Disease in Context: Paleopathological Evidence for Probable Tuberculosis from Ille Archaeological Site, Northern Palawan

Sarah Agatha Villaluz1,2*, Guillermo Pérez Gutérrez3,4, Andrea Dominique Cosalan1, Victor Paz†1, Helen Lewis5, and Kimberly Plomp1

Tuberculosis (TB) has long been a significant infectious disease shaping human populations and remains a re‑emerging global health concern; despite its historical and contemporary importance, evidence for TB in Southeast Asian archaeological contexts is relatively limited, underscoring the need to document its antiquity and regional distribution. This preliminary study presents two cases of archaeological skeletal remains, relatively dated to the eighteenth century, recovered from the Ille archaeological site, Northern Palawan. Macroscopic analysis identified palaeopathological changes affecting the vertebrae, ribs and sternum that are consistent with chronic systemic infectious disease. While differential diagnoses were considered, the pattern and distribution of lesions point to tuberculosis as the most probable aetiology. These findings provide insight into disease transmission within relatively localised communities in eighteenth‑century Palawan and highlight the value of cave sites in preserving skeletal material with diagnostically significant lesions. Situating these cases within broader regional and historical contexts raises questions regarding population interaction, trade networks, colonial‑era dynamics and ecological factors that may have facilitated the spread of infectious disease. By integrating palaeopathological evidence with archaeological context, this study demonstrates the contribution of bioarchaeology to reconstructing past health landscapes in Island Southeast Asia.