Embora estudadas há décadas, a origem e dispersão de treponematoses permanecem como questões das mais acirradamente discutidas. No intuito de enriquecer esta discussão, a presente tese avalia sistematicamente 45 coleções osteológicas de populações costeiras do sul-sudeste do Brasil datadas entre 5000 anos AP e 1500 AD. Foram combinadas três metodologias numa abordagem conservadora para estabelecer o diagnóstico diferencial entre sífilis venérea, congênita, endêmica (bejel) e framboesia (yaws). Dentre os 768 indivíduos estudados foram encontrados 22 casos suspeitos de treponematose, inclusive com lesões tipo Caries sicca e tíbia em forma de sabre (sinais patognomônicos). A frequência geral resultante (22/768=2,86%) é certamente uma subestimativa. Houve 4 casos claros de sífilis venérea e 9 de framboesia, sendo os demais inconclusivos. Não foi observado nenhum caso claro de bejel e nos sítios com mais de um tipo suspeito, os diagnósticos eram iguais ou inconclusivos. Não houve tampouco um padrão geográfico ou temporal claro na distribuição dos casos de treponematose. Algumas outras paleopatologias (Cribra orbitalia, hiperostose porotica, periostite e osteomielite) foram estudadas no intuito de testar se os grupos acometidos por treponematose apresentam maior estresse fisiológico. Esta hipótese foi confirmada; embora as causas para maior susceptibilidade à estresse fisiológico e treponematoses em alguns sítios em comparação com outros permaneçam em aberto. Algumas tendências temporais foram observadas, porém necessitam de confirmação. Ao longo dos milênios parece ter havido uma frequência decrescente de Cribra orbitalia, osteomielite, periostite e remodelação óssea. Por outro lado, parece ter havido uma frequência crescente nos aumentos de porosidades cranianas (Hiperostose porótica, porosidade serpentinosa craniana) e de treponematoses de 5000 anos AP a 1500 AD. Se os diagnósticos aqui apresentados forem confirmados, corrobora-se a hipótese pré-Colombiana. Por outro lado, a hipótese Colombiana da origem da sífilis há somente 500 anos, assim como a Unitária (de acordo com a qual a treponematose é uma doença com manifestações moduladas por fatores climáticos e bioculturais) não explicariam a distribuição das treponematoses aqui encontradas. / Although studied for decades, origin and dispersal of treponemal diseases remain one of the most discussed issues in paleopathology. Aiming to enrich this discussion, the present study systematically evaluates 45 osteological collections from coastal groups aged 5000 BP to 1500 AD, exumed from sites in south-southeastern Brazil. Three different methods were combined and used in a conservative approach to establish differential diagnosis between venereal syphilis, yaws and bejel. Amongst the 768 individuals studied there are 22 cases with possible treponematosis, including some with Caries sicca and saber shin tibiae (patognomonic signs). The final frequency (22/768=2,86%) is certainly an underestimation. There are 4 cases affected with venereal syphilis and 9 with yaws. The remaining 9 cases are inconclusive. No clear case of bejel was found and in those sites were more than one individual was affected, the diagnoses were either the same or were inconclusive. No clear temporal nor geographic pattern of distribution was found. Some other paleopathologies were also studied (cribra orbitalia, porotic hyperostosis, periostitis and osteomyelite) in order to test if those groups affected with treponematoses also showed more physiological stress. Although this hypothesis was confirmed, the reasons that some groups were more susceptible to physiologial stress and treponemal diseases than other remains open. Some temporal tendencies were observed but need confirmation. There seems to have been a decrease in frequency of cribra orbitalia, osteomyelitis, periostitis and bone remodellling across time. On the other hand, there is also a upward shift in the frequency of porotic hyperostosis and treponematoses from 5000BP to 1500AD. If the candidate cases presented here would be confirmed, the pre-Columbian hypothesis seems more plausible. On the other hand, the Columbian hypothesis on the recent origin of syphilis, as well as the Unitarian hypothesis (according to which treponematosis is one disease with clinical manifestations influenced by climatic as well as bio-cultural factors) does not explain the distribution of treponematoses found herein.

Embora estudadas há décadas, a origem e dispersão de treponematoses permanecem como questões das mais acirradamente discutidas. No intuito de enriquecer esta discussão, a presente tese avalia sistematicamente 45 coleções osteológicas de populações costeiras do sul-sudeste do Brasil datadas entre 5000 anos AP e 1500 AD. Foram combinadas três metodologias numa abordagem conservadora para estabelecer o diagnóstico diferencial entre sífilis venérea, congênita, endêmica (bejel) e framboesia (yaws). Dentre os 768 indivíduos estudados foram encontrados 22 casos suspeitos de treponematose, inclusive com lesões tipo Caries sicca e tíbia em forma de sabre (sinais patognomônicos). A frequência geral resultante (22/768=2,86%) é certamente uma subestimativa. Houve 4 casos claros de sífilis venérea e 9 de framboesia, sendo os demais inconclusivos. Não foi observado nenhum caso claro de bejel e nos sítios com mais de um tipo suspeito, os diagnósticos eram iguais ou inconclusivos. Não houve tampouco um padrão geográfico ou temporal claro na distribuição dos casos de treponematose. Algumas outras paleopatologias (Cribra orbitalia, hiperostose porotica, periostite e osteomielite) foram estudadas no intuito de testar se os grupos acometidos por treponematose apresentam maior estresse fisiológico. Esta hipótese foi confirmada; embora as causas para maior susceptibilidade à estresse fisiológico e treponematoses em alguns sítios em comparação com outros permaneçam em aberto. Algumas tendências temporais foram observadas, porém necessitam de confirmação. Ao longo dos milênios parece ter havido uma frequência decrescente de Cribra orbitalia, osteomielite, periostite e remodelação óssea. Por outro lado, parece ter havido uma frequência crescente nos aumentos de porosidades cranianas (Hiperostose porótica, porosidade serpentinosa craniana) e de treponematoses de 5000 anos AP a 1500 AD. Se os diagnósticos aqui apresentados forem confirmados, corrobora-se a hipótese pré-Colombiana. Por outro lado, a hipótese Colombiana da origem da sífilis há somente 500 anos, assim como a Unitária (de acordo com a qual a treponematose é uma doença com manifestações moduladas por fatores climáticos e bioculturais) não explicariam a distribuição das treponematoses aqui encontradas. / Although studied for decades, origin and dispersal of treponemal diseases remain one of the most discussed issues in paleopathology. Aiming to enrich this discussion, the present study systematically evaluates 45 osteological collections from coastal groups aged 5000 BP to 1500 AD, exumed from sites in south-southeastern Brazil. Three different methods were combined and used in a conservative approach to establish differential diagnosis between venereal syphilis, yaws and bejel. Amongst the 768 individuals studied there are 22 cases with possible treponematosis, including some with Caries sicca and saber shin tibiae (patognomonic signs). The final frequency (22/768=2,86%) is certainly an underestimation. There are 4 cases affected with venereal syphilis and 9 with yaws. The remaining 9 cases are inconclusive. No clear case of bejel was found and in those sites were more than one individual was affected, the diagnoses were either the same or were inconclusive. No clear temporal nor geographic pattern of distribution was found. Some other paleopathologies were also studied (cribra orbitalia, porotic hyperostosis, periostitis and osteomyelite) in order to test if those groups affected with treponematoses also showed more physiological stress. Although this hypothesis was confirmed, the reasons that some groups were more susceptible to physiologial stress and treponemal diseases than other remains open. Some temporal tendencies were observed but need confirmation. There seems to have been a decrease in frequency of cribra orbitalia, osteomyelitis, periostitis and bone remodellling across time. On the other hand, there is also a upward shift in the frequency of porotic hyperostosis and treponematoses from 5000BP to 1500AD. If the candidate cases presented here would be confirmed, the pre-Columbian hypothesis seems more plausible. On the other hand, the Columbian hypothesis on the recent origin of syphilis, as well as the Unitarian hypothesis (according to which treponematosis is one disease with clinical manifestations influenced by climatic as well as bio-cultural factors) does not explain the distribution of treponematoses found herein.

Bioarchaeologists and palaeopathologists have recently turned their attention towards one critical aspect of the study of the history of disease: health-related caregiving. In response, an approach, the bioarchaeology of care, and, within it, the web-based Index of Care (IoC) have been developed to enable the identification and interpretation of past caregiving. Here, we apply the IoC to Burial 86, a young adult (18–25 years) female from the late Mississippian period, Dallas cultural phase Holliston Mills site (40HW11; ca. ad 1348–1535), TN. Burial 86 exhibits pathologies specific to treponematosis. They also exhibit a suite of pathologies indicative of physical impairment, including a varus angular deformity in the right tibia that is potentially the result of a malaligned pathological fracture. Following the IoC, we determine that Burial 86 probably experienced moderate clinical impacts on several domains (e.g., musculoskeletal system) with various functional impacts on essential activities of daily living. This means that Burial 86 likely had a disability and likely received caregiving, though it is impossible to determine if the care was efficacious. That care was provided likely reflected the community of Holliston Mills' more egalitarian socio-political structure, which was unusual for the late Mississippian. It may also reflect Burial 86's agency, the presence of adequate resources at the site, as indicated by high frequencies of high status mortuary artifacts, or a combination of these factors. The mortuary program for Burial 86 does not indicate that they were marked as being different—in status or other social categories—than other community members. This study highlights how bioarchaeological evidence can be used to explore the downstream effects of chronic infections, such as treponematosis, throughout the body and across the life course, and the opportunities for health-related caregiving in past societies that these processes can potentially create.

This dissertation deals with the study of ancient diseases mentioned in the historical period of the Scriptures in the region of Syro-Palestine. The definition, history, methodology and etymology of the terms relating to biblical diseases are discussed. Leprosy, syphilis, plague and anaemia amongst other diseases leave skeletal signs and lesions. Paleopathologists may reveal these diseases by studying skeletal remains of the population of Syro-Palestine. Criticisms and recommendations are offered for the practical paleopathologist, anthropologist or archaeologist. More interest should be taken in the study of coprolite in every new discovery of human remains. The scarcity of skeletal remains in the region is well known. The past and present law structure, the Halakah, may partly be to blame. The future of paleopathology worldwide is undisputedly the biochemical science of DNA analysis. With this new science the role for macromorphological examination may diminish. The diseases mentioned in the Bible are finding it increasingly difficult to hide behind the words in the Scriptures. / Old Testament and Ancient Near Eastern Studies / MA (Biblical Archaeology)

This dissertation deals with the study of ancient diseases mentioned in the historical period of the Scriptures in the region of Syro-Palestine. The definition, history, methodology and etymology of the terms relating to biblical diseases are discussed. Leprosy, syphilis, plague and anaemia amongst other diseases leave skeletal signs and lesions. Paleopathologists may reveal these diseases by studying skeletal remains of the population of Syro-Palestine. Criticisms and recommendations are offered for the practical paleopathologist, anthropologist or archaeologist. More interest should be taken in the study of coprolite in every new discovery of human remains. The scarcity of skeletal remains in the region is well known. The past and present law structure, the Halakah, may partly be to blame. The future of paleopathology worldwide is undisputedly the biochemical science of DNA analysis. With this new science the role for macromorphological examination may diminish. The diseases mentioned in the Bible are finding it increasingly difficult to hide behind the words in the Scriptures. / Old Testament and Ancient Near Eastern Studies / MA (Biblical Archaeology)