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Health in Ancient Mariana Islanders: ABioarchaeological PerspectiveMichael Pietrusewskya, Michele Toomay Douglasa, Marilyn K. Swiftb,Randy A. Harperb & Michael A. Flemingb

a Department of Anthropology, University of Hawai‘i at Mānoa,Honolulu, Hawai‘i, USAb Swift and Harper Archaeological Resource Consulting, Saipan,Northern Mariana Islands, USAPublished online: 06 Nov 2014.

To cite this article: Michael Pietrusewsky, Michele Toomay Douglas, Marilyn K. Swift, Randy A. Harper& Michael A. Fleming (2014) Health in Ancient Mariana Islanders: A Bioarchaeological Perspective, TheJournal of Island and Coastal Archaeology, 9:3, 319-340, DOI: 10.1080/15564894.2013.848959

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Journal of Island & Coastal Archaeology, 9:319–340, 2014Copyright © 2014 Taylor & Francis Group, LLCISSN: 1556-4894 print / 1556-1828 onlineDOI: 10.1080/15564894.2013.848959

Health in Ancient MarianaIslanders: ABioarchaeologicalPerspectiveMichael Pietrusewsky,1 Michele Toomay Douglas,1 Marilyn K.Swift,2 Randy A. Harper,2 and Michael A. Fleming2

1Department of Anthropology, University of Hawai‘i at Manoa, Honolulu,

Hawai‘i, USA2Swift and Harper Archaeological Resource Consulting, Saipan, Northern

Mariana Islands, USA

ABSTRACT

Previous investigation of health and lifestyle in the Mariana Islands in-dicated that the prehistoric inhabitants living on the smaller islands ofthis archipelago experienced more stress than those living on the largerislands. This article expands on previous research by using one of thelargest datasets (N = 385) now available for examining the health ofprehistoric skeletons from the Mariana Islands. A total of 13 indicatorsof health are investigated, including cribra orbitalia, linear enamelhypoplasia, stature, trauma, infection, and dental disease. There is con-siderable inter-island variability for many of the indicators but, in gen-eral, the highest frequencies of stress are often associated with skeletonsfrom the smaller islands. The sole exception is Rota, the smallest islandthat reveals levels of stress similar to Guam, the largest island. For sev-eral indicators (e.g., stature, long bone fracture, spondylolysis, alveolardefect) there were no significant differences among islands. Culturalhabits such as chewing areca (betel) nut, environmental factors, andother cultural differences are examined to explain these differences.

Keywords betel nut, bioarchaeology, Chamorro, dental pathology, Mariana Islands,paleopathology

Received 24 July 2013; accepted 18 September 2013.Address correspondence to Michael Pietrusewsky, Department of Anthropology, University of Hawai‘iat Manoa, 2424 Maile Way, Saunders Hall 346, Honolulu, HI 96822, USA. E-mail: [email protected]

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Michael Pietrusewsky et al.

INTRODUCTION

Previous investigation of health and diseasein the Mariana Islands suggested that the pre-historic Chamorro on smaller islands such asRota and Saipan experienced higher levelsof specific as well as non-specific indicatorsof stress, including dental enamel hypopla-sia, cribraorbitalia, and treponemal infectionthan the prehistoric Chamorro living on thelargest of the islands, Guam (Pietrusewskyet al. 1997). The reason for this island dif-ference was hypothesized as the smaller is-lands’ greater susceptibility to environmen-tal perturbations which would affect hu-man health because of smaller land mass,remoteness, lower rainfall, freshwater lens,slightly cooler temperatures, narrow andnon-continuous fringing reefs, earthquakes,volcaniceruptions, andsea-levelfluctuations(Hunter-Anderson 2010). It is also possiblethat small sample size and temporal prove-nience may account for some of the ob-served differences. This article re-examinesthe question of inter-island variability inhealth and lifestyle of precontact Chamorrousing recently excavated human skeletal se-ries from Tinian, Saipan, and Rota. Althoughthere have been studies of health using skele-tons from the Mariana Islands (e.g., Douglaset al. 1997; Stodder 1997), there have beenfew regional syntheses of accumulated datathat address the health in the Mariana Islands(e.g., Pietrusewsky et al. 1997, 2010, 2011;Roy 1989).

MARIANA ISLANDS

Located between 13◦ and 21◦ North lati-tude in the northwestern Pacific, the Marianaarchipelago consists of 15 volcanic islandsand numerous much smaller geologic out-croppings (Russell 1998) (Figure 1). Guam,Rota,Tinian, andSaipan, located in thesouth-ern group, are the largest islands in thearchipelago; places where people have pre-ferred to live in prehistory and the present.Geologically, the islands of the southern por-tion of the Mariana chain (Guam, Tinian,Saipan, and Rota) are a combination of

volcanic and raised coralline deposits sur-rounded by a fringing reef. The least popu-lated northern islands are of recent volcanicorigin.

Guam, at 549 km2, is the largest is-land of the Mariana Islands and in Microne-sia followed by Saipan (115 km2), Tinian(101 km2), and Rota (85 km2). Today, theclimate of the Mariana Islands is classified asmarine tropical, or humid tropical, with apronounced summer monsoon often associ-ated with heavy downpours, tropical storms,and typhoons, especially during the secondhalf of the year (Hanson and Butler 1997).Although all of the southern islands receivehigh annual rainfall (2000–2500 mm) seriousdrought conditions can occur during the dryseason, which is often prolonged by the ElNino/Southern Oscillation (ENSO) phenom-ena.WiththeexceptionofGuam,surfacewa-ter on the southern islands is scarce, whichcan lead to serious water shortages. TheMariana Islands’ susceptibility to droughts,severe tropical storms, and cyclones causesperiodic devastation of reef systems and ter-restrial vegetation, contamination of freshwater sources with seawater, and damage toother resources (Hunter-Anderson 2012).

CHAMORRO PREHISTORYAND SUBSISTENCE

When the first Europeans arrived in 1521,they found the islands inhabited by a sin-gle group of people who spoke Chamorro,an Austronesian language similar to thosespoken by people in the Philippines andmuch of Island Southeast Asia (Blust 2000).In addition to linguistic similarities, close cul-tural relationships between the Marianas andthe Island Southeast Asian late Neolithic cul-tures have been suggested (Bellwood 1997;Kirch 2000). Hung et al. (2011) have fur-ther identified the northern Philippines asa possible source of the earliest humansettlements in the Mariana Islands. Basedon archaeological and palaeoenvironmentalevidence, human occupation of the Mari-ana Islands began approximately 3500 BP(Athens et al. 2004; Hunter-Anderson 2010;Hunter-Anderson and Butler 1995). Recent

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Health in Ancient Mariana Islanders

Figure 1. Map of the Mariana Islands showing the approximate locations of the skeletal series usedin the present study.

JOURNAL OF ISLAND & COASTAL ARCHAEOLOGY 321

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mtDNA evidence suggests that the MarianaIslands may have been initially settled ap-proximately 4000 years BP by a small found-ing group of people from Island SoutheastAsia (Vilar et al. 2013). These same authorsfurther hypothesize that this initial foundingpopulation remained genetically isolated un-til approximately 1000 years BP when a sep-arate wave of migrants from Island SoutheastAsia arrived. This later colonization event co-incides with the introduction of latte struc-tures and rice agriculture (Vilar et al. 2013).

Chamorro prehistory is traditionally di-vided into three periods: Pre-Latte, Transi-tional Pre-Latte, and Latte Periods [followingMoore (1988)]. The term latte is applied to aform of paired stone pillars and cup-shapedcapitals or capstones, which were used tosupport houses, meeting halls, and/or reli-gious structures (Carson 2012; Graves 1986;Hanson and Butler 1997). On the largersouthern islands, during the Pre-Latte Pe-riod (1500 BC–AD 400) population size wassmall, consisting of coastal villages, whichrelied on fishing, shellfish, and agriculturalsubsistence (Hunter-Anderson and Butler1995; Moore 1983). The Transitional Pre-Latte Period (AD 400–900) designates a timeof adaptive change associated with an in-crease in population growth and settlementexpansionoutward fromcoastal settings intothe islands’ interiors (Hunter-Anderson andButler 1995). The Latte Period (AD 900–1700) is characterized by the presence of thelatte structures in larger villages and moreinland settlements (Carson 2012; Hunter-Anderson and Butler 1995). The Latte Pe-riod extends into the Proto-Historic Period,which began with Magellan’s historic land-fall in Guam in 1521 and culminated withsignificant conflicts on Saipan between thelate 1600s and early 1700s with the forcibleremoval of the Chamorro population toGuam (Levesque 1997; Russell 1998). Ethno-graphic accounts suggest that, at the time ofcontact, Chamorro society was a ranked so-ciety divided into descent groups marked bymatrilineal clans (Hunter-Anderson and But-ler 1995). A system of alliances developedbetween the different clans, which servedto control access to resources and to redis-tribute resources among villages in different

environmental zones. These alliances mayhave extended to the other islands as well(Hunter-Anderson 2012).

The precontact subsistence economiesof the Chamorro included reliance oncultivated tree and root crops typical of thetropical islandenvironment suchas coconut,banana, breadfruit, taro, yam, and possiblyrice—all foods high in carbohydrates. TheMariana Islanders diet was also rich in marineresources, including fish and shellfish, foundin the surrounding reefs, reef flats, and deepwater environments (Alkire 1977; Butler1988). In addition to agriculture and fishing,Chamorro subsistence included gatheringand hunting of endemic as well as migratorybirds, fruit bats, monitor lizards, turtles, andcrabs (Dixon et al. 2003; Hunter-Andersonand Butler 1995; Russell 1998). Rats arrivedin the islands during the Latte period, but thecommon Pacific domesticated correlates—pig, dog, and chicken—do not occur in theMariana Islands (Carson 2012).

SKELETAL SERIES

A total of 385 adult skeletons from 22 sites onRota, Tinian, Saipan, and Guam of the Mari-ana Islands are included in this study (Ta-ble 1). With very few exceptions, the sitesrepresented are coastal sites. The majorityof these skeletons are from Latte Period al-though a few skeletons from Tumon Bay onGuam may date to the Transitional Pre-LattePeriod, and a few others (e.g., Matapang andFujita)maydate to thepre-LattePeriod.Over-all, the skeletons used in this study date to theprehistoric (pre-1521) period, though a fewmay date to the time when the Chamorrowere engaged in a strong resistance to Span-ish rule in the 1600s.

Generally, there are more males than fe-males in most skeletal series, and for Saipan,the sex ratio is skewed heavily toward males(Table 2). Overall, young and middle-agedadults are about equally represented; theSaipan series has an older age-at-death pro-file (52.6% middle or old aged) followed bythe Guam series with 45.3% middle or oldaged. Approximately 9% of all adults diedduring old age. In addition to skeletal series

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Table 1. Skeletons from Rota, Tinian, Saipan, and Guam used in the present study.

Island Site No. adults Site dates Reference

Rota Songsong Village 10 AD 1050–1530 McManamon (1989);

Pietrusewsky (1988)

Songsong Village 39 Sava (1999)

SNM Hotel 1 Latte Craib (1992, 1994);

Pietrusewsky (1994);

Pietrusewsky and

Ikehara-Quebral (1995)

Airport Road, north

coast, Rota

16 ∼AD 1–1600 Butler (1988); Hanson (1988)

Rota total 66

Tinian Tinian Rt. 202

Project (Rt 202)

10 ∼AD 1009–1611 ± 30 Pietrusewsky and Douglas

(2010)

Tinian Waterline

Project (TWL)

10 ∼AD 1200–1640 Pietrusewsky and Douglas

(2001a)

Tinian Latte House

(TLH)

3 AD 1000–1521 Pietrusewsky and Batista

(1980)

Unai Chulu 14 Pre-1521 Pietrusewsky (1986a); Ward

and Pickering (1985)

Tinian total 37

Saipan Southern Sewer Line

System Project

(SSLS)

10 AD 1429–16701 Pietrusewsky (2006)

Chalan Monsignor

Guerreo Road

Project (CMG)

8 A.D 1060–14502 Pietrusewsky and Douglas

(2001b)

Hafadai Hotel

Extension Project

19 pre-1521 Pietrusewsky (1986a); Ward


Oleai3 30 pre-1521 Graves (1986, 1991);

Pietrusewsky and Douglas

(1989)

Tanapag 6 pre-1521 Pietrusewsky (1986a); Ward


Marianas High

School

3 no dates Pietrusewsky and Batista

(1980); Russell (1978)

Grotto Site 2 AD 720–210 ± 100 Pietrusewsky and Batista

(1980); Russell (1978)

San Antonio 32 AD 1230–1360 ± 100 Pietrusewsky and Batista

(1980); Russell (1978)

Saipan total 110

(Continued on next page)


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Table 1. Skeletons from Rota, Tinian, Saipan, and Guam used in the present study.(Continued)

Island Site No. adults Site dates Reference

Guam Apotguan,

Tamuning,

Hagatna

101 AD 1000–1521 Douglas et al. (1997); McNeill

(personal communication 1995);

Pietrusewsky et al. (1992)

Fujita Drainfield

(Tumon Ball Park),

Tumon Bay

24 AD 590–900 Bath (1986); Pietrusewsky (1986b)

Leo Palace Hotel Site,

Tumon Bay

16 AD 1000–1400 Davis (1990); Davis et al. (1992);

Douglas and Ikehara (1992)

Matapang Park,

Tumon Bay


Right of Way

(ROW-A), Tumon

Bay


Academy Gym,

Agana

3 pre-1521 Ikehara and Douglas (1995); Welch

(1991)

Guam total 172

Total (Mariana

Islands)

385

1Three burials from this site (Nos. 6, 24, & 24B) were dated to AD 1420–1450 (late Latte Period)and four burials (Nos. 16, 20A, 21A, & 22) were dated to AD 1640 and 1670 (Swift, personalcommunication February 17, 2010).

2This range of dates represents carbon 14 dates for eight of the burials from this site (Nos. 4, 5, 6,7, 16, 19, 20, and 26) (Swift, personal communication February 17, 2010).

3The Oleai skeletons were excavated by Michael Graves and Darlene Moore in April, 1986. Oneindividual was inadvertently excluded from the age/sex table in Pietrusewsky and Douglas (1989).

4The majority of the Matapang burials are from the Latte Period (AD 1000–1521), but three aredated to 1690 BC–1140 BC.

analyzed in an earlier study (Pietrusewskyet al. 1997), the present study includes newdata recorded in skeletons from two sites onTinian (Tinian Rt. 202 Project and Tinian Wa-terline Project) and two sites on Saipan (Cha-lan Monsignor Guerreo Road Project andSouthern Sewer Line System), which wereexcavated during cultural resource manage-ment investigations undertaken by Swift andHarper Archaeological Resource Consulting(SHARC) on Saipan. This new analysis alsoincludes new data from four separate loca-tions in Songsong Village on Rota recordedby Sava (1999). Because of the underrepre-sentation of subadults in most of the skeletalseries from Saipan and Tinian examined by

the authors since 1997, only adults are in-cluded in the present study.

METHODS

The methods used to determine age-at-deathand sex follow standard osteological pro-cedures described in Buikstra and Ube-laker (1994) and Pietrusewsky and Douglas(2002). The 13 skeletal and dental indicatorsof health investigated in this paper includethose that are attributable to non-specific sys-temic stress during growth and development(e.g., LEH, cribra orbitalia, stature) and thosethat suggest specific stressors (e.g., trauma,

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Table 3. Frequency of cribria orbitalia (CO) (reported by individual) and linear enamelhypoplasia (LEH) (by tooth) in the skeletons from the Mariana Islands, sexescombined.

CO LEH

Island A/O1 % A/O %

Rota 1/18 5.6 44/158 27.8

Tinian 5/17 29.4 9/101 8.9

Saipan 11/55 20.0 45/103 43.7

Guam 3/42 7.1 161/520 31.0

Total 20/132 15.2 259/882 29.4

1A/O = Affected/Observed.

infection, dental disease). Most of the datapresented in this paper were recorded byPietrusewsky and, in a few instances whenthis was not the case, they were recorded byindividuals who were trained by him, thusminimizing inter-observer error.

Additional background information onthese indicators will be introduced in theappropriate section when discussing the re-sults. Fisher’s exact test was used to test forsignificant differences of the discontinuousdata and Student’s t-test for continuous data(Thomas 1986).

RESULTS

Unless otherwise indicated, the frequen-cies of dental enamel hypoplasia and dentalpathology are reported on a per tooth/toothsocket basis. The sexes are combined in thisanalysis because of small sample sizes. Forpurposes of brevity, we report combineddata for each of the four islands. More de-tailed data, by site, are presented as supple-mental data in the Appendix (See AppendixTables 1–12).

Cribra Orbitalia

Cribra orbitalia (CO), the sieve-like le-sions that develop in the orbital roofs, is com-monly attributed to iron deficiency anemia(Stuart-Macadam 1989, 1991) or megaloblas-tic anemia (Walker et al. 2009), althoughthe latter attribution has been challenged by

Oxenham and Cavill (2010). We report thefrequency of cribra orbitalia by adult indi-viduals, sexes combined (Table 3). The fre-quency of CO ranges from 5.6% (Rota) to29.4% (Tinian). The only significant differ-ence in the frequency of CO is the one be-tween Tinian (29.4%) and Guam (7.1%). Thecombined frequency of CO in the skeletonsfrom the Mariana Islands is 15.2%.

Dental Enamel Hypoplasia

Linear enamel hypoplasia (LEH), visi-ble as one or more transverse furrows orgrooves of varying depths on the crown sur-faces of teeth, is caused by the disruptionof enamel development during infancy andearly childhood (Goodman and Rose 1991).Disruption of enamel production is causedby a variety of stressors affecting the motherand/or growing child including malnutri-tion, metabolic disorders, acute and chronicinfections, physical trauma, and hereditaryconditions (Goodman et al. 1984; Goodmanand Rose 1991; Hillson 2008). LEH in thepermanent teeth from the Mariana Islandsranged in severity in depth and width fromslight to moderate grooves and often therewas more than one defect per tooth. Obser-vations of LEH are sometimes complicatedby betel staining which may be thick enoughto obscure the defects. When this was thecase, no observations of LEH were recordedin those teeth. All teeth were scored for thepresence/absence of these disruptions, butbecause defects are more frequent in the

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Table 4. Comparison of male and female statures1 (cm) in the skeletons from the MarianaIslands.

Male Female

Island n Mean Range n Mean Range

Rota 10 172.2 167.4–178.6 17 160.5 155.8–170.6

Tinian 9 174.0 168.7–179.9 9 159.8 155.5–166.7

Saipan 19 173.9 166.1–182.1 11 160.0 153.9–164.6

Guam 20 172.5 167.8–177.1 8 162.4 156.7–168.4

Total 58 173.2 166.1–182.1 45 160.6 153.9–170.6

1Stature estimates using Houghton et al. (1975) on complete long bones only.

incisor and canine teeth frequencies are re-ported for those teeth only.

There is considerable variation in the fre-quencies of LEH for the four islands rangingfrom 8.9% (Tinian) to 43.7% (Saipan) (Ta-ble 3). The Rota (27.8%) and Guam (31.0%)LEH frequencies are not significantly differ-ent, but all other island comparisons exhibitstatistically significant differences in LEH fre-quency. The overall frequency of LEH inadults from the Mariana Islands is 29.4%.

Stature

Because of the lack of population-specificstature formulae forChamorroskele-tons the stature estimates reported here(Table 4) are based on formulae for Maori(Houghton et al. 1975) using the maximumand/or physiological length measurementsfor adult males and females. If more than onestature estimate was calculated, the estimatehaving the least error was selected.

A comparison of male and female av-erage statures for the four main MarianaIslands reveals no significant differences be-tween any of the islands. The average malestatures for Guam and Rota (∼172 cm) arenearly identical and approximately 2 cm lessthan the average male statures for Tinian andSaipan. The tallest individual males are foundon Saipan (182.1 cm) and Tinian (179.9 cm).The average male stature for the Marianas is173 cm, 13 cm greater than the average forliving Chamorro males from Saipan reportedby Hasebe (1938).

The average stature for females fromGuam is approximately 2 cm greater than theaverage statures for Rota, Tinian, and Saipan.The tallest individual female is found on Rota(170.6 cm). Overall, the average Mariana Is-land female stature is 160.6 cm, nearly 13 cmshorter than the average male stature.

Long Bone Fractures

Fractures of the adult major long bones(clavicle, humerus, radius, ulna, femur, tibia,and fibula) provide an indication of the fre-quency and type of traumatic, accidentalor deliberate, injury in a population (Lovell2008; Walker 1989). Although healed frac-tures of other bones in the skeleton are ob-served in Mariana skeletal series, becauseof difficulties in establishing frequencies inthese kinds of fractures, we are concentrat-ing on the long bones (Table 5). Fracturefrequency is estimated using the correspond-ing number of complete, or nearly complete,bones reported.

The frequencies of long bone fracturesare low (0.8% to 1.1%) and there are no sta-tistically significant differences between thefour major islands. The combined frequencyof longbonefractures inMariana Islandskele-tons is 0.9%, suggesting that accidental ordeliberate injury, as indicated by long bonefractures, is rare in theprehistoricChamorro.

Spondylolysis

Spondylolysis, or fracture of the lum-bar vertebrae at the pars interarticularis (the


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Table 5. Frequency of long bone fractures, spondylolysis, and infection in the skeletonsfrom the Mariana Islands.

Long bone

fractures1 Spondylolysis2 Infection3

Island A/O4 % A/O % A/O %

Rota 2/234 0.9 2/92 2.2 11/53 20.8

Tinian 2/181 1.1 1/36 2.8 2/23 8.7

Saipan 2/177 1.1 1/78 1.3 13/102 12.7

Guam 5/593 0.8 10/149 6.7 14/172 8.1

Total 11/1185 0.9 14/355 3.9 40/350 11.4

1Observed = the number of clavicles, humeri, ulnae, radii, femora, tibiae, and fibulae.2Observed = lumbar vertebrae.3Observed = individuals.4A/O = Affected/Observed.

narrow area connecting the inferior facets ofthe neural arch with the superior facets), hasbeen related to repeated stress to the lowerlumbar vertebrae by physical activities re-quiring flexion of the lumbar spine with thelegs extended (Merbs 1996; Ortner 2003).Arriaza (1997) proposed hyperextension ofthe lower back under stressful conditions,such as in latte construction, as another ex-planation for spondylolysis.

Although the frequency of spondylolysisis highest in the lumbar vertebrae from Guam(6.7%), there are no statistically significantdifferences in the frequencies for the fourmain islands (Table 5). The lowest frequencyof spondylolysis is reported in the skeletonsfrom Saipan (1.3%). The overall frequency ofspondylolysis is 3.9%.

Bone Infections

Specific bone infections include tuber-culosis, leprosy, treponematoses, and fungalinfections. Treponemal infections includepinta, yaws, and syphilis, which are causedby the spirochete, Treponema pallidum.Only yaws and syphilis affect the skeleton.Infection with the organism Treponema pal-lidum may produce lesions of the cranialvault, as well as very characteristic symmet-rical appositional lesions of the long bones(Ortner 2003).

As is the case for much of the Pacific,it is widely acknowledged that venereal

syphilis was absent in the Mariana Islandsprior to contact with Europeans (Baker andArmelagos 1988; Stewart and Spoehr 1952).Bony lesions with manifestations typicalof treponemal infections from the MarianaIslands and elsewhere in the Pacific areusually diagnosed as evidence of yaws (see,e.g., Rothschild and Heathcote 1993).

Bony changes attributed to treponemalinfection (e.g., periosteal reaction, gumma-tous osteitis and cloacae) were observed inthe skeletons from the Mariana Islands (Ta-ble 5). The frequencies of treponemal in-fection in adult skeletons range from 8.1%(Guam) to 20.8% (Rota)—the only statisti-cally significant inter-island difference. Thefact that several of the new skeletal serieswere not examined in total, but rather sam-pled, suggests the frequency of trepone-mal disease is likely underestimated. Twoof the highest frequencies of treponemal in-fection occur in skeletons from the HafadaiHotel Extension site on Saipan (36.8%) andthe Songsong Village site on Rota (21.6%)(Pietrusewsky et al. 1997). The overall fre-quency of treponemal infection in individualskeletons from the Mariana Islands is 11.4%.

Betel Staining and Dental Pathology

Chewing of the areca nut (Areca cate-chu), more commonly referred to as betelnut, with or without the use of pepper leaf(Piper betle) and/or slaked lime, is common

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throughout South Asia, Southeast Asia, andthe western Pacific. Regular use of betel quidcauses a bright orange/red stain of the teethand gums. Tooth staining, either as a result ofchewingaquidand/ordeliberateapplicationof a mixture of betel nut and lime slurry, hasbeenreported inadultdentitions formanyar-chaeological skeletal series from the MarianaIslands and Micronesia (e.g., Fitzpatrick et al.2003; Hanson and Butler 1997; Hocart andFankhauser 1996; Leigh 1929; Pietrusewsky1986b; Pietrusewsky et al. 1992, 1997).The staining of the tooth enamel, commonamong the present-day Chamorro, is usuallylight to dark brown/reddish brown in color.

Because there is now a substantial epi-demiological literature demonstrating a linkbetween chewing betel nut and cariosta-sis (e.g., Howden 1984; Moller et al. 2009;Schamschula et al. 2010) and other oral-dental pathologies including periodontal dis-ease in living people (e.g., Chatrchaiwi-watana 2006; Trivedy et al. 2002) and a doc-umented increase in dental attrition (IARC2004; Kumar et al. 2004), we report thefrequency of stained teeth for our skeletalseries (Table 6). Although there is consid-erable variation in the frequency of betel-stained teeth, more than half of all adultteeth exhibit staining. The lowest frequen-cies are observed in the skeletons from Rota(54.0%) and Guam (54.8%), while the high-est frequencies of staining are observed inthe skeletons from Tinian (80.4%) and Saipan(75.3%). If all the skeletons from the MarianaIslands are combined, the overall frequencyof betel-stained teeth is 60.4%.

Dental Caries

Dental caries is a demineralization ofthe tooth structures caused by organic acidsproduced by bacterial processes involved inthe fermentation of dietary carbohydrates(Hillson 2008:313). The lowest frequenciesof dental caries are observed in the Tinian(4.6%) and Guam (4.2%) skeletons, while sig-nificantly greater frequencies of caries arefound in the Saipan (8.5%) and Rota (8.7%)skeletons (Table 6). The frequency of cari-ous lesions in the combined Mariana Islandsskeletons is 5.8%.

Alveolar Bone Loss

Two distinct types of bone loss from thealveolar process are recorded in the skele-tons from the Mariana Islands. The first type,referred to in this study as alveolar resorp-tion, is related to theremovalofalveolarbonedue to inflammation of the supporting tis-sues of the teeth associated with periodontaldisease (Hildebolt and Molnar 1991; Hillson2008). The second type of alveolar bone lossis the one concentrated around the apex ofthetoothroots,originatingfrominfectionsofthe pulp, so-called periapical inflammation;a term that has been suggested to replacethe older and somewhat less correct desig-nation, periapical dental abscess (Dias andTayles 1997; Hillson 2008). While we haveadopted the term, alveolar defect, for thistype of bone loss in the present paper, it isreferred to as dental abscess in previous stud-ies (e.g.,Pietrusewskyetal.1997;SteckelandRose 2002).

Alveolar resorption. In this study, alveo-lar resorption is scored as the amount (none,slight, moderate, and marked) of tooth rootexposed above the alveolar bone margin.The frequency of advanced (moderate andmarked) alveolar bone resorption rangesfrom 24.4% in the Tinian skeletons to 60.3%in the Saipan skeletons (Table 6). Compar-isons of the frequencies of alveolar resorp-tion between the four islands were statis-tically significant except for the differencebetween Tinian (24.4%) and Guam (28.3%).The frequency of advanced alveolar resorp-tion is 38.6%, suggesting periodontal dis-ease was relatively prevalent for prehistoricChamorro.

Alveolar defects. The frequency of alve-olar defects in the skeletons from the Mar-iana Islands ranges from 3.8% in the Tinianskeletons to 6.7% in the Saipan skeletons (Ta-ble 6). Comparisons of the frequencies ofalveolar defect among the four main islandsare not statistically significant. The overallfrequency of alveolar defects is 5.0%.

Dental Calculus

Dental calculus, calcified or mineral-ized dental plaque, is composed primarily of


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Ta

ble

6.

Fre

qu

ency

of

bet

elst

ain

ing,

cari

es(b

yto

oth

),al

veo

lar

reso

rpti

on

,an

dal

veo

lar

def

ect

inth

esk

elet

on

sfr

om

the

Mar

ian

aIs

lan

ds.

Bet

elst

ain

ing

Car

ies

Alv

eola

rre

sorp

tio

n1

Alv

eola

rd

efec

t

Isla

nd

A/O

2%

A/O

%A

/O%

A/O

%

Ro

ta42

9/79

454

.069

/790

8.7

199/

425

46.8

38/7

495.

1

Tin

ian

361/

449

80.4

17/3

724.

630

/123

24.4

9/23

73.

8

Saip

an43

5/57

875

.358

/681

8.5

282/

468

60.3

39/5

826.

7

Gu

am12

47/2

274

54.8

98/2

310

4.2

325/

1148

28.3

81/1

745

4.6

To

tal

2472

/409

560

.424

2/41

535.

883

6/21

6438

.616

7/33

135.

0

1 Fre

qu

enci

eso

fad

van

ced

(mo

der

ate

and

mar

ked

)al

veo

lar

reso

rpti

on

are

rep

ort

edin

this

tab

le.

2 A/O

=A

ffec

ted

/Ob

serv

ed.

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calcium phosphate mineral salts depositedbetween and within remnants of formerlyviable microorganisms (White 1997). Dentalcalculus is enhanced in high carbohydrate di-ets and severe dental attrition (Hillson 2008;Lieverse et al. 2007), attaching to the toothsurface at the base of a living plaque deposit.The etiology of dental calculus is dependentupon a number of factors that contribute tothe mineralization of plaque including an al-kaline oral environment, “salivary flow rate”,hydration, calcium and phosphate levels inthe blood, mineral content of drinking wa-ter, silicon content in both food and water,and plaque accumulation” (Lieverse 1999;Lieverse et al. 2007:332).

Although two forms of calculus are gen-erally recognized (Hillson 2008; Lieverse1999; White 1997), supragingival (on thetooth crowns and sometimes roots) and sub-gingival (a less obvious layer coating the sur-face of the root), we report only supragingi-val calculus in this study. In the skeletonsfrom the Mariana Islands, dental calculuswas mainly confined to the tooth crown andcemento-enamel junction. Here, we reportthe overall frequency of advanced (moderateand marked) calculus (Brothwell 1981:figure6.14b) (Table 7). The frequencies of dentalcalculus in the Mariana Island teeth rangefrom 11.1% (Saipan) to 22.5% (Rota). No sig-nificant differences in calculus are noted be-tween Tinian (14.1%) and Saipan or betweenTinian and Guam, but the Rota frequency issignificantlygreater thanall theother islands.

The frequency of advanced calculus build-upfor the combined series is 15.8%.

Dental Attrition

Dental attrition is the physiologicalwearing away of the occlusal and proximalsurfaces of the teeth in function (Hillson1996). In the skeletons from the MarianaIslands, occlusal attrition was recorded onan absent, slight (enamel wear), moderate(dentin exposure), and marked (pulp expo-sure) gradient (Table 7).

The frequencies of advanced (moder-ate + marked) dental attrition are similar inthe skeletons from Guam (26.3%) and Rota(28.8%), significantly less than the frequen-cies in skeletons from Saipan (49.9%) andTinian (47.0%). The combined frequency ofadvanced attrition for the Mariana Islandsteeth is 32.8%.

Antemortem Tooth Loss (AMTL)

The loss of teeth before death (ante-mortemtooth loss—AMTL)canbeattributedto several pathological processes includingperiodontaldisease,carious lesions,andalve-olar defects (Table 7). The lowest frequencyof AMTL is reported for the skeletons fromTinian (2.0%), significantly lower than AMTLfrequencies from the other three island se-ries. Saipan (7.1%), Rota (6.7%), and Guam(5.3%) cluster together, though there is a sig-nificant difference between frequencies in

Table 7. Frequency of dental calculus, attrition, and AMTL in the skeletons from the MarianaIslands.

Calculus1 Attrition AMTL

Island A/O2 % A/O % A/O %

Rota 172/765 22.5 155/538 28.8 64/957 6.7

Tinian 47/333 14.1 174/370 47.0 9/450 2.0

Saipan 74/665 11.1 342/686 49.9 116/1626 7.1

Guam 315/2088 15.1 596/2265 26.3 157/2981 5.3

Total 608/3851 15.8 1267/3859 32.8 346/6014 5.8

1Frequencies of advanced levels (moderate and marked) of dental calculus and attrition arereported in this table.

2A/O = Affected/Observed.


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Guam skeletons and those in Saipan skele-tons. The overall frequency of AMTL for allthe skeletons is 5.8%.

DISCUSSION

Previous research (Pietrusewsky et al. 1997),based on 272 adult skeletons, suggested thatthe precontact inhabitants of the smaller is-lands in the Marianas, such as Rota, Tinian,andSaipan,were lesshealthy thanthose fromGuam, the largest island. This new analysis,based on 385 adult skeletons, allows a morein-depth examination of interisland differ-ences in health and lifestyle. While the datapresented in this study may be influencedby temporaldifferences, insufficient samplespose a greater challenge to fully examine thisissue, one that will require temporally con-trolled samples of especially pre-Latte skele-tons. Some of the differences observed inthese results might be due to greater rep-resentation of males to females and age-at-death differences that are likely to influencethe incidence of many of the dental indica-tors surveyed. Tests of statistical significancein the frequencies of 13 indicators betweenthe four largest islands reveal the majority arenot statistically different. No significant dif-ferences in adult stature, and frequencies oflong bone fractures, spondylolysis, and alve-olar defects were observed in comparisonsbetween islands.

Childhood Health: Cribra Orbitalia, LEH,and Stature

Cribra orbitalia, LEH, and stature gener-ally reflect the prevalence of stress duringchild development. The highest frequenciesof cribra orbitalia occur in the skeletons fromTinian and Saipan. The very low frequency(5.6%) observed in the Rota skeletons may bedue to small sample size. With the possibleexception of Rota, there is more childhoodstress in the skeletons from the more north-ern islands.

The frequencies of LEH exhibit consid-erable variation in the skeletal series sur-veyed. The lowest frequency occurs in theTinian series (8.9%) and the highest in the

Saipan series (43.7%) suggesting that some-thing about this island’s geography and en-vironment (e.g., mineral content of the wa-ter and adequacy of food, susceptibility totyphoons and the aftereffects of these) mayhave adversely impacted the people livinghere.

The lack of statistically significant differ-ences in adult stature among the islands sug-gests recovery from the childhood stressorssignified by frequencies of CO and LEH, es-pecially in the series from Saipan. The adultmales from Tinian and Saipan are slightlytaller than those from Rota and Guam, whileamong adult females those from Guam aretaller than those from Rota, Tinian, andSaipan. The prehistoric inhabitants investi-gated in this study were appreciably tallerthan male Chamorro living on Saipan in the1930s and Micronesians from Kosrae Pon-ape, Truk, Yap, and Palau, described by Hunt(1950:164) as being short to medium stature.It should be noted, however, that the Span-ish forcibly removed all Chamorros living onTinianandSaipanbetweenthe late1600sandearly 1700s and relocated them on Guam.In the early 1800s many Carolinians, espe-cially those from Satawal, began to repopu-late Saipan. The people measured by Hasebeon Saipan in the early decades of the twenti-eth century may have included those of Car-olinian ancestry.

Adult Health: Long Bone Fractures,Spondylolysis, and Infection

Adult health and lifestyle indicators in-clude the prevalence of long bone fractures,a stress fracture of the lumbar vertebrae,and infection. The low frequency of longbone fractures (0.9%) in these skeletons sug-gests very similar patterns of physical ac-tivity and little deliberate or accidental in-jury. The rarity of these fractures supportsthe view that large-scale organized warfarewas largely non-existent in prehistoric times(Hunter-Anderson and Butler 1995); at leastthere is no physical evidence of trauma inthese skeletons.

The frequency of spondylolysis, often at-tributed to repeated stress in the lower lum-bar region, is only slightly higher in the Guam

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series (6.7%) relative to the three remainingisland series. Arriaza (1997) suggested thatthe high incidence of lumbar spondylolysisin ancient Chamorros may be related to trau-matic events associated with activities suchas the transport of latte stones, a risk whichseems distributed fairly equally across thearchipelago. Spondylolysis is much higher inskeletons from the Marianas than in otherPacific Island series, including those fromHawai’i (Pietrusewsky and Douglas 1994).In an earlier study (Pietrusewsky et al. 1997)there was no evidence for long bone frac-tures or spondylolysis in the skeletons fromRota, Tinian, and Saipan but the additionof new skeletons indicates comparable fre-quencies of both types of trauma across thefour main islands.

The highest frequency (20.8%) of bonychanges attributed to treponemal infection(most likely yaws) in individual skeletonswas observed in the Rota series, a findingthat may be influenced by small sample size.The only significant difference observed forthis indicator was that between Rota andGuam, the latter having the lowest frequen-cies (8.1%) of infection.

Comparisons of the overall frequenciesof these selected indicators of health suggestthat inhabitants of the smaller islands, espe-cially Saipan, have greater childhood stressthan inhabitants of Guam, but the disadvan-tage is not carried into adulthood, wherestature, patterns of long bone fracture andspondylolysis are similar.

Betel Nut and Dental Pathology

The differences in the remaining indica-tors, which account for the majority of thesignificant inter-island differences, appear tobe related to the use of betel nut. Althoughnot well understood, the chewing of betel,or areca, nut is believed to confer protec-tion against dental caries. Other research hasdemonstrated periodontal disease and den-tal calculus may be greater in areca chewers(Chatrchaiwiwatana 2006).

Using this as background, the Marianasskeletons with higher levels of betel-stainedteeth are predicted to exhibit lower frequen-cies of dental caries, and higher frequencies

of dental attrition, alveolar resorption, anddental calculus. Given their association, alower caries rate should also result in lowerfrequencies of alveolar defects and AMTL.

Except for alveolar resorption and den-tal calculus, the frequencies of four dentalpathologies in a skeletal series with a highfrequency of betel staining (Tinian) and onewith a low frequency of betel-stained teeth(Rota) conform to these expectations (Fig-ure 2). The Tinian skeletons have low fre-quencies of dental caries, alveolar defects,and AMTL and high frequencies of dentalattrition. Likewise, Rota skeletons have ahigher frequency of dental caries, moder-ately high frequencies of alveolar defectsand AMTL, and a low frequency of dentalattrition.

TinianandSaipanskeletal serieshave thehighest rates of betel-stained teeth in thisstudy, but the anticipated pattern of den-tal pathologies is not consistent betweenthe two. The Tinian skeletons have low fre-quencies of dental caries, alveolar defects,and AMTL and a high frequency of dentalattrition, but alveolar resorption and calcu-lus are unexpectedly low. The Saipan skele-tons have higher frequencies of dental cariesand AMTL and a lower rate of calculus thanexpected, but the high rates of attrition,alveolar resorption and defects in this seriesare consistent with betel nut chewing. Thegreater number of older aged individuals inthe Saipan series may explain some of thesedifferences.

The Guam and Rota skeletal series havelower rates of betel staining, but again, theanticipated pattern of dental pathologies isnot consistent between the two. Rota skele-tonshavehigher frequenciesofdental caries,calculus, and alveolar resorption, moder-ately high frequencies of alveolar defects andAMTL, but a low frequency of dental attri-tion. The Guam skeletons are similar to thosefrom Tinian in that there are low frequenciesof caries, resorption, calculus, and defectsbut slightly higher rates of AMTL and lowfrequency of attrition.

Although it has been shown that loss ofperiodontal attachment and calculus forma-tionaregreater inarecanutchewers (Ånerudet al. 1991), a WHO study on the effects of


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Figure 2. Chart showing the frequencies of occurrence of betel staining and dental pathology in theskeletons from the Mariana Islands.

betel quid and areca nut chewing (IARC2004) found that there are a number of con-founding variables such as the level of oralhygiene, dietary factors, general health, anddental status that may have a significant influ-ence on periodontal status (e.g., 2004:174).According to the same report, areca chewerson Guam do not use slaked lime while chew-ing areca nut (pugua) (Stich et al. 1986), apractice that may help to explain the lowerincidence of dental calculus and alveolar re-sorption in the Guam, Saipan, and Tinianseries.

Nosignificantdifferences in the frequen-cies of alveolar defects are noted among thefour main islands. The frequencies of thisdental pathology, which originates from in-fections of the pulp, correlates with the fre-quencies of dental caries reported for theseseries.Thehighest frequenciesofalveolarde-fect are those reported for Rota and Saipan,which also have the highest frequencies ofdental caries. Overall, the indicators of den-tal disease (ATML, dental caries, and alveolardefects) are uniformly low in the skeletons

from the Mariana Islands. The inter-islanddifferences in dental indicators may reflectdifferences in the age-at-death distributionand/or the individual variation in betel quidchoice and betel chewing habits.

Island Differences

Comparisons between Rota and Guamand between Tinian and Saipan reveal signif-icant differences in four indicators of health.Likewise, comparisons between Rota andTinian and between Guam and Saipan revealsignificant differences in seven health indi-cators. Overall, these results suggest greatersimilarities in health and lifestyle in skeletonsfromRotaandGuamincontrast to those fromTinian and Saipan. An analysis of Latte Periodpottery by Graves et al. (1990) has demon-strated similarities for Guam and Rota and,conversely, for Tinian and Saipan. Because ofits small size, thehighest frequenciesofskele-tal and dental stress were expected to occurin the skeletons from Rota. Unexpectedly,

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several of the frequencies of the indicators ofhealth observed in the skeletons from Rotawere similar to those recorded in the skele-tons from Guam, the largest island. Giventhe proximity of these two islands there isthe possibility that when conditions (e.g.,periods of extended droughts) on Rota be-came intolerable, the people left for Guam.Hunter-Anderson (2010:156) has suggestedthe formation of large island/small island“partnerships”, such as those between Guamand Rota, may have provided a way for peo-ple living on smaller landmasses to minimizedeficits and vulnerabilities that occurred inthe past. Alternatively, compared to Tinianand Saipan, the relatively low populationdensity on Rota and the existence of springwater caves (Keel et al. 2005), which todayprovide a reliable source of fresh mineral-infused water even during times of drought,may help to explain the lower prevalence ofthese disease/health indicators in the skele-tons from this island.

CONCLUSIONS

Utilizing what is arguably the largestdataset of skeletal/dental indicators of stressrecorded in 385 adult skeletons from theMariana Islands allows more robust conclu-sions regarding the health and lifestyle ofthe Latte Period Chamorro. While differen-tial preservation as well as possible tempo-ral differences in provenience, and unevenand small sample sizes requires cautious in-terpretations of these results, there are fewerstatistically significant differences in indica-tors of health among the four largest islandsthan previously thought. No significant dif-ferences inadult stature, longbone fractures,stress fracture of the lumbar vertebrae, tre-ponemal infection, andalveolardefects (den-tal abscesses) were observed in the skeletalseries.

The prehistoric inhabitants of the Mar-ianas were relatively tall and exhibit verylow frequencies of healed bone fractures,spondylolysis, and alveolar defects. Tallstature and little evidence of trauma sug-gest the prehistoric inhabitants of the Mar-ianas were healthy and not prone to injuries

resulting from accidents or warfare. How-ever, there is evidence of treponemal dis-ease, most likely yaws, in skeletons from allislands, which is likely to have negatively im-pacted the health of these people.

The frequencies of two childhood indi-cators of stress, cribra orbitalia and LEH, aresignificantly different between islands, withgenerally the highest frequencies among theskeletons from Tinian and Saipan. The sig-nificantly higher frequency of LEH in theskeletons from Saipan suggests greater child-hood stress for the inhabitants of this island.Mostly lowerandsimilar frequenciesof thesetwo childhood indicators were observed inthe skeletons from Rota and Guam. Some ofthe observed differences in the frequenciesof these indicators may reflect differencesin sex, and/or environmental and nutritionaldifferences between the main islands.

Overall, the dental health of prehistoricinhabitants of the Mariana Islands was gener-ally good. The frequencies of dental caries,AMTL, and alveolar defects were low andadvanced dental calculus and attrition wereonly moderately high. The cultural practiceof chewing areca nut explains some of theobserved variations in the pattern of den-tal pathology. As expected, low frequenciesof dental caries, AMTL, and alveolar defectand a high frequency of dental attrition wereobserved in the skeletons from Tinian withthe highest frequency of betel-stained teeth.Likewise, Rota, a series with the lowest fre-quency of betel-stained teeth, was observedto have higher frequencies of dental caries,alveolar defects, and AMTL, and a lower fre-quency of dental attrition.

This new analysis, while providinggeneral confirmation of an earlier study(Pietrusewsky et al. 1997), which demon-strated that the inhabitants of the smaller is-lands in the Marianas were less healthy thanthose living on Guam, the largest island, alsoreveals new associations, most notably thesimilarities between Rota and Guam.

After Guam, the skeletons from Tinian,the third largest island investigated,andRota,the smallest island, have the lowest levels ofstress. The skeletons exhibiting the highestfrequencies of stress are those from Saipan,the most northerly of the islands investigated


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and the one farthest from Guam. Some of theobserved differences between islands maybe attributed to differential access to envi-ronment and/or resource availability and thepossible effects of microclimates and naturaldisasters on smaller more northerly islands.

Future research may address questionsof intra- and interisland variability in skele-tal indicators of health, temporal changesin health, and variability by sex and age.The gradual accumulation of archaeologicalskeletal series from all of the southern islandsof the Marianas over the last several decades,the greater attention to temporal assign-ment (i.e., more specific than “pre-1521”),the recent discovery of pre-Latte skeletal re-mains, and the continued use of standardizedrecording methods, will, most certainly, im-prove our assessment of the health of earlyMariana Islanders.

ACKNOWLEDGEMENTS

Mr. Marween Yagan, Center for Instruc-tional Support, University of Hawai‘i atManoa, assisted with the two figures usedin this article. SHARC received U.S. Capi-tal Improvement funds for the Tinian Wa-terline Project and U.S. Federal Highwayfunds for the Tinian Route 202 project. Weare grateful for the comments provided bythree anonymous reviewers.

SUPPLEMENTAL

Appendix Tables 1–2 are available assupplemental content at http://dx.doi.org/10.1080/15564894.2013.848959.

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