The girl from the Church of the Sacrament: a case of congenital syphilis in XVIII century Lisbon

Abstract

Syphilis is a sexually or congenitally transmitted infectious disease with an impact on the health of human populations that has undergone important cycles in different countries and periods of history. Its presence was first diagnosed in Europe in the late XIV century. In Portugal, although there are various written records of the infection in the last centuries, there are rare references to it in archeological findings (mummified bodies are also rare in Portugal). The current study describes a probable case of congenital syphilis in an 18-month-old girl buried in the Church of the Sacrament in Lisbon. Her body, dating to the XVIII century, was found mummified together with dozens of others, still not studied. Symmetrical periostitis of the long bones, osteitis, metaphyseal lesions, left knee articular, and epiphyseal destruction, and a rarefied lesion with a radiological appearance compatible with Wimberger's sign all point to a diagnosis of congenital syphilis. The diagnosis of this severe form of the infection, possibly related to the cause of death in this upper-class girl, calls attention to the disease's presence in XVIII century Lisbon and is consistent with the intense mobilization at the time in relation to the risks posed by so-called heredosyphilis. It is the first case of congenital syphilis in a child reported in archeological findings in Portugal, and can be correlated with other cases in skeletons of adults buried in cemeteries in Lisbon (in the XVI to XVIII centuries) and Coimbra (XIX century). Finally, this finding highlights the need to study the entire series of mummified bodies in the Church of the Sacrament in order to compare the paleopathological findings and existing historical documents on syphilis, so as to expand the paleoepidemiological knowledge of this infection in XVIII century Lisbon.

Treponemal disease in the Old World? Integrated palaeopathological assessment of a 9th–11th century skeleton from north-central Spain

“…This might have been historically unnoticed, given the presumably high mobility of sailors in the past and the documented speed with which the epidemic moved (Tognotti, 2009), which would have made any area of the European continent equally affected in a few years. While this is a hypothesis to consider, it is not currently supported by available data, as, to our knowledge, there have been relatively few published cases of palaeopathological putative acquired syphilis (Reverte, 1979;Lopes and Cardoso, 2000;Codinha, 2002;De Souza et al, 2006;Rissech et al, 2013;Schwarz et al, 2013) coming from the Iberian Peninsula before the Modern Age.…”

The History of Paleopathology in Brazil: skulls, parasites, and diseases from the past

“…In 1840 he described the human bones from Lapa do Sumidouro, Minas Gerais in Memórias (Lund, 1950). The skulls caught his attention due to their less "mongolized" shape as compared to those of other Native Americans, and they immediately sparked the first debates on the peopling of America (Souza et al, 2006).…”

“…In North America as well, Ales Hrsdlicka prioritized evolutionary studies, despite having published work in paleopathology (Buikstra & Beck, 2006). Although the first Brazilian physical anthropologists were also physicians and anatomists, there was little interest in diseases and a greater focus on evolutionary studies (Souza, Codinha & Cunha, 2006).…”

Syphilis and cirrhosis: a lethal combination in a XIX century individual identified from the Medical Schools Collection at the University of Coimbra (Portugal)

“…Another relatively common cause of injury to the liver is the administration of drugs, such as mercury compounds that were used to treat acquired syphilis (Quétel 1990, Hall 2001 and were prescribed in Portugal (Quétel 1990, Ortner 2003, Souza et al 2006. However, the effectiveness of mercury is still a matter of debate (Tucker 2007).…”

“…Medication with mercury may also produce several types of damage to the teeth (Powell & Cook 2005, Souza et al 2006, including gingivitis, that result in the loss of dentition (Quétel 1990), abrasions and discoloration of the tooth enamel (Souza et al 2006). The loss of 18 teeth in this relatively young individual makes it difficult to evaluate the possible changes in the surface of the teeth that may have been related to treatment with mercury.…”