Evidence of inflammatory response, usually appearing as symmetric periostitic expressions on the surfaces of the limb long bones, is common in North American skeletal series. South American materials are said to present similar symptoms (Williams 1932; Goff 1967). At times accompanied by evidence of osteomyelitic changes, as well as occasional stellate scarring of the external table of the skull, these lesions are the basis of a long-standing controversy concerning the possible New World origin of venereal syphilis (e.g., Jones 1876; Whitney 1883; Williams 1932; Goldstein 1957; Bullen 1972; Cook 1976; Brothwell 1981). Theoretical articles by medical historians enrich this literature (e.g., Cockburn 1963; Hudson 1965; Hackett 1967; Crosby 1969, 1972).

The cause of these lesions, which are characteristic of many cemetery samples from throughout eastern North America, has been a matter of debate for more than a century. In 1876 J. Jones argued that the "erosions" he observed in burials from stone box graves and mounds in Tennessee and Kentucky were syphilitic, a conclusion cautiously supported by W. F. Whitney (1883), curator of the Warren Anatomical Museum of the Harvard Medical School, a decade later. Such notables as the anatomist R. Virchow have disputed this conclusion, thus fueling an argument that continues today (Jarcho 1966).

The nature of the debate has changed, however. Today few would disagree with the notion that the skeletal lesions presented by these prehistoric remains resemble most closely the constellation of related diseases collectively known as the trepone-matoses. Included within this group are venereal syphilis, yaws, and endemic syphilis. In her rigorous consideration of clinical and epidemiological patterning from recent medical literature, D. Cook (1976) argues compellingly that either nonvenereal syphilis or yaws is the best modern model for the observed prehistoric pathology. Her thesis is based on the high prevalence of lesions observed in American prehistoric series, the age-accumulative patterning of incidence, and the total absence of dental changes diagnostic of congenital syphilis, such as Hutchinson's incisors or mulberry molars.

Yet it is clear that, in isolated examples, venereal transmission of this disease occurred. The most convincing cases are two prehistoric burials that include both adults and juveniles with the stigmata of venereal syphilis. In one of these, a mulberry molar was found in juvenile remains in a burial site that also included adult skeletons having treponemal long-bone lesions (Clabeaux Geise 1988). A second example is represented by the remains of a prehistoric achondroplastic dwarf recovered from a Middle Woodland burial mound in Illinois (Charles, Leigh, and Buikstra 1988; Burgess 1988). This adult woman, whose left lower limb is heavily remodeled, died in childbirth. Her fetus presents evidence of periostitic changes, as well as dwarfing. Although the data are scant, they suggest that at least some prehistoric American women acquired treponemal infections as adults, presumably through sexual intercourse. The infection thus acquired would have been in an acute stage during the childbearing years, which would have facilitated transplacental infection (Grin 1956; Powell 1988).

The most recent overview of theoretical and empirical arguments concerning the origin of venereal syphilis is that of B. Baker and G. Armelagos (1988). After extensively reviewing current evidence, these authors conclude that pre-Columbian American skeletal materials reflect a treponematosis that spread to the Old World through nonvenereal contact. European social and environmental conditions favored the development of venereal transmission, and thus originated the "French disease."

Doubtless the question of treponematosis and the development of venereal forms will remain controversial for some time. Eagerly awaited is further skeletal evidence from Europe, as well as the devel opment of an immunological technique that will make it possible to identify treponemal antigens in ancient materials (Baker and Armelagos 1988).

Even though there is little evidence for venereal transmission of treponematosis in pre-Columbian American skeletons, it is important to underscore the presence on this continent of a chronic treponemal disease that affected a significant number of individuals. Beginning in childhood and progressing throughout life, inflammations produced by the illness doubtless created a considerable health burden for prehistoric peoples of the Americas.

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