Prepared for

CASE STUDY SUGGESTING NON-VENEREAL TREPONEMAL DISEASE IN A PREHISTORIC SOUTH FLORIDA OSSUARY

Rose Drew PhD Candidate, Department of Archaeology, University of Winchester UK Visiting Researcher, Department of Biology, University of Oslo, Norway E-mail: [email protected] HEADER: Treponemal Disease in S Florida

Abstract: Prehistoric human remains showing evidence consistent with non-venereal syphilis are described. A pair of forearms presumed to be from the same individual were excavated in articulation from an ossuary. All four elements have lesions consistent with yaws, tertiary stage. Other elements such as sabre-shinned tibiae show bone changes considered pathognomic of treponemal disease. Treponematosis has been identified in prehistoric remains from other SE American regions, including Florida, but this case study is the first report of remains from Miami with evidence of this condition. Key words: Yaws, treponematosis, coastal populations, Miami, osteomyelitis, periostitis.

Introduction During commercial development along the Miami River in downtown Miami, fragmentary human remains were found in abundance. This required the developer to engage the services of an archaeological firm (see below) to estimate the extent of the burial area, locate all additional internments, and remove the remains from the privately owned land. During the excavation process, which continued for several years, large quantities of fragmented, commingled human remains were recovered. The riverine site consists of very sparse topsoil over limestone bedrock, and remains were typically located within naturally-occurring cavities created by water. Such crevices in the limestone would have been identifiable by opportunistic plant growth within accumulating soil (Bob Carr, personal communication, 2003). Site 8DA11, MDM Development Tracts B and D (Miami One) is potentially associated with the famed Miami Circle (Echazabal 2010) which lies directly south across the Miami River. Archaeological and Historical Conservancy Inc (AHC), which had previously worked the Circle site (Carr & Ricisak 2000; Wheeler & Carr 2004), began monitoring construction at Miami One in 2003 to fulfill cultural conservation regulations in the City of Miami (Saldana Design & Preservation Inc, 2004: 3). Workers began to recover unmarked burials in September 2003. The author was hired in October 2004 to organize an osteological analysis

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lab and begin processing the massive quantity of bone fragments. Commentary on work done at the Miami One site after August 2005 is beyond the scope of this paper. Prehistoric inhabitants of the area had placed primary burials and disarticulated bones within a series of deep, often connecting ravines eroded into limestone bedrock in what became the southeast section of Parcel D. Both Parcels B and D subsequently contained the Royal Palm Hotel complex (c. 1897 to 1934), which included an Olympic sized swimming pool, rail road extension, gardens, and a large series of connected buildings. After the Royal Palm was demolished, the area became parking lots. By May 2005, six large feature areas had been identified in Parcel D: 164, 210, 222, 223, 224, and 225. Feature 164, approximately N 107 E 50, contained at least 4 primary burials (commingled with additional individuals) and fragmentary remains of up to 85 additional individuals (Drew 2005a - 2005c). The burials were delineated into Human Burial 1, Human Burial 3, and Human Burial 4 (Feature 210) by AHC; the 4th burial was catalogued as Feature 500 by New South Associates of Georgia, a commercial archaeological firm that began working the site in February 2005. As of May 2005, the total minimum number of individuals found at Miami One was 169 adults and 88 juveniles (Drew 2005c). Subsequent findings support the possibility that the Miami One site one was occupied between the Late Archaic and Glades II periods (ca. 3000 to 1000 BP) (Echazabal, 2010: 35). This paper focuses on four elements found in anatomical position in Feature 164, on a slope of bedrock within a ravine (Figure 1). The four bones, catalogued as Unit 218 FS 1099 (B-E), are left and right ulnae and left and right radii. All recognizable epiphyses are fused, indicating the individual had reached skeletal maturity. A range of skeletal elements from the site have lesions suggestive of non-venereal treponemal disease: radii, ulnae, clavicles, and tibiae. Abnormalities include highly remodeled cortices and medullary canals filled with trabecular bone. Potentially associated with the elements discussed here are two tibiae (left and right) with moderate sabre-shinning found in adjacent Unit 222, same Context Level 25, immediately north and up slope. Figure S1 is an admittedly inadequate photograph of the left tibia. This upslope unit contains over 40 skeletal elements from up to four individuals including left and right humerii, left and right femora, and a left ulna, proximal half, with exposed medullary canal obscured by abnormal trabecular bone, with the expanded shaft highly remodelled (Figure S2). Other elements in nearby units, again within the same context level are also abnormal: a proximal left ulna from Feature 500 shows an expanded diaphysis, abnormal cortical bone and intrusive trabecular bone in the medullary canal (Figure S3). These elements are not described further in this paper. Anecdotally, archaeological field technicians from New South that worked this area of the ossuary reported finding “many” bones with irregular contours, enlarged diaphyses, and medullary canals filled with bone; the technicians would describe the anomaly as ‘osteitis’. Their quantification of “many” was not elaborated upon. Sabre-shinned tibiae are considered pathognomic, or certainly ‘typical’ of treponemal disease by most researchers. This agrees with evidence for non-venereal treponematoses reported from prehistoric locations elsewhere in the American Southeast. Previous reports from Florida include Crystal River on the Gulf Coast, and north of the Fort Lauderdale area on the Atlantic Coast (Bullen 1972; Hutchinson 1993; Hutchinson et al. 2005; Isçan & Miller-Shaivitz 1985; Larsen 1997; Parramore 1970). The site is viewed as an ossuary, due to the fragmented and isolated condition of most of the human material and due to the recognized practice of secondary interments in Late Archaic/Glades I contexts (Felmley 1991: 84-87). Nonetheless, several primary burials have

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been found; also, since discrete, natural fissures were utilized for internment, one can presume an individual’s remains were placed in a single suitable opening. When the elements were initially examined in March 2005, it seemed probable the individual had suffered from some form of infectious disease. After consulting the literature, conferring with a range of colleagues, and continuing analyses on the remains of hundreds of individuals from this site, it became increasingly more likely treponematosis was present in the host population. Over the years, examinations of complete skeletons from the Caribbean, North American Plains and 19th century Norway have only strengthened the opinion that treponemal disease can be observed in the Miami population. Materials and Methods When analyzing co-mingled and fragmentary remains from secondary burial contexts that have undergone significant disturbance, it can be difficult to ensure that even adjacent remains are from the same individual. Determining MNI present is also not straightforward: the most predominant element, for example the left temporal (or for this site the left ulna) will not be found for every individual. Individuals may be represented by every bone except a left ulna. Traits of other elements were considered: for example, if left ulnae for five adults and a juvenile approximate age at death of 6 to 8 years were in a unit with a femur from a markedly older or younger juvenile, the MNI would be counted as seven. The four bones described in this paper (Figure 1) are presumed to be from the same individual based on similarity of size and maturity; their proximity and articulation within Unit 218; and the similarity of the abnormalities. The methodology included gross inspection and analysis. All four elements have transverse breaks, allowing the internal surfaces to be examined. An osteometric board, sliding callipers and digital camera were used during analysis. When possible, standard measurements for diameters and maximum lengths were taken. Differential diagnoses are discussed, and a probable diagnosis is suggested. Results Left ulna: Half of the element is present, from proximal articulation to mid-shaft. No maximum length can be taken, but estimated maximum diameters on the proximal interosseous crest are 24 mm across the sagittal anterior-posterior plane (AP), and 25 mm across the transverse medial lateral plane (ML). The shaft is greatly expanded with highly remodelled cortical bone, and the break at the midshaft exposes extremely dense trabecular bone in the canal. The invasive material is almost solid at the margins of the medullary cavity. A thick ridge of bone on the anterolateral surface is either the anteriorly displaced interosseous crest, or abnormal bone with the original crest displaced posteriorly. The two ridges create a wide, rather symmetrical groove running lengthwise along the shaft. The anterior ‘crest’ has rugose angular margins resembling a linea aspera. The posterior crest is very thin and, if the actual interosseous crest, is atrophied. The more robust crest originates below a large irregular, somewhat concave mass of remodelled bone that resembles a pinched hump. Only the anterior portion of the radial notch is present, the posterior half replaced by a deep, 7 mm defect with sclerotic rims. A shallow depression is just inferior. On the posterior aspect, mid-shaft, is a longitudinally oriented oval defect (Figure 2), 11 mm x 9 mm maximum dimensions, with ragged unhealed margins. Spiculated bone fills the interior. This defect is centred in a 30 mm long depression on the shaft; this suite of features will be discussed in the diagnosis.

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The proximal articulation is enlarged, with abnormal margins; the semi-lunar notch is riddled with lytic defects, ridges and raised plateaus. The olecranon process has one large 8 mm perforation at the most superior surface, with two smaller openings lateral; these extend through the olecranon and onto the trochlear surface (Figure 2). Lytic defects are located along the medial edge of the trochlear. The superior posterior aspect of the olecranon fossa is flattened and striated. A section of spiculated bone is located just below the semi-lunar notch at the brachial tuberosity. Left radius The incomplete element is in three re-fitting pieces, lacking the lower one-third. No maximum length can be taken. Based upon the right radius, an approximate mid shaft can be determined in order to record mediolateral and anteroposterior diameters; the estimated diameters are 17 mm AP and 23 mm ML. Most of the rugose shaft is heavily remodelled; the diaphysis is irregularly expanded with highly abnormal external surfaces. A 65 mm oval plaque of sclerotic bone is oriented longitudinally on the lateral aspect, midshaft. Dense cancellous bone is seen in all exposed medullary cavities, with large 2 mm spaces between the struts and plates (Figure 3); this material is denser medially. The proximal epiphysis is enlarged and irregular. The proximal ulnar articulation is elevated above the shaft. Right ulna This element is complete and in two re-fitting sections, with a transverse break near midshaft. The exposed medullary cavity is filled in with dense trabecular material. The ulna has fusiform expansion throughout the shaft. Distally the element is stunted and atrophied, lacking both a radial articulation and a styloid process. Midshaft, the bone is bowed as if from rickets, an appearance enhanced by ridges of callus running longitudinally on the posterior aspect of the shaft. An oval defect on the lower medial surface of the shaft, with a lengthwise orientation is filled with remodelled bone and will be discussed further in the diagnosis. Adjacent and on the anterior aspect are several vascular impressions, created when arteries and veins have been outlined by bone deposition (Wells 1963) (Figure 4). As on the left ulna, a patch of spicules is located below the semi-lunar notch at the site of the brachial tuberosity. The proximal epiphysis has multiple internally connecting defects with rounded, sclerotic margins that expose an excavated interior with extensive bone destruction. Several are located medially along the trochlear, two large slot-like openings are on the superior olecranon fossa, and several smaller ones are on the semi-lunar notch on either side of the guiding ridge. A 5 mm x 3 mm rectangular erosion is supero-lateral to the radial notch (Figure S4); it widens into a smooth cavern that extends beyond visual inspection. Right Radius The radius is broken just below mid-shaft but complete, exposing a fairly typical medullary canal, free of intrusive cancellous bone. The bone appears somewhat normal proximally, but expands distally into an area of spiculated bone (Figure 5). The distal articulation has a raised rim surrounding a central, deeply excavated area. The distal ulnar notch is obliterated by a triangular spiculated region which extends to an apex of 68mm from the ulnar notch. The proximal epiphyseal articulation is similar to that of the left radius: enlarged, with irregular margins, and a lipped plateau for the ulnar radial notch. The articular fovea has two 2mm defects extending into the shaft.

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Discussion The (presumed) bilateral expression of disease, endosteal bone accumulation, extensive cortical remodelling, and other traits discussed below suggest non-venereal syphilis. Additionally, the presence of sabre-shinned tibiae in other units supports this option. Several alternative diagnoses are considered, including pyogenic osteomyelitis, periostitis, Paget's disease, healed trauma, metabolic disorders, and non-suppurative osteomyelitis of Garré. Osteomyelitis is caused by opportunistic bacteria that invade the marrow space of bones. This is usually a chronic condition that instigates bone and tissue destruction, repair, and the discharge of necrotic tissue and pus. Macroscopically this can appear as diffuse periosteal destruction, new bone formation, and large perforating erosions of subchondral bone (Aufderheide & Rodriguez-Martin 1998; Mays 1998: 123-127; Ortner 2003: 180-183; Waldron 2009). Bacteria may be present in the bloodstream due to infections in other areas of the body, or by entering the host via a wound, in which case the original lesion and the infection will present as two pathologies, such as osteomyelitis and an adjacent healed fracture (Aufderheide & Rodriguez-Martin 1998; Mays 1998; Ortner 2003; Waldron 2009). Chronic osteomyelitis can be recognized by expanded shafts, highly irregular bone deposits, drainage canals, and, if endosteal pressure from accumulated bacteria has sufficiently restricted blood supply, necrotic bone. The endosteal bacteria moves throughout the medullary canal causing lytic destruction but also instigating internal bone growth in order to restrict the spread of infection (Ortner 2003: 185). Among the defining characteristics are remnants of necrotic original bone (a sequestrum) surrounded by an envelope of new bone, the involucrum. While passages from the medullary canals are found on the bones examined in this paper, pathognomic features such as sequestra and an involucrum are not observed. Further, as osteomyelitis is the result of opportunistic bacteria entering a host and persistently exploiting a food supply, it does not usually present globally. With hematogenous (blood-borne) infection there is a predilection for skeletal elements with bone close to the surface, as in the tibia or the ulna (Ortner 2003; Waldron 2009: 85) but rarely does adult osteomyelitis present bilaterally, as in this presumed case of associated forearms (Aufderheide & Rodriguez-Martin 1998: 175). The periosteum is a dense, fibrous membrane that surrounds all bone surfaces except synovial joints. The internal surface is lined with bone-forming cells. Chronic periostitis, better termed periosteal reaction, instigates abnormal bone growth due to disturbances in the periosteum caused for example by trauma or infection (Ortner 2003). Periosteal reaction in response to infection, trauma, and some metabolic conditions is not considered a disease (Brickley & Ives 2008; Ortner 2003); if due to infection, it can be termed periosteal inflammation (Ortner 2003: 206). The new bone can appear as woven bone, plaques, or spicules, and can be remodelled into layers of undulating, irregular bone after healing (Mays 1998; Ortner 2003). These layers may be symmetrical (Ortner 2003). The abnormal bone growth does not cause necrosis and gummata (localized areas of bone loss) (Ortner 2003), nor infiltrate the medullary cavity (Ortner 2003; White 2000). Classifying high frequency of heavily remodelled and rugose bone within a population to be ‘periostitis’ can create a limited view of the population (Ortner 2003: 209), particularly if considered a classic indicator of overcrowded living conditions, diffuse poor hygiene, inadequate nutrition, and inadequate care for the afflicted (Larsen 1997). Alternatively, it can be argued that prevalent non-venereal syphilis is indicative of a population coping with a common health issue (Powell 1986: 139-142). If periostitis and healed yaws are confused, the overall health and well being of the population may be improperly assessed.

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Paget’s disease is considered an affliction of older adults, can affect only one bone, and is often restricted to axial elements, such as the sacrum, spinal elements or skull; or proximal femur (Ortner 2003: 435; Waldron 2009: 125-6). Although the surfaces of these arm bones are rough and extremely abnormal, they lack the characteristic “pumice-like” (Ortner 2003: 438) appearance of bone affected by Paget’s disease, in which normal cortex is replaced by proliferative woven bone. While Paget's can lead to endosteal bone formation, secondary osteoarthritis, and transcortical lytic lesions (Ortner 2003: 437-8; Waldron 2009: 126), Cook (1980) has determined that cases presumed to be Paget’s may have been treponemal disease, and recommends histology to support a diagnosis of Paget’s (Cook 1980). Paget’s disease can result in bowing of weight bearing bones subsequent to transverse pathological fractures, due to the proliferative new bone being inadequately mineralized and mechanically weak (Ortner 2003). There are no obvious healed fractures in these elements; however, radiographs would have been beneficial. Other workers have dismissed Paget’s in favour of treponematoses based on bilateral expressions of abnormality and evidence of active lesions (Suzuki et al. 2005: 256). Only the two right elements are complete enough to remark on the apparent lack of healed fractures, but both the left and right ulnae are remarkably similar in the proximal regions. Metabolic disorders such as Vitamin D deficiency can be considered due to shaft curvature of most of the elements. Also, the rachitic bending to both ulnae and the left radius could be construed as a result of microtrauma and transverse fractures, creating the pseudofractures seen in Paget’s. However, these are not weight bearing bones. Vitamin D deficiency before a young child can walk can result in upper-limbed deformities as it crawls on inadequately mineralized limbs (Brickley & Ives 2008: 92), but if these elements are from one individual, one would expect the right radius to be similarly curved. Residual rickets deformities acquired at so young an age are more typical in the legs than in the arms (Brickley & Ives 2008: 111), would appear elliptical in cross-section (Brickley & Ives 2008: 112-113; Currey 2002: 338), and would presumably have been resolved by bone deposition and removal while being remodelled during further growth (Cowin 2001). Ortner (2003: 271-276) describes rachitic bending of the radius and ulna associated with yaws (based on archaeologically obtained samples); he further states that unequal cortical mass, on concave versus convex surfaces, would be indistinguishable from post-rachitic modifications and doubts they would result solely from yaws (Ortner 2003: 276). The exposed cortical mass of each element appears thinned, but is uniform in appearance and shows no variation between concave and convex mass. Osteomyelitis of Garré is a non-suppurative chronic condition and is considered a rare condition that typically afflicts only one element (Aufderheide & Rodriguez-Martin 1998: 178) and tends to afflict the young (Schwartz & Pham 1981). This disease presents as a result of local injury or insult (i.e., a carious tooth), and results in a sclerotic, proliferative cortical thickening rather than a lytic disorder (Schwartz & Pham 1981: 283). Finally, haematogenous osteomyelitis will also tend to affect one element; the four elements discussed here are similarly affected and appear to be from the same individual. In support of a diagnosis of treponemal infection, the four elements are highly abnormal, non-redundant mature forearm bones, similar in size and degree of disease involvement, and appear to articulate. They were found interred in a pattern suggestive of postcranial articulation during life, resting against a large boulder of bedrock; if from one individual, he or she suffered from a bilateral, multi-element infectious bone disorder (Drew 2007). Diagnostic features include symmetrical involvement of both forearms; severe periosteal and cortical destruction and endosteal bone growth resulting in medullary obstruction; hypervascularization; gummata; expanded bone shafts; and joint destruction with erosive arthropathies. The lack of any involucrum and sequestra are also diagnostic (Ortner 2003).

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Yaws is the most likely candidate of the four treponemes (Hutchinson et al. 2005: 110; Larsen 1997: 96-97; Powell & Cook 2005: 13; Walker 2005; Walker et al. 2005; Waldron 2009: 103). Yaws is found in tropical and subtropical environments probably due to inhabitants wearing less clothing, which would expose open sores on the afflicted (Parramore 1970; Powell & Cook 2005). Postcranial treponemal lesions particularly affect tibiae, fibulae, skull, clavicles and bones in the forearm (Aufderheide & Rodriguez-Martin 1998; Larsen 1997; Ortner 2003; Powell & Cook 2005). Due to post-mortem midshaft transverse fractures, the internal bone surfaces are viewable, and three of the four exposed medullary canals are completely filled with dense cancellous bone. Trabecular bone is normally associated with the epiphyses and metaphyses of long bones. Abnormal spongy bone, termed sclerotic trabeculae (Aufderheide & Rodriguez-Martin 1998), medullary osteosclerosis (Ortner 2003), medullary cavity obstruction or endosteal remodeling, is a pathognomic trait cited by all authors in The Myth of Syphilis (Powell & Cook 2005). An oval defect with spiculated floor is found on the left ulna, posterior midshaft (Figure 2). Localized gummata are present on both ulnae. “Gummatous osteomyelitis of the long bones” is described by Aufderheide and Rodriguez-Martin (1998: 156), who then add, “Localized cortical destruction produced by gummas (focal areas of necrosis) is a prominent feature in yaws [Steinbock 1976]. The lesions are oval and with their long axis parallel to the shaft.” (Aufderheide & Rodriguez-Martin 1998: 156). Other bone lesions pathognomic for treponemal disease found at this site include a left tibia (Figure S1) and right tibia with apparent sabre shinning, located in an adjacent unit, and from the same archaeological context as the forearms, Context 25. Nongummatous lesions on tibiae are considered primary evidence of treponematoses; sabre-shins are described as “most typical feature of the tertiary stage [of yaws]” and “the most consistent finding in yaws” (Aufderheide & Rodriguez-Martin 1998: p 156). These tibial lesions are created by accumulations of abnormal subperiosteal bone growth, stimulated by periosteal inflammation (Aufderheide & Rodriguez-Martin 1998; Larsen 1997; Ortner 2003; Powell & Cook 2005; Roberts & Manchester 2005). The penetrating cavitations found throughout both proximal ulnae would have affected joint articulation. Some authors consider joint destruction to be related to yaws in particular (Heathcote et al. 1998: 364; Ortner et al. 1992: 345; Roberts & Manchester 2005: 208), while others relate joint damage to neuropathy (Waldron 2009: 106). Indeed, Heathcote et al. (1998) claim a differential diagnosis of yaws may be reached by considering joint destruction with “erosive excavation of subchondral and para-articular compact and (often) spongy bone, [to be] diagnostic of yaws alone” (Heathcote et al. 1998: 364). This is almost a direct quote from Ortner et al. (1992: 345). The concave expansion of bone adjacent to the proximal articulation the left ulna (the ‘pinched hump’) would be considered a “juxta-articular node” (Ortner et al. 1992: 345). Ortner et al. (1992) compare the joint destruction to the erosive arthropathy associated with rheumatoid arthritis (Ortner et al. 1992: 347). Conclusion Endemic treponemal disease and/or yaws has been documented in Florida and Georgia coastal populations (Hutchinson et al. 2005), including in a prehistoric Crystal River group from the Gulf Coast of Florida (Isçan & Miller-Shaivitz 1985). The forearms discussed here are the first report for non-venereal syphilis in Miami (Drew 2007, Echazabal 2010). The loss of the medullary cavities to excessive trabecular bone is typical of most treponemal diseases. Sabre-shinned tibiae and an abnormal ulna were recovered in an adjacent unit, and similarly affected elements (clavicle; ulna) were discovered elsewhere in

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this site by the author. Fusiform expansion of long bones and loss of the medullary cavities, particularly on elements protected by less flesh such as the ulna and tibia, are typical of all tertiary stage treponemal diseases that affect bone (Aufderheide & Rodriguez-Martin 1998; Bullen 1972; Hutchinson 1993; Isçan and Miller-Shaivitz 1985; Larsen 1997; Ortner 2003; Powell & Cook 2005; Roberts & Manchester 2005; Steinbock 1976). Only Pinta, restricted to skin lesions and lymph nodes, cannot affect skeletal tissue (Aufderheide & Rodriguez-Martin 1998). Erosive arthropathy is considered indicative of tertiary stage yaws (Ortner et al. 1992; Ortner 2003, Roberts & Manchester 2005); both ulnae have enlarged articulations with destructive lesions. Except for the right radius, the other elements have areas of dense, healed bone on the outer cortex (Figure 1); evidence consistent with periosteal inflammation still active at death is found on the right radius (Figure 5). Powell found a high prevalence of tibial periostitis among inhabitants of Moundville, with 51% of adults showing evidence of localized, well-remodeled bone on the anterior tibiae (Powell 1986: 139). Powell notes that there was no statistical difference in between age, sex, or social status, and views the widespread incidence of mild bone lesions on anterior tibiae as evidence of endemic treponemal disease that was well-incorporated into the population, and was not generally related to the death of an adult (Powell 1986: 139). Long-term survival is a successful response to acute inflammation and bone destruction; the “high degree of healing” among past populations at Moundville indicative that the residents had “more or less successfully adapted to the disease” (Larsen 1997: 98). If yaws was not uncommon among this coastal population, one wonders how the disease affected daily life and to what degree a common, moderate to severe disability impacted the population as a whole. Extensive bone destruction may affect the sufferer emotionally, socially, and perhaps even economically; but if the disease is common in the society perhaps less so. Chronic and debilitating effects on daily life include open ulcerations on the palms of the hands and on the soles of feet, the latter a complication of yaws that makes walking painfully difficult (Parramore 1970: 573; Powell & Cook 2005: 15). Persistent, deep burning bone pain is a primary complaint from both contemporary sufferers (Larsen 1997, Powell & Cook 2005), and in historical accounts (Larsen 1997). Treponemal disease would have been a chronic condition, endured, and perhaps not very unusual. In a subsistence economy the tasks of daily life continue, and the afflicted individual must do so as well.

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Acknowledgements: This paper was stimulated by the first annual PAMinSA conference (Paleopathology Meeting in South America), held in 2005 in Rio de Janeiro, Brazil. Sincere thanks to the late Phil Walker, and all of the presenters, participants and course facilitators. Don Brothwell was an invaluable sounding board. Special thanks to Bob Carr, for the opportunity to work with the Archaeological and Historical Conservancy crew from October 2004 to August 2005.

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References Aufderheide AC, Rodriguez-Martin C. 1998 The Cambridge Encyclopedia of Human Paleopathology. Cambridge: Cambridge University Press. Baker BJ, Armelagos GJ. 1988 The origins and antiquity of syphilis. Current Anthropology 29: 703737. Bullen, AK. 1972 Paleoepidemiology and distribution of prehistoric treponemiasis (syphilis) in Florida. Florida Anthropologist, Vol. 25: 133-174. Carr, RS, and John Ricisak J. 2000 Preliminary Report on the Salvage Archaeological Investigations of the Brickell Point Site (8A12), Including the Miami Circle. The Florida Anthropologist 53:258284. Cowin, SC, editor 2001 Bone Mechanics Handbook, 2nd ed. Boca Raton FL: CRC Press Currey, JD. 2002 Bones: Structure and Mechanics. Princeton University Press, Princeton NJ. Drew R 2005a. 8DA11 MDM Development tracts B and D. Report prepared for Archaeological and Historical Conservancy, Inc., January 7 2005. Drew R. 2005b. Miami One Parcel D. Report prepared for Archaeological and Historical Conservancy, Inc., March 7 2005. Drew R. 2005c Miami One, Parcel D: MNI. Report prepared for Archaeological and Historical Conservancy Inc., May 11 2005. Drew R. 2007 Treponemal Disease in a Coastal S. Florida Ossuary. Paper presented at the 34th annual meeting of the Paleopathology Association. Philadelphia, PA. Echazabal C. 2010. Life in the Florida Everglades: Bioarchaeology of the Miami One site. Masters Thesis, Department of Anthropology, University of South Florida. Theses and Dissertations. Paper 1624. http://scholarcommons.usf.edu/etd/1624, accessed May 22, 2011. Felmley A. 1991. Prehistoric Mortuary Practices in the Everglades Cultural Area, Florida. Masters Thesis, College of Social Sciences, Florida Atlantic University, Boca Raton. Hackett C. 1976 Diagnostic Criteria of Syphilis, Yaws and Treponarid (Treponematoses) and Some Other Diseases in Dry Bones. Berlin: Springer-Verlag. Heathcote GM, Stodder AL, Buckley HR, Hanson DB, Douglas MT, Underwood JH, Taisipic TF, Diego VP. 1998. On Treponemal Disease in the Western Pacific: Corrections and Critique. Current Anthropology 39: 359-368. Hutchinson DL. 1993 Treponematosis in regional and chronological perspective from central Gulf Coast Florida. American Journal of Physical Anthropology, 92: 249-261. Hutchinson DL, Larsen CS, Williamson MA, Green-Clow VD, Powell ML. 2005. Temporal and Spatial Variation in the Patterns of Treponematosis in Georgia and Florida. In The Myth of Syphilis, edited by Mary Lucas Powell and Della Collins Cook, pp. 92-116. Gainesville: University Press of Florida.

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Isçan, MY, Miller-Shaivitz P. 1985. Vol. 72, 109-113.

Prehistoric Syphilis in Florida. Florida Medical Annals,

Larsen CS. 1997 Bioarchaeology: Interpreting behavior from the human skeleton. Cambridge UK: Cambridge University Press Levy JE, editor 1986. Skeletal Analysis in Southeastern Archaeology. North Carolina Archaeological Council Publication No. 24. Ortner DJ. 2003 Identification of Pathological Conditions in Human Skeletal Remains, 2nd Edition. London: Academic Press. Ortner DJ, Tuross N, Stix AI. 1992 New Approaches to the Study of Disease in Archaeological New World Populations. Human Biology 64: 337-360. Parramore TC. 1970. Non-Venereal Treponematosis in Colonial North America. Bulletin of the History of Medicine 44:571-581. Powell ML. 1986 Late Prehistoric Community Health in the Central Deep South: Biological and Social Dimensions of the Mississippian Chiefdom at Moundville, Alabama. In Skeletal Analysis in Southeastern Archaeology, edited by Janet E. Levy, pp: 127-150. North Carolina Archaeological Council Publication No. 24. Powell ML, Cook DC. 2005 Treponematosis: Inquiries into the Nature of a Protean Disease. In The Myth of Syphilis, edited by Mary Lucas and Della Collins Cook, pp. 8-62. Gainesville: University Press of Florida. Powell ML, Cook DC, editors. 2005. The Myth of Syphilis. Gainesville: University Press of Florida. Roberts CA, Manchester K. 2005. The Archaeology of Disease, 3rd Edition. Stroud UK: Sutton Publishing. Rothschild BM, Heathcote GM. 1993 Characterization of the skeletal manifestations of the treponemal disease Yaws as a population phenomenon. Clinical Infectious Disease 17: 198-203. Saldana Design & Preservation Inc. 2004 Documentation of Historic and Existing Conditions: North Wing – Basement Level Workshop of the Royal Palm Hotel: Documentation of Historic and Existing Conditions. Miami Fl. Schwartz S, Pham H. 1981. Pediatric Dentistry 3: 283-286. Steinbock RT. 1976. Paleopathological Diagnosis and Interpretation. Springfield Illinois: CC Thomas. Suzuki T, Matsushita T, Han K. 2005. On the Possible Case of Treponematosis from the Bronze Age in China. Anthropological Science, 113: 253-258. Walker PL. 2005. A Paleopathological Perspective on the Evolution of Coastal Adaptations in the Western Hemisphere. Plenary Lecture, presented at the First annual meeting of the Paleopathology Meeting in South America, Rio de Janeiro, Brazil. Walker PL, Lambert PM, Schultz M, Erlandson JM. 2005. The Evolution of Treponemal Disease in the Santa Barbara Channel Area of Southern California”. In The Myth of Syphilis, edited by Mary Lucas Powell and Della Collins Cook, pp. 281-305. Gainesville: University Press of Florida.

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Wells C. 1963. Cortical Grooves on the Tibia. Man 63: 112-114 White T. 2000. Human Osteology 2nd Edition San Diego: Academic Press.

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Figures for main article: Photographs by Rose Drew and Alan Gillott.

Figure 1. The four elements described in this paper, found in articulation in Unit 218 of Miami One, Parcel D, catalogued as Field Specimens (FS) 1099 B-E. From Left: Right radius, right ulna, plastic model of mature left ulna, left ulna, left radius. Figure 2. Left hand photo: FS 1099 Left ulna, posterior aspect, remnant of a gumma, which is a localized area of necrosis. Right hand photo: Proximal left ulna, superior view. Anterior at left. Uppermost defect perforates olecranon completely. Figure 3. Left radius, FS 1099, reflected views of upper midshaft. The medullary cavity is filled with trabecular bone. Medial at lower left and right corners. Figure 4. Right ulna, FS 1099, medial view. A repaired defect is at the centre, while along the anterior margin of the shaft are vascular impressions. Anterior down. Figure 5. Distal right radius, FS 1099, ulnar notch. Spicules indicate there was an active periosteal reaction at time of death. Medial aspect.

Supplementary Figures for Web access only: Photographs by Rose Drew and Alan Gillott. S1. Lateral aspect, left tibia from Unit 222 Field Specimen 1083I S2. Transverse break at upper midshaft, left ulna, lateral aspect up. Unit 222 Field Specimen 1083D. S3. Left: lateral aspect, proximal left ulna; Right: reflected upper midshaft transverse break 30 mm below radial notch, posterior aspect up. Unit 254 Field Specimen 2943 J 1 S4. One of the elements described in the paper. Right ulna, Field Specimen 1099, lateral view of proximal. 5mm x 3 mm defect at middle expands to interior excavation.

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