International Journal of Osteoarchaeology

Int. J. Osteoarchaeol. (2010)

Published online in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/oa.1178

Variation in Health and Socioeconomic

Status within the W. Montague Cobb
Skeletal Collection: Degenerative Joint
Disease, Trauma and Cause of Deathy
R. WATKINS*
Department of Anthropology, American University, 4400 Massachusetts Avenue NW, Washington DC 20016,
USA

ABSTRACT This paper examines health differences between two distinct samples within an African American skeletal
population by investigating variation in osteoarthritis (OA) patterns, the presence of enthesopathies, fractures
and cause of death. Surveys and statistical treatments tested the hypothesis that two samples within a
population that have different socioeconomic contexts will present associated differences in health.
Binomial statistics were used to examine differences in OA patterns and prevalence within and between
groups, and according to age and sex. These data were paired with information on the presence of
enthesopathies at select muscle attachment and insertion sites to add another dimension to the assessment
of mechanical strain. Finally causes of death, when available, were recorded to compare leading causes within
and between samples, as well as with the larger population.
Data reveal significant differences in the prevalence of OA between groups. Significant differences also
presented when comparing the prevalence of unilateral and bilateral affect. Although a number of differences in
health status observed can be attributed to age, relationships between the presence of OA and enthesopathies in
a portion of the sample indicates that degenerative change and hypertrophy in the samples reflect both systemic
and non-systemic change. The presence and pattern of fractures and causes of death are also suggestive of
differences in social context between the two samples. Copyright ß 2010 John Wiley & Sons, Ltd.

Key words: osteoarthritis; enthesopathies; Washington DC; binomial statistics; African Americans

Introduction within the W. Montague Cobb skeletal collection, a

Contemporary studies of African American skeletal
populations examine, among other things, how
biological and social well-being is informed by the
impact of slavery, segregation and other discriminatory
practices (Rankin-Hill, 1997; Blakey, 2001). Rather
than pointing to a common experience of disenfranch-
isement, these studies highlight variation within and
between these populations resulting from different
social and biological responses to these constraints.
Therefore, the interpretation of health and disease
patterns is a complex and nuanced part of the
bioanthropological project (Wood et al., 1992; Good-
man, 1993; Armelagos & Van Gerven, 2003). The
purpose of this study is to examine heterogeneity
* Correspondence to: Department of Anthropology, American University,
4400 Massachusetts Avenue NW, Washington DC 20016, USA.
e-mail: watkins@american.edu
y
Research completed with assistance from an American Association of
University Women post-doctoral fellowship.
predominantly African American population from
Washington, DC that dates between 1932 and 1969.
Health differences between two distinct samples
within the population that emerged during a previous
analysis (Watkins, 2003) are the focus of this paper: a
sample of residents form the city’s almshouse (n ¼ 74)
and individuals living in the general population
(n ¼ 71). This investigation draws upon four variables:
osteoarthritis (OA) prevalence, the presence of
enthesophytes, fractures and documented cause of
death to assess differences in health and socioeconomic
status between these two segments of the population.
A number of past and present studies include
osteoarthritic change in assessments of mechanical
strain, human adaptation and cultural change (Jurmain,
1991, 1999; Lai & Lovell, 1992; Pechenkina & Delgado,
2006; Lieverse et al., 2007; Weiss & Jurmain, 2007;
Klaus et al., 2009). However, long-term clinical and
anthropological studies of OA make it clear that age
and other systemic factors contribute a great deal to its

Copyright # 2010 John Wiley & Sons, Ltd. Received 24 June 2009
Revised 26 March 2010
Accepted 31 March 2010

patterning and prevalence in populations (Dieppe,
1990; Jurmain, 1991; Rogers et al., 1997; Pearson &
Lieberman, 2004; Villotte et al., 2010; Cardoso &
Henderson, 2010). As a result, there continues to be
much debate over the validity of OA as an accurate
indicator of the cumulative effects of mechanical strain.
Nonetheless, a wealth of past and present studies
suggest that scholars still find value in considering the
role that physical activity and mechanical strain play in
the manifestation of osteoarthritic change (Ortner,
1968, 2003; Radin, 1976, 1982; Kennedy, 1989;
Jurmain, 1991, 1999; Hough, 2001; Lieverse et al.,
2007; Klaus et al., 2009).
The presence and frequency of fractures can also
reflect adaptive patterns, health and social status in a
population (Lovejoy & Heiple, 1981; Crist et al., 1997;
Kilgore et al., 1997; Judd & Roberts, 1999; Jurmain,
1999, 2001). In the case of this study, the prevalence of
healed but poorly set fractures can be useful in
investigating differences in access to medical care,
interpersonal violence and the level of quality and
safety in living and working environments. Documen-
tary and skeletal evidence indicating cause of death can
also be useful in assessing a population’s quality of life
and health. This study considers what this information
suggests about a population’s exposure to infectious
disease, although scholars have questioned straightfor-
ward interpretation of morbidity and mortality from
these data (such as Wood et al., 1992).
In sum, this paper uses data from the observation of
skeletal remains in concert with documentary sources
to test the following hypotheses: (1) moderate and
severe osteoarthritic change in both almshouse
residents and individuals living in the general
population was primarily caused by excessive physical
activity and (2) that as a result of living conditions and
extreme poverty, individuals who resided in the city
almshouse will present skeletal evidence of greater
mechanical strain and exposure to infectious disease. A
comparative analysis of the two samples will contribute
to an assessment of the relationship between different
local social conditions and health within the popu-
lation, as well as test for disparities that reflect these
differences.
Biocultural context
19th and 20th century Washington, DC
The historical record documents the unique role
Washington, DC played in the early rural-to-urban
migration of Blacks in the United States. African
Copyright # 2010 John Wiley & Sons, Ltd.
R. Watkins
Americans made up the majority of the District’s
migrant population throughout the late 19th and early
20th century. In fact, former slaves arriving in the
District during and after the Civil War represent some
of the first African Americans to migrate from rural to
urban areas in the South—some 50 years before the
northward Great Migration that is more extensively
documented in the historical record (Byrand, 1999).
Between 1860 and 1880, Washington, DC maintained
a higher Black population in overall numbers and
proportion than other major cities to which Blacks
migrated such as Baltimore, MD and Richmond, VA.
District officials assumed that the huge influx of
African Americans to the District during and immedi-
ately after the Civil War was a result of the dependency
that slavery engendered; Blacks were thought to have a
‘natural tendency’ to seek shelter and protection at the
‘seat of government’ (Commissioners of the District of
Columbia, 1874; Joint Select Committee, 1878). As a
result, Blacks were marked as the ‘undeserving poor’ at a
time when relief provisions were determined by
placing people in categories deeming them ‘worthy’
or ‘unworthy’ of receiving aid. Discourses conflating
poverty, crime and disease were used to define
conditions in most US cities dealing with an influx
of indigents during the 19th century. However, this
discourse also became highly racialised in the District
and informed the development of inequitable policies
regarding social services, housing and labour that
targeted the overwhelmingly Black underclass (Greene,
1963; Swain, 1868; Horton, 1977).
Public assistance
Although consistent information on the distribution of
public assistance to Blacks in the District is not
available, public welfare records from the time period
relevant to the Cobb collection indicate that trends of
inadequate financial relief and difficulty gaining
employment evident during the 19th century con-
tinued through the mid 20th century. Because
information about the distribution of relief to Blacks
during the Depression is the most detailed, it will be
the focus of this discussion.
Poor Black communities in DC were subject to
persistent social and economic pressures that made it
difficult to establish residence and be recognised as full
citizens throughout the 19th and 20th centuries.
These constraints also impacted their eligibility for
monetary aid. For instance, achieving ‘deserving poor’
status required proof of DC residence for 12
consecutive months (Hudnut, 1930). The discrimina-
Int. J. Osteoarchaeol. (2010)
Variation in Health and Socioeconomic Status
tory practices of agencies providing assistance to
newcomers and transients made it difficult for African
Americans to establish immediate documented resi-
dence. In fact, only one-third and one-sixth of
municipal and private lodging houses for men and
women, respectively, accepted Blacks (Hudnut, 1930).
Reports also indicate that a very limited number of
employment agencies provided help to transient
Blacks. Only six of the 20 agencies mentioned assisted
Blacks with finding a job. Three of those strictly
provided domestic referrals, which was primarily a
woman’s occupation (Hudnut, 1930; Clark-Lewis,
1994). Documents indicate that a disproportionately
large number of Blacks were not a part of religious or
social networks that served as buffers to such
constraints (Rankin-Hill, 1997).
Blacks in the District continued to be disproportio-
nately affected throughout the Depression, as they
represented the majority of individuals and families in
need of public assistance for the duration of the period.
Monetary grants for all individuals and families
consistently remained 20–30% below the cost of
living and were often cut because of the high number of
cases. Therefore, even individuals and families counted
among the ’deserving poor’ did not receive enough
support to improve their economic condition.
Although a more systematic program of relief came
about after an act of Congress expanded social services
beyond an emergency capacity in February of 1935,
agencies were continually plagued with insufficient
funds for providing aid to all applicants in need (Public
Assistance Division, 1934, 1935). Appropriations
remained inadequate after grant caps were removed
in 1943. As a result, in 1945 grants were reduced by
10% to ensure ‘equitable distribution’ of funds between
January and June (Public Assistance Division, 1945). In
addition to inadequate appropriations, the steady
increase in the number of cases prevented bringing
grants in line with the cost of living. In 1949, grants
were based on 1946 prices. Since rent prices were fixed,
cuts translated into less money for food and utilities
(Public Assistance Division, 1949). Grants remained
22% below living costs through the mid-1950s (Public
Assistance Division, 1953).
Occupation
There is little evidence of change in the occupational
status of poor Blacks between the late 19th and early
20th centuries. For instance, a study of occupation and
residence in the Shaw neighbourhood, an area known
to have a high African American concentration,
Copyright # 2010 John Wiley & Sons, Ltd.
documented that the majority of household heads
were employed as labourers between 1880 and 1920
(Byrand, 1999). Seventy-nine per cent of unemployed
Blacks in 1880 were jobless for more than 3 months and
over half were out of work for 6 months or more of the
year (Johnston, 1993).
The period between 1910 and the 1920s reflects the
continuing trend of Blacks remaining on the bottom of
the occupational structure. Ninety per cent of
employed African American males worked as day
labourers, janitors and servants, and 70% of all
positions as waiters, labourers in public service and
helpers in building and hand trades. Similarly, Black
women comprised close to 80% of all people working
in domestic service and nearly 70% of all people
working in the unskilled labour sector (Greene & Callis,
1930). A major factor in the primary confinement of
Blacks to menial jobs was systematic racism. Through-
out the decade following World War I, the Wilson
administration circumvented civil service commission
regulations to keep Blacks from obtaining government
positions (Greene & Callis, 1930; Johnston, 1993;
Byrand, 1999).
After the Federal Works Progress Administration
(WPA) program was initiated in 1935, public assistance
was cut for families with at least one healthy individual
of working age. However, jobs were not available for
all employable individuals and families, which led some
families to slip through the cracks of the relief system
altogether. As Blacks represented the majority of
people in need of and receiving public assistance, their
families were more likely to suffer as a result of these
policies.
Data on Black employment between 1930 and 1938
indicate patterns of unemployment and underemploy-
ment that were also evident in the 19th century.
Although Blacks represented 27.1% of the District
population in the 1930 census, they constituted 58% of
the unemployed. Blacks who were employed were, as
was the case 50 years prior, confined to domestic
service and menial labour (Ginsburg, 1938). Forty per-
cent of Black men in trade and 80% of those in public
service were labourers. Eighty-five per cent of working
Black women were employed in domestic service
(Greene & Callis, 1930). A survey of 330 employers at
industrial and business establishments showed that of
the 259 who employed Blacks, only 71 offered jobs
with advancement opportunities and 24 provided
opportunities to perform higher-paying skilled labour.
In 1937, the overall unemployment rate for the District
was 9.9%. According to data organised by racial group,
the unemployment rate was 5.4%for Whites and 22.5%
for Blacks. Almost 50% of men and over 50% of
Int. J. Osteoarchaeol. (2010)

unemployed women were under the age of 30. The
mean age of the partially unemployed was between 30
and 34 years. In 1940, the unemployment rate for
Blacks remained 2.4 times that of Whites and made up
59.2% of the emergency work relief rolls. Therefore,
the occupational status of Blacks, characterised by
racial discrimination, unskilled labour and low wages
helped to maintain conditions of poverty reflected in
their residence characteristics and patterns.
Housing and residence patterns
After a Freedmen’s Bureau office opened in Washing-
ton, DC in July of 1865, makeshift dwellings were
erected in alleys from scavenged materials to address
the need for refugee housing (Horton, 1977). Scholars
have written extensively on African American ‘alley life’
in the District (Greene, 1967; Borchert, 1980;
Johnston, 1993; Byrand, 1999). However, it was not
the predominant housing for migrant Blacks. Lodging
for Blacks in ‘contraband’ camps, army barracks and
local farms has not been researched to the same extent,
although they were an initial point on a continuum of
municipal residence for the poorest Blacks in the city
(Collins, 1997).
After closing contraband camps and army barracks,
the Refugee and Freedmen’s Fund purchased lots in the
city and built tenements for more permanent housing.
The largest of these plots was 375 acre Barry Farm in
southeast DC. Nonetheless, housing remained limited
and conditions were substandard. Between 1874 and
1877, the Board of Health condemned a substantial
portion of these dwellings (Kober, 1907). As was the
case with free Blacks who came to the city before the
Civil War, Washington’s poorest Blacks settled at the
city’s west and east edges and central alleyways
throughout the late 1880s and 1900s (Groves & Muller,
1975; Borchert, 1980; Johnston, 1993). These areas
were not only peripheral in terms of location, but also
in their lack of inclusion in city sewerage, paving and
public transportation schemes. The neighbourhoods
and dwellings in which many poor Blacks lived tended
to lack plumbing, and were often poorly ventilated and
crowded. As a result, the likelihood of illness from
respiratory problems and infectious diseases like
tuberculosis (TB) was extremely high.
Morgue records listed the addresses of 70 individuals
living in the general population. The majority of these
residences clustered in areas cited in studies of Black
communities in the District in the late 19th and early
20th centuries as having high African American
concentrations (Ginsburg, 1938; Groves & Muller,
Copyright # 2010 John Wiley & Sons, Ltd.
R. Watkins
1975; Johnston, 1993; Byrand, 1999). Figure 1 indicates
that the majority of addresses on morgue records were
concentrated in the Northwest quadrant north of I
street, bordered by 13th street to the west, 5th street to
the east and south of Florida avenue.
Another small cluster of residences was found in the
northwest quadrant north of Florida Avenue up
Georgia Avenue in the Brightwood Park neighbour-
hood (bordered by Ingraham street to the north).
South of the capitol, a small cluster of addresses
between 4th streets southeast and southwest was
found. None of these addresses were located further
south than M street. The location of most addresses
north of I street NW is consistent with existing data on
late 19th and early 20th century residential concen-
trations of Blacks in the District (Byrand, 1999). The
addresses of individuals in the Cobb collection south of
the capitol do indeed fall in this area and indicate a
consistent presence of Blacks in the Shaw neighbour-
hood and bordering areas for nearly 100 years.
Therefore, it is appropriate to draw upon the cited
studies and reports to understand conditions of poverty
associated with individuals in the Cobb collection.
The city almshouse
Some of the poorest DC residents who were eligible for
public assistance were sheltered at the city’s almshouse,
called the Home for the Aged and Infirm (Figure 2). The
institution was established by the Board of Charities in
1906, and was opened in 1907 (Architects & Builders
Journal, 1903; Department of Public Welfare, 1956).
The poorhouse opened in 1907 as the culmination of
large-scale municipal housing for the poor in the District
which began in 1846 at the Washington Asylum. This
institution was located in an area of the District called
Blue Plains, which is located at the southernmost tip of
the District on the bank of the Potomac River near the
Maryland border (see Figure 1).
The impact of discourse conflating poverty, race,
crime and disease was evident in the make up of residents
throughout the home’s operation. Until the home closed
in the late 20th century, it was used to accommodate
individuals belonging to a variety of marginal groups
such as convalescent indigents, prisoners released from
jail, young and middle-aged men considered ‘poor but
employable’. Moreover, patients with active TB, drug
addiction or psychosis continued to be eligible for
admission until 1956 (Department of Public Welfare,
1956).
Several other factors contributed to the substandard
accommodations at the almshouse. Congress provided
Int. J. Osteoarchaeol. (2010)
Variation in Health and Socioeconomic Status

Figure 1. Washington, DC map showing location of residents living in the general population from the Cobb sample and Blue Plains. This
figure is available in colour at www.interscience.wiley.com/journal/oa.

Figure 2. Home for the Aged and Infirm, Blue Plains, DC.

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2010)

limited appropriations for construction and day-to-day
operations. As a result, the home was run at a per capita
cost less than half of similar institutions and
condemned materials from District buildings used
for construction compromised the structural integrity
of the building. (Kober, 1907; Washington Post, 31
January 1940c; Washington Daily News, 27 January
1940; Washington Post, 27 January 1940a; Public
Assistance Division, 1949).
Inadequate appropriations also limited infirmary
space and medical and attendant staff. For instance,
during the 1940s, there were only 58 employees to
tend to the needs of the home’s 700 inmates
(Washington Post, 3 February 1940b). Therefore, it
was difficult to perform regular exterminations, and
keep dorm floors and patients clean (Board of Charities,
1924; Board of Public Welfare, 1927, p. 87; Public
Assistance Division, 1938, 1939; Washington Post, 20
September, 1941; Board of Public Welfare, 1946). In
fact, the almshouse physician only treated acute
medical cases and inmates suffering from chronic
illnesses went without special medical care (Washing-
ton Post, 6 April 1948). Like other almshouse units, the
infirmary was supplied with second-hand items.
Hospital equipment came from discarded Army
medical supplies (Washington Daily News, February
15, 1940; Public Assistance Division, 1938, 1939;
Washington Post, 31 January 1940c).
Living conditions in the home were also affected
by overcrowding. The home opened with a population
of 208, which increased by 10% each year and peaked
at 880 residents in 1936 (Washington Post, 31 January
1940c). With the exception of dormitories for White
women, all units were filled to capacity by 1938.
Eligibility requirements for income assistance estab-
lished during the Depression had much to do with
the Home’s population increase during the 1930s
and 1940s. Many elderly who qualified for public
assistance declined it to reside at the Home because
of the inadequacy of these funds for sustaining
basic living expenses (Washington Star, 3 March
1940).
Where available, population reports according to
race indicate that Black men and women made up the
majority of almshouse residents. Other information on
the limited employment and lodging resources
available to Blacks mentioned above suggests why
the Black male population of the Home for the Aged
and Infirm was the first to reach capacity (Board of
Charities, 1908). Since support organisations for Black
women in the District have been in place since 1869
(Smith-Wilson, 1930), it is possible that women
admitted to the Home for the Aged and Infirm were
Copyright # 2010 John Wiley & Sons, Ltd.
R. Watkins
the extremely destitute cases without access to
resources specific to their needs.
Work therapy, endorsed since the 19th century, was
included in the home’s daily regime since its opening
(Washington Post, 1936; Washington Post, 30 August
1958). Labour therapy implemented in these institu-
tions often centred around farmland commonly
established on these sites. In addition to providing
residents with the experience of participating in a
labour force, the work helped to supplement food
supplies. At the Home for the Aged and Infirm, tasks
included grounds keeping and sweeping for men, and
meal preparation for women (Washington Post, 1936;
Washington Post, 30 August 1958).
The infamous home closed in 1996 still referred to as
a home for the elderly, mentally retarded, physically
disabled ‘and those with nowhere else to go’
(Washington Post, 25 June 1996). Officials assumed
that increased funding would improve conditions in the
home and were perplexed when conditions did not
change. The conflation of race, poverty, crime and
illness was a ‘sociopolitical process long displaced in
space and time’ that negatively affected the city’s care
of some of its poorest residents throughout 20th
century (Goodman et al., 1988).
The following skeletal analyses are informed by
knowledge of the social milieu in which individuals in
the Cobb sample lived. Specifically, the methodology is
designed to examine relationships between the impact
of discriminatory practices that limited Black DC
residents’ access to public assistance, employment,
adequate housing and mechanical strain, trauma and
exposure to infectious disease. These statistical tests and
surveys are also used to explore possible differences in
the lived experiences of individuals residing in the city’s
almshouse and the general population.
Materials and methods
The W. Montague Cobb skeletal collection includes
the remains of individuals used as cadavers in anatomy
classes at Howard University Medical School between
1932 and 1969. This collection is referred to as an
’African American’ skeletal population because the
majority of individuals were identified as such using the
labels of the time (‘Negro’, ‘Colored’ or marked as ‘C’).
However, roughly 120 individuals in the collection are
listed as ‘White,’ as well as a several marked ‘Indian’ and
‘Chinese’. In most cases, individuals were unclaimed by
relatives who lacked means for burial. While all 834
original morgue records are available, the remains of
634 individuals are available for study. The combi-
Int. J. Osteoarchaeol. (2010)
Variation in Health and Socioeconomic Status
nation of skeletal remains, individual names, place of
nativity, duration of residence in the District and
detailed morgue records is unique among African
American skeletal collections. Occupation is docu-
mented for 95 of the 634 individuals in the collection:
48 males were labourers, 20 females were domestics
and 27 more individuals had other occupations listed
(such as chauffeur, busboy and housewife). Cause of
death is listed for 790 individuals and 27 contain
clinical medical histories. According to morgue
records, the length of residency in Washington for
these individuals ranged from 3 days to 75 years. That
only 10 individuals in the entire collection were listed
as lifetime residents indicates the significance of
migration as an extra-local force shaping the local
history of the poorest people in the District. Seven
hundred records provide local addresses. Most
individuals resided in the northwest quadrant of the
District. However, 104 African American individuals in
the collection resided at the Washington, DC Alms-
house (called the Home for the Aged and Infirm)
located in the southeast quadrant (see Figure 1).
It is important to note that the collection is
undoubtedly a biased sample of the African American
community in Washington, DC. For example, females
and young adults are underrepresented; only 287 of the
individuals in the collection are female and only 13 are 25
years of age or younger. Therefore, biological data only
provide information on a portion of the Black
Washington, DC population. A goal of this research
was to understand the local conditions of poverty;
therefore, using these data to extrapolate health
standards of Blacks throughout the District was not an
objective. I argue that the sample’s distribution indicates
who was disproportionately affected by the environ-
ments of inequality during the time period represented in
the collection. For instance, sex biases in the sample
suggest that men were less likely to be a part of familial or
social networks that could afford to bury their deceased.
The composition of the collection, thus, provides an
insight into the cultural and economic context and
serves as an important example of how social phenomena
are retained in the skeletal record.
Table 1. Age and sex distribution of the almshouse and general population study samples
Series Sex N (%)
Almshouse Females 29 (39.2)
Male 45 (60.8)
Total 74
General population Female 27 (38)
Male 44 (62)
Total 71
Copyright # 2010 John Wiley & Sons, Ltd.
As stated, this paper examines remains from two
distinct groups within the population sample that died
between 1930 and 1960 with known age and sex listed
on morgue records (see Tables 1–3).
The primary sample is comprised of individuals who
lived in the city almshouse aged 25 years and older
(n ¼ 74). Individuals in this group reached skeletal
maturity between the late 1800s and the mid-1920s, as
years of birth ranged from 1850 to 1901. Continuing
the use of residence to situate individuals in the Cobb
Collection within the local history of the District, I
chose a general population sample of individuals living
in the general population (n ¼ 71). Individuals in this
sample were born between 1900 and 1927 and,
therefore, reached skeletal maturity between the
mid-1920s and 1950. With these dates in mind, the
discussion about biocultural context is focused on
1930s–1960s. Accordingly, these samples are referred
to as ‘almshouse’ and ‘general population’ in the results
section and subsequent discussion.
Contact information was included in morgue records
of 30 individuals (13 women and 17 men) that lends
insight into the type of social networks to which
people in the sample belonged. Twenty-five of these
records listed next of kin or friends (12 women and 13
men). In 13 cases, relatives were listed as contacts for
the deceased. Parents and siblings were listed most
often (four cases each), followed by husbands and
children (two cases each) and an aunt. In all but two
cases, authorities were able to locate or contact
relatives. The remaining individuals had friends listed.
In all but two cases, records indicated that friends had
been located or contacted. In only two instances (one
relative, one friend), contacts stated that they wanted
nothing to do with handling the affairs of the deceased.
That remains ended up a part of a research collection of
unclaimed individuals suggests that these people
belonged to families or friendship networks that were
equally destitute and without means of support.
Joint surfaces of the shoulder, elbow, hip and knee
were observed for osteoarthric change (see Table 4).
Bones comprising these joints were also examined at
muscle attachment sites for enthesopathy. The entire
Minimum Age Maximum Age Mean Age
50 90 71.24
45 87 69.58
45 90 70.23
25 55 39.19
25 61 42.43
25 61 41.20
Int. J. Osteoarchaeol. (2010)
 R. Watkins

Table 2. Age category distribution of the almshouse and general population samples

Series Age category N (%) Total

25–45 46–65 66–90

Almshouse 1 (2.3) 26 (48.1) 47 (100) 74

General population 43 (97.7) 28 (51.9) 0 (0) 71
Total 44 54 47 145

Table 3. Age category and sex distribution of the almshouse and general population samples

Sex Series Age category N (%) Total

25–45 46–65 66–90

Females Almshouse 0 (0) 11 (55) 18 (100) 29 (51.8)

General population 18 (100) 9 (45) 0 (0) 27 (48.2)
Total 18 (32.1) 20 (35.7) 18 (32.1) 56 (100)
Males Almshouse 1 (3.8) 15 (44.1) 29 (100) 45 (50.6)
General population 25 (96.2) 19 (55.9) 0 (0) 44 (49.4)
Total 26 (29.2) 34 (38.2) 29 (32.6) 89 (100)

Table 4. Bones and joint surfaces observed for the study (adapted from Larsen et al., 1995)

Joint system Articular surfaces observed

Shoulder Humeral head; glenoid fossa

Elbow Trochlea and capitulum of the distal humerus; head of the radius; trochlear notch, radial notch
Hip Acetabulum; femoral head
Knee Medial and lateral femoral condyles; patello-femoral surfaces; medial and lateral tibial condyles

skeletons of individuals included in the study were
examined for fractures. The specific bone affected as
well as the number of fractures per individual was
recorded. Additional joints typically included in recent
studies were omitted due to the limited availability and/
or comingling of bones of the hands, feet and
vertebrae. Skeletons lacking elements for examining
a minimum of two joints were excluded from the
skeletal study. Table 5 indicates the number of
preserved joints for each sample. Only the associated
morgue record was used to collect demographic data,
residence and cause of death. Because age and sex were
already provided in the autopsy records, no further
determination was made. Skeletons of questionable age
and sex (noted on morgue records), non-matching
elements, and elements with serious post-mortem
degradation were also excluded from the sample. Only
skeletons exhibiting good skeletal preservation on joint
surfaces, margins and select muscle insertion sites were
included in the study.

Table 5. Summary of joints available for observation and number of joints preserved

Sample Shoulder N (%) Elbow N (%) Hip N (%) Knee N (%)

Almshouse Joints preserved 67 (90.5) 61 (91) 57 (77) 45 (60.8)

Missing 7 (9.5) 6 (9) 17 (23) 19 (25.7)
Total 74 67 74 64
General population Joints preserved 43 (60.5) 34 (79) 47 (66.1) 42 (59.1)
Missing 28 (39.5) 9 (21) 24 (33.9) 29 (40.9)
Total 71 43 71 71

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2010)
Variation in Health and Socioeconomic Status
Observation was limited to macroscopic, non-
invasive and non-destructive techniques to record the
presence and absence of OA, enthesophytes and
fractures. In response to the methodological reconsi-
derations highlighted in recent OA studies (Buikstra &
Ubelaker, 1994; Jurmain & Kilgore, 1995; Larsen et al.,
1995; Hemphill, 1999; Weiss, 2005; Weiss & Jurmain,
2007). Initial documentation included scoring the
presence and severity of osteoarthritic change as
indicated by marginal osteophytes, subchondral poros-
ity and the presence of eburnation on the surfaces of
elements comprising a joint on the right and left sides of
the body. I also noted the presence of enthesopathies at
the supinator crest of the ulna, tuberosity of the radius
and deltoid tuberosity of the humerus. The supinator
crest is one of the proximal attachment sites for the
supinator muscle, which supinates the forearm and hand.
The supinator also works with the biceps brachii to
facilitate rapid supination when resistance is required
and the arm is flexed. The tuberosity of the radius is one
of the two insertion sites for the biceps brachii, which is
responsible for flexion of the elbow (especially when
forearm is supinated) and supination of the forearm.
Finally, the deltoid tuberosity is the insertion site for the
deltoid muscle, which facilitates abduction and medial
and lateral rotation of the arm. All of these muscles are
involved in the flexion, abduction, rotation and exten-
sion of the arm. In keeping with other studies of these
muscle markers (Hawkey & Merbs, 1995; Hawkey, 1998;
al-Oumaoui et al., 2004; Molnar, 2006; Weiss & Jurmain,
2007; Cardoso & Henderson, 2010; Villotte et al., 2010),
these features are examined for possible associations with
differing activity levels. Using evaluative criteria
presented in Buikstra and Ubelaker (1994), only indivi-
duals with moderate or severe OA were included in the
study. This choice was made in consideration of ongoing
debates regarding whether or not OA is a reliable
indicator of cumulative strain (Rogers & Waldron, 1995;
Wilczak, 1998; Weiss, 2003, 2004, 2007).
Although scholars note that slight osteoarthritic
change is a common occurrence, moderate and severe
osteoarthritic change is not inevitable (Rogers &
Waldron, 1995; Waldron, 1995; Weiss & Jurmain,
2007). Therefore, controlling for age and other
systemic factors, these particular changes can be
associated with cumulative effects of strain and are
attributed cultural significance regarding the general
burdens of labour and activity in a population (Rogers &
Waldron, 1995; Harrington, 1998; Molnar, 2006;
Lieverse et al., 2007). I also used these data to see if
associations with osteoarthritic change emerged in
these samples, which would substantiate my hypoth-
esis that moderate and severe osteoarthritic change in
Copyright # 2010 John Wiley & Sons, Ltd.
these samples was primarily due to excessive physical
activity. To ensure consistent recording, tests for intra-
observer error were conducted and produced errors of
less than 10%.
The analysis in this paper focuses on conversion of
the initial scores into the designation of presence or
absence of osteoarthritic change and enthesopathy for
each joint complex. OA was marked as present in a
skeleton if found in one joint complex, and affected
joint regions had to have at least two articular surfaces
with marginal osteophytes and subchondral porosity to
be scored as present. In all but two cases, over 50% of
joints were affected by osteoarthritic change on both
sides of the body. Therefore, following Lieverse et al.
(2007) scores for right and left sides were combined.
To produce data in a format consistent with existing
OA studies, binomial statistics were used to examine
differences in prevalence within the sample. Fisher’s
Exact tests were used when sample sizes were too small
for normal testing (Klaus et al., 2009). The prevalence
and distribution of OA and enthseophytes was
compared by subsample, age, sex and when possible,
age categories (25–45; 46–65; 66–90). Tests were also
conducted to compare distribution between males and
females for each of the joint regions observed.
A small number of individuals (n ¼ 11) in the sample
had occupations listed on morgue records. However, the
burden of unskilled labour can also be traced through an
analysis of skeletal material. Therefore, patterns of OA
were also used to assess the presence of mechanical strain
associated with unskilled labour. Although both samples
represent African American residents of Washington,
DC during the late 19th and early 20th century, they also
reflect different gradients of poverty and, therefore,
warrant individual examination.
Results
Osteoarthritis prevalence
No significant difference between the proportions of
individuals with OA in at least one joint in the body
was found between the two samples. This was also the
case when data were organised by age group and when
males and females were considered separately both
within and between samples. When considering the
average number of joints affected (see Table 6), the
odds of the almshouse sample having 7–8 joints
affected was found to be 3.6 times greater than the odds
of individuals in the general population sample
(X2 ¼ 4.211, df 1, p < 0.05). Therefore, this sample
also had the greatest bilateral affect.
Int. J. Osteoarchaeol. (2010)
 R. Watkins

Table 6. Summary of osteoarthritis prevalence in subsamples general population sample. Tables 7–10 indicate
by number of joints affected differences in the prevalence of bilateral OA between
Series N (%) Number of joints with OA
two samples. Taking specific joints into consideration,
statistically significant differences between both samples
5–6 joints 7–8 joints Total (%) were found in the shoulder and hip. The odds of
Almshouse 5 (12.8) 34 (87.2) 39 (62.9)
individuals in the almshouse sample having bilateral OA
General population 8 (34.8) 15 (65.2) 23 (37.1) in the shoulder were 40 times greater than individuals in
Total 13 (21.0) 49 (79) 62 (100) the general population sample (X2 ¼ 27.696, df 1,
p < 0.05) and five times greater than the general
population sample for having bilateral OA in the hip
(X2 ¼ 12.031, df 1, p < 0.05). When considering men
In tests for individual joints, several significant and women separately, the odds of females in the
differences were observed between the two samples almshouse sample having bilateral affect in the shoulder
(see Tables 4 and 5). The odds of individuals in the were 20 times greater than females in the general
almshouse sample having OA in the shoulder were 14 population sample. The odds of males in the almshouse
times greater than the odds of individuals in the general sample presenting bilateral OA in the shoulder were 4.4
population sample having OA in the shoulder times greater than men in the general population sample.
(X2 ¼ 43.17, df 1, p < 0.05). Similarly, the odds of
individuals in the almshouse sample having OA in the
elbow was five times greater than the odds of Enthesophytes and fractures
individuals in the general population sample having
the condition more likely to have OA of the elbow A total of 117 fractures were observed on the
(X2 ¼ 13.446, df1, p < 0.05). Figures 3–7 illustrate some individuals examined for this study. Fractures were
of the osteoarthritic changes observed in joints. observed on a total of 47 individual skeletons, 13 of
whom were female (see Tables 11 and 12). Therefore,
males represented the majority of individuals with
Unilateral and bilateral affect fractures (n ¼ 34, 82%). In terms of distribution
between samples, the majority of individuals with
As indicated in Table 6, the odds of individuals in the fractures (n ¼ 29) were in the almshouse sample.
almshouse sample having 7–8 joints affected was found Considering the two samples separately, 68% of
to be 3.6 times greater than the odds of individuals in the fractures were found on skeletons in the almshouse

Figure 3. Differential osteoarthritic change the left and right scapulae of an 81-year-old male, with extensive osteophytic lipping on the
left glenoid. This figure is available in colour at www.interscience.wiley.com/journal/oa

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2010)
Variation in Health and Socioeconomic Status

Figure 4. Osteoarthritis in the elbow joint of a 40-year-old female, including extensive marginal lipping, severe modification of the distal
humerus and hypertrophy at the radial tuberosity and supinator crest, general population sample. This figure is available in colour at
www.interscience.wiley.com/journal/oa

sample. The majority of fractures in the sample used for
this study were found in the tibiae and fibulae, followed
by the scapula. Five fractures were found in the
scapulae and humerii, which are frequently associated
with injuries from accidental falls (Lovejoy & Heiple,
1981; Ortner, 2003). Several fractures were also
observed in the radius and ulna (see Figure 8).
Tests for the prevalence of enthesophytes (see
Figure 9) presented significant results (see Tables 13–
16). Conducting tests for differences between samples,
the odds of individuals in the almshouse group having
enthesophytes on the radial tuberosity were found to be
4.5 times greater than the odds of the general population
sample having the same lesion (X2 ¼ 12.272, df 1,
p < 0.05). Statistically significant results for this same
stress marker also presented when men and women were
considered separately. The odds of women in the
almshouse sample having hypertrophy at the radial
tuberosity and supinator crest were found to be 3.8 times
greater than women in the general population sample
(X2 ¼ 4.894, df 1, p < 0.05 and X2 ¼ 5.728, df 1, p < 0.05,
respectively). The odds of men in the almshouse sample
having enthesophytes at the radial tubersoty were found
to be 5.9 times greater than men in the general
population sample (X2 ¼ 7.897, df 1, p < 0.05).
A significant relationship also exists between the
presence of hypertrophy at the biceps attachment on
the humerus and OA of the shoulder. The odds of

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2010)

Figure 5. Osteoarthritis in the hip joint of an 81-year-old man, including extensive lipping of the acetabulum and femoral head. This
figure is available in colour at www.interscience.wiley.com/journal/oa
individuals in the general population sample having
deltoid enthesopathies of the humerus are 5.4 times
greater than individuals in the general population
sample (X2 ¼ 5.177, df 1, p < 0.05). No significant
relationship between the presence of OA and
hypertrophy in the almshouse sample was found.
Eburnation
The final aspect of repetitive physical strain considered
was eburnation. Forty-seven cases of eburnation were
observed during data collection (see Figure 10). While
statistical tests were not possible, Tables 17 and 18
present the number of cases in each sample and by age
group and sex. The presence of eburnation can be
considered as yet another aspect of osteoarthritic
presentation in these samples (Ortner & Putschar,
1981; Rogers et al., 1997; Rogers & Waldron, 1995;
Brown et al., 2008; Rojas-Sepulveda et al., 2008).
Individuals in age group 3 (66–90) had the most
cases of eburnation, followed by individuals in age
group 2 (45–65). Most eburnated surfaces were found
in the knee joint (n ¼ 22), followed by the elbow
(n ¼ 9) and shoulder (n ¼ 9).
Cause of death
Cause of death was listed on 105 morgue records for
individuals comprising this study. Tables 19 and 20
indicate the leading causes of death for individuals in
the Cobb collection and African Americans in
Washington, DC between 1930 and 1960.
Copyright # 2010 John Wiley & Sons, Ltd.
R. Watkins
The majority of deaths in the Cobb subsamples were
attributed to heart disease and TB. Figure 11 provides
an example of tuberculous change observed on
skeletons in the collection. Heart disease was the
leading cause of death in both samples. Health officer
reports for the District suggest that most Blacks in the
general Washington, DC population died from heart
disease also, followed by cancer, TB and pneumonia.
Like the Cobb sample, heart disease was the leading
cause of death among Blacks in DC between 1930 and
1960. However, according to morgue records, it
accounted for nearly half (49%) of all African American
deaths, which was a substantially greater percentage
than what was found in the Cobb sample. Cancer was
the second leading cause of death among Blacks in
Washington, DC, while only accounting for a small
number of deaths in the Cobb collection.
Discussion
Although the fact that these samples are separated by
almost a generation complicates the interpretation of
non-systemic factors involved in osteoarthritic change
between samples, it serves to illustrate the persistence
of extreme poverty in a segment of Washington, DC’s
African American population over time. Building upon
current political economic understandings of human
biology (Goodman, 1993; Goodman & Leatherman,
1998; Leatherman & Thomas, 2001), the socioeco-
nomic status of individuals in these samples is
considered to be a product of particular historical
factors and human interactions associated with
Int. J. Osteoarchaeol. (2010)
Variation in Health and Socioeconomic Status

Figure 6. Bilateral osteoarthritis in the right and left knee joints of a 53-year-old female, with extensive marginal lipping subchondral
surface porosity and eburnation (on patellae). This figure is available in colour at www.interscience.wiley.com/journal/oa

Table 7. Prevalence of bilateral osteoarthritis in the shoulder by Table 8. Prevalence of bilateral osteoarthritis in the hip by sub-
subsample sample

Presence/absence of bilateral OA in the shoulder Presence of bilateral OA in the hip

Series OA on one Bilateral Total joints Series OA on one Bilateral Total

side of the OA preserved side of the OA
body body

Almshouse N (%) 1 (1.4) 66 (98.5) 67 (60.9) Almshouse N (%) 8 (14.0) 49 (86.0) 57(54.8)
General population N (%) 17 (39.5) 26 (60.5) 43 (39.1) General population N (%) 21 (44.7) 26 (55.3) 47(45.2)
Total N (%) 18 (16.4) 92 (83.6) 110 (100) Total N (%) 29 (27.9) 75 (72.1) 104 (100)

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2010)
 R. Watkins

Table 9. Prevalence of bilateral osteoarthritis in the shoulder by Table 10. Prevalence of bilateral osteoarthritis in the shoulder by
subsample: females subsample: males

Percentage of bilateral OA in the shoulder Presence of bilateral OA in the shoulder

Series OA on one Bilateral Total Series OA on one Bilateral Total

side of the OA side of the OA
body body

Almshouse N (%) 1 (4) 24 (96) 25 (58.1) Almshouse N (%) 0 (0) 42 (72.4) 42 (62.7)
General population N (%) 8 (44.4) 10 (55.6) 18 (41.9) General population N (%) 9 (36) 16 (64.0) 25 (37.3)
Total N (%) 9 (20.9) 34 (79.1) 43 (100) Total N (%) 9 (13.4) 58 (86.6) 67 (100)

conditions of hardship. Therefore, it is not a naturally
occurring phenomenon to which health and disease
patterns are simply related. Rather different health
patterns can be observed in groups assumed to be of
similar socioeconomic status because of local differ-
ences in how individuals experience poverty and
inequality.
In spite of the substandard living conditions in the
almshouse, the environmental context of poor Blacks in
the District indicates that they were at a particular
disadvantage regarding access to decent housing, jobs
or monetary assistance. As a result, it is likely that there
were negative biological consequences associated with
belonging to either group. The health risks posed by
the conditions of the almshouse are rather self-
explanatory. However, the particular disadvantage at
which the most destitute lived in the general
population deserves to be restated. As migrants, this
sample had disproportionately limited access to decent
housing and labour. Documents also indicated that
these individuals represented the most ill among the
poor, which would have an impact on their ability to
work. Morgue records indicate that the social networks
people belonged to did not provide a buffer for these
conditions. The disproportionately limited access
these individuals had to public assistance put them
at further risk for what was referred to in reports as
‘permanent breakdowns’ (Public Assistance Division,
1938, p. 187). Therefore, patterns of OA, trauma and
cause of death in both population samples should
reflect the differential gradients of poverty they
embody according to municipal records.
The lack of statistically significant variation in the
severity of OA by sex suggests that men and women

Figure 7. Osteoarthritic change in the knee joint of a 37-year-old male, including extensive osteophytic change on the articular surface of
the tibia (lower image provides close-up). This figure is available in colour at www.interscience.wiley.com/journal/oa

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2010)
Variation in Health and Socioeconomic Status
Figure 8. Left: healed fracture of the left radius and ulna of a 79-
year-old male with callous formation. Right: improperly set frac-
ture of the left tibia and fibula with subsequent ankylosis from the
remains of a 65-year-old male. This figure is available in colour at
www.interscience.wiley.com/journal/oa
Figure 9. Left: enthesophytes on the radial tuberosities of a 67-year-old male. Centre: bilateral hypertrophy of the deltoid tuberosities of
a 57-year-old female. Right: Supinator crest enthesophytes on the ulna of a 40-year-old female. This figure is available in colour at
www.interscience.wiley.com/journal/oa
Copyright # 2010 John Wiley & Sons, Ltd.
were physically taxed to similar degrees. This point is
also supported by x2 tests for associations between
having specific enthesopathies and sex, as well as the
observation of a younger peak age for cases of
moderate and severe marginal osteophytes in women
(Watkins, 2003). Overall, the results of these tests
support that women in the Cobb sample represent a
particularly impoverished subgroup. Historical studies
note that when possible, African American women
arrived to the District by way of a fairly systematic
process (Clark-Lewis, 1994). Women would stay with
relatives who migrated ahead of them in the process of
establishing residence and finding work. Initially
helping to run the family household, these women
would eventually seek employment in domestic
service. Clark-Lewis’ (1994) study notes that support
systems of this type often helped to buffer the
economic and social constraints families and individ-
uals faced (Jones, 1985).
Because men were less likely to have access to
support from friends or family in the process of
migration, moderately poor and destitute males are
more than likely represented in the sample. None-
theless, the peak age of moderate and severe marginal
lipping in men in the sample is consistent with age-
related change. With the exception of the elbow,
osteoarthritic change peaked among individuals in the
66–90 group. That the peak age of moderate and severe
osteoarthritic change in the elbow was in the 46–65
age group fits with the few statistically significant
Int. J. Osteoarchaeol. (2010)

Figure 10. Eburnated gleno-humeral joint of a 54-year-old male, including extensive marginal lipping of the humerus (lower image
provides close-up of eburnated surface on the humeral head). This figure is available in colour at www.interscience.wiley.com/journal/oa
differences for the shoulder and elbow between men
and women in the sample, as well as between men in
the almshouse and general population samples.
As mentioned, profiling differences in osteoarthritic
change between samples was somewhat limited by age
distribution. Therefore, information on enthesophytes
helped clarify the extent of age or activity-related
change within and between groups. The greater
prevalence of these markers in the almshouse (older)
sample only helped to situate osteoarthritic change in
that group within the context of age. This finding is
consistent with previous studies illustrating a strong
correlation of enthesophytes with age (Hawkey &
Merbs, 1995; Rogers et al., 1997; Wilczak, 1998; Eshed
et al., 2004; Molnar, 2006; Weiss & Jurmain, 2007).
Nonetheless, the association of hypertrophy at deltoid
attachment on the humerus and OA of the shoulder in
the general population sample is a likely illustration of
Copyright # 2010 John Wiley & Sons, Ltd.
R. Watkins
the type of mechanical strain associated with heavy
lifting that a segment of this population experienced.
While these changes are used to reconstruct occu-
pational activities in prehistoric and historic popu-
lations, this is a less reliable enterprise in historic
population samples such as the Cobb collection (Angel
et al., 1987; Owsley et al., 1987; Lai & Lovell, 1992;
Churchill & Morris, 1998; Hawkey, 1998; Eshed et al.,
2004; al-Oumaoui et al., 2004; Molnar, 2006; Weiss &
Jurmain, 2007).
A number of studies underscore that the prevalence
and location of trauma is influenced by cultural context
(Ortner, 2003). A comprehensive study of fractures in
the Cobb collection indicates a higher prevalence than
in other populations of similar temporal and socio-
economic context (Muller, 2006). Women are also
found to have an equally high number of fractures,
which is also uncharacteristic of skeletal populations.
Int. J. Osteoarchaeol. (2010)
Variation in Health and Socioeconomic Status

Figure 11. Tuberculous change in the innominate, femur and ribs of an 81-year-old male. This figure is available in colour at
www.interscience.wiley.com/journal/oa

Table 11. Number of males and females in the Cobb collection the tibiae and fibulae, followed by the clavicle. Existing
with fractures studies attribute fractures of these elements primarily to
Fractures N (%)
falls associated with accidents, particularly falls from
heights. Fractures of the tibiae and fibulae have also
Women 16 (18) been associated with the hazards of construction work
Men 34 (82) in historical and contemporary studies (Fife et al., 1984;
Total 47 (100)
McNamee et al., 1997).
Differences in the prevalence of TB in other African
American skeletal samples of similar socioeconomic
The almshouse and general population samples do not and temporal contexts suggest differential burden of
have the same distribution of fractures in men and disease among poor Blacks in urban areas throughout
women reported in Muller’s study of the Cobb the 19th and early 20th centuries. Although TB was the
collection. However, they do reflect the prevalence leading cause of deaths among Blacks in Philadelphia
of upper and lower limb fractures that Muller observed. throughout the 19th century (Rankin-Hill, 1997), it
The majority of fractures in the sample were located in accounted for only 4% of deaths in the First African

Table 12. Number of males and females in the Cobb collection with fractures by sex and subsample

Series Sex N fractures N individuals Total N individuals (%)

(%) with fractures (%)

Almshouse Women 11 (9.4) 11 (23.4) 29 (37.9)

Men 69 (59) 21 (44.6) 45 (46.6)
General population Women 9 (7.7) 5 (10.6) 27 (18.5)
Men 28 (23.9) 13 (27.6) 44 (29.5)
Total 117 (100) 47 (100) 145 (100)

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2010)
 R. Watkins

Table 13. Prevalence of enthesophyte at the radial tuberosity by subsample

Sample Enthesopathy present Enthesopathy absent Missing Total (%)

Almshouse (%) 60 (81.1) 8 (10.8) 6 (8.1) 74 (100)

% Preserved tuberosities 57.0 24.0 75.0 51.0
General population (%) 44 (62.0) 25 (35.2) 2 (2.8) 71 (100)
% Preserved tuberosities 42.3 75.8 25.0 49.0
Total (%) 104 (71.7) 33 (22.8) 8 (22.8) 145 (100)

Table 14. Prevalence of radial tuberosity enthesophyte by subsample: Females

Sample Enthesopathy present Enthesopathy absent Missing Total (%)

Almshouse (%) 23 (79.3) 5 (17.2) 1 (3.4) 29 (100)

% Preserved tuberosities 60.5 29.4 100.0 51.8
General population (%) 15 (55.6) 12 (44.4) 0 27 (100)
% Preserved tuberosities 39.5 70.6 0 48.2
Total (%) 38 (67.9) 17 (30.4) 1 (1.8) 56 (100)

Table 15. Prevalence of radial tuberosity enthesophyte by subsample: Males

Sample Enthesopathy present Enthesopathy absent Missing Total (%)

Almshouse (%) 37 (82.2) 3 (6.7) 5 (11.1) 45

% preserved tuberosities 56.1 18.8 71.4 50.6
General population (%) 29 (65.9) 13 (29.5) 2 (4.5) 44
% preserved tuberosities 43.9 81.3 28.6 49.4
Total (%) 66 (74.2) 16 (18.0) 7 (7.9) 89 (100)

Table 16. Prevalence of supinator crest enthesophyte by subsample: Females

Sample Enthesopathy present Enthesopathy absent Missing Total (%)

Almshouse (%) 2 (6.9) 25 (86.2) 2 (6.9) 29 (100)

% preserved tuberosities 66.7 50.0 66.7 51.8
General population (%) 1 (3.7) 25 (92.6) 1 (3.7) 27 (100)
% preserved tuberosities 33.3 50.0 33.3 48.2
Total (%) 3 (5.4) 50 (89.3) 3 (5.4) 56 (100)

Baptist Church sample. This is likely the product of
social networks providing better housing conditions
and improved diet among church members. Cedar
Grove is another sample considered to be similar in
context to the Cobb sample in which researchers found
little skeletal evidence of TB (Rose, 1985). However,
less than 10% of TB cases involve skeletal lesions
(Roberts & Manchester, 1995). As indicated on morgue
records and death certificates, the prevalence of deaths
by infectious disease in the Cobb sample is not

Table 17. Cases of eburnation in each joint by subsample

Series Shoulder Elbow Hip Knee Total Cases

Almshouse N (% of joints preserved) 8 (11.9) 9 (14.7) 6 (10.5) 18 (40) 41 (17.8)

General population N (% of joints preserved) 1 (2.3) 1 (2.1) 4 (9.5) 6 (3.6)
Total (% of joints preserved) 9 (8.1) 9 (9.4) 7 (6.7) 22 (9.5) 47 (25)

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2010)
Variation in Health and Socioeconomic Status

Table 18. Cases of eburnation by subsample and sex

Series Sex Shoulder Elbow Hip Knee Total Cases

Almshouse Women 1 3 9 13
Men 7 9 3 9 28
General population Women 3 3
Men 1 1 1 3
Total 9 9 7 22 47

Table 19. Leading causes of death in the Cobb sample and attributed the unusually high prevalence of TB in this
Washignton, DC, 1930–1960 sample to the home being a ‘last resort’ for many just
Cause of Death Cobb Collection Washington, DC
prior to death. Therefore, the sample reflects a
sample N (%) N (%) disproportionate number of destitute and diseased
individuals ‘culled from the larger population due to
Tuberculosis 22 (21) 2350 (16) destitute circumstances’ (Phillips, 2001, p. 133).
Heart Failure 13 (12) N/A
Heart Disease 24 (23) 7084 (49) Although not an almshouse sample, the prevalence
Pneumonia 7 (6.6) 2273 (16) of TB in the Cobb general population sample also
Cancer 10 (9.5) 2606 (18) reflects this characteristic. Notes on morgue records for
Unknown 29 (2.76) N/A
Total 105 (100) 14 313 (100) individuals who were not almshouse residents illustrate
their particularly destitute circumstances such as not
having known next of kin and not being eligible for
public assistance. As a result, these individuals more
than likely reflected a segment of the population that
reflected in the larger Black Washington, DC slipped through the cracks of a relief system that had
population. Tuberculosis and pneumonia are tied for very particular criteria recipients had to meet. As
the third leading cause of death among Blacks in the opposed to surmising that individuals living in the
District between 1930 and 1960 (16%). These results general population were ‘not as healthy’ as individuals
indicate a greater burden of infectious disease among in the almshouse sample, it is likely that variations in
individuals in this sample and suggest that, as expected, cause of death between groups suggests the prevalence
individuals in the collection represent a particularly of certain diseases among younger and older groups of
destitute segment of the populations. destitute Blacks Washington, DC.
Tuberculous lesions found in skeletons from a mid to
late 19th century almshouse cemetery from the
northeast provides further evidence for this assessment Conclusion
(Lanphear, 1988; Phillips, 2001). In the case of Phillip’s
Oneida asylum and Albany almshouse samples men- The results of this study suggest that the samples used
tioned earlier, 6.3 and 21.4%, respectively, of skeletons in this study do indeed represent two distinct groups
exhibited tuberculous lesions. Therefore, such a large within the population. Individuals in the almshouse
presence of skeletal lesions suggests an even greater sample were older and present osteoarthritic change,
presence of the disease throughout the sample. Since enthesophytseal stress and a prevalence of fractures
the almshouse was a short-term institution, Phillips that reflects their advanced age. In addition, infectious

Table 20. Leading causes of death in Washington, DC and the Cobb collection, 1930–1960, by subsample

Cause of Death N Almshouse N General population Washington,

sample (%) sample (%) DC (%)

Tuberculosis 1 (3.7) 10 (20.4) 2350 (16)

Heart Failure 5 (18.5) 4 (8.16) N/A
Heart Disease 15 (55.5) 28 (57.1) 7084 (49)
Pneumonia 2 (7.4) 3 (6.1) 2273 (16)
Cancer 4 (14.8) 4 (8.16) 2606 (18)
Total 27 (100) 49 (100) 14 313 (100)

Copyright # 2010 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. (2010)

disease was a minimal factor in causes of death for this
group. In contrast, individuals in the general popu-
lation sample had a higher frequency of deaths from
infectious disease. Moreover this group had osteoar-
thritic change and enthesophyseal stress at a younger
age than the almshouse (older) sample, which suggests
that habitual activity plays a role in osteoarthritic
change in that group (Rogers & Waldron, 1995;
Jurmain, 1999; Knusel, 2000; Hough, 2001; Pearson &
Buikstra, 2006Pearson & Buikstra, 2006; Klaus et al.,
2009). However, this does not mean that OA in the
almshouse sample can solely be attributed to advanced
age. As stated, prevalence of eburnation is not only
associated with age, but also possible trauma that
impacts the integrity of joint cartilage (Rogers &
Waldron, 1995). A more detailed survey of all forms of
trauma in the collection is needed to accurately
determine the relationship between OA, systemic and
non-systemic factors. Moreover, the presence of
fractures in each sample cannot merely be interpreted
by comparing the number present in each group. This
is because although most fractures were found in the
almshouse sample, a larger proportion of fractures are
present in the general population sample (36 versus
48.6%, respectively). Therefore, it is likely that the
younger sample experienced more trauma relative to
age.
Together, these samples highlight the variety of
factors that influence the biological well-being of
African American and low socioeconomic status
populations. Therefore, a number of variables should
be taken into consideration when assessing quality of
life and health within and between groups. Systematic
studies of OA, in concert with other activity-related
changes and cultural context, is essential for exploring
homogeneity within populations related to differences
in local social and environmental conditions.
Acknowledgements
The author acknowledges Lisa Holly Robbins, M.A. for
her assistance with data collection. Two reviewers
provided helpful suggestions and editorial comments.
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