Morbus gallicus in the Roman Empire

Italians called it the "French disease," the Dutch called it the "Spanish disease," the Russians called it the "Polish disease," and the Tahitians called it the "British disease." In the late 15th century, people around the world were blaming a particularly virulent, suddenly endemic disease on their improperly hygienic neighbors.  The disease started off with a single chancre sore, then became a whole-body rash, and eventually caused people to go insane.  In an era before antibiotics easily cured contagion, whole cultural groups needed someone to blame for mal de Naples, Arboyne pimple, Scottish sibbens, and Swedish saltfluss.

I'm talking, of course, about syphilis.  In 1530, the Italian physician Girolamo Fracastoro created the neologism in an epic poem he wrote about a man who was cursed with disease by Apollo.  Syphilus may have been named after the son of the nymph Niobe, mentioned as Sipylus in Ovid's Metamorphoses and himself named after a mountain in Turkey that Niobe fled back to when Artemis killed her daughters and Apollo killed her sons.  Fracastoro both named the disease and got in a dig at his cultural neighbors with his book, Syphilis sive morbus gallicus ("Syphilis, or, The French Disease").

Between about 1495 and 1550, there is quite impressive historical evidence on epidemics of syphilis in Europe, but records before 1493 are less clear, which leads us to one of the most important discussions in palaeopathology: Did syphilis originate in the Old World or the New World?  We don't yet have an answer to this question in part because we don't really know whether the treponemal diseases - venereal syphilis, endemic syphilis (bejel), yaws, and pinta - are all caused by one species of bacteria in the Treponema genus or by different species.  And we don't have an answer yet because of the palaeopathological record itself: it's not a normal population, since it only has dead people; those skeletons that seem most healthy may be from people who died before a disease could progress to bony changes; not everyone is dug up from the ground, etc.

Since the first well-documented outbreak of syphilis happed in Naples, Italy, in 1494, the Columbian Exchange theory suggests that syphilis was a New World disease brought back by Columbus and his crew to Europe. Both skeletal evidence and recent genetic studies in the Americas seem to support the antiquity of a disease that was, if not modern syphilis, quite similar to the modern understanding of syphilis.  On the other hand, the Pre-Columbian theory suggests that syphilis was present in Europe prior to Columbus' contact with the New World.  Skeletal evidence of lesions that appear syphilitic in nature have been found in Europe dating to centuries before Columbus, and some palaeopathologists have concluded from rereading historical accounts that many descriptions of leprosy better fit the signs and symptoms of syphilis.  Yet a third theory suggests that treponemal diseases were found all over the globe for tens of thousands of years but that contact between the previously isolated populations and/or other social and environmental conditions in the late 15th century caused the pathogen to mutate into a new disease that rapidly spread: venereal syphilis.

A new article just published in the International Journal of Osteoarchaeology details the latest skeletal evidence in the Pre-Columbian theory of treponemal disease: "A Roman Skeleton with Possible Treponematosis in the Northeast of the Iberian Peninsula: a Morphological and Radiological Study" (Rissech et al. 2011).  In it, the authors argue that lesions from the tibia of a well-preserved 2nd-3rd c AD skeleton from Barcelona indicate the 25- to 30-year-old male suffered from a treponemal disease.

The authors' examination of the skeleton revealed that the left tibia was saber-shaped and that the upper half of its shaft was thickened.  Further, the tibia had pitted areas and vascular grooves.  A x-ray showed that the entire marrow cavity of the upper half of the tibia was completely closed up by new bone, and there was plenty of new bone formation on the outer surface of the tibia.  These observations suggest a diagnosis of infectious disease that caused long-term inflammation.  But was the infectious disease syphilis?

Example of caries sicca (credit)
Bone changes occur in syphilis between 2-10 years after the onset of the infection (Ortner 2003).  Most often, a person suffers changes in the tibia and cranium, particularly in venereal syphilis.  The tibia often has expansion of the shaft of the bone and an excess of new bone (periostitis), resulting in the characteristic saber shape.  Sometimes, the tibia also has osteomyeitis - an infection of the bone marrow that results in openings in the bone to allow for pus drainage.  However, diagnosis of venereal syphilis specifically has generally rested on finding cranial lesions - the "worm-eaten" appearance known as caries sicca.  While the cranial lesions characteristic of the treponematoses are quite unique to the disease, they are also quite rare, occurring in 14% of cases of venereal syphilis and in only 4% of cases of endemic syphilis, whereas lesions to the tibia are observed in 36% and 61% of cases of venereal and endemic syphilis, respectively. The skeletal remains of the man from Roman Spain do not include a cranial vault, meaning diagnosis of his condition can only be based on the tibia. The authors argue, however, that:
Fig. 9. Cross-sections of tibiae.
(Rissech et al. 2011)
the observed lesions of the tibia in the skeleton from Gava, characterized by encroachment into the medullary cavity of coarse cancellous bone, cancellization of the cortex, thickening of the diaphysis, the presence of small raised plaques of new bone bridging over minor blood vessels, a sabre-shaped morphology and a predominance of bone remodeling rather than periosteal reaction, are the typical characteristics of tibiae affected by treponematosis (Rissech et al. 2011, p. 10).
These bones from Roman-period Spain join other pre-Columbian evidence for treponemal disease, including data from the 6th-3rd c BC Greek colony of Metaponto, Italy (Henneberg & Henneberg 1994), from Roman (1st-4th c AD) Gloucester, England (Simmonds et al. 2008), and from Late Antique (4th c AD) France (Palfi et al. 1992).

It's not news that Romans had venereal diseases (as the very word comes from the name of the Roman goddess of love) like gonorrhea, but the evidence for venereal syphilis prior to the Medieval period in Europe is sparse at the moment.  Still, with perhaps 10,000 skeletons from Imperial Rome having been excavated in recent years and only cursorily studied, it is highly likely that palaeopathologists will soon begin to uncover more skeletal lesions and diagnose more diseases.  And although the Romans didn't understand germ theory, the medical treatises of Galen, for example, are of immense help in our understanding of the epidemiology and presentation of a variety of diseases that afflicted the Romans.

So did the Romans have syphilis?  The jury's still out, but I'm guessing there will be enough evidence soon for someone to add "insanity resulting from neurosyphilis" to the list of crazy theories for why the Roman Empire fell.


M. Henneberg & R.J. Henneberg.  1994.  Treponematosis in ancient Greek colony of Metaponto, Southern Italy, 580-250 BCE.  In L'origine de la syphilis en Europe, avant ou apres 1493?, O. Dutour et al. eds., pp. 92-98.  Editions Errance.

D. Ortner.  2003.  Identification of pathological conditions in human skeletal remains.  Academic Press.

G. Pàlfi, O. Dutour, M. Borreani, J. Brun, & J. Berato. (1992). Pre-Columbian congenital syphilis from the late antiquity in France International Journal of Osteoarchaeology, 2 (3), 245-261 DOI: 10.1002/oa.1390020309

C. Rissech, C. Roberts, X. Tomas-Batlle, X. Tomas-Gimeno, B. Fuller, P.L. Fernandez, & M. Botella (2011). A Roman Skeleton with Possible Treponematosis in the North-East of the Iberian Peninsula: a Morphological and Radiological Study International Journal of Osteoarchaeology early view.

A. Simmonds, N. Marquez-Grant & L. Loe.  2008.  Life and death in a Roman city.  Oxford Archaeology Monographs 6.

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Unknown said…
The multi-ethnic character of the Roman Empire is a warning against attempts to generalise about what Romans knew and did.
You write:
"And although the Romans didn't understand germ theory..."
If that is true for Romans, it is not necessarily true for all those within the empire. Jewish physicians, for example, had access to knowledge from beyond Roman borders (and were generally careful protect both their knowledge and sources), from the East especially.
This makes a good introduction to the subject:
Roman medical writers (and the Greeks before them) had quite vast and in-depth knowledge of the diseases that plagued their populations. Still, they were pretty clueless about the actual methods of transmission of infectious diseases (like malaria) and had a very hard time distinguishing among the various kinds of "pox."

I'll admit that I don't know a lot about ancient Eastern medicine, except that there are archaeological examples of surgeries (e.g., for cleft lip/palate) in ancient China, and treatises on remedies for disease. Perhaps I need to read up on the state of Eastern medical knowledge during the Empire!
Anonymous said…
To John Bartram.

The Jews did not have the germ theory of disease. For a start, they didn't know that micro-organisms existed: no one before the 17th century did or could have.


This theory might be worth looking into once prominent specialists in ancient medicine have been convinced. Physicians and other with different expertise have a track record of postulating the most bizarre and untenable explanations of ancient evidence.
George Myers said…
See also "The unsung Columbus of New Hampshire" Martin Pring and sassafras, thought the cure.
Anonymous said…
Why not look for microbial DNA in these bones? The efficiency will be poor but it still might be possible if several sites from the same skeleton are sampled.
I think DNA analysis is the next step - not just for this project, but for projects on malaria, etc. aDNA of pathogens is expensive, though. Thousands of dollars per sample. And this type of analysis involves destruction of bone, so osteologists don't undertake it lightly. Basically, between expense and destruction, many researchers are waiting a couple years for aDNA analysis to get better, less invasive, and cheaper.
Jan Helldén said…
The problem when discussing the origin of syphilis is that we have three other diseases so very similar to syphilis that it is difficult to distinguish at least two of them - bejel and jaws - are followed by bone changes very similar to the ones associated w. syphilis (Pinta lesions are confined to the dermis).

DNA analysis have been made, and the results points towards syphilis being closely related to the yaws-causing strains from South America. Furthermore it has been concluded that the syphilis-causing strains evolved "relatively recently in human history" - just in time to be brought back to Europe by Columbus and his men. That would also explain the very virulent outbreak of syphilis from 1495 and the next 30-40 years: It was a new disease! The Pre-Columbian skeletons with "clear" signs of syphilis could then be ascribed to either bejel or jaws.

cf. On the Origin of the Treponematoses: A Phylogenetic Approach, PLoS Neglected Tropical Diseases 2008
I did see the PLoS article, Jan. It's a very good one. I didn't, however, look to see if there were molecular studies done on the bones of any of these supposedly pre-Columbian cases of syphilis. If studies of the Old World bones isolate the same pathogen that causes modern venereal syphilis, what happens to the argument?

The authors of the new article on the Romano-Spanish case of treponemal infection do suggest that it could have been bejel, which results in lesions to the tibia quite often. The diagnosis of venereal syphilis from a skeleton is usually made only when there are also changes to the cranium (caries sicca, which happens quite rarely with bejel).

This skeleton didn't have a preserved head. Still, the authors want to revise the palaeopathological guidelines for diagnosing treponemal disease and to train more osteologists to recognize treponemal lesions, especially in the postcranial remains (tibia).

I hope that with the increase in availability of molecular methods and the decrease in price, eventually we'll get more DNA analysis of skeletons with treponemal disease, malaria, etc., which will help us understand the diseases in antiquity and lead to better diagnostic criteria for identifying lesions in bone.
Jan Helldén said…
I quite agree: It will be very interesting to hear of future results of DNA analysis from the pre-Columbian European bones. It can surely change everything.

The other day i tweeted this: Pathogen Genomics Has Become Dirt Cheap (podcast) - The cost has dropped in 10 years from $500,000 to as low as $10, so hopefully we don't have to wait long for new insights into the riddle of syphilis.
I saw that tweet, Jan, and it made me very happy. I'm starting a new aDNA project on my Romans very soon, and the next step of the project (after finding out more about their origins) is to look for malaria. It's nice that the cost is coming down so much and so quickly - even anthropologists will be able to afford it!

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