Syphilis in post-medieval London | Human Anthropology

Syphilitic lesions on a cranial fragment
Syphilitic lesions on a cranial fragment from London.

In the Natural History Museum’s collections there are a number of human remains from various sites throughout London. Many of these originate from post-medieval burial grounds which were closed in the 1850s. Although many of the bodies were moved to outer-London cemeteries, some were left behind. It is, therefore, not unusual to accidentally uncover post-medieval burials during building works in the capital.

Natural History Museum scientists have been analysing some of these remains, and have discovered fascinating insights into life and death in post-medieval London. Among these were discovered five instances of severe pathological changes from syphilis infections. Here, Rosalind Wallduck, describes the disease and how we identify it in archaeological collections.


Electron micrograph of Treponema pallidum, the cause of syphilis.
Electron micrograph of Treponema pallidum, the cause of syphilis.

Syphilis is an infectious disease caused by a bacterium known as Treponema pallidum. It is spread through sexual contact and can be passed on from mother to baby during foetal development or birth.

The origins of the disease are somewhat debatable, but it appears to be a relatively modern disease; becoming prevalent during the post-medieval period. In Britain it was often known as the French disease, reportedly brought across from our neighbours over the channel; but in France it was known as the English disease. It has also been theorised that explorers and settlers in North America brought the disease into Europe.

When passed on during sexual context, the disease manifests within a few weeks as sores at the point of contact, as the primary stage of syphilis. If left untreated, over the following months the sores will heal but the infection becomes more widespread. This stage, secondary syphilis, causes symptoms ranging from a rash to a fever which can be mistaken for a ‘flu like illness. Years may pass without any further signs of infection, and the individual might be unaware that they are carrying the disease.

In around a third of infected people, tertiary syphilis may occur up to thirty years after initial infection. During this time the individual is no longer infectious. The disease causes erosive granulomas (infected and inflamed masses) to form on the skin, and importantly for archaeologists, the bones.

Identifying syphilis from bones

The faces of a female and male showing the bone and soft tissue erosions characteristic of tertiary syphilis.

Early manifestation of syphilis arises as periosteal reaction and the deposition of new bone. The development of gumma (benign masses) then results in lesions as tissues undergo necrosis, effectively being eaten away. This is the body’s attempt to slow down the action of the bacterium after the immune system fails to kill it off. The bone reacts by trying to heal, causing traces of remodelling and scarring of the surface. These changes are known as caries sicca.

Identifying advanced cases of tertiary syphilis is in fact relatively easy for archaeologists. The disease causes bone to have a characteristic moth eaten appearance. Effects of early stage syphilis on the bone, however, are rare, with the most characteristic pathological changes occurring in the tertiary phase, most commonly on the skull. The frontal bone is usually affected first, but lesions can occur diffusely over the cranium.

Two cases of tertiary syphilis from Ludgate Hill and Whitechapel, London.


The physical effects of syphilis are particularly unsightly (and smelly!). If infected for long enough, the necrosis of tissue might lead to skin ulcers, nerve paralysis, and gradual blindness and the lesions can even penetrate through the skull leading to metal defects and dementia. Saddle nose would have been particularly hard to disguise. This is where the flesh of the nose rots away and the bridge of the nose caves into the face. To hide this deformity a prosthetic nose made of metal was sometimes used, but others turned to surgeons in order to achieve more ‘natural’ looking reconstructions.   Small areas of skin could be removed from unaffected areas of the face and attached to the nose, twisted in place, and sewn on. Another method sewed the skin of the upper arm, while still attached to the arm, onto the face before severing the skin a few weeks later after it had time to heal in place.

Without barrier contraception or antibiotics, syphilis remained prevalent and individuals with the disease were effectively incurable. Some medical practitioners tried to use mercury, which sometimes reduced the visible appearance of the sores but had undesirable side effects of its own.

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The Human Remains Digitisation Project was made possible thanks to the generous support of the Charles Wolfson Charitable Trust.