A possible case of treponemal disease from England dating to the 11th–12th century AD

SHORT REPORT

A Possible Case of Treponemal Diseasefrom England Dating to the 11th–12thCentury AD

S. MAYS,a* S. VINCENTa AND J. MEADOWSb

a Department of Archaeological Science, English Heritage, Fort Cumberland, Portsmouth PO4 9LD, UKb Department of Archaeological Science, English Heritage, Waterhouse Square, London EC1N 2ST, UK

ABSTRACT This short report describes a human skeleton from an archaeological site in England showing signs oftreponemal disease. A radiocarbon determination indicates that it is firmly pre-Columbian in date. Theimplications for recent debates concerning the origin of treponemal disease in Europe are discussed.Copyright � 2010 John Wiley & Sons, Ltd.

Key words: palaeopathology; pre-Columbian; radiocarbon; treponematosis

Introduction

The treponemal diseases are a group of four alliedbacterial infections: syphilis, bejel, yaws and pinta. Allsave pinta may cause skeletal lesions. Syphilis, bejeland yaws are caused by three sub-species of Treponemapallidum, pinta by T. carateum (Centurion-Lara et al.,2006). The origins and spread of the treponemaldiseases have been much debated. Traditionally, themain controversies have centred around syphilis, and inparticular the relationship between the disease inEurope and the Americas. The Columbian hypothesismaintains that it originated in the Americas and wasintroduced to Europe by Columbus and his crew upontheir return from his first voyage of discovery to theNew World in 1493. Other theories maintain that itwas present in Europe before this (discussion in Roberts& Manchester, 1995: 155–159; Meyer et al., 2001).Recently, spurred by phylogenetic studies of modernisolates of pathogenic Treponema, the debate hasbroadened to encompass the origin of the treponemaldiseases as a whole (Harper et al., 2008; Zuckermanet al., 2008; Mulligan et al., 2009; de Melo et al., 2010).

Until recently, a New World origin for Europeantreponemal disease seemed credible because of apaucity of good skeletal evidence for it in Europe priorto 1493 (Baker & Armelagos, 1988). Lately however, asprinkling of cases of treponemal disease have beenreported from pre-Columbian archaeological contextsin north-west Europe and the Mediterranean basin(Dawes, 1980; Stirland, 1991, 1994; Mays et al., 2003;Ortner, 2003: 313–316; Mitchell, 2005, 2009; Erdal,2006). These appeared to countermand a New Worldorigin for European treponemal disease. However, therehave been recent attempts to revive the Columbianhypothesis on the basis of phylogenetic work. Harperet al. (2008) suggest that the sub-species of T. pallidumresponsible for syphilis evolved from New World yaws-causing strains, supporting a NewWorld origin, althoughnon-venereal treponemal diseases may have originated inthe Old World. In addition, this research group hasattempted to discredit published pre-Columbian OldWorld skeletal cases of treponematosis. In particular, theypoint out that many of these cases do not haveradiocarbon dates, and those which have generally givedates in the 14th and 15th centuries, and are hence onlynarrowly pre-Columbian (Zuckerman et al., 2008).The inclusion of marine resources in palaeodiets hasthe potential to cause radiocarbon dates to over-estimate the age of bone samples, the so-called marinereservoir effect (e.g. Bayliss et al., 2004). For example,

International Journal of Osteoarchaeology

Int. J. Osteoarchaeol.

(wileyonlinelibrary.com) DOI: 10.1002/oa.1210

* Correspondence to: Department of Archaeological Science, EnglishHeritage, Fort Cumberland, Portsmouth PO4 9LD, UKe-mail: [email protected]

Copyright # 2010 John Wiley & Sons, Ltd. Received 5 July 2010Revised 29 July 2010

Accepted 6 August 2010

22: 3 –3 (2012)66 72Published online in Wiley Online Library4 October 2010

dates for treponemal skeletons from Hull, England,which initially seemed pre-Columbian, in fact extendinto the post-Columbian period once the marinereservoir effect is taken into account (von Hunniuset al., 2006). Zuckerman et al. (2008) raise thepossibility that this problem may be more widespreadthan has been appreciated for supposedly pre-Columbian Old World cases of treponemal disease,as a fairly modest marine reservoir effect wouldbe sufficient to push dates for many of them intothe post-Columbian period.The above debate has prompted us to publish this

short report on a skeleton from England which showssigns of treponemal disease and which has beenradiocarbon dated to at least three centuries beforeColumbus.

Materials and methods

The skeleton which is the subject of the current reportis burial HC017 from the Castle Mound cemeterysite in Huntingdon, England (Figure 1). The burialground was in use sometime between the 8th andthe 17th century AD (Vincent & Mays, 2009).

The skeleton survives only from the 4th lumbarvertebra downwards (Figure 2), probably due to truncationof the burial by a later feature. Gross condition ofthe surviving remains is good with minimal post-depositional erosion of bone surfaces. All epiphyses arefused, indicating fully adult status. Pelvic morphology(Phenice, 1969; Brothwell, 1981) indicates female sex.The pathological lesions were examined using grossinspection and radiography.

Figure 1. Site location.Figure 2. Surviving elements of skeleton HC017. Diseasedareas are shaded.

Copyright # 2010 John Wiley & Sons, Ltd.

367Possible Case of Treponemal Disease

Int. J. Osteoarchaeol. 22: 366–372 (2012)

The pathological changes

All surviving lower leg long bones show concentricthickening throughout their diaphyses (Figures 3, 4). Inmost places the bony deposits are well-remodelled, butin a few locations they show finely pitted surfacessuggestive of less well remodelled lesions. There aresome small bony plaques with under-cut edges withinthe new bone deposits (Figure 5). Radiography revealsthe abnormal presence of substantial amounts of coarsecancellous bone within the medullary cavities offemora, tibiae and fibula. The tibiae also show somecancellisation of cortex (Figure 6).

Diagnosis

The presence of both thoroughly remodelled andpoorly remodelled bone deposits indicates chronic

bone lesions which were active shortly before death.Although we believe that treponemal disease is mostlikely responsible for the bone changes in HC017, wefirst considered a number of competing diagnoses.Paget’s disease of bone may produce thickened bones

with pitted, porous surfaces. However this diagnosticoption may be eliminated since the pathognomonicradiographic appearance (Mirra et al., 1995a, b) islacking. In any event, the bone changes in the current

Figure 3. Tibiae, anterior view. This figure is available in colour atwileyonlinelibrary.com/journal/oa

Figure 4. Left fibula, lateral view. This figure is available in colourat wileyonlinelibrary.com/journal/oa

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. 22: 366–372 (2012)

368 S. Mays, S. Vincent and J. Meadows

case have the appearance of infectious lesions. The lackof sinus or sequestrum formation argues against adiagnosis of pyogenic osteomyelitis, and multiple boneinvolvement is also atypical of this condition (Stein-bock, 1976: 60–85). The formation of bone within themedullary cavities and the involvement of the femoraexcludes periostitis as a result of localised non-specificinfection of the lower legs (Loudon, 1981). Thepresence of abnormal bone in the medullary cavitiesalso enables exclusion of hypertrophic osteoarthro-pathy (Greenfield et al., 1967) and venous stasis(Resnick & Niwayama, 1981: 2996–3000). We con-sidered as diagnostic options various fungal infectionswhich occur in a north-west European environment,such as sporotrichosis and cryptococcosis. However,the absence of lytic lesions argues against thesediagnoses (Ortner, 2003: 325–332).The pattern of concentric thickening of long bones

as a result of osteo-periostitis, the presence of smallundercut plaques within the new bone deposits,encroachment into the medullary cavity of cancellousbone and localised cancellisation of compacta aretypical of non-gummatous lesions of treponemaldisease (Hackett, 1976; Steinbock, 1976: 86–169;Aufderheide & Rodriguez-Martin, 1998: 154–171;Ortner, 2003: 273–319).Of the treponemal diseases which may lead to bone

lesions, yaws is today a disease of the humid tropics,and there is no evidence that it was ever a problem innorth-west Europe. Bejel is currently found in warm,dry regions (Engelkens et al., 1991). However, untilrecently it occurred in south-eastern Europe (Grin &Guthe, 1973; Nadazdin & Karlovac, 1977; Arslanagicet al., 1989), so there is no reason why it should nothave occurred in the past in other parts of Europe.

Indeed, the historic terms ‘button scurvy’ in Ireland,‘sibbens’ in Scotland and ‘radesyge’ in Norway allappear to refer to bejel (Morton, 1964, 1967; Andersonet al., 1986), and seem testify to the historic presence ofthis disease at least as far back as the 17th century innorth-west Europe.The most likely diagnoses for HC017 are syphilis or

bejel. The two cannot be distinguished, as theosteological lesions caused by all three treponematosesthat affect the skeleton are similar (Hackett, 1976;Heathcote et al., 1998; Ortner, 2003).

Figure 5. Detail of new bone formation on fibula shaft, showingpresence of small, raised, undercut plaques of bone (arrowed).This figure is available in colour at wileyonlinelibrary.com/journal/oa

Figure 6. Antero-posterior radiograph of tibiae. The medullarycavities are occludedwith large amounts of abnormal cancellousbone. There is also cancellisation of cortical bone (particularlyon the medial sides of the diaphyses) resulting in loss ofthe normally sharp cortico-medullary distinction. This figure isavailable in colour at wileyonlinelibrary.com/journal/oa




Radiometric dating

A 2.3 g sample of bone was removed from the lefttibia of HC017 and submitted for radiocarbon dating.Chemical pre-treatment and isotopic measurementfollowed standard procedures (Bronk Ramsey et al.,2004a, b). The results are shown in Table 1.The radiocarbon determination shows HC017 to be

pre-Columbian. However, the potential influence of amarine reservoir effect remains to be evaluated. In anEnglish Mediaeval context, d13C human bone collagenendpoints for completely terrestrial and completelymarine diets are about –21.5% and –12%, respectively(Mays, 1997). The d13C for HC017 therefore indicatesthat dietary protein came predominantly from terres-trial foods, but probably with a minor marine input.The d15N is typical of the slightly elevated values oftenproduced by English Mediaeval skeletons (Muldner &Richards, 2005). Although a multiplicity of factors mayinfluence human bone d15N (discussion in Waters-Rist& Katzenberg, 2010), the value for HC017 wouldbe consistent with a modest marine contribution todiet.In order to assess whether the marine component in

HC017’s diet could be sufficient to undermine theburial’s pre-Columbian status, the potential size of themarine contribution needs to be estimated. Taking aconservative stance that the entire offset in d13C from aterrestrial endpoint of –21.5% reflects marine carbonsources, and using a linear mixing model (Mays, 1997),about 24% of the carbon in HC017’s collagen couldcome from marine sources. The Mix_Curves function ofOxCal v4.05, assuming 76% terrestrial carbon, calibratedusing the IntCal04 data, and 24% marine carbon,calibrated using the Marine04 calibration model, gives acalibrated date range of AD1050–1250. Hence, despite aprobable minor marine dietary component, the skeletonis clearly pre-Columbian.

Discussion

Skeleton HC017 is currently the earliest radiocarbondated skeleton with indications of treponemal disease

from Britain. It suggests treponematosis was present inBritain three centuries prior to the Columbus voyage.It has been postulated (Hudson, 1963) that trepone-

mal infection may have been introduced into Europefrom south-west Asia via the Crusades. Alternatively, itmay have been introduced from contacts with Africawhere treponematosis appears to have a long-standingpresence (Livingstone, 1991).The European Crusades to the Middle East took place

between AD1096 and the early 13th century. Early casesof treponemal disease from Europe with publishedradiocarbon dates of which we are aware (the currentcase, York (Dawes 1980;Mays 2010: 204–205), Norwich(Stirland, 1991, 1994, 2009), Hull (von Hunnius et al.,2006), Rivenhall and Ipswich (Mays et al., 2003), all fromEngland; Waterford, Ireland (Housley, 1998); and Arles,France (Mafart et al., 1998)) all overlap or post-date thisperiod. Therefore the temporal distribution of radio-metrically dated European cases would appear consistentwith this hypothesis. There is evidence (Mitchell, 2005,2009) for the presence of pre-Columbian treponematosisin theMiddle East, although this post-dates the Crusaderperiod. An example from Egypt dates from AD300–700(Ortner, 2003: 313–316).Contacts between Europe and tropical Africa date

back to at least the 7th century BC (Brun et al., 1998).Some European cases of possible treponematosis havebeen reported from Classical Antiquity (Palfi et al.,1992; Blondiaux & Alduc-Le Bagousse, 1994; Henne-berg & Henneberg, 1994). If these diagnoses can besustained they would obviously countermand thehypothesis of introduction via the Crusades, but wouldleave open the possibility of an African source. Howeverthese early European cases do not, to our knowledge,have published radiometric dates. The earliest Africancase showing evidence of treponematosis of which weare aware is the Egyptian case from AD300–700 referredto above (Ortner, 2003: 313–316). The characteristicallypoor survival of buried bone in tropical soils may havecontributed to the paucity of other African cases.In conclusion, the present case provides evidence for

treponemal infection in north-west Europe in the lateMediaeval period, three centuries before Columbus. Itadds to a small but growing body of well-dated skeletalevidence for treponematosis in the late Mediaeval

Table 1. Radiometric dating of HC017

Laboratorydate code

Radiocarbonage BP

Calibrated date range(95% confidence limits)a

d13C d15N

SUERC-19641 955� 30 AD1010–1170 –19.2% þ12.5%

aCalibrated using OxCal v4.05 (http://c14.arch.ox.ac.uk/embedphp?File¼oxcal.html), using the InCal04 calibration data and themaximum intercept method, rounded out to decadal endpoints.



period in Europe. This is consistent with theintroduction of treponemal disease not as a result ofthe Columbus voyage, but via the Crusades or otherearlier events. A systematic review of the skeletalpathology and a programme of radiometric dating(including d13C and d15N measurements to check thatresults are not subject to major marine reservoir effects)for early cases of treponematosis would help resolvesome of the questions over the origin and spread ofsyphilis and allied conditions.

References

Anderson T, Arcini C, Anda S, Tangerud A, Robertsen T.1986. Suspected endemic syphilis (treponarid) in six-teenth century Norway. Medical History 30: 341–350.

Arslanagic N, Bokonjic M, Macanovic K. 1989. Eradication ofendemic syphilis in Bosnia. Genitourinary Medicine 65: 4–7.

Aufderheide AC, Rodriguez-Martin C. 1998. The CambridgeEncyclopaedia of Human Palaeopathology. Cambridge Univer-sity Press: Cambridge.

Baker BJ, Armelagos GJ. 1988. The origin and antiquity ofsyphilis. Current Anthropology 29: 703–737.

Bayliss A, Shepherd Popescu E, Beavan-Athfield N, BronkRamsey C, Cook GT, Locker A. 2004. The potentialsignificance of dietary offsets for the interpretation ofradiocarbon dates: an archaeologically significant examplefrom Medieval Norwich. Journal of Archaeological Science 31:563–575.

Blondiaux J, Alduc Le Bagousse A. 1994. Une treponematosedu bas-Empire Romain en Normande?. In L’Origine duSyphilis en Europe, Avant ou Apres 1493?, Dutour O, PalfiG, Berato J, Brun J-P (ed.). Editions Errance CentreArcheologique do Var: Toulon; 99–100.

Bronk Ramsey C, Higham T, Leach P. 2004a. Towards highprecision AMS; progress and limitations. Radiocarbon 46:17–24.

Bronk Ramsey C, Higham T, Bowles A, Hedges R. 2004b.Improvements to the pretreatment of bone at Oxford.Radiocarbon 46: 155–163.

Brothwell DR. 1981. Digging Up Bones (3rd edn). OxfordUniversity Press/BritishMuseum (Natural History): Oxford.

Brun J-P, Dutour O, Palfi G. 1998. L’antiquite des trepone-matoses dans l’ancien monde: evidence historiques, arche-ologiques et paleopathologiques. Bulletins et Memoires de laSociete d’Anthropologique de Paris 10: 375–409.

Centurion-Lara A, Molini BJ, Gordones C, Sun E, Hevner K,van Voorhis WC, Lukehart SA. 2006. Molecular differ-entiation of Treponema pallidum subspecies. Journal of ClinicalMicrobiology 44: 3377–3380.

Dawes JD. 1980. The human bones. In The Cemetery of StHelen-on-the-Walls, Aldwark, Dawes JD, Magilton JR, TheArchaeology of York 12/1 Council for British Archaeol-ogy: London; 19–82.

Erdal YS. 2006. A pre-Columbian case of congenital syphilisfrom Anatolia (Nicaea, 13th century AD). InternationalJournal of Osteoarchaeology 16: 16–33.

Engelkens HJH, Niemel PLA, van der Sluis JJ, Mehues A,Stolz E. 1991. Endemic treponematoses. Part II. Pinta andendemic syphilis. International Journal of Dermatology 30:231–238.

Greenfield GB, Schorsch HA, Shkolnik A. 1967. Thevarious roentgen appearances of pulmonary hypertrophicosteoarthropathy. American Journal of Roentgenology 101:927–931.

Grin EI, Guthe T. 1973. Evaluation of a previous masscampaign against endemic syphilis in Bosnia and Herze-govina. British Journal of Venereal Diseases 49: 1–19.

Hackett CJ. 1976. Diagnostic Criteria of Syphilis, Yaws andTreponarid (Treponematoses) and of Some Other Diseases in DryBones. Springer: Berlin.

Harper KN, Ocampo PS, Steiner BM, George RW, Silver-man MS, Bolotin S, Pillay A, Saunders NJ, Armelagos GJ.2008. On the origin of the treponematoses: a phyloge-netic approach. PLoS Neglected Tropical Diseases 2: e148.

Heathcote GM, Stodder ALW, 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.

Henneberg M, Henneberg RJ. 1994. Treponematosis in anancient Greek colony of Metaponto, southern Italy, 580-250BCE. In L’Origine du Syphilis en Europe, Avant ou Apres 1493?,Dutour O, Palfi G, Berato J, Brun J-P (eds.) Editions ErranceCentre Archeologique do Var: Toulon; 92–98.

Housley RA. 1998. Accelerator dating of syphilitic bone. InLate Viking Age and Mediaeval Waterford. Excavations 1986–1992, Hurley MF, Scully O, McCutcheon SWJ (eds.)Waterford Corporation: Waterford; 817.

Hudson EH. 1963. Treponematosis and pilgrimage. AmericanJournal of Medical Science 246: 645–656.

von Hunnius TE, Roberts CA, Boylston A, Saunders SR.2006. Histological identification of syphilis in pre-Colum-bian England. American Journal of Physical Anthropology 129:559–566.

Livingstone FB. 1991. On the origin of syphilis: an alterna-tive hypothesis. Current Anthropology 32: 587–590.

Loudon ISL. 1981. Leg ulcers in the 18th and early 19th

centuries. Journal of the Royal College of General Practitioners31: 263–273.

Mafart B-Y, De Lumley MA, Housley R, CantaloubeP, Martin J-P, Joffre P, Spitery E, Gagniere S. 1998.Le crane ‘‘Romain’’ d’Arles: une syphilis frontale etnaso-palatine post-Columbienne, apport des nouvellesmethodes de datation C14 en paleopathologie. Bulletinset Memoires de la Societe d’Anthropologique de Paris 10: 333–344.

Mays S. 1997. Carbon stable isotope ratios in Mediaeval andlater human skeletons from northern England. Journal ofArchaeological Science 24: 561–567.

Mays S. 2010. The Archaeology of Human Bones (2nd edn).Routledge: London.




Mays S, Crane-KramerG, Bayliss A. 2003. Two probable casesof treponemal disease of Mediaeval date from England.American Journal of Physical Anthropology 120: 133–143.

de Melo FL, de Mello JCM, Fraga AM, Nunes K, Eggers S.2010. Syphilis at the crossroad of phylogenetics andpaleopathology. PloS Neglected Tropical Diseases 4: e575.

Meyer C, JungC, Kohl T, Poenicke A, Poppe A, Alt KW. 2001.Syphilis 2001–a palaeopathological reappraisal. HOMO 53:39–358.

Mirra JM, Brien EW, Tehranzadeh J. 1995a. Paget’s diseaseof bone: review with emphasis on radiologic features,Part I. Skeletal Radiology 24: 163–171.

Mirra JM, Brien EW, Tehranzadeh J. 1995b. Paget’s diseaseof bone: review with emphasis on radiologic features, PartII. Skeletal Radiology 24: 173–184.

Mitchell PD. 2005. Pre-Columbian treponemal diseasefrom 14th century AD Safed, Israel, and the implicationsfor the Medieval eastern Mediterranean. American Journal ofPhysical Anthropology 121: 117–124.

Mitchell PD. 2009. Revised radiocarbon date for a case oftreponemal disease from Safed, Israel, from the 15th cen-tury AD. American Journal of Physical Anthropology 139: 274.

Morton RS. 1964. The button scurvy of Ireland. British Journalof Venereal Diseases 40: 271–272.

Morton RS. 1967. The sibbens of Scotland. Medical History11: 374–380.

Muldner G, Richards MP. 2005. Fast or feast: reconstructingdiet in later Mediaeval England by stable isotope analysis.Journal of Archaeological Science 32: 39–48.

Mulligan CJ, Norris SJ, Lukehart SA. 2008. Molecularstudies in Treponema pallidum evolution: toward clarity. PLoSNeglected Tropical Diseases 2: e184.

Nadazdin M, Karlovac K. 1977. Investigations on reactivityof sera in endemic syphilis from Bosnia 20 years aftertreatment. British Journal of Venereal Diseases 53: 216–217.

Ortner D. 2003. Identification of Pathological Conditions in SkeletalRemains. Academic Press: London.

Palfi G, Dutour O, Borreani M, Brun J-P, Berato J. 1992. Pre-Columbian congenital syphilis from late antiquity inFrance. International Journal of Osteoarchaeology 2: 245–261.

Phenice TW. 1969. A newly developed visual method ofsexing the os pubis. American Journal of Physical Anthropology30: 297–302.

Resnick D, Niwayama G. 1981. Diagnosis of Bone and JointDisorders. WB Saunders: London.

Roberts C, Manchester K. 1995. The Archaeology of Disease(2nd edn). Sutton: Stroud.

Steinbock RT. 1976. Palaeopathological Diagnosis and Interpret-ation. Charles C Thomas: Springfield.

Stirland A. 1991. Pre-Columbian treponematosis in Med-iaeval Britain. International Journal of Osteoarchaeology 1: 39–47.

Stirland A. 1994. Evidence for pre-Columbian treponema-tosis in Mediaeval Europe. In L’Origine de la Syphilis enEurope, Avant ou Apres 1493?, Dutour O, Palfi G, Berato J,Brun J-P (eds.) Editions Errance Centre Archaeologiquedu Var: Toulon; 109–115.

Stirland A. 2009. Criminals and Paupers: the Graveyard of StMargaret Fyebriggate in combusto, Norwich, East AnglianArchaeological Report 129 Norfolk Museums andArchaeology Service: Gressenhall.

Vincent S, Mays S. 2009.Osteological Analysis of the HuntingdonCastle Population, English Heritage Research DepartmentReport 8/2009 English Heritage: Portsmouth.

Waters-Rist AL, Katzenberg MA. 2010. The effect ofgrowth on stable nitrogen isotope ratios in subadultbone collagen. International Journal of Osteoarchaeology 20:172–191.

Zuckerman M, Harper KN, Harper ML, Boylston A, Arme-lagos GJ. 2008. The origin and antiquity of syphilisrevisited: an appraisal of Old World pre-Columbianevidence for treponemal infection. Paper presented at theAnnual Meeting of the Palaeopathology Association, Columbus,Ohio, April 2008



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A possible case of treponemal disease from England dating to the 11th–12th century AD