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Specific dental abnormalities are considered pathognomonic of congenital syphilis (CS); however, European physicians recognized their variation during the late 19th to mid 20th centuries. Observations of syphilis-related dental abnormalities in American individuals from similar time periods are made to determine types of variation among the American population. From a survey of the Smithsonian Institution’s National Museum of Natural History anatomical human skeletal collection, five individuals demonstrated dental characteristics consistent with CS (P00011R, P219398, P000707, P000679, and P000161). Hutchinson’s three categories of dental anomalies were used to describe variations among syphilitic individuals. Previously identified pathological dental characteristics related to CS were present in the analyzed individuals. P00011R, 24-year-old Black female, has a maxillary right Moon’s molar. P219398, approximately 20-year-old Black female, has Hutchinson’s incisors and Fournier’s molars. P000707, 26-year-old Black male, displays severe hypoplasia on all incisors, canines and maxillary first molars. P000679, 33-year-old Black female has “screwdriver” shaped maxillary central incisors, altered occlusal morphology of first maxillary molars and hypoplasia. P000161, 45-year-old Black female, demonstrates severe hypoplasia on incisors and canines (molars lost). “Classic” dental characteristics of CS are not ubiquitous to all identified cases. This study exemplifies that dental anomalies associated with CS do not all have to be present for diagnosis. Although other causes for some of these anomalies are possible, observations in these five cases are most consistent with CS. Five Cases of Dental Anomalies Attributable to Congenital Syphilis from Early 20 Century American Anatomical Collections Stella Ioannou*, David Hunt, and Maciej Henneberg 1 Biological Anthropology and Comparative Anatomy Research Unit, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005 2 Department of Anthropology, National Museum of Natural History, Smithsonian Institution, Washington, DC, 20013-7012 Prior to the introduction of penicillin in the 1940s, syphilis was a public health problem in the United States (Lancet, 1930; Lancet, 1937a). The prevalence of syphilis in the United States at that time is difficult to determine, as data collection for syphilis by state health departments did not begin until the early 20th Century, and the Venereal Disease Division of the U.S. Public Health Service was not created until 1918 (Nakashima et al., 1996). To control venereal disease, various states implemented programs (free treatment, and clinics that offered free, pay, and part pay clinics) (Lancet, 1937a), and legislation (marital examination law and prenatal law) (Lancet, 1917; Prebble, 1938; Lancet, 1940; DePorte, 1941). In cases of medical intervention, mercury was used to treat congenital syphilis in the 19th and early 20th centuries throughout the United States (Conrad and McCann, 1922; Cole et al., 1929; Scheer and Fraser, 1930; Cole et al., 1933; Chargin and Saunders, 1939). Treatments of syphilis also included chemotherapies of arsenic and bismuth compounds (Lee, 1878; Cole et al., 1929; Eller and Maloney, 1929). The chemotherapies most favored in the treatment of congenital syphilis included mercury, arsphenamine and potassium iodide (United States. Public Health Service. Division of Venereal Diseases, 1930). The effectiveness of mercury as a treatment for syphilis has been questioned (Miller, 1858: Weatherill, 1833); although, the treatment remained popular with some physicians. In some cases, syphilitic lesions completely healed and patients became seronegative (Wakerlin, 1934). In syphilitic women treated with mercury during their pregnancy, 91.5% were efficient in completing their pregnancies successfully by live birth, while 47.6% non-treated women experienced fetal death (United States. Public Health Service. Division of Venereal Diseases, 1930). Mercury and its compounds were seen to *Correspondence to: Stella Ioannou The University of Adelaide Adelaide 5005, South Australia, Australia email: stelzy_25@hotmail.com

Five Cases of Dental Anomalies Attributable to Congenital Syphilis from Early 20th Century American Anatomical Collections