Given what we now know about the existence of treponematosis in the premodern world, it will be necessary to reexamine ancient and medieval medical treatises that might yield evidence of the disease. Two clinicians-turned-historians of the twentieth century, Ellis Herndon Hudson and Richmond C. Holcomb, have led the way and their provocative findings need to be reconsidered, along with those of other historians who remained skeptical of the Columbian hypothesis. In addition, much original work will have to be undertaken to create a fuller picture. Such an endeavour is beyond the scope of this study, but examples from the writings of one man, John Arderne (b. 1307/8, d. in or after 1377), may serve to highlight the need for careful analytical work in these rich sources.

Arderne was a respected general surgeon, best known for his treatment of anal fistulas, for which he pioneered a number of highly effective techniques. He was proud of his success, which brought him wealth and fame. He tells us, in his Practica, that he charged £40 (forty pounds) for his ser vices, an extraordinary amount for the era. As observed by Peter Murray Jones, the foremost expert on Arderne:

These fees are commensurate with the elevated status of Arderne's patients. Based on recent discoveries, we can now posit that the need for anal surgery was a consequence of the prevalence of syphilis among elites in Arderne's day. One common symptom of the secondary stage of the disease is condyloma lata, lesions that appear around the anus. As described by the nineteenth-century syphilologist Franz Mraček, “In the anal region peculiar formations sometimes develop on account of the anatomical parts.