic implic ati ons. Exa mination of s ixth
millen n i um b efore p r es en t Texas c emet eri es f a lsi fi es th e n on - sp eci f ic tr au ma h ypo th es i s, wh ile exa m i n ati on of a
second millennium before present site reveals a new (at least to Texas) population phenomenon. In contrast to
isola ted bumps and osteomyelit is, the stu dy of periosteal rea ction in ea rly Texas is th e stud y of “virgin s,” indi-
viduals spa red the phenomenon that cause s uch bone altera tion. It is only in th e second millen nium before pre-
sent that periosteal reaction becomes widespread, both in population penetrance and in extent of skeleton af-
fected. That pattern has previously been documented for the treponematosis yaws, similar to what has been
found in other areas of Archaic North America.
Keywords: Treponematoses, Yaws, Periosteal Reaction
The tenet of “in vivo veritas” directs that the etiology of at-
tributed phenomena be established by comparison of criteria
with those established in validated populations. That is espe-
cially important for treponemal disease. Repetition of specula-
tive ideas has in th e past achieved prominence in t he “collect ive
consciousness” of the field, so much so that it is often over-
looked that such “di agnostic criteria” si mply represent un tested
thoughts. Will Rogers stated that it ain’t so much what we don’t
know th at gets us in to troub le, as what we “kno w” that ain ’t so
(Spodick, 1975).
The suggestio n t hat periost eal reactio n has disease sp ecificit y
as a population phenomenon is well documented (Rothschild &
Martin, 1993, 2006; Rothschild & Rothschild, 1996, 1998a).
Cook’s (1976a-b, 1984) attribution of non-focal periosteal reac-
tion to trauma has been falsified, except in the presence of
complicating osteomyelitis or stress fracture (Resnick, 2002;
Rothschild & Martin, 1993, 2006).
Pathology can provide valuable clues to population origins
and migrations (Rothschild & Rogers, 2010). It is therefore
essential that pathology be accurately recognized and that its
implications be validated. The concept that periosteal reaction
is non-specific apparently had it origins in variable skills of
examiners (Byers, 1998; Cook, 1998; Katzenberg, 1992; Pow-
ell & Eisenberg, 1998; Rose, 1985; Rothschild & Rothschild,
1995b) and preconceived notions as to its significance/deriva-
tion (Goodman et al., 1988) and as to the nature of disease
(Buikstra & Cook, 1980; Cook, 1976a-b, 1998; Powell &
Eisenberg, 1998; Power, 1992; Sanford et al., 1998; Spirov,
1991). The speculation that current distribution of disease im-
plies climatic restriction was never actually tested by those
involved in its promulgation (Cook, 1998; Powell & Cook,
2005; Powell & Eisenberg, 1998). Their attribution of perio-
steal reaction to trauma has impeded progress in our under-
standing of peoples and the disease with which they were af-
flicted. The work described herein further evidences the fallacy
of the trauma hypothesis and removes periosteal reaction as
simply a stress marker (Cook, 1998; Sanford et al., 1998). In
vivo veritas replaces speculation with a new opportunity for
clarification of the anthropologic record.
Treponemal disease, in the form of Yaws, has been docu-
mented on the basis of periosteal reaction in much of North
America (Rothschild & Rothschild, 1994, 1998, 2000; Roths-
child et al., 1995a). This pattern extends from the Cascade
mountains to the east coast of Florida, dating from 8 - 9 millen-
nia before present (bp). Its distribution has been contiguous
across North America east of the Cascade mountains, with sev-
eral notable exceptions (Rothschild & Rothschild, 1998, 2000):
The Northwest territories of Canada were unaffected, as was
Ontario prior to invasion by the Iroquois. This caveat must
considered for some areas (e.g., Saskatchewan, Nebraska, Iowa,
Kansas, Oklahoma) which have not had skeleton populations
available for analysis in the post-1987 time period for which
data-based criteria have been available (Rothschild & Roths-
chil d, 1995 ).
Texas skeletal populations were therefore examined for evi-
dence of periosteal reaction.
Materi als and Me tho ds
The Texas and other North American sites delineated in Table
1 were chosen to assess the population frequency and nature,
extent and character of any non-focal (e.g., bump) periosteal
reaction pr e s e nt.
Skeletal remains were subjected to visual examination of all
articular and cortical surfaces—to identify all occurrences of
alterations throughout each skeleton, specify the types of bony
alterations at each occurrence, and map the distribution of oc-
currences in each skeleton. In sites where preservation was
fragmentary, the sample size (denominator) was determined on
the basis of sufficient tibial preservation for assessment, as the
tibia is the sentinel bone for recognition of treponemal disease
as a populat ion ph eno menon (Roth schi ld & Rot hschi ld, 1995 ;
Table 1.
Texas and North American eviden ce of non-fo cal periosteal re action*.
Site Century BP** # Periostitis Sabre shin
Buckeye Knoll (41VT98) Texas 60 37 0 Absent
Bird Island (8DI52) Florida 45 19 0 Absent
Kamarvik (LeHv-1) NW Territories 8 79 Absent
Kulaituijavik (LaHw-1) NW Territories 8 22 0 Absent
Sadlermuit (KkHh -1) NW Territories 8 25 0 Absent
Port Au Chaux, Newfound land 34 - 51 124 0 Absent
Glen Williams, Ontario 9 90 0 Absent
Maurice Ossuary (BeHa-1), Ontario 10 50 0 Absent
Hind (AsdHk-1), Ontario Archaic 18 0 Absent
Fairty Ossuary, Ontario 11 147 0 Absent
Rankin (CK6) Tennessee Woodland 21 0 Absent
Big Sandy (Hy16), Tenn essee Archaic 35 0 Absent
Oakview Landing (40DR1) Tennessee Archaic 56 0 Absent
Hatte n Mound (23MN275) Missouri 28 23 0 Absent
Anderson Minnesota 30 30 12 (40%) Present***
Younge, Michigan 10 23 9 (39%) Present***
Galbreath Mounds (33FR58) Ohio 22 26 7 (27%) Present***
McMurray (15Fa313) Ohio Woodland 33 7 (21%) Pre sent***
Sidner Mound (Franklin County) OH Woodland 46 10 (22%) Present***
Palmer (8OS2) Florida 11 92 28 (30%) Present***
Windover (Titusville) Florida 79 112 30 (27%) Present***
Grant Mound (8BR56) Florida 18 - 24 12 3(25%) Present***
Olmos Dam, Texas 11 - 18 8 3 (38%) Present***
Carrier Mills (11SA86088) Illin ois 6 3 159 57 (36%) Present***
LU-25 (Alabama) 43 89 36 (40%) Present***
Ward (15MCL11) Kentucky 43 203 73 (36%) Present***
Ghost Warrior and Nevada 10 - 90 51 13 (26%) Present***
Note: * Derived from Rothschild and Martin, 2005; Rothschild and Rothschild, 1998c, 2000; **BP = before present; *** Without visible surface periosteal reaction.
Rothschild & Martin, 2006). Periosteal reaction in treponemal
disease invariably affects the tibia (Rothschild & Rothschild,
1995; Rothschild & Rothschild, 1996; Rothschild et al., 1995a).
Examination of the skeletons of 37 (number determined on
basis of sufficient tibial preservation) individuals from 6000
year bp Texas revealed evidence of isolated bumps and occa-
sional cases of osteomyelitis, but no diffuse periosteal reaction
(Table 1) and no sabre shin reaction. This was similar to obser-
vations in the Florida 4500 year bp Bird Island (8DI52) site, in
which th e 19 individuals presen t were similarly spared.
This sparing phenomenon contrasted with the east Florida
8000 year bp Windover and 1800 - 2400 ybp Grant mound sites
and the 1800 - 2000 year bp Texas Olmos Dam site in which
periosteal reaction was common (Table 1). Tibial involvement
in th e east Florida and Olmos Dam sites was invariable bilateral.
Disease was predominantly poly-ostotic (>3 bone groups af-
fected). Hand and foot invo lvemen t was common and ju veni les,
commonly affected.
Actually, most of early North Americans manifested the
phenomenon observed in the east Florida sites and Olmos Dam,
but with other notable exceptions (Table 1). Periosteal reaction
was also rare in the northwest territories of Canada, the Atlantic
provin ces and eastern Ontari o and from Archaic Tennessee an d
Early Texas as a Virgin State for Treponematoses
Absence of periosteal reaction (unassociated with osteomye-
litis and exclusive of isolated bumps) from the 6000 year bp
Texas site examined documents a greater degree of population
virginity, with respect to exposure to the entities that commonly
cause periosteal reaction. Periosteal reaction occurring as a
population phenomenon (e.g., more 1% of population mani-
festing diffuse involvement of more than one bone) has only a
very limited number of etiologies: Treponematoses and hyper-
trophic osteoarthropathy (McCarty & Koopman, 1993; Resnick,
2002; Rothschild & Martin, 1993, 2006; Rothschild & Roths-
child, 2005). While hypertrophic osteoarthropathy (as a compli-
cation predominantly of intrathoracic disease) is actually quite
rare in unselected populations (Resnick, 2002; Rothschild &
Rothschild, 1998b) and as noted in the populations studied
herein, treponemal disease has a unique population signature, if
it is present. That population signature is in the form of perio-
steal reaction, affecting 2% - 13% of skeletons with syphilis
and 20-40% of skeletons with yaws or bejel (Rothschild &
Martin, 2005, 2006; Rothschild & Rothschild, 1995).
The rarity of periosteal reaction in 191 individuals in a zone
extending from western Florida to Texas and North to Tennes-
see and Missouri, and in 619 individuals from Northern and
eastern Canada, clearly documents this region as virgin territory
or at least that the lo cal Native American s were not afflict ed b y
any known treponematosis in the time periods studied. It also
falsifies the speculation (Goodman et al., 1988) that periosteal
reaction represents a no n-specific stress reaction.
This contrasted with observations in eastern Florida and
more recent Texas and outside of the above defined trepone-
matosis-free areas. Periosteal reaction was prominent outside
that catch ment area (Table 1), in a frequen cy and pattern ind is-
tinguishable from what is seen in yaws (Helfet, 1944; Hudson,
1958; Hunt & Johnson, 1923; Moss & Bigelow, 1922; Roths-
child & Rothschild, 1995; Rothschild & Martin, 2005). This
disease is easily distinguished from the more pauci-ostotic
syphilis (Chi square = 3.973, p < 0.05), in which hand and foot
and subadult affliction are so rarely observed in skeletal popu-
lations (Rothschild and Rothschild, 1994, 1995a-b); Rothschild
et al., 1995a). Other evidence for syphilis (in the form of com-
plete sab er shin surface remodelin g and unilateral tibial disease)
was also lacking. This was also easily distinguished from the
more pauci-ostotic bejel, which infrequently affects hands and
feet (Hershkovitz et al., 1995; Rothschild & Rothschild, 1995b).
Sabre shin reaction is not found in hypertrophic osteoarthropa-
thy, predominantly a disease of distal diaphyses (Resnick, 2002;
Rothschild, 1982; Rothschild & Martin, 1993). Thyroid acro-
pachy spares the proximal appendicular skeleton, pred ominantly
producing hand and foot bone periosteal reaction (Resnick,
2002; Rothschild, 1982; Rothschild & Yoon, 1982). Infantile
cortical h yperostosi s is a disorder afflictin g clavicles, scapulae,
and ribs (Resnick, 2002). Hypervitaminosis A is predominantly
an enthesial disease, and fluorosis produces highly characteris-
tic trabecular alterations (Resnick, 2002; Rothschild & Martin,
1993; Seawright & English, 1967).
Possible Reasons for a Treponematosis-Free Zone in
Early Texas Native Americans
Although there is clear evidence for treponematosis in North
America, in t he form o f yaws, it is also clear t hat a zo n e existed
in which the inhabitants were not afflicted. Given that yaws is a
population phenomenon (afflicting essentially the entire popu-
lation) and given the evidence (e.g., Windover and Ghost war-
rior) that it had a long history, anteceding the Buckeye Knoll
and Bird Island sites, it would appear that these were distinct
populations. As yaws is contiguous in distribution in Archaic
and Woodland North America, it appears to have arrived with
an immigrant population from Asia. The absence of Yaws in
specific Canadian and Southern zones suggests that these may
have de rived from a se pa r a te imm igr a tion (m igr a tion).
This report further demonstrates how paleoepidemiology can
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