Revisiting Syphilis in the Old World

Scholar have been debating the antiquity and origins of syphilis for 500 years. In 1495, the first recorded epidemic of syphilis broke out in Naples, afflicting the army of Charles VIII. As the army disbanded and returned to their respective homes, they spread the disease across Europe and by 1500 is found everywhere on the continent. The outbreak has been correlated with the return of Columbus’s men from the New World. A number of chronicles from the journey recorded that the crew had contracted a novel disease from Hispaniola, that was potentially syphilis. For the next 400 years this was the common held belief on the origins of the disease. In the past century, however, doubts have been raised on this theory, and the debate has spanned across scientific and humanistic disciplines.

Bioarchaeology plays an important role in determining the geographic and temporal origins of the disease. Not only can we trace the spread and origins through skeletal remains, but it provides an alternative perspective to DNA and ethnographic data. While DNA has been championed as being a scientific solution, it is limited in the information it can provide about social processes. Ethnographic information is the reverse, providing detailed social explanations but often highly biased and often incomplete. A new article in the American Journal of Physical Anthropology, by Harper et al. (2011) takes a comprehensive look at the skeletal evidence in order to present the current understandings of the trends and origins of acquired syphilis.

First, it is important to look at the manifestation of syphilis on human remains. There are two major problems with diagnosis: there are three types of treponemal diseases and while acquired syphilis is one it can easily be confused for the others, and the bony manifestation of the disease is similar to others which can cause confusion. However, by looking at the full pattern of skeletal pathologies a diagnosis can be made. Syphilis occurs in three stages, however it isn’t until the third stage that diagnostic skeletal changes occur. The most common lesion with tertiary syphilis is an osteosclerotic reaction. Bone is destroyed and created in such a way that the lesion has a circular appearance, with thickened irregular bony formation around the perimeter. As the lesion heals it has a star-like appearance. In later stages the continual destruction and healing creates a mottled appearance known as caries sicca. These diagnostic changes are most frequently seen occurring on the cranium.

Tertiary Syphilis of Cranium from Headland Archaeology

Also in the skull, the nasal bones, maxillary sinus bones, and hard palate can be destroyed. In the rest of the skeletal there is bilateral and systemic lesions found on the long bone shafts, ribs, the sternum, scapulae, and the medial portions of the clavicles. Periosteal bony build-up can occur, especially on the tibiae giving the bones a curved appearance.

Tertiary Syphilis on Femur from Museum of London

For more information on the pathology in the skeleton see Ortner (2003).

Harper et al. (2011) reviewed 54 reports from 50 archaeological sites on skeletal remains with diagnosed syphilis from the 20th and 21st centuries. The reports come from a range of old world sites in Asia, Africa and Europe, and were evaluated based on the dating of the material and the diagnosis made.  They found that a number of reports, even more recent ones, were basing diagnosis of syphilis on general periosteal pathologies, and not the more diagnostic lesions. Since periosteal reactions can be due to a number of diseases, more evidence than this is needed for a potential diagnosis. They also found that numerous papers did not discuss the dating methods, which is extremely important in determining the antiquity of the disease.

Harper et al. (2011) Comparison Dating and Diagnosis

By combining the dating with diagnosis for all of the sites, if the Columbian hypothesis is correct none should date earlier than 1492. Harper et al. (2011: 123) found that “the cases with certain diagnoses have confidence intervals that both cluster around and overlap AD 1493. In other words, these 11 individuals represent the earliest definite cases of treponemal disease yet discovered in the Old World, and their radiocarbon dates indicate that they lived in a relatively short time period surrounding 1493. We argue that rather than representing evidence of pre-Columbian treponemal disease, these cases actually provide support for the Columbian hypothesis.” Since only 11 cases were definitely diagnosed with syphilis, it is possible that there are earlier cases which have not been recovered or diagnosed properly. However, Harper et al. 2011 argue that at some point the absence of evidence for an alternative does mean that the alternative doesn’t exist.

Overall the article is a great read regarding the current work being done on the bioarchaeology of syphilis. Harper et al. (2011) objectively assess the skeletal evidence and radiocarbon dating, and are able to show strong support for the Columbian hypothesis. The only thing that would have made this article stronger was a presentation of the DNA and ethnographic information. However, this information is probably beyond the article and would be more suitable for a book. Personally, I’d love to hear more about the demographic profile of those affected and how this may relate to the post-war social processes that potential led to the spread of the disease.

Works Cited

Kristin N. Harper, Molly K. Zuckerman, Megan L. Harper, John D. Kingston, and George J. Armelagos (2011). The Origin and Antiquity of Syphilis Revisited: An Appraisal of Old World Pre-Columbian Evidence for Treponemal Infection Yearbook of Physical Anthropology, 54, 99-133 : 10.1002/ajpa.2161

Ortner 2003. Identification of Pathological Conditions on Human Remains. Academic Press: CA.