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Race health and disease in 19th-century-born males.

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Race, Health, and Disease in 19th-Century-Born Males
Carlina de la Cova*
Anthropology Department, University of North Carolina at Greensboro, Greensboro, NC 27412
paleopathology; 19th century; African American history; tuberculosis;
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1997; Rathbun and Steckel, 2002; Watkins, unpublished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
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.
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
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.
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
TABLE 1. Cohorts used in data analysis and sample size
Ancestry cohorts
African American
Collection cohorts (location)
Terry (St. Louis, Missouri)
Hamann-Todd (Cleveland, Ohio)
Cobb (Washington, D.C.)
Birth cohorts
Civil War
Pre-Reconstruction vs.
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
Sample size by ancestry and collection
Hamann-Todd Terry Cobb
African American
This was all available Euro-Americans for the time periods
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
TABLE 2. Diseases, dietary deficiencies, and pathologies
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.
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
TABLE 3. Average ages of cohorts
Entire sample
African American
Civil War
Antebellum White
Antebellum Black
Civil War White
Civil War Black
Reconstruction White
Reconstruction Black
TABLE 4. ANOVA analysis of birth cohorts and age
Civil War
Antebellum White
Antebellum Black
Civil War White
Civil War Black
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
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).
Std. deviation
Bonferroni Post hoc test
(I) Birth era
Civil War
(J) Birth era
Civil War
Antebellum Black
Civil War White
Civil War Black
Reconstruction White
Reconstruction Black
difference (I 2 J)
7.03 (*)
15.33 (*)
27.03 (*)
8.30 (*)
7.16026 (*)
7.00843 (*)
15.53407 (*)
15.27397 (*)
6.89012 (*)
27.30811 (*)
26.89012 (*)
214.19822 (*)
* 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
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.
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%)
TABLE 5. Chi-squared analyses of ancestry, birth, and collection cohorts
N/total (%), P
N/total (%), P
N/total (%), P
N/total (%), P
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
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)
Civil War
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
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)
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
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)
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)
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
N/total (%), P
N/total (%), P
N/total (%), P
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)
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
Fig. 2. Healed rickets in the tibiae and fibulae (TC 770).
[Color figure can be viewed in the online issue, which is available at]
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
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
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
Fig. 3. Healed rickets in the femora (HTH 3119). [Color figure can be viewed in the online issue, which is available at]
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
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
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
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]
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
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).
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]
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
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
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.
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