A pre-Columbian case of congenital syphilis from Anatolia (Nicaea, 13th century AD)

Abstract

In this study, the skeleton of an approximately 15-year-old child, dating back to the Late Byzantine period (13th century AD) is examined with the aim of determining where this specimen fits in the continuing arguments on the origins of syphilis. It was unearthed during an excavation at an amphitheatre in Nicaea dating to the Roman period. The Nicaea specimen displays common symptoms found in the majority of people with congenital syphilis such as Hutchinson's incisor, mulberry molar, darkened enamel, radial scar on frontal bone, sabre tibia, syphilitic dactylitis, and gummatous and non-gummatous osteomyelitis on almost every post-cranial bone. Because of the sub-periosteal new bone formation, the medullary spaces in some long bones are narrowed or completely obliterated. These lesions, which were observed via macroscopic and radiological examination, reflect the late stages of congenital syphilis. The specimen, when examined together with increasing numbers of other finds from the Old World, contributes to the argument that venereal syphilis did exist in the Old World before 1493, and brings forward the need to revise the Columbian hypothesis, which maintains that syphilis is a new disease carried to the Old World from the New World by Columbus' crew.

Higoumenakis’ sign in the diagnosis of congenital syphilis in anthropological specimens

“…This observation is also supported by the inclusion of the criterion in several major reviews of disease clinical diagnosis [4,5,26]. The additional fact that dental stigmata of the disease, such as Hutchinson's incisors and mulberry molars, are only observed in about 30% of all patients [2,11,27], allow us to advocate evaluating the clavicle sign in osteoarcheological studies, especially when cranial data evaluation is missing or remains inconclusive. In fact, even within the clinical scenario, the disease is so diverse (la grande simulatrice) that no single criterion can be independently applied for a clinical diagnosis and the actual definite decision can only be provided via serological / molecular testing, which, however, is not available in archaeological / anthropological samples [6,7,10].…”

“…Syphilis seems to have appeared in Europe soon after Columbus returned from America, but the origin of the disease still remains a debatable issue, as a number of authors support the concept of a Pre-Columbian presence of the disease in the Old World [1]. In addition, some European anthropological specimens have already been reported in an attempt to verify this hypothesis [2,3]. Regardless of its exact natural history, the disease has been a major morbidity factor, with a variable clinical picture depending on whether it is acquired during an individual life or it is congenitally transferred to the foetus.…”

“…The diagnosis of congenital syphilis on bones is based on osseous evidence, making osseous signs of congenital syphilis very important for the differential diagnosis of the disease [2,8,9], especially when ancient treponemal DNA is considered impossible to detect in archaeological specimens [10]. Dental stigmata, such as Hutchinson's incisor and mulberry molar, are very important for the diagnosis of congenital syphilis in archaeological populations but are not always sensitive / specific enough for a definite diagnosis [2,11]. On the other hand, if other signs are present on the bones of the remaining skeleton, this is very helpful in making the differential diagnosis in favour of congenital syphilis.…”

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

“…In recent years, some authors have reported lesions compatible with acquired syphilis in Pre-Columbian skeletons in regions as distant as Britain (Stirland, 1991;Mays et al, 2003Mays et al, , 2012von Hunnius et al, 2006;Cole and Waldron, 2011), central Europe (Gaul et al, 2015), and the eastern Mediterranean (Mitchell, 2003(Mitchell, , 2009Erdal, 2006). These findings, if their palaeopathological assessments are correct, support a view different to the Columbian hypothesis: the Pre-Columbian hypothesis.…”

Evidence of Periostitis in Joseon Dynasty Skeletons

“…However, more studies on Old World samples are still needed for confirmation of hypothesis because another research group still insisted that syphilis was established in the Old World even before the discovery of the Americas [18,29]. Certainly, if Old World skeletal series of 1492 or earlier were to show osteological evidence of syphilitic infection, the argument would take on a whole new complexion [30]. However, no reports of any osteological signs of tertiary syphilis in archaeologically obtained skeletal series have yet been published in Korea.…”