AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 144:526–537 (2011) Race, Health, and Disease in 19th-Century-Born Males Carlina de la Cova* Anthropology Department, University of North Carolina at Greensboro, Greensboro, NC 27412 KEY WORDS treponematosis paleopathology; 19th century; African American history; tuberculosis; ABSTRACT This study analyzed skeletal health disparities among African American and Euro-American males of low socioeconomic status born between 1825 and 1877. A total of 651 skeletons from the Cobb, Hamann-Todd, and Terry anatomical collections were macroscopically examined for skeletal pathologies related to dietary deficiencies and disease. Individuals were separated into age, ancestry, birth (Antebellum, Civil War, Pre-Reconstruction, and Reconstruction), combined ancestry/birth, enslaved versus liberated, and collection cohorts. These groups were statistically evaluated using ANOVA and v2 analyses to determine if The skeletal health of 19th century Americans has been a topic of recent interest to biological anthropologists (Kelly and Angel, 1987; Owsley et al., 1987; Rathbun, 1987; Lanphear, 1990; Rathbun and Scurry, 1991; Owsley, 1994; Blakely and Harrington, 1997; RankinHill, 1997; Rathbun and Smith, 1997; Higgins, 2001; Sledzik and Sandberg, 2002; Steckel and Rose, 2002; Wols and Baker, 2004). This scholarship has mainly focused on the skeletal health of African Americans or Euro-Americans. Few studies have compared 19th-century-born African Americans and Euro-Americans (Rathbun and Scurry, 1991; Blakely and Harrington, 1997; Rathbun and Steckel, 2002; Watkins, unpublished data). This article expands on previous research by examining skeletal health disparities in 651 African Americans and Euro-Americans of low socioeconomic status born between 1825 and 1877 from the HamannTodd, Robert J. Terry, and William Montague Cobb collections. It was hypothesized, based on existing historical and anthropological scholarship, that African Americans and persons born during the Reconstruction era (1866–1877) would have the highest rates of infectious diseases, nutritional deficiencies, and biological stress. Historical data indicate that African American mortality increased and fertility declined after the Civil War and remained low through the early 20th century (Farley, 1970; Giffin, 2005). Census data supports this trend, illustrating that African Americans had higher death rates and larger frequencies of tuberculosis, malaria, measles, pneumonia, scrofula, and venereal diseases between 1880 and 1900 (Billings, 1885, 1896; King, 1902). Several historical events also coalesced to decrease longevity and increase disease frequencies and biological stress among African Americans. These included the treatment of runaway slaves in Union-run contraband camps, the postwar economy, migration from the South to densely populated Northern cities, and job competition. The transition from enslavement to freedom for C 2010 V WILEY-LISS, INC. age, ethnic, and temporal differences existed. Results indicated that African Americans, especially those born during Reconstruction, had significantly higher frequencies of tuberculosis (P 5 0.004) and treponematosis (P 5 0.006) than Euro-Americans. Historical sources are important in contextualizing why these different ethnic and temporal patterns were present, pointing to environmental conditions related to enslavement, postliberation migration to the industrialized North, crowded urban living conditions, and poor sanitation. V 2010 Am J Phys Anthropol 144:526–537, 2011. C Wiley-Liss, Inc. Black Southerners would have been stressful. Many slaves fled their masters during the Civil War, seeking refuge in Union army encampments. The Confiscation Act of 1861 also dictated that any Confederate property, including human chattel used for insurrectionary activities, was subject to confiscation by the U.S. military. Slaves, now contrabands of war, flocked daily to Union lines in increasing numbers. Army officers initially placed them in contraband camps on the periphery of Federal encampments and assigned the men to work as laborers, cooks, launderers, servants, and eventually soldiers (Nolen, 2001; Reid, 2002). Females, children, and the elderly remained in the designated areas, where crowding was constant, food and supplies were lacking, white soldiers were condescending, and diseases spread rapidly. Many succumbed to illness and malnutrition, perishing before attaining freedom (Reid, 2002). In late 1862, these poor conditions forced the army to organize the refugees into established settlements and provide some rations, clothing, and medicine. However, mortality rates, crowding, and malnutrition still plagued the camps (Click, 2001; Reid, 2002). The army lacked the resources to support hundreds of thousands of contrabands. Soldiers also met with hardships during the war. Camp life was grueling with bad sanitation, frequent Grant sponsors: Smithsonian Institution and Indiana University Department of Anthropology, and Indiana University Graduate Student and Professional Organization. *Correspondence to: Dr. Carlina de la Cova, Anthropology Department, University of North Carolina at Greensboro, Greensboro, North Carolina 27412. E-mail: [email protected] Received 29 March 2010; accepted 5 October 2010 DOI 10.1002/ajpa.21434 Published online 1 December 2010 in Wiley Online Library (wileyonlinelibrary.com). DISEASE IN 19TH CENTURY MALES illnesses, harsh exposure to the elements, and a poor diet. Disease was responsible for two-thirds of the 600,000 war-related deaths (Bollet, 2002). Measles, mumps, chickenpox, and whooping cough infected regiments and recruits never exposed to these illnesses in epidemic proportions. Unsanitary camp conditions prompted numerous cases of dysentery, typhoid fever, jaundice, and typhus. Warm weather exposed soldiers to unwanted intermittent fevers, malaria, and sunstrokes. Colds, coughs, pneumonia, bronchitis, and tuberculosis were also common. The end of the Civil War ushered in the Reconstruction era (1866–1877) and the Gilded Age (1878–1900). The Southern infrastructure and economy remained stagnated throughout these periods. Many Southern African Americans and poor Euro-Americans turned to sharecropping to survive, which left them permanently indebted to landowners. Blacks fared worse with discrimination, Jim Crow laws, and persecution from the Ku Klux Klan (Phillips, 1999). These proved to be major factors that pushed Black Southerners to migrate to Northern states. As the South languished, the North advanced economically. The post-Civil War years saw increasing job opportunities and further industrialization. Urban areas grew denser and transportation advancements allowed for the rapid mobility of people and their pathogens across the American landscape. Southern African Americans, fleeing the sharecropping system and oppressive discrimination, chose to relocate to industrialized cities like Cleveland, Ohio, and St. Louis, Missouri, in search of better lives (Phillips, 1999; Giffin, 2005). This in-migration of over one million Southern Blacks to the North, Midwest, and West, known as the Great Migration, began in 1910 and continued until 1930 (Giffin, 2005). Poor Euro-Americans in these regions did not eagerly welcome the new arrivals. They saw their job prospects narrowing in an economy where they already competed with European immigrants (Bonacich, 1972, 1975). The population influx prompted housing shortages and further crowding of the lower classes into tenements, substandard rooms with poor ventilation, and bad sanitation. Tensions between Blacks and whites over access to jobs and housing eventually exploded when numerous race riots erupted across the U.S. during the summers of 1917 and 1919. Bioanthropological studies of 19th century African Americans have shed light on how the above historical factors impacted health. Scholarship has mainly focused on the Antebellum era due to salvage archaeology projects (Kelly and Angel, 1987; Rathbun, 1987; Rathbun and Scurry, 1991; Blakely and Harrington, 1997). These analyses indicated that enslaved Blacks suffered from malnutrition, enamel hypoplasia, growth disruption, disease, anemia, infection, bone hypertrophy, arthritis, and high mortality rates (Kelly and Angel, 1987; Martin et al., 1987; Rathbun, 1987; Rathbun and Scurry, 1991; Rankin-Hill, 1997; Blakey, 2001). Post-Reconstruction African Americans from Arkansas had higher rates of nutritional stress, growth disturbances, and infectious diseases when compared with their Antebellum brethren, suggesting that health declined after liberation (Rose, 1985, 1989). Watkins (2003; in press) examination of late-19th and early 20th century African Americans from the Cobb and Terry anatomical collections also indicated that Blacks had high rates of infectious disease and arthritis. 527 Studies of Euro-Americans have examined diverse samples, including soldiers, indigents from almshouses, and wealthy plantation owners (Lanphear, 1990; Rathbun and Scurry, 1991; Rathbun and Smith, 1997; Higgins, 2001; Rathbun and Steckel, 2002). Despite their social differences, many of these Euro-Americans also suffered from periosteal reactions, growth disruption, porotic hyperostosis, enamel hypoplasia, caries, osteoarthritis, trauma, and disease (Lanphear, 1990; Rathbun and Scurry, 1991; Higgins et al., 2002; Rathbun and Steckel, 2002; Saunders et al., 2002; Sledzik and Sandberg, 2002). Few studies have compared 19th century African Americans and Euro-Americans. Rathbun and Scurry (1991) examined white South Carolinian Croft family elites and their slaves, but sample sizes were too small for any cogent findings. Analyses of human remains discovered in the Georgia Medical College’s basement in 1989 could only assess ancestry for twenty-four persons and focused on African Americans, who had slightly higher rates of infectious lesions, but shared low calcium levels with Euro-Americans (Blakely and Harrington, 1997). The Global History of Health Project compared the skeletal health of 19th century Euro-Americans and African Americans using a complied sample of various individuals (Steckel and Rose, 2002). Whites included middle class Canadians, almshouse inmates from Rochester, New York, wealthy Southern plantation owners, and U.S. Army soldiers. African Americans were also diverse with slaves from Antebellum Charleston, members of the 55th Massachusetts Regiment, post-Reconstruction African Americans living in the Southwest, and free Antebellum Blacks residing in Philadelphia. After these samples were combined into ancestry cohorts and analyzed, results revealed that Euro-Americans were healthier than African Americans (Rathbun and Steckel, 2002; Steckel et al., 2002). However, when examined independently, free Antebellum Philadelphia Blacks were the ‘‘healthiest.’’ Regardless of their limitations, these studies have provided important insights into 19th century American health, indicating that both African Americans and Euro-Americans suffered from biological stress and infectious diseases. Destitution and dissection in 19th century America The samples analyzed for this project come from three major American anatomical collections: Hamann-Todd, Robert J. Terry, and William Montague Cobb. The 19thcentury-born subjects associated with these collections died in almshouses, charity institutions, and municipal hospitals without anyone claiming their remains (Cobb, 1935; Watkins, 2003; Hunt and Albanese, 2004). This was common in the late 19th and early 20th centuries when anatomical laws dictated that unclaimed bodies be given to medical schools for dissection (Blakely and Harrington, 1997; Richardson, 2001; Sappol, 2002). Previous studies have compared 19th century Blacks and whites but few have examined large sample sizes. Rathbun and Steckel (2002) admitted their combined sample of Euro-Americans and African Americans was small, limited, and heterogeneous, since it was pooled from various sites and time periods. Combining individuals from different socioeconomic contexts to represent an ethnic group can be problematic and lead to misrepreAmerican Journal of Physical Anthropology 528 C. DE LA TABLE 1. Cohorts used in data analysis and sample size Ancestry cohorts African American Euro-Americana Collection cohorts (location) Terry (St. Louis, Missouri) Hamann-Todd (Cleveland, Ohio) Cobb (Washington, D.C.) Birth cohorts Antebellum Civil War Reconstruction Pre-Reconstruction vs. reconstruction Prereconstruction Reconstruction Ancestry/birth cohorts Antebellum White Antebellum Black Civil War White Civil War Black Reconstruction White Reconstruction Black Enslaved vs. liberated ancestry/birth cohorts Enslaved Black Pre-Reconstruction White Liberated/Reconstruction Black Reconstruction White Age cohorts 29–39 40–49 50–59 60–100 Sample size by ancestry and collection Hamann-Todd Terry Cobb African American Euro-Americana Total 171 19 190 117 258 375 73 13 86 a This was all available Euro-Americans for the time periods examined. sentations of health as salubrity is tied to access to health care, environmental stressors, nutrition, and socioeconomic status. The current project builds on these previous studies of 19th century health by examining a larger sample of individuals (n 5 651) from the same socioeconomic background with shared occupations that lived in similar environments. The subjects studied were indigent at death and, according to morgue records, were unskilled laborers in Cleveland, Ohio, St. Louis, Missouri, and Washington, D.C. In addition to examining persons of the same socioeconomic status with similar occupations, this project focused on males born during the Antebellum (1800– 1860), Civil War (1861–1865), and Reconstruction (1866–1877) eras. As discussed earlier, these epochs were associated with political, social, and cultural upheavals that impacted all Americans including the lower socioeconomic classes. By examining these important periods, a better understanding of the relationship between environmental stressors and changes in skeletal health among African Americans and Euro-Americans of low socioeconomic status can be ascertained. Blacks born during the Antebellum period would have grown and matured whilst enslaved and lived through Reconstruction. Euro-Americans born in the Antebellum era would have lived through the stressful period of the Civil War. Civil War-born persons would have American Journal of Physical Anthropology COVA TABLE 2. Diseases, dietary deficiencies, and pathologies examined Dietary deficiencies (present/absent) Rickets (Ortner, 2002) Porotic hyperostosis (Stuart-Macadam, 1989) Infectious diseases (present/absent) Treponematosis (Ortner, 2002) Tuberculosis (Kelley and El-Najjar, 1980; Kelley and Micozzi, 1984; Roberts et al., 1994; Ortner, 2002) Osteomyelitis (Ortner, 2002) undergone growth and development during Reconstruction but lived their adult lives in post-Reconstruction. Those born in Reconstruction matured during the postReconstruction eras, weathering the financial panics of 1873 and 1893 and the Influenza Pandemic of 1918. It is expected, based on historical evidence, that African Americans and Reconstruction-born individuals will have the highest rates of infectious diseases and nutritional deficiencies. MATERIALS AND METHODS A total of 651 male skeletons from the Hamann-Todd, Robert J. Terry, and William Montague Cobb anatomical collections were analyzed for skeletal markers of disease and dietary deficiencies (Tables 1 and 2). The HamannTodd Collection contains more than 3,000 persons born between 1825 and 1910 that died in Cleveland, Ohio, or neighboring cities. The Robert J. Terry Collection is comprised of 1,728 individuals that lived between 1837 and 1943 and expired in St. Louis. The William Montague Cobb Collection at Howard University includes 987 persons that lived from the mid-19th century until the 1960s and died in Washington D.C. Each collection has morgue documentation for most individuals that include, age, ancestry, occupation, cause of and place of death, and source of donation (Cobb, 1935; Rankin-Hill and Blakey, 1994; Watkins, 2003; Hunt and Albanese, 2004). This research focused on the earlier parts of these collections and excluded body donors. Morgue records were consulted to confirm this. All three anatomical samples are also biased towards older individuals and African Americans. Therefore, all available Euro-Americans were included in this study. Persons were placed in age, ancestry, birth, pre-Reconstruction versus Reconstruction, combined ethnicity/ birth, enslaved versus liberated, and collection cohorts to determine if ethnic and temporal differences existed between African Americans and Euro-Americans born during the Antebellum, Civil War, and Reconstruction time periods (Table 1). The enslaved versus liberated cohorts were constructed to test for significant differences between African Americans born before and after emancipation, and contemporary Euro-Americans. Age cohorts comprised of 10-year intervals were examined to see if pathologies were concentrated in certain age groups. Age was based on morgue records and the U.S. Census. If discrepancies existed between these reports, then recorded age in the census was relied upon as it was taken while the person was living. Remains were macroscopically studied for the pathologies listed in Table 2. All were recorded as present or absent and statistically analyzed by the cohorts defined in Table 1 using v2 analyses. Morgue records were used 529 DISEASE IN 19TH CENTURY MALES TABLE 3. Average ages of cohorts Cohort Entire sample African American Euro-American Antebellum Civil War Reconstruction Antebellum White Antebellum Black Civil War White Civil War Black Reconstruction White Reconstruction Black Terry Hamann-Todd Cobb TABLE 4. ANOVA analysis of birth cohorts and age N Mean 651 360 291 175 133 343 91 84 60 73 140 203 375 189 87 65.515 65.019 64.127 75.029 68.000 59.697 75.077 74.976 67.917 68.068 59.543 59.803 67.149 58.545 73.609 Antebellum Civil War Reconstruction Total Antebellum White Antebellum Black Civil War White Civil War Black Reconstruction White Reconstruction Black Total Terry Hamann-Todd Cobb Total to ensure the diagnosis was accurate. Age was examined using ANOVA tests. Historical research Rankin-Hill (1997, p 14) has indicated that information ‘‘generated from skeletal biological analyses must be placed within the context of a population’s lifeways and history to explain the conditions that produced the disruptions.’’ Therefore, historical methodology was employed by analyzing primary sources such as newspapers, letters, manuscripts, and pamphlets, to reconstruct the socioeconomic and cultural contexts of the shifting environments in which the individuals being studied lived. Basic demographic data on all persons came from morgue records accompanying the remains. Further information on the subjects, including birthplace, residence, and occupation, was acquired by searching the U.S. Census. Individuals were searched in the census by name, location, and birth date. Additional data from morgue records, including the hospital in which the person expired, parent’s birthplace, or occupation was also utilized to ensure that the proper subjects were located in the census. For example, an individual from the Terry Collection was traced through the census for the last thirty years of his life. He had spent them in the City Sanitarium, where he died. Morgue data regarding his date and place of birth matched the census data. Previous demographic studies done on these collections were also consulted (Cobb, 1935, Watkins, 2003; Hunt and Albanese, 2004). Primary sources that provided insights into life among the working-class of Cleveland, Ohio, St. Louis, Missouri, and Washington, D.C. were examined at the National Archives and the Library of Congress in Washington, D.C. Contemporary newspapers were also reviewed using several online databases including ‘‘America’s Historical Newspapers’’ and ‘‘19th Century Newspapers.’’ RESULTS The average age at death was 65.51 years (Tables 3 and 4 and Fig. 1). African Americans and Euro-Americans were of similar ages for all time periods. The birth and combined ancestry/birth cohorts revealed a significant decline in age at death through time (Table 4). Antebellum persons lived 7 years longer than Civil War-born individuals and 15.3 years longer than those born during Reconstruction (F 5 183.63; P 5 0.000). N Mean Std. deviation F Sig. 175 133 343 651 91 84 60 73 140 75.03 68.00 59.70 65.51 75.08 74.98 67.92 68.07 59.54 7.19 7.29 9.95 10.97 5.51 8.68 4.07 9.15 10.79 183.63 0.000 73.141 0.000 203 59.80 9.36 651 370 169 82 621 65.51 67.19 60.30 74.50 66.28 10.97 9.13 10.11 9.22 10.37 67.044 0.000 Bonferroni Post hoc test (I) Birth era Antebellum Civil War (J) Birth era Civil War Reconstruction Antebellum Reconstruction Antebellum White Antebellum Black Civil War White Civil War Black Reconstruction White Reconstruction Black Terry Hamann-Todd Cobb Terry Cobb HamannTodd Mean difference (I 2 J) Sig. 7.03 (*) 15.33 (*) 27.03 (*) 8.30 (*) 0.000 0.000 0.000 0.000 0.10073 7.16026 (*) 7.00843 (*) 15.53407 (*) 15.27397 (*) 1.000 0.000 0.000 0.000 0.000 6.89012 (*) 27.30811 (*) 26.89012 (*) 214.19822 (*) 0.000 0.000 0.000 0.000 * Denotes statistical significance. Combined ancestry/birth cohorts further illustrated these differences. Collection cohorts (Table 4) were also significant with Hamann-Todd having the youngest individuals (F 5 67.004, P 5 0.000). Chi-squared and frequency analyses of porotic hyperostosis (PH), rickets, treponematosis, skeletal tuberculosis (TB), and osteomyelitis are reported in Tables 5 and 6 by cohorts. Cohorts are bordered in Table 5 to illustrate which were analyzed together. Approximately 85.6% of the sample had PH, with Euro-Americans and Civil War-born persons having the highest rates but these observations were not statistically significant. However, Hamann-Todd had significantly more cases of PH when compared to the other collections (Table 5). Rickets was present in 4% (n 5 26) of the individuals examined; no statistical differences existed among the cohorts (Table 5; Figs. 2 and 3). Skeletal manifestations of treponematosis were observed in 2.2% of the sample (Table 5) with African Americans having significantly higher frequencies when compared with Euro-Americans (P 5 0.004). Furthermore, Reconstruction-born Blacks were significantly different, but the expected cell counts were low. An analysis of the Enslaved versus Liberated Ancestry/Birth cohorts (Table 5) clarified these findings indicating that Liberated/Reconstruction Blacks had significantly higher rates of treponematosis when compared with Pre-Reconstruction Whites, Enslaved Blacks, and Reconstruction Whites (P 5 0.046). Tests on skeletal tuberculosis (TB) mirrored these results (Table 5). ApproxiAmerican Journal of Physical Anthropology 530 C. DE LA COVA Fig. 1. Distribution of age at death. mately 4.4% of the sample suffered from TB but African Americans (4.5%) had significantly higher rates (P 5 0.004). While there was a temporal increase in disease prevalence among the birth cohorts, only the combined ancestry/birth cohorts were significant, with Reconstruction-born African Americans having higher rates of TB (P 5 0.015). Again, the cells had low counts, but an examination of the Enslaved versus Liberated Ancestry/ Birth cohorts revealed that Liberated/Reconstruction Blacks were significantly more afflicted with TB (P 5 0.007) when compared with their enslaved brethren, Pre-Reconstruction Whites, and Reconstruction-born Whites (Figs. 4 and 5). Collection analyses for both treponematosis and TB were not statistically significant, but Hamann-Todd had the most cases. Statistical analyses of the age cohorts and pathologies indicated there were no differences, with the exception of TB (Table 6).The youngest cohorts had significantly higher rates of TB (P 5 0.002). These findings suggest that, in regard to most paleopathological conditions, the birth cohorts are comparable as they have similar frequencies of pathologies. DISCUSSION Based on previous historical and bioanthropological scholarship, it was hypothesized that African Americans would have higher frequencies of biological stress, nutriAmerican Journal of Physical Anthropology tional deficiencies, and disease when compared to EuroAmericans. It was also surmised that health would decrease through time and the Reconstruction era would be the least salubrious. The results partially supported these research hypotheses. There were no significant differences among the cohorts and the prevalence of PH and rickets. However, African Americans, especially those born during Reconstruction, had significantly higher rates of treponematosis and TB when compared to Euro-Americans. This suggests that Blacks suffered more from these infectious diseases than whites, especially after emancipation. The lack of differences between African Americans and Euro-Americans in regard to PH and rickets indicates that both groups in this sample shared similar rates of nutritional deficiencies and biological stress. Compared with other 19th and early 20th century African American skeletal series, Blacks in this study had higher rates of TB than their Antebellum brethren from Philadelphia’s First African Baptist Church (3%), but not as high as the 6% frequency associated with Post-Reconstruction Cedar Grove (Rose, 1985, 1989; Rankin-Hill, 1997). In contrast, this research had low frequencies of treponemal disease that differed from the 16.1% observed in 40 individuals from the New York African Burial Ground, of which 28 (31.5%) were male (Null et al., 2004). High rates of periostitis at Cedar Grove among subadults and premature infants (81.8%) 531 DISEASE IN 19TH CENTURY MALES TABLE 5. Chi-squared analyses of ancestry, birth, and collection cohorts Cohorts Porotic hyperostosis N/total (%), P Rickets N/total (%), P Treponematosis N/total (%), P Tuberculosis N/total (%), P Osteomyelitisa N/total (%), P Entire sample 495/578 (85.6) 26/644 (4.0) 30/644 (4.7) 28/644 (4.3) 9/605 (1.5) African American Euro-American 263/313 (84.0), 0.229 232/265 (87.5) 17/357 (4.8), 0.297 9/287 (3.1) 24/357 (4.2), 0.006 6/287 (2.1) 23/357 (6.4), 0.004 5/287 (1.7) 8/321 (2.5) 1/284 (0.4) Antebellum Civil War Reconstruction 129/154 (83.8), 0.696 103/118 (87.3) 263/306 (85.9) 7/175 (4.0), 0.957 6/135 (4.5) 13/335 (3.9) 5/175 (2.9), 0.277 9/134 (6.7) 16/335 (4.8) 3/175 (1.7), 0.073 5/134 (3.7) 20/335 (6.0) 0/166 (0.0) 2/126 (1.6) 7/313 (2.2) Antebellum White Antebellum Black Civil War White Civil War Black Reconstruction White Reconstruction Black 69/81 (85.2), 0.802 60/73 (82.2) 52/58 (89.7) 51/60 (85.0) 111/126 (88.1) 3/91 (3.3), 0.943 4/84 (4.8) 2/60 (3.3) 4/74 (5.4) 4/136 (2.9) 2/91 (2.2), 0.048b 3/84 (3.6) 2/60 (3.3) 7/74 (9.5) 2/136 (1.5) 1/91 (1.1), 0.015c 2/84 (2.4) 0/60 (0.0) 5/74 (6.8) 4/136 (2.9) 0/90 (0.0) 0/76 (0.0) 1/60 (1.7) 1/66 (1.5) 0/134 (0) 152/180 (84.4) 9/199 (4.5) 14/199 (7.0) 16/199 (8.0) 7/179 (3.9) Pre-Reconstruction Reconstruction 232/272 (85.3), 0.823 263/306 (85.9) 13/309 (4.2), 0.833 13/335 (3.9) 14/309 (4.5), 0.883 16/335 (4.8) 8/309 (2.6), 0.036 20/335 (6.0) 2/292 (0.7) 7/313 (2.2) Enslaved Black Pre-Reconstruction White Liberated/ Reconstruction Black Reconstruction White 111/133 (83.5), 0.667 121/139 (87.1) 8/158 (5.1), 0.758 5/151 (3.3) 10/158 (6.3), 0.046 4/151 (2.6) 7/158 (4.4), 0.007 1/151 (0.7) 1/142 (0.7) 1/150 (0.7) 152/180 (84.4) 9/199 (4.5) 14/199 (7.0) 16/199 (8.0) 7/179 (3.9) 111/126 (88.1) 4/136 (2.9) 2/136 (1.5) 4/136 (2.9) 0/134 (0) Terry Hamann-Todd Cobb 309/357 (86.6), 0.008 156/178 (87.6) 30/43 (69.8) 14/374 (3.7), 0.889 8/185 (4.3) 4/85 (4.7) 17/374 (4.5), 0.784 10/185 (5.4) 3/85 (3.5) 12/374 (3.2), 0.106 13/185 (7.0) 3/85 (3.5) 3/374 (0.8) 2/185 (1.1) 4/46 (8.7) a b c Prevalence was too small for statistical analyses. Four cells (33.3%) have expected counts of less than 5. One cell (14.7%) has an expected count of less than 5. TABLE 6. Chi-squared analyses of age cohorts Age cohort Entire sample 29–39 40–49 50–59 60–100 a b c Porotic hyperostosis N/total (%), P Rickets N/total (%), P Treponematosis N/total (%), P Tuberculosis N/total (%), P 495/578 (85.6) 5/6 (83.3), 0.873a 36/40 (90.0) 96/113 (85.0) 358/419 (85.4) 26/644 (4.0) 0/6 (0.0), 0.603b 3/43 (7.0) 6/117 (5.1) 17/478 (3.6) 30/644 (4.7) 0/6 (0.0), 0.153c 5/43 (11.6) 5 /117 (4.3) 20/478 (4.2) 28/644 (4.3) 1/6 (16.7), 0.001c 5/43 (11.6) 10/117 (8.5) 12/478 (2.5) Osteomyelitis N/total (%), P 9/605 (1.5) 0/6 (0.0) 1/43 (2.3) 2/114 (1.8) 6/442 (1.4) One cell (12.5%) had expected counts of less than 5 Three cells (35.7%) have an expected count of less than 5. Two cells (25.0%) have an expected count of less than 5. led Rose (1985, 1989) to conclude that congenital and venereal syphilis was present. Age and socioeconomic status at death African Americans and Euro-Americans were not significantly different with regard to age at death. However, persons born during the Antebellum period lived 15 years longer than those born during Reconstruction. This does not mean Antebellum individuals had extended life spans. This is probably an artifact of cadaver acquisition procedures. Carl Hamann started gathering skeletons for his collection in 1893. Robert Terry began in 1910. William Montague Cobb collected his sample in the 1930s. The gap between the Antebel- lum era and body acquisition for the collections best explains the large age difference. Age distributions of the collections also differ. Hamann-Todd had the youngest average age, with all ages represented. This reflects T. Wingate Todd’s interests in skeletal aging and his desire to have an all inclusive sample (Meindl et al., 1990). The Cobb Collection had the oldest average age, which may be the result of the time period in which the collection was started. Individuals born during the eras examined in this study would have been over fifty when they were included in the collection. U.S. Census records and previous studies on the demography of the collections indicated that most of the African Americans examined were Southern-born. EuroAmerican Journal of Physical Anthropology 532 C. DE LA Fig. 2. Healed rickets in the tibiae and fibulae (TC 770). [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] Americans were from the collection cities or neighboring states. Watkins’ (2003; in press) research on the Cobb Collection supports this finding, indicating that most individuals were native to Washington, D.C., Maryland, and Virginia. The demographics of the Hamann-Todd Collection, published by Cobb (1935), reflected contemporary social, industrial, and migratory patterns. The ‘‘cadavera’’ were ‘‘unclaimed dead from the least stable elements of marginal economic groups in the living population. . .people who with few exceptions were without skilled occupations’’ (Cobb, 1935, p 157). Most of Hamann-Todd’s native-born whites (n 5 292) were first generation Americans, originating from 21 states (Fig. 6). The majority, however, were born in the Northern states of Ohio, New York, and Pennsylvania. African Americans (n 5 447) covered a larger expanse, coming from 27 states (Fig. 7). Most were Southern-born and from the cotton belt, with the largest numbers associated with Georgia, Alabama, and South Carolina. Others were from Tennessee, Kentucky, Virginia, Mississippi, North Carolina, and Arkansas. American Journal of Physical Anthropology COVA Cobb (1935) also observed an increase in the number of African American remains entering the Hamann-Todd Collection from 1915 to 1930 and attributed this to the influx of Southern Black migrants associated with the Great Migration. Census records supported this, revealing that from 1910 to 1930, the African American population in Cleveland surged from 8,448 to 72,120 (Cobb, 1935). The Terry Collection exhibits a similar pattern, with the majority of African Americans being Southern-born. Census and morgue records indicated that nearly all of the individuals examined were unskilled laborers. None owned property and many lived in boarding houses or were confined to hospitals. Few were married and those that were rarely lived with their partners. These findings supported the claim that the subjects were part of the poor working-class of late 19th and early 20th century America. These results illustrate the limits of cadaver collections and the effects of the ‘‘osteological paradox’’ (Wood et al., 1992). The age at death, age distributions, and socioeconomic findings are the results of selectivity bias. Historically, collection managers did not have numerous options for cadaver acquisition. Most bodies donated to medical schools were of older unclaimed impoverished persons. Furthermore, the doctors amassing these collections chose which remains they wanted to curate for further study based on age, pathologies, and abnormalities. Therefore, the sample analyzed in this study is not representative of the general population. The average age at death and age distributions within the collections exemplify this. Most individuals examined survived beyond fifty, which contrasts with the average life expectancies of twenty to forty years of age that have been recorded at other 19th century sites (Kelly and Angel, 1987; Owsley et al., 1987; Rathbun, 1987; Rathbun and Scurry, 1991; Rankin-Hill, 1997; Blakey, 2001). Many persons in this study also survived long enough for their immune systems to respond by forming bone lesions, especially those associated with TB, treponematosis, and other disorders. In the ‘‘osteological paradox,’’ individuals with bone pathology are believed to represent the most robust, or healthiest, citizens in a population that have an increased ability to tolerate disease. In contrast, persons with no skeletal pathologies were either extraordinarily healthy before their death, or may have expired from acute diseases which resulted in quick death, before a skeletal response could occur (Wood et al., 1992). The presence of bone lesions in the sample studied implies that these individuals’ battles with infectious disease were more chronic. Furthermore, this suggests that the African Americans examined were the most robust as they had the highest rates of TB and treponematosis. Despite the ‘‘osteological paradox,’’ anatomical collections can still be utilized to provide information on health disparities among 19th-century-born persons of low socioeconomic status. The results of this study agreed with historical data and current research on the susceptibility and higher rates of TB observed among African Americans. The 1880, 1890, and 1900 U.S. censuses consistently recorded that African Americans had higher rates of TB and other transmissible diseases for all ten year intervals (Billings, 1885, 1896; King, 1902). Research by Stead et al. (1990) has also noted that this pattern of increased susceptibility to TB continues among African Americans into the present day. The sample studied agrees with historical trends about TB and DISEASE IN 19TH CENTURY MALES Fig. 3. Healed rickets in the femora (HTH 3119). [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] can provide insight into health among the poorest denizens of Cleveland, St. Louis, and Washington, D.C. Contextualizing and comprehending illness in the poorest denizens Many environmental stressors contributed to the biological stress and high TB and treponematosis rates observed in the sample during the Civil War and Reconstruction periods. Firsthand accounts illustrate how the Civil War affected soldiers, slaves, and civilians. In August of 1865, T. T. Tredway wrote to C. T. Chase expressing concern for local yeomen living in Prince Edward 533 County, Virginia, where both Union and Confederate armies had foraged from the local population. Tredway (1865) lamented that ‘‘great destitution’’ existed among the residents, ‘‘especially those living in the broad track of the Armies. Bread is scarce & bacon scarcer.’’ The shortage of tobacco seeds, farming implements and draft animals, all confiscated by the armies, left tobacco farmers handicapped in planting crops and desperate for funds. The time periods associated with the transition from slavery to freedom were also stressful for African Americans, especially those that sought refuge in Union Army contraband camps. Sanitary Commission agent Maria Mann described the abuse and neglect she witnessed toward African American refugees while working at the ‘‘sickly, pestilential, [and] crowded’’ government-administered St. Helena Contraband Camp in Helena, Arkansas, in 1863 (Mann, 1863a). The refugees had been destitute for months with no relief, with the exception of the males who, through the military, were ‘‘comfortably clothed’’ (Mann, 1863b). Food was lacking, beef was scarce, and army rations formed the dietary staple. Living arrangements for the runaway slaves were abysmal and described by Mann as ‘‘sadly narrowed habitations, half of them with ground floors, without window or closet, and the mud of this locality’’ (1863b). The hospital was also a ‘‘wretched hovel’’ where many came ‘‘to die. . .very rapidly’’ (Mann, 1863a). Three months after Maria Mann’s correspondences, T. A. Goodwin, an Indiana native who observed the conditions of Black refugees in Union army camps, wrote to fellow abolitionist Robert Dale Owen that ‘‘able-bodied’’ male contrabands ‘‘fair well enough, as laborers or as servants or soldiers, but the thousands of women and children which are huddled in the filthy quarters appeal to our sympathy’’ (Goodwin, 1863). In December of 1863, an editorial in the Washington, D.C. Daily Constitutional Union (The Contrabands in the South, 19 December 1863) indicated that the poor conditions of the contrabands continued. Fit males were ‘‘forced into the army, either for labor or military service’’ while the elderly, women, and children were ‘‘provided with insufficient shelter and abandoned to the chances of hunger, nudity, and disease’’ (Washington Daily Constitutional, 19 December 1863, p 2). The government failed to support the ‘‘miserable wretches’’ who were ‘‘deluded into our lines by the promise of freedom’’ (Washington Daily Constitutional, 19 December 1863, p 2). The above conditions, including poor nutrition, crowding, and inadequate access to food and shelter may be responsible for the high prevalence of TB and treponematosis observed among the African Americans in this sample. Poor nutrition could easily compromise an individual’s immune system, making them more susceptible to contagious illnesses. Crowding would also increase one’s probability of infection. Treponematosis and TB rates continued to rise after the Civil War, as indicated by the results of this study. The Reconstruction cohort and liberated African Americans had the largest frequencies of TB and treponematosis. These findings supported the research hypotheses that African Americans and the Reconstruction cohort would have the highest prevalence of disease. The results also agree with historical evidence. At the turn of the century, more African Americans suffered from infectious illnesses than Euro-Americans (Farley, 1970; Billings, 1885, 1896; King, 1902). TB was a major killer in American Journal of Physical Anthropology 534 C. DE LA Fig. 4. HTH 2126, diagnosed with tuberculosis, had lesions on his lumbar vertebrae and ribs. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] the Black community, with an affliction rate three times higher than that of whites (Farley, 1970; Kiple and King, 1981). In 1920 Cleveland, TB and pneumonia mortality rates were more than twice that of Euro-Americans (Giffin, 2005). Many historical factors may have contributed to the larger frequencies of TB and treponemal disease observed among the Reconstruction cohort and liberated African Americans. These individuals lived through financial panics, the 1918 flu pandemic, and industrialization. However, the increase in TB and treponematosis may also be reflecting environmental changes from a rural Southern setting to a Northern or Midwestern urban ambiance. Census records, morgue documentation, and previous research by Cobb (1935) and Watkins (2003) indicated that most of the African Americans studied were Southern-born. Cobb’s noted increase of African Americans in the Hamann-Todd Collection during 1915 to 1930 coincided with the largest influx of Black Southerners in Cleveland. This is significant because it illustrates that the historical event of the Great Migration is represented in the anatomical collections. African American in-migrants would have spent their childhoods in rural atmospheres where illnesses were not as communicaAmerican Journal of Physical Anthropology COVA ble as in the dense cityscapes of St. Louis, Cleveland, and Washington, D.C. The move northward exposed Black Southerners to fatally new environments where they were more susceptible to contracting diseases. Finding shelter and employment were obstacles that faced African American migrants settling in urban areas (Phillips, 1999; Giffin, 2005). It was easy to obtain work during the First World War, but finding proper housing proved to be more difficult. The large influx of migrants into many industrialized cities led to housing shortages, tenement overcrowding, and homelessness (Kusmer, 1978; Phillips, 1999; Giffin, 2005). Southern-born African Americans arriving in these urban centers had limited options and unequal access to lodging due to color discrimination (Phillips, 1999; Giffin, 2005). Housing shortages also prompted landlords to increase rent, often targeting African Americans for higher rates (Giffin, 2005). Many were marginalized to specific neighborhoods, living in tenements, where sanitation was poor. Black migrants in Cleveland were competing for the scarce rentals available on the east side, often sharing neighborhoods with European immigrants (Phillips, 1999). In 1919, the Cleveland Advocate, a historically Black newspaper, described the substandard lodgings and poor sanitation along Central Avenue, from ‘‘E. 14th Street to E. 29th Street,’’ where ‘‘hundreds of respectable Colored citizens are forced to live because of confounded color prejudice’’ (Cleveland Advocate, 27 September 1918, p 8). The Advocate lamented that the area and its associated houses were ‘‘unsightly, unsanitary, disease-breeding plague,’’ a ‘‘veritable miasma’’ and a ‘‘menace to the health and moral civic progress of the Colored people who are forced to inhabit them’’ (Cleveland Advocate, 27 September 1918, p 8). A public plea was made to clean up Central Avenue and have the tenements razed to the ground and replaced with new buildings (Cleveland Advocate, 27 September 1918, p 8). The conditions of Cleveland’s African American inmigrants soon became a public health problem. Ohio officials complained that poor housing and residence crowding were a threat to the health of the state’s Black population (Giffin, 2005). In 1920, the Cleveland Hospital Council health survey indicated that tenement and lodging houses were ‘‘in a deplorable condition, in no way complying with city regulations. People most crowded are the Negroes, Italians, Jews, and foreign-born Slavs, Slovaks, Lithuanians and Poles’’ (Cleveland Hospital Council, 1920, p 7). The survey denoted that the cheapest lodging houses found in New York City’s Lowest East Side ‘‘shined’’ in comparison to ‘‘Cleveland’s ’flophouses,’ which are a disgrace’’ (Cleveland Hospital Council, 1920, p 53). Precisely 27.1% of Cleveland’s industrial workers lived in crowded tenement housing in 1920 with ‘‘50% of the families having less than one room per person’’ (Cleveland Hospital Council, 1920, p 353). The Council’s review of lodgings provided by the New York Central Railroad (NYCR) is of interest as this company recruited heavily among Southern Black males. These men were enticed to relocate to Cleveland as railroad workers with promises of higher wages and free housing (Phillips, 1999). These complimentary lodgings designated for NYCR employees were criticized by the Cleveland Hospital Council (1920, p 53) as violating ‘‘reasonable provisions for sanitary living and disease prevention.’’ The structure had ‘‘inadequate light and ventilation, old, soiled stained bed coverings, filthy floors, overcrowding, lack of space between bunks, etc’’ (Cleveland Hospital Council, 1920, p 53). DISEASE IN 19TH CENTURY MALES 535 Fig. 6. Birthplaces of native-born Euro-Americans in the Hamann-Todd Collection (after Cobb, 1935). Fig. 5. Rib lesions associated with tuberculosis in HTH 2126. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] Based on the above descriptions, it is not surprising that TB and treponematosis peaked among African Americans, especially those born liberated during the Reconstruction-era. The stresses of emancipation and migration to an urban environment with its close proximities and tenement crowding would have taken its toll on Southern-born African American in-migrants. Poor sanitation and lack of ventilation associated with these hovels would have created breeding grounds for infectious diseases such as TB. Historical records confirm that mortality rates among Blacks in Cleveland increased by 80% from 1920 to 1926, while the death rate for other Cleveland inhabitants remained stable (Giffin, 2005). Census data also indicates that African Americans were plagued with higher rates of TB, pneumonia, scrofula, and venereal diseases from 1880 to 1900 (Billings, 1885, 1896; King, 1902). Since most of the African Americans examined in this study were Southernborn, a shift in environment from a warmer, dispersed locality, to a Northern city with high population density, colder climates, and poor living conditions would have aided the transmission of TB (Roberts and Buikstra, 2003). This shift in venue also meant greater contact with larger numbers of persons, which would have also increased treponematosis rates. Racial discrimination Fig. 7. Birthplaces of native-born African Americans in the Hamann-Todd Collection (after Cobb, 1935). further ostracized Southern-born African Americans, making them targets for violence at the turn-of- the-century and confining them to tenement ghettos with poor sanitation. Since the Euro-Americans examined in this research were mostly from the surrounding regions and the North, it is possible that they may have lived their entire lives in more densely populated areas. The urban lifestyle of a poor Euro-American would have introduced numerous stressors, including poor sanitation, poor housing, and competition for resources which would have caused the biological stress recorded in this sample. Overcrowding, as in the case of African Americans, would have also increased the risks of infectious diseases in Euro-Americans. American Journal of Physical Anthropology 536 C. DE LA CONCLUSION The purpose of this study was to determine if skeletal health disparities existed among African Americans and Euro-Americans born from 1822 to 1877. Based on previous studies of 19th century-born Blacks and whites, it was hypothesized that African Americans and Reconstruction-born (1866–1877) individuals would have the highest rates of infectious diseases, nutritional illnesses, and biological stress. Results indicated that skeletal health disparities did exist between 19th-century-born African Americans and Euro-Americans. The Reconstruction cohort and African Americans, especially those born liberated during Reconstruction, had significantly higher rates of TB and treponematosis. Historical sources were important in illustrating and contextualizing why these different ethnic patterns existed, pointing to environmental conditions related to enslavement, postliberation migration to the industrialized North, crowded urban living conditions, and poor sanitation. Further research is necessary to analyze dental health, enamel hypoplasia, femoral lengths, skeletal robusticity, and osteoarthritis. It is hoped that these findings encourage future comparative studies on health among African Americans and Euro-Americans so that a better understanding of health disparities can emerge. ACKNOWLEDGMENTS This work would not have been possible without the assistance of Della Cook, David Hunt, Paul Jamison, Lyman Jellema, Mark Mack, Valerie O’Loughlin, Doug Owsley, Anne Pyburn, and Steven Stowe. 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