A possible case of acquired syphilis at the former Royal Hospital of All-Saints (RHAS) in Lisbon, Portugal (18th century): a comparative methodological approach to differential diagnosis

Abstract

Between the years of 1999 and 2001, during the excavation of the Praça da Figueira (Lisbon, Portugal), several human osteological remains from various chronological periods were discovered. Amongst them several skeletons are known to be related with the Hospital Real de Todos-os-Santos (Royal Hospital of All Saints-RHAS), which had an important role. The hospital history begun in 1492 and ended in 1755 largely as a consequence of the Lisbon earthquake. Of the skeletons exhumed, one in particular, the adult female Sk. 1310 showed significant pathological changes. The bone lesions characterized by new bone deposition, with a symmetric and disseminate pattern, were found in the upper limbs, distal end of femurs and in tibia and fibula diaphyses. A bowing deformity with "sabre shape" morphology was also observed in the tibiae. The most striking lesions, characterized by healed nodular cavitations and similar to those of caries sicca, were recorded on the frontal bone. Considering the value of a complete description, as well as the application of multiple lines of enquiry for a reliable differential diagnosis, three distinct techniques were applied and compared: visual examination, imagiology and histology. The results showed that the macroscopic analysis coupled with conventional X-ray analysis were fundamental to obtain a possible diagnosis of acquired syphilis. In contrast, the CT-scan and the histological analyses were less informative. The application of a new scoring system also supports a diagnosis of acquired syphilis. This case-study constitutes the first evidence of syphilis associated with the RHAS, supporting historical data on the pivotal role that this hospital had on the treatment of several conditions, namely, syphilis.

Metagenomic Research of Infectious Diseases in Archaeological Contexts: Evidence from the Hospital Real de Todos-os-Santos (Portugal)

“…The methods included the macroscopic visual examination of the remains, an imagological assessment of the bone changes, and a paleohistological study. All these supported a diagnosis of acquired syphilis [21].…”

“…The Sk.1310, a skeleton of an adult female, was buried with three adult males and is the only skeleton in this collection exhibiting syphilitic-related bone changes [21]. Sk.1310's disease-related bone changes were composed of a matrix of new bone formation, affecting both the left and right upper limbs and distal ends of the femurs and tibias, and fibula diaphysis.…”

Um possível caso de sífilis adquirida num esqueleto oriundo da Ermida do Espírito Santo (séculos XV–XIX, Almada, Portugal)

“…A presença em simultâneo de fenómenos osteolíticos (porosidade) e osteogénicos (formação de osso novo junto à órbita direita) é também característica dos processos de formação das gomas (Campillo, 2001). As lesões gomatosas cranianas serviram para fortalecer o diagnóstico de treponematose/sífilis em casos observados no registo arqueológico português (Codinha, 2002;Ferro e Fernandes, 2011;Assis et al, 2015) bem como em coleções osteológicas de referência (Lopes et al, 2010;Lopes, 2014).…”

“…Por um lado, o perfil etário do indivíduo estudado não é congruente com um caso de sífilis congénita -embora não afaste em absoluto essa hipótese diagnóstica. Finalmente, a cronologia deste caso, provavelmente pós-terramoto, orienta as hipóteses diagnósticas para a sífilis adquirida por via sexual (Sousa, 1996;Waldron, 2008;Assis et al, 2015).…”

“…XVIII, é rica em evidências de sífilis, inventariada como um flagelo social, cujas ligações rizomáticas congregam múltiplas províncias de sentido: a medicina, a religião, a saúde pública, a expansão imperial e o colonialismo, os movimentos migratórios, a prostituição ou a arquitetura hospitalar (Sousa, 1996;Lopes, 2014). Nada obstante, o registo da doença em contexto arqueológico é ainda parco, apesar de um aumento do número de casos descritos nos últimos anos (ver, por exemplo, Lopes, 2014;Assis et al, 2015).…”