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Cases of late syphilis documented at the cemetery of noblemen residents of the Knights of the Holy Sepulchre poorhouse (XVII-XVIII centuries) on Stradom in Cracow, Poland.


Anita Szczepanek1, 2, Jerzy Walocha3, Piotr Kochan4



Introduction

Syphilis, the most stigmatized and disgraceful disease (Fig. 1), is a common find in skeletal material from historic times especially at graveyards from bigger towns and cities.

figure1
Figure 1. Reconstruction of syphilitic changes, drawn by Jolanta Ożóg.
[please click on the image to enlarge]


One example is the cemetery of mainly male residents of the Knights of the Holy Sepulchre poorhouse on Stradom in Cracow, that was used in XVII and XVIII centuries. Landless nobility who fought in many battles for the Commonwealth of Poland lived there.

During excavations conducted in the year 2018, three parts of a large cemetery were found. At the biggest one, 1609 skeletons were discovered and the excavations were conducted by Dr Jacek Pierzak. This part was a multilayer burial ground with skeletons inhumed one by one without any coffins (Fig. 2, 3). Some of them were re-deposited earlier, so not all bone elements were present or could be matched with other parts.

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Figure 2. Stradom 12-14 cemetery, the concentration of skeletons during excavations.
[please click on the image to enlarge]


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Figure 3. Stradom 12-14 cemetery, skeleton documentation.
[please click on the image to enlarge]


The whole material was anthropologically analysed according to standard methods [1], with special attention focused on paleopathological changes. Most of them developed as a consequence of infectious diseases with both determined and underdetermined agents. Some of the most spectacular are cases of late (tertiary) syphilis. In poems which could be associated with this cemetery, the problem of the so-called Morbus Gallicus that led to the extinction of the Jagiellonian dynasty [2], as well as other royal families in Europe is mentioned. Mikołaj Rej (1505-1569) wrote about this condition in a dialogue between a bawd (“zwodnica” in old Polish language) and a courtier:

"ZWODNICA
Wiem tu, panie, na ulicy
Jeszcze prawie dwie dziewicy,
Talara by nie żałować
Pewnie będziecie dziękować,
DWORZANIN
Nic by nam o talar nie szło,
Ale owo więc nie śmieszno,
Kiedy na łbie rosną guzy,
Co je zowiecie francuzy"



Original Polish text from
"Pisma wierszem" by Mikołaj Rej


Here is the loose English translation of the same dialogue, describing syphilis that was roaming on the streets back then:

"BAWD
I know here, sire, on the street
There is almost for two virgins,
A thaler, will you not spare
And then thankful be,
COURTIER
A thaler would do the deed,
But no funny business here,
When the head is full of tumours,
And their name is French disease"


Original text
"Pisma wierszem" written by Mikołaj Rej
translated by Piotr Kochan


The description of the gumma in the poem probably reflects the frequent affliction of Cracow inhabitants, where in the 16th century about 20% of the population suffered from syphilis [3]. Therefore, in the year 1528, near the city walls a (no longer existent) church of St. Sebastian and the hospital for venereal patients were founded. The location of these buildings at the current St. Sebastian street, near the excavated cemetery, created the possibility of interring infected patients there. Spread of the disease was enhanced by the moral relaxation in public baths. Hence, when in the 14th century there were 12 public baths, in 1669 there was only one left [4]. The same happened in other European towns suffering from syphilis [5]. The deprivation of the original character of baths was captured by Jan Kochanowski (1530-1584) in his limerick:
"Łaziebnicy a kurwy jednym kształtem żyją,
W tejże wannie i złego i dobrego myją"
(from Fraszki, księgi trzecie "O łaziebnikach").
This may be translated as:
"Bath attendants and whores are shaping lives the same,
in the same bathtub they the good and bad people bathe" (translation by Piotr Kochan).


Syphilis

Bacteria of the Treponema genus (species carateum, denticola, pallidum with subspecies pallidum, endemicum, pertenue) are spiral, anaerobic or relatively anaerobic and are considered Gram-negative because of the lipopolysaccharide content. Bacteria can be observed in a dark field, where they resemble springs, they also dye using the Dieterle stain (with silver nitrate). Treponema pallidum subsp. pallidum causes syphilis, other species and subspecies cause non-venereal conditions. Treponema pallidum, is mid-sized, having a diameter of 0.5 µm and reaching 5 to 15 µm. The bacterium is not cultivable on solid media. Current epidemiologic data for Poland show a growing number of cases from approx. 900 in 2010 to almost 1 600 cases in 2016 [6, 7]. According to WHO, globally there are about 6 million infections annually which makes syphilis one of the less common sexually transmitted diseases as compared to some viral aetiologies like HSV, HPV or HBV with hundreds of millions infected [8].

According to the latest 2018 case definition of syphilis from the Centers for Disease Control and Prevention (CDC), syphilis may be divided into [9]:
Syphilis, primary: stage characterized by one or more painless ulcerative lesions i.e. chancre, which might differ in appearance and be present on genitals, around the oral cavity or extragenitally (e.g. fingers).
Syphilis, secondary: stage characterized by localized or diffuse mucocutaneous rash – it may be macular, maculopapular, papular or pustular, often accompanied by lymphadenopathy. Other signs may include mucous patches, condyloma lata, alopecia with the primary ulcerative lesion, that may still be present.
Syphilis, early non-primary non-secondary: stage of infection where the initial infection has occurred within the previous 12 months, but there are no signs or symptoms of primary or secondary syphilis.
Syphilis, unknown duration or late: stage of infection where the initial infection has occurred >12 months previously or in which there is insufficient evidence to conclude that infection was acquired during the previous 12 months. Clinical signs or symptoms and laboratory results that meet the likely or verified criteria for neurologic, ocular, otic or late clinical manifestations of syphilis.
Syphilis, congenital: caused by infection in utero with Treponema pallidum. A wide spectrum of severity exists. A child less than 2 years may have signs such as hepatosplenomegaly, rash, condyloma lata, snuffles, jaundice, pseudoparalysis, anaemia, or oedema and older child may have stigmata such as interstitial keratitis, nerve deafness, anterior bowing of shins, frontal bossing, mulberry molars, Hutchinson teeth, saddle nose, rhagades or Clutton joints.
Syphilitic stillbirth: foetal death that occurs after 20-weeks gestation or in which the foetus weighs more than 500 g and the mother had untreated or inadequately treated syphilis at delivery.

In the diagnostics of fresh syphilis, one may use light microscopy in a dark field or direct fluorescent staining with the help of antibodies that makes the spirochetes visible. In addition, there are also tests for antibodies that differ in sensitivity depending on the stage of the disease:
- directed against the lipid components of bacteria (screening tests, the so-called reagin, VDRL, RPR, USR or TRUST) and
- antibodies specific to Treponema pallidum (the so-called confirmation tests, FTA-ABS, TP-PA, EIA).
Recently, molecular studies based on PCR are also available, however, they are performed only in selected laboratories. Mainstay of treatment is still penicillin.

The aim of this paper is a description of pathologically changed skeletons and their classification according to a specific sequence of progression.


Materials

At the presented part of cemetery, 15+ individuals with syphilitic changes were discovered (Table 1). Skeletons were partially preserved so diagnoses had been based mainly on fragments of skulls with features characteristic for syphilitic changes. Only in four cases, nearly complete skeletons were preserved. Three skulls demonstrated changes that do not strictly reveal diagnostic features needed for syphilis criteria and they are shown as an example of ambiguous identification (Fig. 4).

figure4
Figure 4. Stradom 12-14 cemetery, skull no. 52 during excavations.
[please click on the image to enlarge]


Methods

Syphilis sequence scoring system
Diagnostic criteria of syphilis are revealed as the caries sicca sequence and were published by Hackett in his classic monograph [10]. Although the final stage might have been simply named “multinodulation”, traditionally it is defined as the term “caries sicca”, introduced by Bertrandi in 1792 and maintained by Virchow [11]. This widely adopted sequence comprises three main stages with more detailed phases.

Description of the pathologically changed skeletons and their classification according to Hackett’s sequence of progression is shown in Figures 5 to 6.

figure5
Figure 5. Hackett’s syphilis sequence scoring system – initial and discrete series. For legend descriptions, see the text below [10].


figure46
Figure 6. Hackett’s syphilis sequence scoring system – contiguous series. For legend descriptions, see the text below [10].


Initial series
1. Clustered pits. The earliest change is one or several well-defined round areas (10-15 mm) of clustered pits, each pit being about 1 mm in diameter.
2. Confluent clustered pits. As the pits increase in size, adjacent ones fuse so that either the centre of the pitted area is eroded, or the periphery is eroded to leave a central pitted plug. Stanley [12] described this last change as a "syphilitic ulcer of bone".

Discrete series
3. Focal superficial cavitation. The confluence of the clustered pits opens a superficial cavity; its walls are concave and its base is the cancellous tissue of the diploë. Round the irregular and sharp-edged opening is some pitted new bone, so healing occurs.
4. Circumvallate cavitation. As the healing proceeds, a rim of new bone forms around the opening (1-2 cm) and "appears to roll over" into the cavity. There are only minor inner surface changes.
5. Radial scars. Continued healing covers the walls and base of the cavity with new bone which then fills the cavity until only a shallow depression remains with a radial pattern of scanty, thin wavy lines and perhaps a small, finely granular central area. The inner surface of the calvaria may be slightly thickened from organized new bony deposits. Radial scars remain for life but may become more shallow.

Contiguous Series
6. Serpiginous cavitation. The earliest stage starts as an irregular confluence in the centre of a large area (3-4 cm) of clustered pits. This produces an irregular (serpiginous) pattern of openings into confluent superficial cavities. The change may extend over a large area (5-10 cm) by peripheral spread of pitting and further superficial cavitation. The openings of these cavities have sharp irregular margins and concave walls.
7. Nodular cavitation. As healing proceeds, the sharp margins become rounded and here again, as in circumvallate cavitation, the bone seems to “flow” from the irregular fragments of the original outer table into the cavities to produce a pattern of nodules (5 mm) separated by the open superficial cavities. It may cover areas of 5-10 cm as it follows the extension of the serpiginous cavitation.
8. Caries sicca. With further healing the nodules become larger (5-10 mm) and encroach upon the spaces between them. Many nodules press against each other or remain separated only by narrow spiky spaces.

Analysis of skulls and skeletons from Stradom cemetery

Hackett’s sequence was used to classify pathological changes of skulls that were found at the part of Stradom cemetery [10]. These alterations mainly affected the outer surface of analysed skulls and in some cases large areas of the calvaria were covered by caries sicca alone, or by a combination of the advanced caries sicca and earlier phases of changes.

Skeleton 44 (Fig. 7)
Partially preserved skeleton of a female at the age of 50-60 years. Skull: At the outer surface of right parietal bone there are two superficial depressions. The bigger one (23×10 mm) may be a trace of healed injury inflicted by a blunt edged implement. The smaller one (5 mm in diameter) is supposed to be the first phase of syphilitic sequence - clustered pits. A destructive lesion within this depression may also be the effect of bone reaction coursed by the process of healing the injury. Postcranial skeleton: no pathological changes.

figure7
Figure 7. Stradom 12-14 cemetery, skull no. 44: a – norma verticalis; b – norma lateralis; c – detail of the larger depression.
[please click on the image to enlarge]


Skeleton 52 (Fig. 8)
Partially preserved skeleton of a female at the age of 45-55 years. Skull: The outer (Fig. 8a) and partially inner (Fig. 8b) surfaces of the cranial vault are covered by irregular cavitation, nodules and perforations visible also on the corpus of the mandible (Fig. 8c). Perforations and lesions firstly involve the inner table of the calvaria and mean that changes may be the result of tuberculosis of cranial vault secondary to tuberculous meningitis [13]. Postcranial skeleton: pathological changes include fusion of cervical vertebra (C2-C3) as well as inflammatory changes of scapula, femur and tibia. In the supraspinatus fossa of the preserved left scapula there is a perforation with surrounding bone reaction (Fig. 8d, d1). Right tibia and femur exhibit penetrating defects surrounded by periosteal buildup (Fig. 8e, e1, f, f1).

figure8
Figure 8. Stradom 12-14 cemetery, skeleton no. 52: a – skull, external view; a1 – skull, endocranial view; b – right part of the mandible; c – left part of the mandible; d – dorsal surface of the left scapula; d1 – costal surface of the left scapula; e – anterior surface of the right femur; e1 – posterior surface of the right femur; f – anterior surface of the right tibia; f1 – posterior surface of the right tibia.
[please click on the image to enlarge]


Skeleton 74 (Fig. 9)
Partially preserved skeleton of a male at the age 45-55 years. Skull: The outer surface of the frontal and parietal bones are covered by large areas of irregular, serpiginous and nodular cavitations. At the upper part of frontal squama there is a shallow depression (23 mm in diameter) that is a trace of a healed injury inflicted by a blunt edged implement. Postcranial skeleton: only upper part preserved; no pathological changes.

figure9
Figure 9. Stradom 12-14 cemetery, skull no. 74: a – norma verticalis; b – norma frontalis; c, d – norma lateralis.
[please click on the image to enlarge]


Skeleton 152 (Fig. 10)
Partially preserved skeleton of a male at the age of 35-45 years. Skull: The outer surface of right part of the frontal squama and left parietal bone are covered by large areas of serpiginous, irregular cavitations. In these areas bone is partially thinned and therefore the inner table of the left parietal bone is secondarily destroyed (Fig. 10a, c). Changes at the left part of the frontal squama are less advanced and reflect focal superficial cavitation phase.Postcranial skeleton is partially preserved. In the middle part of diaphysis, the healed diagonal fracture of the left radius with marked mediolateral and longitudinal displacement of the broken ends is visible. Moreover periostitis is present at the distal part of secondarily destroyed bone (Fig. 10d, d1).

figure10
Figure 10. Stradom 12-14 cemetery, skeleton no. 152: a – norma verticalis; b – norma frontalis; c – details of the left secondarily destroyed parietal bone; d – anterior surface of the left radius; d1 – posterior surface of the left radius.
[please click on the image to enlarge]


Skeleton 190 (Fig. 11)
Partially preserved skeleton of a female at the age of 20-25 years. Skull: At the outer surface of frontal and both parietal bones, there are several serpiginous and nodular cavitations. Postcranial skeleton: no pathological changes

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Figure 11. Stradom 12-14 cemetery, skull no. 190: a – norma verticalis; a1 – details of the changes at the left part of the frontal squama.
[please click on the image to enlarge]


Skeleton 191 (Fig. 12)
Partially preserved skeleton of female at the age of 20-30 years. Skull: Nearly the whole outer surface of the frontal and right parietal bone exhibit advanced sclerotic healing with well-marked lines of demarcation. On the outer surface of the left parietal bone there are areas with multinodular caries sicca or nodular cavitations. Inflammatory changes in a form of penetrating defect partially surrounded by periosteal build-up are present at the left zygomatic bone (Fig. 12f). Postcranial skeleton: only the upper part of the skeleton is present, no pathological changes.

figure12
Figure 12. Stradom 12-14 cemetery, skull no. 191: a – norma verticalis; b – norma occipitalis; c, d – norma lateralis; e – norma frontalis; f – details of the left zygomatic bone.
[please click on the image to enlarge]


Skeleton 283 (Fig. 13)
Partially preserved skeleton of a female at the age of 30-40 years. Skull: At the nasal part of frontal bone and in the region of frontal tubers of the squama there are irregular depressions in the form of focal superficial and circumvallate cavitations which can be described as the “worm eaten skull” in a place where nodular syphilids were present. Inflammatory changes in a form of pitted defects are visible at the right zygomatic process of temporal bone (Fig. 13d). Postcranial skeleton is partially preserved. Periosteal bone reaction involves preserved both tibiae and fibula.
















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figure13
Figure 13. Stradom 12-14 cemetery, skeleton no. 283: a – norma frontalis; b – details of the upper part of viscerocranium; c – norma lateralis; d – details of the right temporal bone; e, f, – tibiae; g – fibula; e1, f1 – details of tibiae; g1 – details of fibula.
[please click on the image to enlarge]


Skeleton 364 (Fig. 14)
Partially preserved skeleton of a male at the age of 40-50 years. Skull: calvaria with the outer table of the frontal and left parietal bones are covered by irregular, superficial serpiginous cavitations with nodular surface. Pathologically altered bone is thinned and secondarily destroyed. Postcranial skeleton is partially preserved. Inflammatory changes include the right clavicle, right and left humeri, radii and ulnae, both femurs and fibulae, tibia were not preserved. The most advanced periosteal bone formations are visible at both fibulae (Fig. 14i, j), inflammatory alterations of upper limbs are present mainly at distal parts of bones and in the mid part of the right clavicle.

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Figure 14. Stradom 12-14 cemetery, skeleton no. 364: a – norma verticalis; b – norma frontalis; c, d – clavicles; e, f – humeri, anterior surfaces; e1 – posterior surface of the right humerus; g, h – radii; i, j – fibulae.
[please click on the image to enlarge]


Skeleton 531 (Fig. 15)
Partially preserved skeleton of a male at the age of 25-30 years. Skull: Calvaria with the outer table of the frontal, both parietal and occipital bones covered by the irregular, superficial serpiginous cavitations with nodular surface. Postcranial skeleton: only a segment of the upper part of the skeleton is preserved, pathological changes include inflammatory changes of clavicles.

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Figure 15. Stradom 12-14 cemetery, skull no. 531: a – norma verticalis; b – norma lateralis; c – details of frontal and parietal bones; d – norma frontalis.
[please click on the image to enlarge]


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Figure 16. Stradom 12-14 cemetery, skull no. 602: a – norma frontalis; b – norma lateralis; c – details of inner table of the left temporal bone; d – details of the orbits; e – details of inner table of the frontal bone.
[please click on the image to enlarge]


Skeleton 602 (Fig. 16, 17)
Partially preserved skeleton of a male at the age of 30-40 years. Skull: The outer surface of frontal and parietal bones demonstrate advanced syphilitic changes expressed in a form of serpiginous cavitations and nodular cavitations. Inner tables of frontal and left temporal bones are covered by arabesque lesions and superficial new bone appositions (Fig.16c, e). These changes may be the consequence of tuberculous meningitis. At the upper part of the left orbit there is a healed injury inflicted by a sharp edged weapon (Fig. 16d). Postcranial skeleton: pathological changes include periosteal bone reaction of the manubrium of sternum, left humerus and both tibiae (Fig. 17d-f). Osteoarthritis is visible at the bodies and articular processes of cervical and thoracic vertebrae (Fig. 17 a-c). These changes may have been initiated by trauma.

figure17
Figure 17. Stradom 12-14 cemetery, postcranial skeleton no. 602, selected pathological changes: a – atlanto-occipital fusion; b – cervical vertebra; c – thoracic vertebra; d – humerus, anterior surface; e, f – tibiae, anterior surfaces.
[please click on the image to enlarge]


Skeleton 930 (Fig. 18)
Preserved frontal bone only of a female at the age of 20-30 years. Skull: At the outer table of the frontal squama there are three irregular breaks in the surface that can be determined as focal superficial cavitations (Fig. 18a). The bases of these foci are pitted, healing is occurring. In the centre of the squama there is also a healed depression probably inflicted by a blunt edged item (20 mm in diameter; Fig. 18a, c, d). On the inner surface in the left part of the squama, is an irregular partially depressed erosion (2.4×1.7 mm) with an undermined edge, not related to changes of the outer surface. In the centre of this erosion, a sequestrum is visible. Next to it there are arabesque lesions and superficial new bone appositions (Fig. 18b). These changes may be the effect of tuberculous meningitis.

figure18
Figure 18. Stradom 12-14 cemetery, skull no. 930: a – squama frontale, external view; b – squama frontale, inner table; c, d – details of pathological changes.
[please click on the image to enlarge]


Skeleton 1599 (Fig. 19) Preserved skull only of a male at the age of 30-40 years. Skull: The outer surface of frontal and parietal bones are covered by advanced changes of tertiary syphilis expressed in a form of serpiginous cavitation, nodular cavitation and caries sicca as well as perforations that indicate a secondary infection with pyogenic microorganisms or tuberculosis causing further extensive destruction of bone.

figure19
Figure 19. Stradom 12-14 cemetery, skull no. 1599: a – norma verticalis; b – norma frontalis; c, d – details of pathological changes.
[please click on the image to enlarge]


Skeleton 1604 (Fig. 20)
Preserved is the cranial vault only of a female at the age of 35-45 years. Skull: At the outer surface of the frontal and parietal bones there are several clustered pits, each pit being about 1 mm in diameter. Moreover, at the top of the skull there is a healed injury inflicted by a sharp edged weapon, probably an axe (83×14 mm). The inner surface of calvaria is not changed.

figure20
Figure 20. Stradom 12-14 cemetery, skull no. 1604: a – norma verticalis; b – details of the injury; c – norma frontalis; d – details of pathological changes.
[please click on the image to enlarge]


Skeleton 1605 (Fig. 21)
Preserved is calvaria only of a male (?) at the age of 30-40 years. Skull: At the left part of the frontal squama there is a large irregular depression (4×2.5 cm) with a thin base and nodular surface. In the middle of it there is an irregular perforation with sharp margins. It is probably the evidence of an injury inflicted by a sharp edged object (?).

figure21
Figure 21. Stradom 12-14 cemetery, skull no. 1605 – norma verticalis.
[please click on the image to enlarge]


Skeleton 1609 (Fig. 22)
Preserved skull only of a male at the age of 40-50 years. Skull: Nearly the whole outer surface of the skull vault is covered by multinodular caries sicca lesions locally, with advanced sclerotic healing.

figure22
Figure 22. Stradom 12-14 cemetery, skull no. 1609: a – norma verticalis; b – norma frontalis; c – norma lateralis; d – details of pathological changes.
[please click on the image to enlarge]


Discussion and conclusions

The changes and lesions described above, affecting skeletal bones are mainly advanced manifestations of late (tertiary) syphilis, that usually need many years to develop since the time of exposure (Table 1). According to clinical cases, gummata of bone usually appear from 5 to 20 years after infection [10, 13, 14]. During this period, other diseases can possibly superimpose on the detected picture of changes, causing for example, supportive osteomyelitis which is a secondary infection with pyogenic microorganisms [15]. Examples of such condition are clearly visible in skeletons no. 52, 602 and 930. Skulls of these individuals exhibit endocranial lesions that may be the bone manifestation of TB-meningitis [16], but neurosyphilis, in a form of the meningovascular syphilis should not be excluded [17]. Moreover, according to contemporarily treated cases, the former methods of treatment of this disease, such as the toxic effect of mercury treatment, may enhance the pathological process. An example is the complete case history of a Canadian prostitute aged 30, who had been treated with mercury for syphilis and nearly her entire skeleton had periostitis of the bones with subsequent ulceration that seldom healed [15]. Cases from Stradom cemetery generally reflect the sequence of changes published by Hackett [10]. The most pathologically altered skulls no's 191 and 1609, demonstrate the differences in late syphilis manifestation, that can be the result of patient's individual reaction.

Table 1. Stradom cemetery, skeletons with pathological changes.
table1
[please click on the image to enlarge]


Distribution of age and sex of the infected deceased is variable but the number of males and females is nearly similar (Table 1). Most of the afflicted females are younger than males although it may be a coincidence. Young age at death of some of the analysed male and female individuals indicate infection at adolescence, maybe during the first sexual contacts. Congenital syphilis was not identified, because of a special character of the cemetery, i.e. a small number of children and dominance of male skeletons that came from different regions of south-eastern Poland (mainly the Crown) within boundaries from XVII and XVIII centuries. Lifelong syphilis development with periods of latency and less onerous symptoms enabled the individuals affected participation in everyday life, that is reflected by acquired bone fractures and other injuries on skulls of individuals no's: 44, 74, 602, 930, 1604 (Fig. 23), 1605 and bones of postcranial skeletons – for example no. 152.

figure23
Figure 23. Skull no. 1604 - reconstruction of the trauma caused probably by a hatchet.


It is hard to establish the proper sequence of events, but it is possible that at least some cases of healed traumas were later-year episodes in the lives of individuals suffering from syphilis. These were injuries mostly acquired during the armed conflicts and were often the reason for placing wounded individuals in this hospital. In this part of the cemetery, 67 individuals with healed injuries of skulls and bones of postcranial skeletons were found. Traumas in the course of healing, detectable on analysed skulls demonstrate that even severe wounds were correctly treated and recovery was possible. However, accumulation of wounded individuals without preservation of proper hygienic conditions enhanced infectious diseases. Therefore, on the bones of 238 individuals, advanced pathological changes mainly osteomyelitis, were found. The number of patients with bone manifestations suggest a huge number of individuals with more severe lethal cases, the course of which did not have the time to leave marks and signs on the skeletons.

The picture of inhabitants with tertiary syphilis living in this refuge (Fig. 24) was for sure so terrifying, that it forced their contemporaries towards a more safe, faithful life with their wives, which is briefly described in the following part of the poem:

"Której bezpiecznie możesz zwierzyć zdrowia swego,
Nie wieszasz go na kołku, skacząc przez prog psiego.
Nie będą-ć już na głowie rosły ony guzy,
Albo takież na czele, jak perły, francuzy."


M. Rej, Wizerunek własny
cz. 1, rodz. Piąty, list 58, s. 274


"The one you can trust your health upon,
Not lose it over unfaithful storm.
They tumours will not grow on the head of thee,
Or on the forehead, like pearls, in the French disease."


M. Rej, Wizerunek własny
Part 1, Chapter Five, letter 58, p. 274
translated by Anna and Piotr Kochan

figure24
Figure 24. Reconstruction of an inhabitant of the Stradom refuge, drawn by Jolanta Ożóg.
[please click on the image to enlarge]


The fragments of contemporary poems quoted in the article illustrate the excellent knowledge of modes of transmission of this disease, its progress and methods of its avoidance [19] and they are also a testimony of universal knowledge of writers in the XVIth century.

The photographs shown in this article also demonstrate the need to look at archeological digs from the medico-anthropological perspective, but not only using the modern molecular tools, but also examining and comparing the skeletal morphology with widely available literature resources. In our opinion cooperation between different specialists, such as archeologists, anthropologists, medical doctors incl. anatomists, radiologists, microbiologists continued with possible output from molecular geneticists may solve and change the way we look at history and at our ancestors, many times wrongly portrayed in popular literature and films.

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[3] Kracik J, Rożek M. Hultaje, złoczyńcy, wszetecznice w dawnym Krakowie: o marginesie społecznym XVI-XVIII w. Wydawnictwo Literackie, Kraków 1986.
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Conflict of interest: PK is the Editor-in-Chief of WJOMI.

Acknowledgements:
Authors would like to thank Angel Garden Sp. z o.o. Sp. K from Cracow for financing the anthropological and paleopathological analysis.
Big thanks to Jolanta Ożóg for drawing the patient reconstructions (Fig. 1 and Fig. 24).
Word of thanks to Anna Kochan for help in translation of M. Rej, Wizerunek własny cz. 1, rodz. Piąty, list 58, s. 274.

Authors’ affiliations:
1 Chair of Anatomy, Jagiellonian University Medical College, Cracow, Poland.
2 Chair of Institute of Archaeology and Ethnology Polish Academy of Sciences, Cracow, Poland.
3 Head of the Chair of Anatomy, Jagiellonian University Medical College, Cracow, Poland.
4 Chair of Microbiology, Jagiellonian University Medical College, Cracow, Poland.

Corresponding author:
Associate Prof. Anita Szczepanek, Ph.D.
Chair of Anatomy, Jagiellonian University Medical College,
ul. Kopernika 12, 31-034 Cracow, Poland
Tel. +4812 422 95 11
e-mail: anita.szczepanek@uj.edu.pl

To cite this article: Szczepanek A, Walocha J, Kochan P. Cases of late syphilis documented at the cemetery of noblemen residents of the Knights of the Holy Sepulchre poorhouse (XVII-XVIII centuries) on Stradom in Cracow, Poland. World J Med Images Videos Cases 2019; 5:e26-52.

Submitted for publication: 24 March 2019
Accepted for publication: 24 May 2019
Published on: 31 May 2019



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