Deadly Signs of the Past: How Syphilis Shaped Generations with Dental Deformities
Hutchinson’s Teeth, named after the British physician Sir Jonathan Hutchinson (July 23, 1828 – June 23, 1913), are a diagnostic feature that appears in children with congenital syphilis. This characteristic dental deformity represents a valuable source of information for forensic anthropologists like myself, especially when investigating historical skulls. Their unique shape, marked by a notch in the central incisors of the upper jaw, provides a clear indication of an individual’s medical history and can contribute to identifying disease patterns in past societies.
In my work, I have repeatedly encountered skulls bearing this distinctive sign of congenital syphilis, and notably, these findings often come from England. This concentration raises questions: Was syphilis indeed more widespread in England than in other parts of Europe? What was the reason for the strong presence of a disease that not only affected individuals but entire generations?
This article aims to thoroughly explore the phenomenon of Hutchinson’s teeth, not only in the context of the disease itself, but also in the social and historical context of England. The question of why syphilis was so prevalent there is of central importance for understanding the history of the disease and its impacts on the lives of people at that time. The dental deformity that developed because of this disease is more than just a clinical symptom – it tells a story of suffering, social isolation, and medical progress.
During my forensic examinations of skulls in London, these deformities repeatedly catch my attention. The historical context provides important clues as to why this dental morphology is so commonly found. The high degree of urbanization, combined with poor hygienic conditions and poverty in 18th and 19th-century England, offers an explanation for the spread of syphilis in this region. However, the traces left by this disease are not only found in social archives but directly in the anatomical remains of those who suffered from it.
With this article, I not only want to explain the medical and historical backgrounds of these very specific dental forms but also to place my own experiences and findings from forensic practice in England into a scientific context. The question about the spread and impacts of syphilis in past centuries is not only a medical challenge but also a social and cultural one, which leaves deep traces in forensic anthropology.
Hutchinson’s Triad and Its Clinical Features
Hutchinson’s Triad is a clinical syndrome consisting of three characteristic symptoms: specific dental anomalies, interstitial keratitis, and damage to the auditory nerve. This triad occurs as a result of congenital syphilis, which is transmitted from mother to unborn child during pregnancy. The disease causes severe damage already in the uterus. The dental anomalies arise from a disturbance in tooth development during the calcification of the incisors, leading to a characteristic deformity. These teeth are smaller, flatter, and often have a central notch.
Interstitial keratitis, another symptom of the triad, results from inflammatory processes in the cornea, which can eventually lead to blindness. Often, the disease starts with a gradual decline in vision before the cornea becomes completely clouded. Together with the dental deformity, it forms a clear indication of a syphilis infection in childhood. The third component of Hutchinson’s Triad, damage to the auditory nerve, often leads to irreversible hearing loss, typically occurring in early childhood.
What makes this triad so significant is its ability to enable us to draw conclusions about an individual’s medical history through the analysis of these symptoms. In my forensic work, such dental anomalies provide an important clue for reconstructing both the medical and social past of a person. A skull with these typical dental deformities tells not only the story of an infection but also about the living conditions, medical possibilities, and social challenges faced by the affected individual.
The deformation of the teeth due to syphilitic damage begins in the uterus when the infection impairs tooth formation. The bacterium Treponema pallidum causes these malformations during pregnancy, which manifest later in the child’s life. The affected teeth, particularly the incisors, remain smaller, with their edges flat and notched.
Thus, Hutchinson’s Triad is not just a physical feature, but a comprehensive clinical picture that offers more profound insights into the effects of syphilis.
Historical Background of Syphilis in England
The spread of syphilis, especially in 18th and 19th-century England, represents a dark chapter in the history of public health. While the disease likely originated much earlier, it spread almost epidemically during this period, particularly in England’s urban centers, which were growing rapidly due to industrialization. The close relationship between syphilis and the social conditions of the time cannot be denied: densely populated cities, poor hygienic conditions, poverty, and lack of medical care created the ideal breeding ground for the spread of infectious diseases.
London Alley, Late 1800s
Syphilis was not only a disease of the poor, but they certainly were the ones who suffered most from its consequences. In the working-class districts of London, Manchester, or Birmingham, there was little access to medical care, and sexual education was virtually nonexistent. Moreover, syphilis was often only noticed in its late stages when the damage was already significant. In these urban environments, children of infected mothers were born with the disease already transmitted in the womb – the result was often the so-called lues connata, or congenital syphilis.
What has continually surprised me in my examinations of skulls from this era is the frequency with which signs of congenital syphilis – particularly the pathological changes in the teeth – are found. It seems this disease was not just an occasional occurrence, but indeed affected a significant portion of the population. The poverty of the working class, combined with ignorance about the risk of infection, led to an almost unstoppable cycle of the disease. Even in the higher echelons of society, syphilis was a taboo subject rarely discussed, which only facilitated its spread further.
This skull shows clear signs of syphilitic lesions, particularly the so-called “skull cap” or caries sicca, which is typical for the tertiary phase of syphilis. The surface of the frontal bone shows scar-like depressions due to inflammatory processes. These changes result from the destruction of bone tissue due to chronic infection with the bacterium Treponema pallidum. These anomalies are characteristic of advanced, untreated syphilis and have been frequently found in historical skulls.

This skull shows clear signs of syphilitic lesions, particularly the so-called “skull cap” or caries sicca, which is typical for the tertiary phase of syphilis. The surface of the frontal bone exhibits scar-like depressions due to inflammatory processes. These changes are caused by the destruction of bone tissue as a result of chronic infection with the bacterium Treponema pallidum. These anomalies are characteristic of advanced, untreated syphilis and have been frequently found in historical skulls.
The medical treatment of syphilis at this time was rudimentary at best. Mercury baths and other questionable remedies were widespread but rarely effective. The significance of the disease and its consequences were often underestimated or even ignored, so syphilis was passed down through generations in many families. Only with the advent of modern antibiotics at the beginning of the 20th century could the disease be effectively combated, but by then, it had left deep scars on the British population.
Interestingly, England seems to have been particularly affected by syphilis compared to other European countries. The reasons for this are complex and could be linked to societal structure, early industrialization, and the geographical location of the country, which played a special role in the international exchange of goods – and diseases – through its maritime trade. However, social change accompanying industrialization also contributed to the spread. People lived in close quarters, working conditions were harsh, and sexual freedom was often the only outlet from the oppressive living conditions of the working class. Unfortunately, this freedom often led to further spread of syphilis, which eventually affected entire families.
When I come across a skull today that shows these typical deformities, I see not only the traces of an individual’s medical history, but the reflection of a historical phenomenon inextricably linked with England’s social and economic development. The dental pathology tells a story of neglect, social change, and a time when medical progress was still far away.
Forensic-Anthropological Significance
In anthropology, physical anomalies like syphilitic dental deformities are of inestimable value. They allow not only insights into an individual’s life but often into the living conditions and disease courses of entire populations. For me, the finding of such dental changes represents a valuable bridge between medical history and anthropological research. These pathological changes provide clear indications of developmental disturbances caused by syphilis, and simultaneously allow for the reconstruction of certain historical and social contexts.
In the skulls I’ve examined from archaeological digs in England, these dental deformities are not rare. What’s particularly impressive is how these deformities can provide insights into the health and life of individuals. A single tooth can give us clues whether a person suffered from severe health issues in childhood that persisted into adulthood. These problems were not limited to the appearance of the teeth, but often indicated underlying medical complications affecting the entire organism.
What seems particularly significant to me about these findings is that they go far beyond individual medical histories. When repeatedly encountering skulls with Hutchinson’s teeth in a specific geographic or temporal context, it suggests that the disease was not just an isolated occurrence but possibly affected entire communities. This provides valuable insights into the disease patterns of past epochs and allows us to consider these findings within a broader socio-historical framework. The recurrence of such findings suggests that congenital syphilis was a widespread problem in large parts of England, which in turn raises questions about the living conditions, spread of diseases, and medical care at the time.
A particular aspect of my work is the ability to link such dental anomalies with other pathological findings. Skulls showing syphilitic dental deformities often also exhibit other signs of the disease, like bone damage or systemic inflammations, which are typical for advanced syphilis. This combination of findings allows for a detailed reconstruction of an individual’s disease history. What’s interesting is not just the dental deformity itself, but also how the disease affected the whole body.
In my work, I often see how such dental anomalies are just one piece of a larger puzzle. They tell not only the story of an individual infection but also of the disease within a specific population. Often, these dental anomalies point to more in-depth health issues within a particular social class or region. This is particularly revealing when trying to understand the social and economic conditions of the respective epoch. Forensic anthropology enables us to interpret these traces and place them in a larger context – whether to better understand the spread of diseases like syphilis or to draw conclusions about medical care and life in a specific time.
Examining these dental anomalies in historical skulls thus not only gives us insight into the medical history of syphilis but also opens up a wide field of social and anthropological insights. Through these findings, I can reconstruct the past and also raise deeper questions about the relationship between health, social structure, and medical development.
Comparison with Other Regions
While syphilis took on almost epidemic proportions in 18th and 19th-century England, the picture was quite different in other parts of the world. In Continental Europe, particularly in France and Germany, the disease was also widespread, but the societal and medical responses to syphilis varied significantly. In my forensic work, I’ve noticed significant differences in the prevalence and expression of syphilitic dental anomalies in different regions, pointing to different disease courses and social conditions.
In France, where syphilis was known as “maladie royale,” there were more intensive efforts to curb the disease through state measures. In my analyses of French skulls, dental anomalies from congenital syphilis are present but less common than in England, possibly due to more effective measures.
In Germany, there was a unique dynamic. Here, medical progress, like the discovery of the syphilis-causing agent by Fritz Schaudinn (died June 22, 1906, in Hamburg), led to earlier diagnostic possibilities. Here too, I find signs of dental deformities due to syphilis, but the prevalence is lower than in England.
In the USA, syphilis was particularly rampant in poorer neighborhoods, while wealthier strata could respond better to the disease. Dental anomalies as a result of the disease were more frequent and severe in socially disadvantaged groups, highlighting the close relationship between health and socioeconomic status.
In Scandinavia, where stricter social norms prevailed, and the population was more spread out in rural areas, such deformities were rarer. Eastern Europe, often politically unstable, showed patterns similar to England, but the scientific documentation of the disease progressed more slowly there.
These regional differences show that diseases like syphilis are not just biological phenomena but are profoundly shaped by social and cultural contexts. Dental deformities caused by syphilis in various geographic and historical contexts illustrate how deeply diseases can affect societal structure and how their impacts can vary by region and social class.
Even today, syphilitic dental anomalies occur. While modern medicine has made great strides, the unequal distribution of resources means many regions are still affected by the disease. Modern forensics allows us to reconstruct the past while recognizing that the fight against diseases like syphilis has not yet been fully won.
Syphilis: An Underestimated Risk – Why Children Are Still Born with Its Terrible Consequences Today
Syphilis is by no means an extinct disease, and even today, children are born with the typical dental and other physical defects associated with congenital syphilis. Despite all medical advances, syphilis remains a serious problem in many regions, particularly where access to medical care is limited. The notion that syphilis is entirely a thing of the past is a dangerously misleading one, casting its ongoing existence into the shadows.
In many developing countries, there are still high rates of syphilis, both among adults and newborns. This is often due to inadequate prenatal care, insufficient health education, and the lack of effective screening programs for expectant mothers. The result is children born with lues connata, and even though we in more affluent countries have the luxury of largely controlling this disease, the world as a whole is repeatedly caught up by the late consequences of syphilis.
In areas where access to penicillin and other medications is not guaranteed, syphilis can persist and be passed down through generations. Even in the Western world, there are still cases of congenital syphilis, often in socially disadvantaged groups or among people without regular access to medical care. These children, born with dental defects or other signs of congenital syphilis, are evidence that the disease has not been completely vanquished.
For me, as a forensic anthropologist, it’s a sobering sign when I encounter Hutchinson’s teeth in modern findings. They symbolize not only a medical challenge, but also the ongoing social injustice that persists to this day. Each child born with these defects is a testament to our collective failure to ensure that diseases like syphilis should no longer exist – at least not in a world where we have the means to eradicate them completely. It reminds us that our medical achievements are only as strong as the access the weakest members of our society have to them.
In Germany, syphilis, including its congenital form (lues connata), remains a relevant topic, although at a much lower frequency than in past centuries. According to the annual reports of the Robert Koch Institute (RKI) on notifiable infectious diseases, there has been a slight increase in syphilis cases recently, partly attributed to increased risk behavior in certain population groups.
Fortunately, the numbers for congenital syphilis (lues connata) remain very low, thanks to relatively good prenatal care and screening programs in Germany, which allow for timely testing and treatment of expectant mothers. Statistically, there are only a very few reported cases of lues connata per year in Germany. For instance, according to the RKI report, there were less than five cases of congenital syphilis reported in both 2020 and 2021.
However, the total number of syphilis cases in adults is higher and has been rising since the early 2000s. In 2021, over 7,500 cases of syphilis were reported in Germany. These cases predominantly affect men, especially in larger cities and in specific risk groups like men who have sex with men (MSM). This increase in numbers is often linked to a decline in condom use and increased unprotected sexual activity, particularly since the availability of medications for HIV prevention (PrEP).
Overall, this shows that while syphilis in Germany does not reach the epidemic levels seen in the 18th and 19th centuries, it is still present. The congenital form remains rare due to existing preventive measures, but the general spread of syphilis among adults should continue to be a reason for preventive measures and health education.
Some of the most significant individuals in the fight against syphilis have made remarkable scientific breakthroughs:
Paul Ehrlich (March 14, 1854 – August 20, 1915): A German physician who discovered the first effective treatment for syphilis, Salvarsan. This was the first specific chemotherapy for treating syphilis.
Fritz Schaudinn (September 19, 1871 – June 22, 1906): A German zoologist who, along with Erich Hoffmann, discovered the bacterium Treponema pallidum, the causative agent of syphilis.
John Mahoney (August 1, 1889 – February 24, 1957): An American physician who demonstrated the effectiveness of penicillin for treating syphilis in the 1940s.