Diagnosis of Mercurial Teeth in a Possible Case of Congenital Syphilis and Tuberculosis in a 19th Century Child Skeleton

By Ioannou, Stella; Henneberg, Maciej et al. | Journal of Anthropology, Annual 2015 | Go to article overview

Diagnosis of Mercurial Teeth in a Possible Case of Congenital Syphilis and Tuberculosis in a 19th Century Child Skeleton


Ioannou, Stella, Henneberg, Maciej, Henneberg, Renata J., Anson, Timothy, Journal of Anthropology


1. Introduction

In the past, the presence of numerous diseases and the lack of an effective form of treatment meant individuals could have suffered from more than one disease. This is especially the case in relation to chronic afflictions that could be combined with congenital diseases or acute infections. Syphilis and tuberculosis (TB) were two of these diseases. Significant in the past, both diseases continue to be an important public health problem. Syphilis, caused by the spirochete Treponema pallidum is typically transmitted through sexual contact. It can also be transmitted via the placenta from an infected mother to the fetus while she is in the most infectious stages of the disease (early primary or secondary stage). It is known as congenital syphilis [1]. Syphilis affects more than 12 million adults [2-4] and a million pregnancies each year [4-6]. Tuberculosis, a chronic infectious disease caused by Mycobacterium tuberculosis, is usually transmitted through the inhalation of airborne droplets filled with bacteria produced by infected individuals usually when coughing [7, 8]. Approximately 9 million new cases were registered and 1.5 million people died from tuberculosis in 2013 [9].

In most palaeopathological studies, skeletal signs of diseases are diagnosed to one nosological unit. This finds some justification in the fact that only a small portion of diseases leave recognizable signs on hard tissues of the body (bones and teeth). It is, however, possible to find signs of more than one affliction on a single skeleton [10]. When this is the case, study of skeletal involvement should not be the only method applied when making a differential diagnosis.

The differential diagnosis of syphilis and tuberculosis in palaeopathological specimens remains difficult as both diseases rarely affect or leave any signs on hard tissues of the body. In syphilis, only 1/3 of individuals suffering from the tertiary stage of the disease will develop any bone lesions [10] while only about 3% to 5% of individuals with active TB will have skeletal changes [11-13]. The diagnostic characteristic of syphilis include "caries sicca," sclerosis, and pitting of the outer table of the cranial vault resulting from accumulation of stellate scarring [11, 14] creating a "worm eaten" appearance [14], tibial bowing, known as sabre shin [11, 15, 16], and the expansion of the long bones with nodes with superficial cavitation [14]. In tuberculosis diagnostic elements include osteolytic lesions on the thoracic and lumbar vertebral bodies [10, 13, 17]. Rib involvement including new bone formation, particularly periosteal reactions on the visceral surface [1821] is now considered in the diagnosis of tuberculosis [22].

Lesions of congenital syphilis can also be difficult to identify in skeletal samples as many pregnancies can result in stillbirths, abortion, or death [15, 23] and those skeletons are not often preserved. However, in those patients that do survive, the disease causes a disturbance in dental development producing abnormalities that are distinguishable features of the disease. The most recognisable are Hutchinson's incisors, while others include Moon's molars and Fournier's "mulberry" molars [15,16,24-30]. It is this characteristic that can support a differential diagnosis of the disease.

However, in cases where these diagnostic changes are not present, differential diagnosis of a specimen can be difficult. Our knowledge of the type of treatments used to combat syphilis and tuberculosis throughout history is well known. They used natural remedies, chemical compounds, and recently penicillin; however, our knowledge of the effects of these treatments on hard tissues has not been explored in depth.

Mercury has been used as early as the 27th century BC in China [31]. It was recognised as a form of treatment for venereal diseases [31-33] prior to the introduction of salvarsan [34-37] and penicillin in the 20th century [38]. …

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