Historic Dispute : Did syphilis originate in the New World, from which it was brought to Europe by Christopher Columbus and his crew?

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Viewpoint: Yes, syphilis originated in the New World and was brought to Europe by Christopher Columbus's crew.

Viewpoint: No, syphilis was a disease that had long been in the Old World; it was simply a coincidence that it flared up shortly after Columbus's return from the New World.

Since the emergence of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) in the 1970s, interest in the origin of syphilis has grown because of parallels between the history of syphilis and that of AIDS. Both diseases seemed to arise suddenly and spread rapidly, causing severe illness and death. Scholars have suggested that understanding the history of syphilis might provide a guide for AIDS policy. Today, AIDS, syphilis, and gonorrhea are considered the major venereal or sexually transmitted diseases, but other venereal diseases, such as genital herpes, trichomoniasis, nongonococcal urethritis, chlamydia, chancroid, lymphogranuloma venereum, and granuloma inguinale, can also cause serious complications. The term "venereal" has long served as a euphemism in matters pertaining to sex. In the late twentieth century, the phrase "sexually transmitted disease" officially replaced the older terminology. Although both terms have been applied to diseases that are incidentally transmitted by sexual contact, such as scabies and crab lice, a more restricted definition includes only those diseases that are never, or almost never, transmitted by any other means.

Syphilis and the Renaissance Syphilis has been called many things, including the "Scourge of the Renaissance." European art, culture, science, and scholarship were transformed during the period known as the Renaissance. This period is also remarkable for its changing patterns of epidemics and its vivid reports of apparently new and violent diseases. In part, the expanding medical literature is associated with the invention of the printing press in the early 1400s, one of the inventions that helped transform the medieval world. The printing press made it easier to disseminate reports of new diseases. Diseases previously rare, absent, or unrecognized—such as syphilis, typhus, smallpox, and influenza—became major public health threats. No disease raises more intriguing questions than syphilis, a disease that traces the hidden pathways of human contacts throughout the world, and the intimate links between social and medical concepts. Despite the number of historical references to venereal diseases, many Renaissance physicians were convinced that syphilis was unknown in Europe until the end of the fifteenth century; others argued that there was only one "venereal scourge," with variable manifestations. The confusion is not surprising, given the natural history of the major venereal diseases.

The Symptoms of Syphilis Syphilis has been called the "great mimic" because its symptoms are similar to those of many other diseases. In fact, before the introduction of specific bacteriological and immunological tests, many physicians believed that "whoever knows all of syphilis knows all of medicine." Untreated, syphilis progresses through three stages of increasing severity. A small lesion known as a chancre is the first stage. The second stage involves generalized symptoms, such as fever, headache, sore throat, skin lesions, and swollen lymph nodes. Severe damage to major organ systems occurs in tertiary syphilis. Confusion between gonorrhea and syphilis has been a major theme in the history of venereal disease, but there is little doubt that gonorrhea is a very ancient and widespread disease. Fritz Richard Schaudinn (1871-1906) and Paul Erich Hoffmann (1868-1959) discovered the spirochete that causes syphilis in 1905. One year later August von Wassermann (1866-1925) discovered a specific blood test for the disease.

Early Descriptions When accounts of syphilis appeared in the sixteenth century, the disease was known by many names, including the "French disease," the "Neapolitan disease," the "Great Pox," and "lues venereum." Syphilis, the name used today, was invented by Girolamo Fracastoro (1478?-1553), an Italian physician, scientist, and poet. An acute observer of plague, typhus, and other contagious diseases, Fracastoro was a pioneer of epidemiology (the study of the spread of epidemic diseases) and an early advocate of the germ theory of disease. In On Syphilis, or the French Disease (1530), Fracastoro created the story of Syphilis the shepherd, whose blasphemy brought about the first outbreak of the scourge. Ever since Fracastoro described the disease, its natural history, mode of transmission, and contemporary remedies, medical historians have debated the same questions: when and where did syphilis originate?

The "Columbus Theory" According to sixteenth-century medical astrologers, a strange conjunction of Jupiter, Saturn, and Mars produced a toxic miasma, or poisonous gas, that brought a new epidemic disease to Europe. Even today, astrologers might argue that this theory has never been disproved. Another sixteenth-century theory was based on the idea that the New World was the source of new diseases, as well as new plants and animals. The expansion of commerce, travel, and warfare that characterized the fifteenth century transformed patterns of epidemic disease. Thus, many Renaissance physicians adopted the "Columbus Theory" as an answer to the origin of syphilis; that is, they assumed that Christopher Columbus and his crew had imported syphilis from the New World to the Old World. Fracastoro recommended mercury as a remedy for syphilis, but many other physicians favored an expensive remedy known as "Holy Wood," which was made from the bark of trees indigenous to the New World. According to the ancient Doctrine of Signatures, if syphilis originated in the New World, the remedy should be found there. Therefore, physicians and merchants who profited from the use of Holy Wood were staunch advocates of the Columbus Theory. The Columbus Theory appeared to explain many observations about syphilis, but critics argued that coincidence should not be confounded with causation. Some historians blamed the physical and mental deterioration of Columbus on syphilis, but other explanations are equally plausible. Rodrigo Ruiz Diaz de Isla (1462-1542) was one of the first physicians to assert that members of the crew of Columbus had imported syphilis to Europe. Although de Isla claimed that he had treated sailors with a new disease in 1493, he did not publish his observations until 1539.

The "French Gonorrhea" Circumstantial evidence supported the Columbus Theory, but Fracastoro argued that there was significant evidence that syphilis was not an imported disease. The physician and alchemist known as Paracelsus (1493?-1541) called the new venereal disease "French gonorrhea" and suggested that it arose through sexual intercourse between a leprous Frenchman and a prostitute with gonorrhea. Some physicians thought that the disease that was diagnosed as syphilis in the sixteenth century might have been misdiagnosed as leprosy in previous eras. Allusions to "venereal leprosy" and "congenital leprosy" before 1492 suggest that some medieval "lepers" might have been syphilitics. To determine the validity of this theory, scientists have looked for syphilitic lesions in bones found in leper cemeteries throughout Europe and the Middle East.

The "Unitarian Ancestral Treponematosis Theory" Two other interesting theories of the origin of syphilis require some knowledge of the causative agent of the disease as well as its natural history. These theories are known as the "African, or Yaws Theory" and the "Unitarian Ancestral Treponematosis Theory." If diseases were catalogued in terms of etiological, or causative, agents instead of means of transmission, syphilis would be described as a member of the treponematosis family. The treponematoses are diseases caused by members of the Treponema group of corkscrew-shaped bacteria known as spirochetes. The four clinically distinct human treponematoses are syphilis; yaws and pinta (contagious diseases commonly found in the Tropics); and bejel (or nonvenereal endemic syphilis). Some bacteriologists believe that these diseases are caused by variants of an ancestral spirochete that adapted to different patterns of climate and human behavior. Syphilis is caused by Treponema pallidum ; bejel by Treponema pallidum endemicum ; yaws by Treponema pertenue ; and pinta by Treponema carateum .

The Yaws Theory According to the African, or yaws theory, syphilis was the result of the unprecedented mixing of the germ pools of Africa, Europe, and the Americas. With the Native American population decimated by smallpox and other Old World diseases, Europeans began importing African slaves into the New World within 20 years of the first contacts. If Africans taken to Europe and the New World were infected with yaws, changes in climate and clothing would have inhibited nonvenereal transmission of the spirochete. Under these conditions, yaws could only survive by becoming a venereal disease.

Skeletal Evidence The Columbus Theory requires, at the very least, conclusive proof of the existence of syphilis in the New World before 1492; unequivocal evidence of syphilis in Europe before the voyages of Columbus would disprove this theory. Human skeletal samples provide the bulk of the evidence for the presence of various diseases in pre-contact America and Europe. During the 1990s bones with diagnostic signs consistent with syphilis were discovered in some allegedly pre-Columbian skeletons in several European burial grounds. However, few diseases leave a characteristic mark in the bones, and different diseases may produce similar lesions. If the diagnosis and dating of skeletons in these European sites can be confirmed, it would mean that syphilis was present in both the Old World and the New World before the voyages of Columbus. However, given the difficulties inherent in paleopathology, many researchers argue that the diagnostic evidence for syphilis in pre-Columbian America and Europe remains problematic. Although partisans of various theories present many ingenious arguments, many experts believe the evidence is not yet compelling. Some historians argue that despite advances in understanding the treponematoses, medical detectives are no closer to a definitive account of the origin of syphilis than medical authorities are to eradicating sexually transmitted diseases.

—LOIS N. MAGNER

Viewpoint: Yes, syphilis originated in the New World and was brought to Europe by Christopher Columbus's crew. The question of the origin of syphilis has been energetically debated since the disease first appeared in Europe in the late fifteenth century, ravaging the continent with an epidemic of great virulence. Charles VIII, the Valois king of France, invaded Italy in 1494 with an army of over 30,000 mercenary soldiers hired from all over Europe. Charles's army reached Naples, which was primarily defended by Spanish soldiers, in early 1495. After holding the city for a few months, Charles's forces retreated; by early summer King Charles had disbanded his army and returned to France. Unfortunately, his soldiers were infected with a mysterious disease, one so new that doctors had no name for it. Initially called "the Neapolitan disease," over the next centuries the disease would be known by an extensive variety of terms, with "the French sickness" and "the great pox" being the most common. Although it was not until the nineteenth century that the name "syphilis" was universally accepted, to avoid confusion the term "syphilis" will be used throughout the essay. Regardless of the many names employed, as Charles's mercenaries returned to their native lands or moved elsewhere to wage war, they spread the disease throughout all of Europe in what quickly became a major epidemic. Since this was a period of European expansion, known as the Age of Exploration, syphilis was soon carried by European sailors into the non-European world, reaching India and China by 1504.

Symptoms of Syphilis Contemporaries of the initial epidemic agreed on two things: The first was that the disease was venereal; that is, it was spread by sexual intercourse. The first noticeable symptom of syphilis was (and still is) the development of a chancre or raised pustule on the genital organs of both male and female victims. The second factor agreed upon by all commentators was that syphilis had a frightening impact on the body. After some time, the first chancre would disappear, but new sores would develop over the body, especially on the face. This second period was coupled with great pain in the bones and often ended in death. Alexander Benedetto, a papal doctor, reported in 1497 that he had seen victims who had lost hands, feet, eyes, and noses because of the disease. Syphilis, he remarked, made "the entire body so repulsive to look at and causes such great suffering … that this sickness is even more horrifying than incurable leprosy, and it can be fatal." Europeans were terrified of syphilis. Scores of local rulers and municipal governments quickly issued decrees banning those with the disease from their territories. These early symptoms of syphilis are important in determining the origin of the disease. After several decades, the severity of the symptoms began to abate. Documentary evidence establishes that syphilis was much more severe in the first half of the sixteenth century than it has ever been since then. This epidemiological pattern is consistent with the behavior of a disease in an area that has never experienced it and whose inhabitants thus have no immunity to it. The disease loses its virulence over time as people's bodies begin developing some protective immunity to it. This indicates that until 1495, Europeans had never suffered from syphilis. The bone pains are of even greater significance in determining the disease's origin. Syphilis is one of several diseases that modifies bone structures by causing skull and bone lesions. As will be seen, the existence of these bone lesions will ultimately settle the debate over the origin of syphilis.

Oviedo's New World Theory This debate had divided doctors and other learned authorities since the onset of the disease. Some adopted the usual bromide that syphilis had been inflicted upon humans as punishment for their sins, in particular for their sexual transgressions, given the venereal nature of the disease. Others relied on an astrological explanation, holding that epidemics were the result of unfortunate alignments of planets. However, a new theory of the disease's origin appeared in 1526 with the publication of Fernández de Oviedo y Valdés's Summary of the Natural History of the Indies, in which Oviedo, who spent over a decade in Hispaniola as a Spanish administrator, wrote: "[You] may take it as certain that this malady comes from the Indies" and that it was brought to Europe by Columbus's sailors. Rodrigo Ruy Diaz de Isla made exactly the same claim in his Treatise on the Serpentine Malady (1539). Together these two publications initially proposed the New World, or Columbian, theory of the origin of syphilis. Opponents of this thesis have attacked it on the basis of the timing of its first appearance. Why, they question, did over 30 years pass after Columbus's first voyage before this hypothesis was proposed? There is strong evidence that de Isla, a Spanish doctor, wrote his account in 1506 or earlier, even though it was not published until more than three decades later. Hence, his claim to have treated men who had sailed on Columbus's first 1492-1493 voyage and who had developed syphilis upon their return was written relatively soon after the event. He also claimed to have treated individuals suffering with syphilis in Spain before Charles VIII's invasion of Italy, implying that it was Spanish soldiers who carried the disease to Naples. While this is not incontrovertible evidence for the New World theory, it is difficult to imagine why Diaz de Isla would fabricate his account. Other critics of the New World theory have pointed out that Oviedo had purchased considerable amounts of land in Hispaniola. In his writings Oviedo stated, correctly, that the natives of the island, the Taino, believed that wood from the guaiac trees which grew there could cure syphilis. Oviedo subsequently formed a partnership with the Fuggers of Augsburg (a family of prominent German financiers and merchants) and obtained a monopoly to import guaiac wood into the Holy Roman Empire. Critics claim that Oviedo was exploiting the popular belief that for every harmful affliction, God had placed a cure nearby. If Oviedo could establish that syphilis came from the New World then, according to this assumption, the cure would come from there as well. He stood to make a fortune importing the wood into Europe. However, these critics have failed to question the origin of the idea that guaiac wood cured syphilis. It would only be prevalent among the Taino people if syphilis, or something like it, also existed there. Nor do these critics take into account the fact that a German author named Nicholas Poll claimed in 1517 that guaiac wood from Hispaniola reportedly cured the disease.

The Old World Hypothesis Even before the New World theory was advanced, a number of authors claimed that syphilis had been present in Europe since the time of the ancient world. Those holding this thesis of an Old World origin used passages from the Bible, Galen's writings, medieval texts and works of literature, and Arabic sources to demonstrate that the "new" venereal disease had always been present in Europe and the Mediterranean area. Essentially, their argument was that the descriptions of leprosy and other afflictions in these ancient sources were really misdiagnoses of syphilis. They combed all sorts of literary sources for evidence, much of which even some present-day defenders of the Old World hypothesis admit is often forced and unconvincing. In the rapidly developing polemic over origin—there were 58 books on syphilis published by 1566—neither side could offer irrefutable evidence to win the debate. But the "American," or Columbian, theory was certainly more persuasive than the labored literary interpretations of the Old World adherents, and by the eighteenth century, belief in the New World origin of syphilis was very widely held. Both Montesquieu and Voltaire accepted the Columbian theory, and for good reason: In their 1988 exhaustive review of the controversy, modern scholars Baker and Armelagos conclude that, with regard to reliance on the documentary evidence of written sources, "the case for pre-Columbian syphilis in the Old World rests solely on vague and ambiguous disease descriptions and must, therefore, be rejected." The controversy was far from over, however. In the second half of the nineteenth century, microbiology emerged as a new scientific field. With the formulation of the germ theory, with Robert Koch's demonstration that specific diseases were caused by different bacteria, and with the development of improved microscopes, research into syphilis yielded valuable information. By 1905, it had been discovered that the spirochete bacterium Treponema pallidum caused syphilis and could only be contracted either through sexual intercourse or congenitally. It was soon learned that other treponemata were the agents that produced the diseases yaws and pinta, both of which were endemic to the American tropics and both of which were present on Hispaniola at the time of Columbus's first voyage. These bacteria are so similar that even under today's high-powered microscopes they are still indistinguishable. Evidence also accumulated that under changed environments, treponemata could mutate from one form to another. So Treponema pertenue, the bacterium that caused yaws in Hispaniola, might mutate to Treponema pallidum in Europe's climate, thus causing syphilis there.

Archaeological Evidence As indicated earlier, syphilis is one of the diseases that causes abnormal changes in bone structure. Its lesions leave skeletal evidence of its presence, as do diseases such as yaws and conditions such as lithopedion. Although the documentary evidence indicated a New World origin of syphilis, adherents of the Old World origin argued that this evidence was not absolutely conclusive. This being the case, from the 1890s to the present the focus of the debate shifted from a search for literary sources to the field of archaeology, the study of ancient history through the examination of physical remains. As archaeology developed as an independent science in the late nineteenth century, its practitioners learned that skeletal remains could reveal a great deal about past events and provide information that written sources could not. If bones and skulls were found in the Americas with lesions indicating the presence of syphilis before 1492, but could not be found in the Old World prior to that date, then the Columbian origin of syphilis would be conclusively proven. If, however, the reverse were the case, then the Old World theory would hold sway. That is, if pre-1492 skeletal evidence was found in the Old World with syphilitic lesions but not in the Americas, then obviously the disease could not have come from Hispaniola. If pre-Columbian skeletal evidence of syphilis was found in both areas, the Old World case would be strengthened to the point that it could be demonstrated that while syphilis may not have originated in Europe, it was not a fifteenth-century New World import. The results of this century-long search of archaeological sites in both Europe and the Americas have demonstrated the validity of the New World thesis of syphilis's origin. Numerous sites in the Americas stretching from New York to Peru have provided an abundance of skeletal evidence indicating the pre-1492 existence of the treponemata diseases of yaws and syphilis. On the other hand, no pre-Columbian skeletons bearing syphilitic lesions have been found in Europe. For example, in an exhaustive study made in the 1970s and 1980s in Czechoslovakia of over 10,000 skeletons found in medieval cemeteries, no evidence of syphilis was found. These findings conclusively demonstrate the New World origin of the disease. Occasionally a news item will appear claiming that pre-Columbian bones with lesions indicating that the individual suffered from syphilis have been found in Europe, and the debate will momentarily flare up. However, over time it invariably turns out that the lesions were caused by some other disease or condition. In 1996, for instance, it was announced that the skeleton of a seven-month-old fetus dating from the fourth century was found in Costebelle, France, bearing lesions from congenital syphilis. If true, this would have certainly revived the Old World hypothesis. However, a leading paleopathologist examined the skeleton and convincingly demonstrated that the bones were deformed by a case of lithopedion, an extremely rare and fatal occurrence related to the extrauterine formation of a fetus in the abdominal cavity; the fetus was not a victim of congenital syphilis. More recently, in August 2000, English paleopathologists announced that lesions of skeletons excavated at a friary in Hull proved the existence of syphilis in Europe by about 1475. In this case, however, the dating is uncertain, and some scientists believe the disease involved may have been bejel, which is prevalent in North Africa. Hence, while this discovery has refocused interest in the debate, it does not appear to be a viable threat to the New World thesis. There is still, however, some debate among the adherents of the New World theory. A small group of New World theorists advocate what is sometimes referred to as the "unitary" hypothesis. This theory maintains that following their sexual assaults on the Taino women, Columbus's men were infected with yaws, which is spread by skin contact. When these sailors returned to Europe, environmental changes caused the bacterium to mutate into the form that causes venereal syphilis, for which the Europeans had no immunity. Baker and Armelagos hold this position, concluding that "nonvenereal treponemal infection is a New World disease that spread to the Old World and became a venereal disease following European contact." While somewhat modifying the New World theory, this "unitary" position does not vitiate it because it holds that without contact with the diseases of the American tropics, there would have been no initial epidemic of syphilis in Europe. However, leading paleopathologists, such as Bruce and Christine Rothschild, argue that the causal agent of yaws and/or pinta had undoubtedly mutated and was causing syphilis in the West Indies long before Columbus arrived. Their examination of almost 700 skeletons from various New World sites convinced them that venereal syphilis was present in the tropical Americas at least 800 (and possibly as many as 1,600) years ago. They, and many other archaeological medical detectives, strongly claim that syphilis originated as a New World disease, most plausibly from a mutation of yaws. Thus Columbus's crews, after their brutal mistreatment of Taino women, proved to be the vector for the introduction of syphilis into Europe, where the disease had never been encountered. From there it was carried around the world.

—ROBERT HENDRICK

Viewpoint: No, syphilis was a disease that had long been in the Old World; it was simply a coincidence that it flared up shortly after Columbus's return from the New World. Controversies often occur over scientific issues where there is evidence on both sides of the question, but the evidence is not overwhelming on either side. In the case of medical controversies that involve the history of diseases such as syphilis, it is frequently difficult to obtain compelling evidence because descriptions of the diseases written in the distant past are usually vague since writers lacked the precise vocabulary to describe symptoms that is available to medical writers today. Thus it is difficult to make a confident diagnosis on the basis of these early writings. In addition, these descriptions are frequently based on ideas about disease processes that are often different from those we accept today, when evil spirits and punishment for sin—often cited as causes of syphilis—are not seen as valid topics for discussion in medical analyses. Also, at times the symptoms of more than one condition may have been described as signs of a single disease. For example, the symptoms of the two sexually transmitted diseases syphilis and gonorrhea were often confused and combined. This is not surprising since they both can be contracted through sexual intercourse, so it is very possible that the same person could be suffering from the two infections simultaneously. It was not until the creation of improved microscopes in the nineteenth century and the development of chemical tests for these diseases in the twentieth century that doctors were able to clearly differentiate between these two bacterial infections.

What Is Syphilis? Despite the problems involved in diagnosing the diseases of the past, there is a great deal of convincing evidence that syphilis was a disease that had been present in Europe long before Columbus's time, thus making it a disease of the Old World rather than of the New. In order to present this case, some background on the symptoms and course of the infection is useful. Syphilis is caused by a spiral-shaped bacterium, a spirochete, of the species Treponema pallidum pallidum . The corkscrew shape may explain why T. pallidum pallidum, unlike most other bacteria, can pass through the placenta into a developing fetus and cause abnormal development and even miscarriage. This bacterium is a delicate organism that can only survive on warm, moist tissue, which is why it is spread through sexual intercourse. The infection it causes is a slow one, with a series of stages during which the host's immune system attempts to fight off the bacteria, though the bacteria often survive in the body to flare up later. Until the antibiotic penicillin became available in the mid-1940s, there was no effective treatment for syphilis, no effective way to stop the bacterium from causing its later and more damaging effects. Mercury compounds could slow the infection somewhat, but mercury is itself a poison that can damage the nervous system, so this is definitely a case where the cure was, if not worse than the disease, at least as harmful. Though the course of syphilis varies widely from individual to individual and not everyone experiences all the symptoms, the normal course of the disease begins with a chancre or raised pustule that usually develops a few weeks after exposure at the site where the bacteria entered the body—in other words, the chancre usually appears on the genitals. Even if the disease is left untreated, the chancre disappears after several days. Three or four months later a rash and low-grade fever may develop, sometimes accompanied by inflammation of the joints. These are the symptoms of secondary syphilis and are signs that the spirochete has moved from the skin into the blood stream and that the immune system is now mounting a whole-body rather than a localized attack against the bacteria. One third of those with untreated syphilis seem to suffer no further problems after secondary syphilis and show no further evidence of the disease. Another third continue to have what is called a latent infection, which means that while there are no symptoms, they still test positive in blood tests for the infection. Months or years after secondary syphilis, the third group of patients develops tertiary syphilis, in which the immune response to the continuing presence of these spirochete bacteria can lead to destruction of the bones, the nervous system, and the heart and blood vessels, leading to disfigurement and crippling, paralysis and blindness, and ultimately to death. One other point is important to keep in mind about syphilis when weighing evidence as to its origins: T. pallidum pallidum is very similar to the organism T. pallidum pertenue, which causes a non-sexually transmitted disease called yaws. The names of these two organisms indicate just how similar they are: they are two varieties of the same species, T. pallidum . Yaws is now common only in the tropics as a skin disease in children, though, like syphilis, it can have long-term effects and can cause damage to the bones.

Not a "New" Disease The major point in the argument of those who see syphilis as originating in the New World and reaching Europe through the men who had accompanied Columbus on his voyage of discovery is that beginning in 1495 and extending into the first decades of the 1500s, syphilis spread throughout Europe, and at least some observers of the time considered it a new disease. But there are problems with this view, including the fact that it was not until this new wave of syphilis had existed for at least 15 years that observers began to speculate that it was a new disease carried back to Europe by Columbus. In addition, the debate over ancient versus Colombian origins for European syphilis did not intensify until the seventeenth century. This seems odd; if it was in fact so different from the diseases of the past, why was this not noted immediately? Also, could a disease that is relatively slow in the development of its symptoms have spread so fast throughout Europe, to be widespread by the late 1490s when Columbus had only returned in 1493? What everyone does agree on is that the form of syphilis which spread at the time was much more dangerous and deadly than it had been in the past or was to become in the future. Spread by sexual contact, it was highly contagious and caused pustules, pain, and itching of the skin, often spreading all over the body. These symptoms were followed by intense pains and a deterioration of the bones. This stage of the disease often ended in death. A possible explanation for these symptoms is not that they were caused by a new disease, but by a more virulent or deadly form of a long-occurring organism. This is not an uncommon phenomenon among bacterial infections, with a modern-day example being that of Staphylococcus aureus , in most cases a relatively harmless organism commonly found on the skin. But there is a deadly form of S. aureus responsible for toxic shock syndrome, an often-fatal infection that surfaced in the 1980s. When a more virulent form of T. pallidum pallidum did arise in Europe at the end of the fifteenth century, the political conditions were ideal for its spread. There were large armies amassing in several areas and large-scale troop movements. Wherever there are armies there are likely to be illicit sexual activities that spread sexually transmitted diseases; these, coupled with troop movements, hastened the spread of syphilis. Descriptions recorded by firsthand observers at the time tell of patients with many pustules, rather than the single pustule usually seen today, and with the symptoms of rash and painful swellings that are now associated with secondary syphilis occurring much more rapidly than they do today. After about 50 years, this particularly virulent form of syphilis seems to have subsided and was replaced by the more slowly progressing form that we see today.

Biblical and Other Ancient Evidence But is there evidence of syphilis in any form present in Europe and other parts of the Old World before the end of the fifteenth century? Those who support the hypothesis that it was the return of Columbus's expedition that triggered the outbreak of syphilis claim that there is no such evidence, but this view ignores a great deal of information pointing to the presence of this disease in Europe, the Middle East, and elsewhere in the Old World for centuries and maybe even longer. There are many reports in the Bible and other writings of a disease in which there are pustules and swellings, quite reminiscent of syphilis. In the recent study Microbes and Morals, Theodore Rosebury argues that while there are many passages in the Bible that can be more accurately seen as descriptions of syphilis than of any other infection we know of today, the descriptions of the plagues in Egypt and in Moab are the most detailed and convincing passages on syphilis. These plagues are described as causing scabs and itching, perhaps as a result of chancres and rashes. There are also descriptions of madness, blindness, and "astonishment" of the heart, which could be interpreted as heart failure—all three of these symptoms are related to tertiary syphilis. In describing the plague of Moab, there are many references to loose sexual practices leading to disease, another indication that the infection involved was syphilis. Those who support the Colombian origin view argue that many of the passages cited by the anti-Colombian advocates describe leprosy, not syphilis. Admittedly, it is difficult to make a specific diagnosis one way or the other on the basis of sketchy descriptions, but a few details are telling. One is that in some cases, there are Medieval and biblical reports of the disease being transmitted to unborn children. This is never the case with leprosy, but it is possible with syphilis since the spirochete can penetrate the placenta. Also, a number of historians have amassed a large collection of evidence that syphilis was known in ancient China and Japan, and was familiar to Hindus and to ancient Greeks and Romans. This evidence includes comments on the disease's relationship to sexuality and to birth defects, both hallmarks of syphilis as opposed to other diseases with which it might be confused, including leprosy and the plague. Such reports are likely to be documenting cases of syphilis in the ancient world and throughout Asia.

Skeletal Remains There is also more solid evidence rather than just verbal reports. In 2000, British researchers unearthed 245 skeletons from a cemetery in northeastern England. Three of these skeletons showed clear signs of the type of damage associated with syphilis, with 100 more showing slight indications of such damage. Radiocarbon dating was used on the skeleton showing evidence of the most severe disease and revealed that the man died sometime between 1300 and 1450, well before Columbus's voyage. Some argue that the bone lesions could be the result of yaws rather than syphilis. But the same argument can be used against a favorite piece of evidence presented by pro-Colombian advocates: the discovery of syphilis-like skeletal lesions in bones dated to pre-Columbian times and found in various parts of South, Central, and North America. Advocates contend that this proves that syphilis was present in the New World before the time of Columbus, a view that some anti-Colombians argue against. So it would seem that the physical evidence from bone lesions is less than convincing on either side of the dispute. Of course, the presence of syphilis in England in the fourteenth and fifteenth centuries does not necessarily mean that the infection was present in Europe from ancient times. Still another hypothesis, somewhat of a compromise between the Colombian and anti-Colombian views, is that it was not Columbus but the Vikings who brought syphilis back from the New World. There is evidence that the Vikings had reached Canada's eastern shores hundreds of years before Columbus's voyage, and they began trading in northeastern England around 1300, which was about the time the recently discovered skeletons started to show signs of the disease. There may eventually be a resolution of this controversy thanks to molecular genetics. In 1998, the genome, or genetic makeup, of T. pallidum pallidum was completely deciphered, so biologists now have a record of all the information in the genes for the organism that causes syphilis. The same information is now being accumulated for T. pallidum pertenue , the cause of yaws. When this sequence is deciphered, researchers can hunt for bacterial DNA (deoxyribonucleic acid—the nucleic acid found in the nuclei of all cells) in the bones that have been unearthed in England and at other sites and determine which sequence most closely matches the bacterial DNA from the bones. In one sense it would be disappointing if such information finally settled this centuries-old disagreement. As R. R. Wilcox, who argued against the Colombian hypothesis, wrote over a half a century ago: "It would be a great pity if someone did produce irrefutable evidence for either side and thus prevent any further such interesting speculation."

—MAURA FLANNERY

Further Reading Baker, Brenda J., and George J. Armelagos."The Origin and Antiquity of Syphilis: Paleopathological Diagnosis and Interpretation." Current Anthropology 29, no. 5 (1988): 703-737. Reprinted in Kenneth F. Kiple and Stephen V. Beck, eds. Biological Consequences of the European Expansion, 1450-1800. Aldershot, Great Britain: Ash-gate, 1997, pp. 1-35. Crosby, Alfred W. The Columbian Exchange: Biological and Cultural Consequences of 1492. Westport, Conn.: Greenwood Press, 1972. Guerra, Francisco. "The Dispute over Syphilis:Europe versus America." Clio Medica 13 (1978): 39-62. Hackett, C. J. "On the Origin of the HumanTreponematoses." Bulletin of the World Health Organization 29, no. 7 (1963): 7-41. Holcomb, Richmond C. "The Antiquity ofSyphilis." Bulletin of the History of Medicine 10 (1941): 148-77. Kiple, Kenneth, and Stephen Beck, eds. Biological Consequences of the European Expansion, 1450-1800. Brookfield, Vt.: Ashgate, 1997. Malakoff, David. "Columbus, Syphilis, andEnglish Monks." Science 289 (August 4, 2000): 723. Origins of Syphilis. <http:www.archaeology.org/9701/newsbriefs/syphilis> . Quétel, Claude. History of Syphilis. Trans. JudithBraddock and Brian Pike. Baltimore: Johns Hopkins University Press, 1990. Rosebury, Theodore. Microbes and Morals: The Strange Story of Venereal Disease. New York: Ballantine Books, 1973. Salyers, Abigail, and Dixie Whitt. Bacterial Pathogenesis: A Molecular Approach. Washington, D.C.: ASM Press, 1994. Watts, Sheldon. Epidemics and History: Disease, Power and Imperialism. New Haven, Conn.: Yale University Press, 1997. Weisman, Abner I. "Syphilis: Was It Endemic inPre-Columbian America or Was It Brought Here from Europe?" Bulletin of the New York Academy of Medicine 42, no. 4 (1966): 284-300. Zimmer, Carl. "Can Genes Solve the SyphilisMystery?" Science 292 (May 11, 2001): 1091.

SYPHILIS AND AIDS: SOME INTRIGUING SIMILARITIES Although syphilis is caused by a bacterium while the causative agent of acquired immune deficiency syndrome (AIDS) is the human immunodeficiency virus (HIV), there are intriguing similarities in the ways these diseases have afflicted humans. Both erupted suddenly in Western societies: syphilis in Europe in the 1490s; AIDS in the United States in the early 1980s. In both instances, medical experts were baffled over the cause of the new disease. Within a decade of their initial appearance, both diseases became pandemic, spreading rapidly around the world creating a global calamity of massive proportions. In each case, this dispersion was facilitated by improvements in transportation. The expansion of Europe in the sixteenth century expedited the spread of syphilis, while growing international air travel, urbanization, and the construction of roads has accelerated the transmission of HIV in Africa, Asia, and Latin America. Both diseases are spread primarily by heterosexual intercourse. It is true that AIDS was first identified in male homosexuals and intravenous drug users. Nevertheless, today the primary cause of the worldwide spread of HIV is heterosexual intercourse. Unfortunately, both syphilis and HIV can also be contracted congenitally, as the fetus develops in the uterus. As with syphilis, the sudden emergence of AIDS triggered intense debate over the origin of the disease. Some early theories viewed AIDS as a punishment, either natural or divine, for deviant behavior such as homosexuality and drug abuse. Other theories have postulated that HIV was developed in government germ warfare laboratories and had somehow accidentally "escaped." Those attracted to conspiracy theories agreed that the virus was the product of a secret biological warfare project, but they argued that its release was deliberate, not unintentional. Still others have theorized that HIV was the inadvertent result of a medical procedure. Medical historian Edward Hooper, for example, has suggested that the virus was spread to humans through an African oral polio vaccine developed in the late 1950s. This vaccine was grown in fluid containing kidneys of chimpanzees, some of which might have been infected with an animal form of HIV. Throughout the 1990s, however, an increasing number of researchers adopted the hypothesis that HIV was one of those diseases, such as dengue fever (a tropical disease) and the liver disease hepatitis B, that originated in other species. Today, based especially on the work of Beatrice Hahn, the scientific community widely accepts the view that HIV developed first in west-central Africa where humans, when butchering chimpanzees for meat, were infected with an animal version of the virus which closely resembles the HIV now plaguing us.

—Robert Hendrick

KEY TERMS

CHANCRE: A dull, red, insensitive ulcer of sore, usually at the site at which the infectious organism, in this case, the syphilis-causing bacterium, enters the body.

CONGENITAL: Adisease or condition developed by a fetus in the uterus rather than being acquired through heredity. Syphilis can be acquired congenitally.

LEPROSY: A chronic and contagious infection caused by a bacillus (rod-shaped) bacterium; the symptoms of this infection include skin and bone lesions or sores.

LITHOPEDION: An extremely rare and fatal occurrence related to the extrauterine formation of a fetus in the abdominal cavity. Following the fetus's death, severe calcification results in lesions on its skeleton.

PALEOPATHOLOGY: A branch of anthropology and medicine dealing with the analysis of skeletal remains, concentrating on the structural changes produced by diseases.

PINTA: A tropical skin disease caused by a spirochete which is indistinguishable from the treponema responsible for syphilis and yaws. It usually develops in childhood and is spread by skin contact, and not through sexual intercourse.

PLAGUE: A contagious and often fatal epidemic infection caused by a bacterium; it is spread from rats to humans through flea bites.

SPIROCHETE: A general term for any of the slender, spiral-shaped, and mobile bacteria of the order Spirochaetales.