Congenital Syphilis
From bonepath
Congenital syphilis is infection by the Trepanema palladium bacterium, passed from a venereally syphilitic mother to her fetus#1 (Mansilla and Piljoan, 1995; Hillson et al., 1998; Roberts and Manchester 2005). It is estimated that 50% of modern cases of congenital syphilis do not live past five years of age (Mansilla and Piljoan, 1995). Perhaps as a result of the condition’s high mortality rate, it is further estimated that skeletal manifestation of the disease affects only around 5% of infected children (Lewis, 2004).
The cranial and dental representation of congenital syphilis is well-documented. Dental anomalies include a number of enamel deposition abnormalities, manifest as Hutchinson’s incisors, Moon’s molars and mulberry molars (Hillson et al., 1998). Hutchinson’s incisors are central incisors whose middle mamelon (or “denticle”) is typically absent, creating a notch in the center of the incisal edge. However, there are multiple expressions of this trait. Other variants include: quickly-wearing (poorly mineralized) apical enamel; “dirty” coloration; slight depression at the labial aspect of the incisal edge; some combination of the notched and depressed incisal edge. Permanent canines may also express some of these defects to some degree. Moon’s molars are permanent first molars whose cusp apices are more closely-packed than normal, resulting in a crown which is widest at its base. Finally, mulberry molars are permanent first molars whose apical crowns are severely hypoplastic, but are otherwise normal from the last one third of the crown toward the roots. Hillson and colleagues (1998) consider Hutchinson’s incisors and Moon’s molars as unequivocal indicators of congenital syphilis. Mulberry molars, while possibly associated with syphilis, could also possibly be a “plane-form hypoplasia” (Hillson and Bond, 1997), and could have other causes (Roberts and Manchester, 2005).
Congenital syphilis can also have a number of effects on the cranium. Archaeological cases have displayed periostitis of the neurocranial bones (Jacobi et al., 1992; Mansilla and Piljoan, 1995). If the infection spreads to the meninges in early infancy, hydrocephaly can occur (Mansilla and Piljoan, 1995; Lewis 2004). Syphilitic rhinitis is a syphilis-borne infection of the nasal mucosa, causing the atrophy or malformation of the perinasal bones and cartilage, appearing as a “saddle nose” (possibly manifest in individual 96-11-013; Horne, 1954; Fiumara and Lessell, 1983; Mansilla and Piljoan, 1995). Other symptoms include “circumscribed erosions” endo- and ectocranially (Mansilla and Piljoan, 1995:189), a short maxilla and high palatal arch (Fiumara and Lessell, 1983).
Individuals 96-11-013 and -163 display abnormalities suggestive of congenital syphilis, although a certain diagnosis cannot be made simply on the basis of craniodental evidence.
[edit] Examples from Ford Collection
[edit] References
Fiumara NJ and Lessell S. 1983. The Stigmata of Late Congenital Syphilis: An Analysis of 100 Patients. Sexually Transmitted Diseases 10: 126-129.
Hillson S and Bond S. 1997. Relationship of enamel hypoplasia to the pattern f tooth crown growth: A discussion. American Journal of Physical Anthropology 104: 89-104.
Hillson S, Grigson C, and Bond S. 1998. Dental Defects of Congenital Syphilis. American Journal of Physical Anthropology 107: 25-40.
Horne GO. 1954. Differential Diagnosis of Facial and Dental Manifestations in Congenital Syphilis. Archives of Disease in Childhood 29: 123-126.
Jacobi KP, Cook DC, Corruccini RS, and Handler JS. 1992. Congenital Syphilis in the Past: Slaves at Newton Plantation, Barbados, West Indies. American Journal of Physical Anthropology 89: 145-158.
Lewis ME. 2004. Endocranial Lesions in Non-adult Skeletons: Understanding their Aetiology. International Journal of Osteoarchaeology 14: 82-97.
Mansilla J and Pijoan CM. 1995. Brief Communication: A Case of Congenital Syphilis During the Colonial Period in Mexico City. American Journal of Physical Anthropology 97: 187-195.Roberts C and Manchester K. 2005. The Archaeology of Disease, 3rd ed. Ithaca: Cornell University Press
