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Syphilis is an illness with mythology. The story of its origin, dissemination and treatment have all been mired in confusion, a mix of reality and quackery. I have tried to put the organism as the principal protagonist of the story, firmly in an historical focus which centres more on its social impact than on its particular medical management. A diagnosis of Syphilis had personal and community consequence and its impact transcended into the arts. Despite the discovery of an effective treatment to which the organism has fortunately failed to mutate, the restrictions in available management have been social and a result of prejudice towards its victims. This may explain why it is once again on the global rise in places where access to the most basic antibiotics remains limited. This book uniquely considers the sociological sequel of infection, the wider influence extending beyond the physical that has become its legacy.

Syphilis: A Short Biography

Foreword         Dr. Adam Jenney PhD DTM&H BMedSci

Preface

SUMMARY: Why write a book about Syphilis? The preface sets up the story of how devastating Syphilitic infection was in Renaissance Europe. It mirrors the social response when HIV-AIDS first came on the scene. The preface outlines the subject matter of the chapters.

Chapter 1. Fracastoro's Poem and the Origins of Illness

SUMMARY: Fracastoro wrote of the symptoms of Syphilis in his poem Sive morbus Gallicus in 1526 and of his postulate of microscopic spores that could potentially cause infection in his 1546 Treatise on Contagion. This chapter outlines the controversy over whether Syphilis was brought to Europe by Columbus or whether it was Pre-Columbian in its origins. The variants of non-venereal Syphilis (Yaws and Pinta) and its regional variations are mentioned along with postulation about how Syphilis 'venerealized' over time.

Chapter 2. The Protean Manifestations of Disease.

SUMMARY: This chapter elucidates the features of the primary, secondary and tertiary stages of the disease including commentary on their historical accounts. The final stages of neurosyphilis are considered including the bizarre features of General Paresis of the Insane that left many infected individuals poorly treated in lunatic asylums. The problem of congenital Syphilis is part of this discussion where in the 19thC heredos (as they were called) who might spread the disease into the wider population were considered the greatest threat to France's intellectual elite.

Chapter 3. In Search of the Organism and a Zauberkügel (Magic Bullet) for Treatment

SUMMARY: The chapter chronicles the use of mercurial treatments and the rash of anti-mercurialists. The great breakthrough came with Paul Ehrlich's Compound 606 an arsenical called Salvarsan which was administered by injection to troops during WW1. Ehrlich received the Nobel Prize, however, because of some deaths a notorious court case was brought against him, seriously affecting production and dissemination. By 1943 the new antibacterial agent Penicillin became mass produced by Fleming, Florey and Chain and was shown by John Mahoney at the VD Research Laboratory on Staten Island to cure Syphilis in 4 patients. This resulted in worldwide excitement with sufficient quantities mass produced in time for the D-Day landings in 1944 although it ultimately proved unable to eradicate Syphilis.

SUMMARY: The literary legacy of Syphilis is traced in this chapter beginning with Oscar Panizza's play The Council of Love for which he was charged and convicted for blasphemy and imprisoned. There is then a brief chronicle of the physical demise of Charles Baudelaire, Gustave Flaubert, Guy de Maupassant and Oscar Wilde, each purported to be the victim of a syphilitic end. There were others like Leon Daudet who proclaimed their Syphilis the source of a romantic literary genius. In the art world perhaps it is best embodied in the image of the face of the artist Gerard de Lairesse (1641-1711) but exemplified in the caricatures of William Hogarth, (1697-1764) Thomas Rowlandson (1756-1827) and James Gillray (1757-1815) and in the impressionist work of Henri de Toulouse-Lautrec (1864-1901) or Félicien Rops (1833-1898).

Chapter 5. Syphilitic Politics: Ethical Breaches, the Tuskegee Experiment and Beyond

SUMMARY: In the management of patients with Syphilis, there were many who cut ethical boundaries. Fights occurred between France's leading syphilologists Philippe Ricord (1800-1889) and Joseph-Alexandre Auzias-Turenne (1812-1870). Turenne had advocated a wide process of inoculating prostitutes with infected material in a process he called Syphilization. The procedures were stopped after several mysterious deaths. The infamous Tuskegee Study of Untreated Syphilis in the Negro Male conducted out of Macon County in Alabama was designed by the Public Health Service specifically to deny available treatments to 400 African American men with Syphilis so as to observe the natural history of untreated disease. This shameful period in medical history was only brought to an end in 1972 by a whistle blower who revealed the multiple ethical violations of the study which had started in the 1930s.  The chapter reviews the medical, racial, historical and symbolic dimensions of Tuskegee.

Coda         Syphilocentricity: Disease in the Post-HIV Era

SUMMARY: Brief comparisons are made between the communitarian and the medical responses to Syphilis and that against HIV-AIDS. Effective advances in medicine do not necessarily result in the elimination of deadly organisms.  How will the spirochaete genetically respond to future environmental stress and what will be its newest social legacy?

 Footnotes 

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