Treponemal disease is a term that refers to the genus Treponema, from the family Spirochaetaceae (Order; Spirochaetales), that includes four diseases known as; pinta, yaws, endemic syphilis (or bejel) and venereal syphilis. With the exception of pinta (which only causes lesions on the skin), all the rest can affect the skeletal system and other organs. All can be cured by penicillin, and all can reach a tertiary stage, which are the most damaging but the least infectious (Powell & Cook 2005: 9-11).
Warning: Some graphic images ahead
Venereal syphilis is seen as the most dangerous treponemal syndrome, as the tertiary stage can cause cardiovascular syphilis or neurosyphilis, chronic inflammation of blood vessels in the meninges, brain or spinal cord, which may lead to multiple infarctions, as well as nerve cell destruction in the cerebral cortex, leading to insanity (Powell & Cook 2005: 20-21). Venereal syphilis may also pass from mother to foetus to produce congenital syphilis (Roberts & Manchester 2005: 211).
Syphilis’ notoriety is also well known among historians and palaeopathologists, as its origin is confounded in mystery to whether Columbus brought the disease back to the Old World from the new – a debate that began in the sixteenth century (Quétel 1990: 37). Among the two opposing arguments are additional hypotheses that consider other treponemal diseases, these theories will be reviewed within this post on when treponemal disease came to Europe.
The Columbian hypothesis states that syphilis arose in America and the New World, and was taken back to Europe accidentally by Columbus’ crew in 1493 (Erdal 2006: 16). This has occasionally been revised to Antonio de Torres bringing back syphilis in his ships, when sailing back to Spain in 1494, with twelve expedition vessels and several hundred Spaniards whom had set out in 1493 and wished to return (Thomas 2010: 154-155), as well as captive natives (Quétel 1990: 44). An outbreak of venereal syphilis occurred in Europe around 1500 (Baker & Armelagos 1988: 703), but was first recorded in 1495 (Diamond 2005: 210), by laypersons and doctors whom described the disease as new. Their accounts are sometimes seen as primitive by modern academics, yet they were no less intelligent, and capable of describing surface symptoms as well as any modern doctor. At the same time, names for ‘syphilis’ sprung up, such as; French disease (named by the Italians and English), Disease of Naples (named by the French), German disease (named by the Polish), Ulcer of Canton (named by the Chinese) etc, demonstrating how novel syphilis was to the Old World. Not until the 1800s was the word ‘syphilis’ used, coined by Girolamo Fracastoro (Crosby 1969: 219). Yet Española folklore was laced with syphilitic stories (Crosby 1969: 222).
The evidence is not only textual, but skeletal, with abundant samples in North America dating back to about two millennia before Columbus arrived (Powell & Cook 2005: 9), the skeletal lesions produced by treponemes being pathognomonic (Powell & Cook 2005: 6). Some of the earliest evidence of treponemal infection is found in Mohawk Valley River (New York) dated to 500 BC (Baker 2005: 63-64), with more copious finds after 1000 AD, due to higher populations in sedentary towns (Powell et al. 2005: 437). Periosteal reaction, characteristic of syphilis, and sabre-shin remodelling have also been found in 6-14% of pre-Columbian Dominican Republicans, the area where Columbus landed (Rothschild 2005). Yet, in the Old World, only non-syphilitic treponemal diseases are found on skeletons pre-Columbian (Rothschild et al. 2000: 936). There are a few individual cases of syphilitic skeletons, but represent isolated cases whereby alternative diagnoses are more probable since they are not found throughout the population (Rothschild 2005).
Finally, when syphilis is first documented, it appears to be a gruesome death including; severe ulceration on infected area, necrosis leading to bone exposure and rapid onset of gummy tumours. However, a few years later, syphilis symptoms become less severe, until they represent today’s symptoms within half a century of its appearance, many documenting syphilis as weakening (Knell 2004: 174). It is postulated that this was due to less virulent strains being better at keeping their host alive for longer, to spread more bacteria. This is what happened to myxomatosis in Australian and European rabbits. Being a new disease to the area, in a different host population, would explain why syphilis was so virulent at first, but adapted to a less destructive strain with better transmission rates via natural selection (Knell 2004: 175). “Tertiary syphilis will still cause severe pathology, but the host is no longer infectious at this point…so there will be little selection for strains that are less virulent.” The treatment for syphilis will mean that it “…will be selecting for strains of syphilis that are harder to detect and are more infective in the earlier stages…A total of 17% of cases surveyed in a recent study of…[syphilis] in the UK had symptoms that were insufficient to make them seek medical attention” (Knell 2004: 176). Although there is international agreement that European diseases ravaged Americans, the opposite is continually contested (Baker & Armelagos 1988: 719), even though places such as Tenochitlán was one of the most populous cities worldwide (Diamond 2005: 212), and could have easily maintained an infectious disease.
There are many arguments, however, against the Columbian hypothesis. One argument is that financial gain occurred from giving syphilis an American origin, by importing West-Indie Guaiac wood for the treatment of syphilis, based on the religious idea that God provided a remedy in the place he inflicted the disease. This could then replace mercurial treatments that were already on the market (Powell & Cook 2005: 33-34). Other arguments touch on the improbability of the theory, such as; documentation that Columbus’ crew had excellent health (Morison 1942: 359), accounts of syphilis aboard Columbus’ ships are written thirty years after the event (Quétel 1990: 44), or that there simply wasn’t enough time for a syphilis pandemic to occur after the return of Columbus (Roberts & Manchester 2005: 213), although no reason is given to why this is. These disagreements thus lead to the pre-Columbian hypothesis that states that syphilis was in the Old World before Columbus’ voyage, but was confused with leprosy until after the syphilis pandemic (Baker & Armelagos 1988: 703). Interestingly, “as syphilis became widely recognised…’leprosy’ became less common” (Baker & Armelagos 1988: 707), and by the end of the 15th century, Job, the “…patron saint of lepers, became the patron saint of syphilitics” (Baker & Armelagos 1988: 718). The bible has also been said to mention venereal syphilis, with Job described as having genital lesions, and David’s loins described as having a loathsome disease from sleeping with Bathsheba (Baker & Armelagos 1988: 706). However, these examples don’t necessarily mean that ‘leprosy’ was confused with syphilis, in fact, it could have been rubella, measles, smallpox, chickenpox, shingles, genital herpes or gonorrhoea; whereby all can cause skin lesions, cross the placenta, are highly contagious, have short incubation periods, with herpes and gonorrhoea being sexually transmittable (Baker & Armelagos 1988: 717). At the same time, archaeology of leper cemeteries have found leprous skeletons (Lee & Magilton: 1989: 279), while even in Victorian times, they believed that leprosy was sexually transmitted, long after venereal syphilis was known (Rawcliffe 2006: 88).
There have been cases of suspect syphilis found on skeletons in the Old World such as congenital syphilis found in a specimen from Anatolia (Erdal 2006: 18) and cases in Gloucester and Norwich cemeteries (Rawcliffe 2006: 89), although English and Irish cases have been given a differential diagnosis of yaws (Rothschild 2005). So far, there doesn’t seem to be an abundance of skeletal evidence for syphilis in the Old World, like there is in the New. However, this could be due to the minor bone involvement (2-13%) of venereal syphilis, compared to other treponemal diseases (e.g. 20-40% for yaws and bejel, Rothschild 2005), with less than 20% of individuals displaying any bone changes at all for any of the treponemes (Roberts & Manchester 2005: 214), and hence, venereal syphilis may be underestimated by approximately 90% in the osteoarchaeological record (Roberts & Manchester 2005: 210), especially if the palaeopathologist takes a Columbian standpoint.
Whereas the Columbian and pre-Columbian hypotheses only look at whether syphilis was introduced to Europe before or after Columbus, the Unitarian and alternative hypotheses broaden the idea to other treponemal diseases, including a possible origin. The Unitarian hypothesis states that all treponemal diseases are clinical manifestations of the same disease (treponematosis, Crosby 1969: 219), which manifests itself due to climatic and cultural changes (Crosby 1969: 223). The evolutionary trajectory of treponematosis supposedly began as a childhood disease – yaws – in the Palaeolithic period of sub-Saharan Africa (a hot, humid climate) and moved around the globe with hunter-gatherers (Baker & Armelagos 1988: 704). Bejel and pinta flourished in Neolithic villages (Hudson 1965: 899) with drier climates and unsanitary conditions (Baker & Armelagos 1988: 704), but found it harder to spread when hygiene improved within the Fertile Crescent, and changed to venereal syphilis from increased promiscuity and prostitution (Hudson 1965: 890-897). The disease is therefore a highly flexible adaptor, and supports the pre-Columbian hypothesis.
In favour of this hypothesis, it has been found that “…there is a back and forth transition from one treponemal disease to another even within a single group of people when changing from one environment to another…in the yaws regions…Europeans with higher standards of living rarely develop yaws but do develop venereal syphilis” (Roberts & Manchester 2005: 213). Partial cross-immunity also exists between the diseases (Baker & Armelagos 1988: 705), as well as similar bone changes, such as osteomyelitis accompanied by extensive bone regeneration, and gross bone destruction called a gumma (Roberts & Manchester 2005: 208). However, recent DNA analysis has revealed that there is a difference between venereal syphilis and non-venereal treponemes, although “…refinements of bacteriological techniques” are needed (Roberts & Manchester 2005: 207). Animal experiments with rabbits have also shown that they have high susceptibility to syphilis, but low susceptibility to yaws (Rothschild & Rothschild 1996: 560), something that wouldn’t happen if it were one disease, dependent on climate and social change. Skeletal evidence shows that syphilis was around at least 1,600 years ago in the New World (Rothschild & Rothschild 1996: 560), while, for instance, believed syphilitic Egyptian cases turned out to be taphonomic (Baker & Armelagos 1988: 710).
The Alternative hypothesis postulates that a non-venereal treponeme was brought to Europe from Africa, fifteen years before Columbus, which adapted into venereal syphilis (Livingstone 1991: 589). Another theory is Hackett’s (1963: 38), who argues that the treponemal disease originated in 15,000 BC Afro-Asia as pinta from an animal infection, spread throughout the world, becoming isolated in the Americas. A few mutant strains left behind, evolved into yaws around 10,000 BC. Bejel arose from yaws about 7000 BC due to arid climates. Venereal syphilis evolves approximately 3000 BC in south-western Asian cities, that then spread to Europe as a mild disease that became more virulent in the sixteenth century (although this doesn’t explain why the disease then became less virulent again), and was spread worldwide with European expansion.
An Afro-Asian, or at least, an African origin for Treponema may be correct, as possible evidence for yaws has been found on a Homo erectus skull from Kenya (KNM-ER 1808), although differential diagnosis may be a vitamin A overdose, however periostitis says otherwise (Rothschild 2005, Mitchell 2003: 175). Regardless, treponemal diseases are highly infectious and may not have been able to sustain themselves in small hunter-gatherer bands of 200-300 persons, not being able to maintain host transmission, and hence would have died out, although they can survive a long time in the human body (Inhorn & Brown 1990: 94). Instead, the treponemal diseases would have survived much longer in large populous cities such as Tenochitlán, and hence, been brought to Europe from America.
To conclude, this post has reviewed the major hypotheses (Columbian, pre-Columbian, Unitarian and alternative) on the introduction of treponemal disease into Europe and the Old World. The pre-Columbian hypothesis works well with both the Unitarian and alternative theories in positing a date earlier than 1493 for treponemal diseases being in Europe, whether it be since 3000 BC; or fifteen years prior to Columbus; or even, just one disease that can adapt extremely rapidly to changes in climate and human circumstance. However, although there are abundant ideas for a pre-Columbian introduction of treponemal disease to Europe, many lack data to back up their statements. Even though the Columbian hypothesis doesn’t attempt to answer when treponemal disease entered Europe, it does have plenty of data to argue the case of when venereal syphilis entered the continent, and why there was a dramatic change in virulence. This doesn’t necessarily mean that the Columbian hypothesis is correct, but at least it tries to bring evidence to the table. In fact, all the theories believe that treponemal disease was in Europe long before Columbus, with the exception of venereal syphilis. With better technological advancements, we may one day be able to put a sixteenth century debate finally to rest, but until then, the answer still remains disputed.
Interested in more?
Here is a (much better) article dated from 2011 on the Columbian hypothesis:
And another written in 2012, this suggest mutation into venereal syphilis after it hit European shores but again we see the debate is not closed:
- Baker, B. J. (2005). ‘Patterns of Pre- and Post-Columbian Treponematosis in the Northeastern United States’ in Powell, M. L. & Cook, D. C. (eds.) The Myth of Syphilis: The Natural History of Treponematosis in North America. University Press of Florida: Florida
- Baker, B. J. & Armelagos, G. J. (1988). The Origin and Antiquity of Syphilis: Palaeopathological Diagnosis and Interpretation. Current Anthropology 29 (5)
- Crosby, A. W. (1969). The Early History of Syphilis: A Reappraisal. American Anthropologist 71 (2)
- Diamond, J. (2005). Guns, germs and steel: a short history of everybody for the last 13,000 years. Vintage Books: London
- Erdal, Y. S. (2006). A Pre-Columbian Case of Congenital Syphilis from Anatolia (Nicaea, 13th Century AD). International Journal of Osteoarchaeology 16: 16-33
- Hackett, C. J. (1963). On the Origin of the Human Treponematoses (Pinta, Yaws, Endemic Syphilis and Venereal Syphilis). Bulletin of the World Health Organisation 29: 7-41
- Hudson, E. H. (1965). Treponematosis and Man’s Social Evolution. American Anthropologist 67 (4)
- Inhorn, M. C. & Brown, P. J. (1990). The Anthropology of Infectious Disease. Annual Review of Anthropology 19: 89-117
- Knell, R. J. (2004). Syphilis in Renaissance Europe: Rapid Evolution of an Introduced Sexually Transmitted Disease? Proceedings: Biological Sciences 271 (4)
- Lee, F. & Magilton, J. (1989). The Cemetery of the Hospital of St. James and St. Mary Magdalene, Chichester – A Case Study. World Archaeology 21 (2)
- Livingstone, F. B. (1991). On the Origin of Syphilis: An Alternative Hypothesis. Current Anthropology 32 (5)
- Mitchell, P. (2003). The Archaeological Study of Epidemic and Infectious Disease. World Archaeology 35 (2)
- Morison, S. E. (1942). Admiral of the Ocean Sea: A Life of Christopher Columbus. Little, Brown and Company: Boston
- Powell, M. L. & Cook, D. C. (2005). ‘Introduction’ in Powell, M. L. & Cook, D. C. (eds.) The Myth of Syphilis: The Natural History of Treponematosis in North America. University Press of Florida: Florida
- Powell, M. L. & Cook, D. C. (2005). ‘Treponematosis: Inquiries into the Nature of a Protean Disease’ in Powell, M. L. & Cook, D. C. (eds.) The Myth of Syphilis: The Natural History of Treponematosis in North America. University Press of Florida: Florida
- Powell, M. L., Bogdan, G., Cook, D. C., Sandford, M. K., Smith, M. O. & Weaver, D. S. (2005). ‘Treponematosis before 1000 BC? The Skeletal Evidence’ in Powell, M. L. & Cook, D. C. (eds.) The Myth of Syphilis: The Natural History of Treponematosis in North America. University Press of Florida: Florida
- Rawcliffe, C. (2006). Leprosy in Mediaeval England. The Boydell Press: Suffolk
- Roberts, C. & Manchester, K. (2005). The Archaeology of Disease. Cornell University Press: New York
- Rothschild, B. M. (2005). History of Syphilis. Available electronically at http://cid.oxfordjournals.org/content/40/10/1454.full, accessed 18th November 2012, 11:58 pm.
- Rothschild, B. M., Calderon, F. L., Coppa, A. & Rothschild, C. (2000). First European Exposure to Syphilis: The Dominican Republic at the Time of Columbian Contact. Clinical Infectious Diseases 31 (4)
- Rothschild, B. M. & Rothschild, C. (1996). Treponemal Disease in the New World. Current Anthropology 37 (3)
- Thomas, H. (2010). Rivers of Gold: The Rise of the Spanish Empire. Penguin Books Ltd: London
- Quétel, C. (1990). History of Syphilis. Polity Press: Cambridge