Photograph as Skin, Skin as Wax: Indexicality and the Visualisation of Syphilis in Fin-de-Siècle France The William Bynum Prize Essay.

In early twentieth-century France, syphilis and its controversial status as a hereditary disease reigned as a chief concern for physicians and public health officials. As syphilis primarily presented visually on the surface of the skin, its study fell within the realms of both dermatologists and venereologists, who relied heavily on visual evidence in their detection, diagnosis, and treatment of the disease. Thus, in educational textbooks, atlases, and medical models, accurately reproducing the visible signposts of syphilis - the colour, texture, and patterns of primary chancres or secondary rashes - was of preeminent importance. Photography, with its potential claims to mechanical objectivity, would seem to provide the logical tool for such representations. Yet photography's relationship to syphilographie warrants further unpacking. Despite the rise of a desire for mechanical objectivity charted in the late nineteenth century, artist-produced, three-dimensional, wax-cast moulages coexisted with photographs as significant educational tools for dermatologists; at times, these models were further mediated through photographic reproduction in texts. Additionally, the rise of phototherapy complicated this relationship by fostering the clinical equation of the light-sensitive photographic plate with the patient's skin, which became the photographic record of disease and successful treatment. This paper explores these complexities to delineate a more nuanced understanding of objectivity vis-à-vis photography and syphilis. Rather than a desire to produce an unbiased image, fin-de-siècle dermatologists marshalled the photographic to exploit the verbal and visual rhetoric of objectivity, authority, and persuasion inextricably linked to culturally constructed understandings of the photograph. This rhetoric was often couched in the Peircean concept of indexicality, which physicians formulated through the language of witness, testimony, and direct connection.

Congenital syphilis or mercury treatment: dental alterations in a twelfth- or thirteenth-century child from Medinaceli, Soria, Spain.

Syphilis, together with its variant congenital syphilis, is a disease caused by Treponema pallidum subsp. pallidum. This paper documents possible new skeletal evidence for congenital syphilis from the Medieval Era (twelfth and thirteenth centuries CE) burial site of Medinaceli in the Province of Soria in North-Central Spain. What is involved is dental alteration due to congenital syphilis, mercury treatment, or a combination of both. This study focuses on the hypoplastic dental changes observed in a child approximately eight years of age. Only a fragmented skull with left maxilla and the left side of the mandible were preserved. Macroscopic analysis, X-rays, computerized tomography (CT) and mercury detection analysis by inductively coupled plasma mass spectrometry (ICP-MS) techniques were used to observe dental abnormalities. In addition to extensive caries in the upper second deciduous molar, pulpo-alveolar lesions and facial alterations were observed. The absence of the rest of the skeleton tends to make a diagnosis of congenital syphilis difficult. However, the dental stigmata observed do permit a reasonable diagnosis.

Molecular detection of Treponema pallidum subspecies pallidum in 150-year-old foetal remains, southeastern France.

PURPOSE: Syphilis, caused by Treponema pallidum subspecies pallidum , is considered as an old disease affecting humans; traces of such infections, including congenital syphilis, are potentially identifiable in archaeological samples. The aim of this research was to perform macroscopic and molecular investigations of T. pallidum on six infant remains, buried between 1837 and 1867, from the cemetery of 'Les Crottes' in Marseille city (southeastern France). METHODOLOGY: Pathological analysis of bones from individuals, aged from the twenty-ninth week of amenorrhea to 4-9 months, was performed. Samples served also as a source of ancient DNA (aDNA) for PCR-based molecular investigations targeting T. pallidum DNA; all samples were also tested for Mycobacterium tuberculosis and Plasmodium falciparum DNA. Sequences characterized were cloned and sequenced, and compared to those available in databases.Results/Key findings. All samples tested displayed widespread osteoporotic lesions across the skeleton possibly related to some metabolic or infectious disorders. Subsequent molecular analysis revealed that one individual, SP332 (unborn, 29 amenorrhea weeks, inhumation date 1864-1866), exhibited positive signals for the five T. pallidum amplification systems tested; sequence analysis provided strong evidence for the effective detection of T. pallidum subspecies pallidum DNA. CONCLUSIONS: Individual SP332 is the first PCR-confirmed palaeopathological case of syphilis identified in France, and the youngest specimen ever to be diagnosed with certainty for congenital syphilis. Future research aimed at better characterizing this 150-year-old treponeme genome and exploring new archaelogical cases of syphilis in the very young should contribute to a better comprehension of the disease's history.

[A brief history of syphilis. The disease through the art and the artist]. / Une petite histoire de la syphilis. La maladie à travers l'art et l'artiste.

Considering its strong symbolic connotations and its rich history, syphilis could be regarded as the perfect example of venerian disease. It could also be seen as a representative disease of the whole medical history and the evolution of both medical ways of thinking and curing. In this work we will briefly discuss the history of the syphilitic disease and try to show how this condition has affected the life and works of some of the most famous artists of the 19th century. Moreover, we shall try to evoke the complex relationship between art and pathology.

Par ses connotations historiques et symboliques, la syphilis constitue la maladie vénérienne par excellence. Elle peut également être considérée à plus d'un titre comme une maladie représentative de l'histoire de la médecine et paradigmatique de l'évolution de la pensée médicale. Au travers de ce petit historique, nous tenterons de dresser une brève histoire de la maladie et de son traitement avant d'envisager la façon dont elle a pu influencer le parcours créatif de plusieurs figures artistiques majeures du XIXème siècle. Plus encore, nous discuterons brièvement des liens complexes que peuvent entretenir l'art et la maladie.

Vênus nos braços de mercúrio, bismuto e arsênio Notas históricas sobre sífilis gestacional antes da penicilina / Venus en los brazos de mercurio, bismuto y arsenio: Notas históricas sobre sífilis gestacional antes de la penicilina / Venus in the arms of mercury, bismuth and arsenic: Historical notes on gestational syphilis before penicillin

Resumo Buscou-se neste artigo debater sobre os saberes e as práticas médicas referente à sífilis, em especial à sífilis gestacional, no início do século XX. O objetivo central foi apresentar o debate médico travado em uma das principais faculdades de medicina do país acerca das consequências da sífilis para a mulher gestante e para o feto ou criança. A natalidade foi amplamente defendida por médicos que acabavam por condenar algumas práticas de mulheres que levariam a comprometer a gravidez. A metodologia de análise foi estabelecida a partir de um estudo de caso sobre a tese defendida em junho de 1913, na cadeira de clínica obstétrica, pelo médico recém-graduado Arnaldo Cavalcanti de Albuquerque. Constatou-se pela documentação que os tratamentos do período para sífilis gestacional eram ainda bastantes precários e as anotações médicas extrapolavam os limites clínicos, adentrando muitas vezes no plano de cobrança de valores morais.

Resumen Se buscó en ese artículo debatir sobre los saberes y prácticas médicas referentes la sífilis, en especial a la sífilis gestacional, a principios del siglo XX. El objetivo central fue presentar el debate médico desarrollado en una de las principales facultades de medicina del país acerca de las consecuencias de la sífilis para la mujer gestante y para el feto o niño. La natalidad fue ampliamente defendida por médicos que acababan por condenar algunas prácticas de mujeres que llevarían a comprometer el embarazo. La metodología de análisis fue establecida a partir de un estudio de caso sobre la tesis defendida en junio de 1913, en la cátedra de clínica obstétrica, por el médico recién graduado Arnaldo Cavalcanti de Albuquerque. Se constató por la documentación que los tratamientos del período para sífilis gestacional eran todavía bastantes precarios y las anotaciones médicas extrapolaban los límites clínicos adentrando muchas veces en la dimensión de cobranza de valores morales.

Abstract The aim of this article was to discuss the knowledge and medical practices regarding to syphilis, especially gestational Syphilis, in the beginning of the 20th century. The aim goal is to present the medical debate that took place in one of the main medical schools of the country about the consequences of syphilis for the pregnant women and for the fetus or child. The natality was widely defended by doctors who eventually condemned some practices of women that would lead to compromise pregnancy. The methodology of analysis was established from a study case on the thesis defended in June 1913, in the chair of obstetric clinic, by the recently graduated physician Arnaldo Cavalcanti de Albuquerque. It was found by the documentation that the treatments for the period for gestational syphilis were still very precarious and the medical notes extrapoleted the clinical limits charging several times moral values.

Presence of dental signs of congenital syphilis in pre-modern specimens.

OBJECTIVE: Tooth morphology can vary due to genetic factors, infectious diseases and other environmental stresses. Congenital syphilis is known to interrupt tooth formation i.e. odontogenesis and amelogenesis, producing specific dental characteristics. Variation of those characteristics can occur, resulting in dental signs "not typical" of the disease, however, they are described in the 19th century literature. Past treatments of congenital syphilis with mercury also interrupted dental processes resulting in significantly different dental signs. The aim of this study is to examine the dentition of the oldest (pre 15th century) cases attributed to congenital syphilis to determine whether their dental processes have been affected by either congenital syphilis itself, its treatments (mercury) or a combination of both (syphilitic-mercurial). DESIGN: Comparisons of dental signs of congenital syphilis and its mercuric treatments as described by Hutchinson, Moon and Fournier in the 1800s and in standardised methods as established by modern studies, are made with the dentition of specimens found in archaeological sites in Mexico, Italy, Turkey and Austria dating back to the Terminal Formative Period, Classical Antiquity, Byzantine times and Middle Ages. RESULTS: The dentitions of a child from Oaxaca, Mexico, St. Pölten, Austria, and two juveniles from Classical Antiquity site Metaponto, Italy, show signs attributed to syphilis only. One adolescent from Byzantine site Nicaea, Turkey, shows dental signs characterised as syphilitic-mercurial. CONCLUSIONS: Dental abnormalities observed in Mediterranean individuals match a range of signs attributable to congenital syphilis and its treatments, more so than the New World case. Therefore, it is likely that these individuals suffered from congenital syphilis.

Signos dentales de la sífilis congénita / Dental signs of congenital syphilis

La sífilis congénita es causada por una bacteria en forma de espiroqueta denominada Treponema pallidum; se transmite de la madre infectadaaal feto. Esta enfermedad causa distintas alteraciones sistémicas, dependiendoen qué fase de la sífilis se infecta el producto. El incremento de casos a nivel mundial hace necesario el estudio de su epidemiología y que se implementen programas de salud que atiendan a la población embarazada, con seguimiento por medio del control prenatal. Se estima que 1.5 por ciento de las mujeres embarazadas a nivel mundial la padecen. Las alteraciones dentales tienen su etiología en la infl amación provocada por la espiroqueta al momento de la amelogénesis; los signos dentales característicos de la sífi lis congénita son los incisivos de Hutchinson, molares de mora y, en menor medida, los caninos de Fournier. El propósito de este trabajo es hacer una revisión de la literatura, enfatizando en las características clínicas de la enfermedad que nos permitan realizar el diagnóstico de la sífilis congénita.

Congenital syphilis is caused by a spirochete bacterium called Treponema pallidum; it is transmitted from the infected mother to the fetus. This disease causes diff erent systemic alterations, dependingon which phase of syphilis the product is infected. The increase incases worldwide makes it necessary to study its epidemiology andto implement health programs that serve the pregnant population, with follow-up through prenatal control. It is estimated that 1.5% of pregnant women world wide suff er from it. Dental alterations have theiretiology in the infl ammation caused by the spirochete at the momentof amelogenesis; the characteristic dental signs of congenital syphilisare Hutchinson incisors, blackberry molars, and, to a lesser extent, Fournier’s canines. The purpose of this paper is to review the literature, emphasizing the clinical characteristics of the disease that may allowus to diagnose congenital syphilis.

Dental Stigmata of Congenital Syphilis: A Historic Review With Present Day Relevance.

Syphilis was the first sexually transmitted disease to be diagnosed in childhood. Most developed countries controlled syphilis effectively after the 1950s and congenital syphilis became rare. Since the late 1990s there has been a resurgence of syphilis in developed and developing countries and the WHO estimates that at least half a million infants die of congenital syphilis every year. The earliest reference to the dental manifestations of congenital syphilis was by Sir Jonathan Hutchinson, Assistant Surgeon at The London Hospital in 1861. Three main dental defects are described in congenital syphilis; Hutchinson's incisors, Moon's molars or bud molars, and Fournier's molars or mulberry molars. Although many physicians, dentists, and pathologists in developed countries will be aware of the dental features of syphilis, most will never have seen a case or made the diagnosis. The purpose of this article is to review some of the history of congenital syphilis, remind healthcare professionals of the features, and bring to their attention that the changes are still prevalent and that milder cases can be mistaken for other causes of hypoplasia.

A probable case of congenital syphilis from pre-Columbian Austria.

This study examines the skeletal remains of a subadult from an archeological site in Austria. Radiocarbon dating and archeological attribution indicate that this individual is of pre-Columbian origin. Most of the skeleton was recovered, and only the teeth and the orbital roofs show changes. Dental defects such as the mulberry molar and a tapered, fang-like canine suggest a diagnosis of congenital syphilis. This is the first probable case of congenital syphilis from pre-Columbian Central Europe. Our findings contribute to the pre-Columbian theory, offering counter evidence to the assumption that syphilis was carried from Columbus' crew from the New to the Old World.

Henry Moon and his molars.

Henry Moon qualified in London in medicine and dentistry, emigrated to New Zealand, eventually returning to London. He is known for his observations of the malformation of tooth cusps in children with congenital syphilis.

Curse on two generations: a history of congenital syphilis.

Before the microbiologic era, venereal diseases were poorly distinguished. Congenital syphilis was believed to be transmitted during conception by the father's sperm, during delivery in the birth canal, or from infected milk or breasts. The most frequent maternofetal transmission was not considered because the mother's primary infection remained undiagnosed. The concept of treating infants with mercury transmitted by nurses' milk prompted the founding of a specialized infant hospital in Vaugirard in 1780: lactating syphilitic women received mercury orally and by rubbing it into the skin. Their own infant and a second infected infant from the foundling hospital were believed to be cured by their milk. Underwood described snuffles in 1789 and Bertin periosteal bone disease in 1810. Tardive congenital lues with keratitis, deafness, and notched upper incisors were described by Hutchinson in 1863. Feeding remained difficult, as wet nursing transmitted syphilis to the nurse and other infants. Specialized institutions tried goat or donkey milk. A debate between contagionists assuming exclusively maternal infection and hereditists assuming germinal transmission by the father's sperm continued throughout the 19th century. Schaudinn and Hoffmann identified Spirochaeta pallida in 1905. When Ehrlich discovered the efficacy of salvarsan in 1910, Noeggerath treated infants with the new drug, pioneering the injection into scalp veins. In 1943, Lentz and Ingraham established penicillin treatment for congenital syphilis. Whereas this drug effectively prevented maternofetal transmission, treating infants remained difficult due to the Jarisch-Herxheimer reaction.

Sífilis congênita: mais de 500 anos de existência e ainda uma doença em vigência / Congenital syphilis: more than 500 years of existence and still a disease in validity

Objetivo: Objetivou-se, neste estudo, procurar identificar as causas ou falhas que condicionam alta incidência de sífilis congênita. A sífilis, embora conhecida pela humanidade há vários séculos, continua como um crescente desafio, sendo considerada, em alguns países subdesenvolvidos e em desenvolvimento, como o principal problema de saúde pública. Embora a prevalência da infecção pelo Treponema pallidum tenha diminuído sensivelmente com a descoberta da penicilina, na década de 40, ainda se observa tendência mundial de recrudescimento da sífilis entre a população em geral e, de forma particular, dos casos de sífilis congênita (SC). Na década de 1990, o Ministério da Saúde (MS) lançou o projeto de eliminação da SC, cuja meta seria reduzir, drasticamente, os casos para um em cada 1.000 nascidos vivos, porém, esta meta ainda não foi atingida. Este trabalho tem por objetivo averiguar o motivo pelo qual a sífilis congênita, apesar de possuir um tratamento seguro e eficaz, ainda se perpetua. Fontes de dados: Trata-se de uma revisão bibliográfica, que teve como dados secundários sites e revistas científicas. As bases de dados pesquisadas foram de publicações no período de 2001 a 2009. Síntese dos dados: A análise mostrou que os países que tiveram sucesso no controle foram aqueles que, além de eficientes medidas de saúde pública, tiveram melhora das condições gerais de vida da população e no exercício da cidadania. Conclusões: Enquanto estas mudanças não ocorrem, é importante que os profissionais de saúde se esforcem para que os serviços de saúde se tornem mais eficientes e organizados, aumentando as opções de acesso.

[Historical and medical review of syphilis-afflicted army leaders, rulers and statesmen].

Syphilis has changed the course of history. It is a sexually transmitted disease caused by spiral-shaped bacterium, Treponema pallidum. The disease has been known under many names during history, and has had a prominent role in history and literature for the last several hundred years. Since its recognition in 15th-century Europe as a new disease, syphilis has been the subject of great mystery and legends. Many believe that syphilis was brought to Europe by Columbus and his sailors, and, thereafter, many famous persons, such as political figures (King Charles VIII, Queen Mary I, Catherine the Great, Paul I, Vladimir Lenin), musicians and literary greats suffered from syphilis. Syphilis is a chronic, multistage disease with diverse and wide-ranging manifestations. Congenital syphilis is of particular concern, where the lack of prenatal testing and antibiotic treatment of infected pregnant women results in congenital infection of the fetus. Syphilis exists even nowadays and according to the World Health Organization estimates, there are 12 million new cases of syphilis occurring each year. While syphilis eradication seems a biologically plausible goal, the major political, cultural, and logistic difficulties involved make it unlikely. Regrettably, rather than becoming an infection of historical significance, syphilis continues to challenge researchers and clinicians in the era of HIV.

The du Bois sign.

According to the current literature, the term "du Bois sign" characterizes the condition of a shortened fifth finger as a symptom of congenital syphilis, Down syndrome, dyscrania, and encephalic malformation. Modern medical dictionaries and text books attribute the eponym to the French gynecologist Paul Dubois (1795-1871). Yet, a literature analysis revealed incorrect references to the person and unclear definitions of the term. Our findings showed that the origin of the term is based on observations made by the Swiss dermatologist Charles du Bois (1874-1947) in connection with congenital syphilis. In addition, a further eponymical fifth finger sign is closely associated with the du Bois sign. In conclusion, the du Bois sign has only limited diagnostic value and is frequently occurring in the normal healthy population.