The human body hoards its trauma as though it were a dragon seated on a mountain of gold. Skeletons retain evidence of old wounds and diseases, the plaque on our teeth calcifies and preserves the bacteria present in our mouths, and even our hair can be tested for drugs for months after they have left our systems.[1] Externally, human culture adapts and evolves due to upheaval. There are some parts of history that wound more deeply than others, and leave a more permanent mark upon humanity. One such example is syphilis. This article will cover the early history of syphilis, focusing on the period before the 20th century, though there are a great many more instances in which syphilis has changed the world after that.
Page from a 1906 medical book illustrating syphilitic lesions of the cranium
Source: Bryant, Joseph D. (Joseph Decatur), and Albert H. (Albert Henry) Buck. American Practice of Surgery : A Complete System of the Science and Art of Surgery. New York : W. Wood and company, 1906. http://archive.org/details/americanpractice03brya.CloseDeleteEdit
The first reported cases of syphilis in Europe occurred in the War of Naples in 1495. [2], [3] The disease has been called many names; 34 relating to the supposed country of origin, 46 referring to the physical symptoms, 18 that combined the two, 12 specifying the part of the body affected, and 34 describing the cause and extent.[4] The word ‘syphilis’ originates in a poem by Girolamo Fracastoro, entitled Syphilis Sive Morbus Gallicus, about a shepherd punished by a vengeful sun god, with a dreadful plague.[5] These are all interesting facts, but the title that most properly illustrates syphilis’ effect on the globe is simply “The Great Pox”. That moniker is the reason that we refer to the variola virus as “smallpox”; the comparative disease is syphilis.[6] Society changed the entire name of a disease, because of the presence of one that caused more prolonged suffering, and spread not just during pandemics, but insidiously, and often nearly without detection. This seems like such a silly detail in the grand scheme of history, but the fact that syphilis was the default ‘pox’ shows just how ubiquitous it truly was.
Portrait of a woman with cutaneous syphilis- notice how pock-like her facial lesions are.
Source: Wellcome Collection. “Photographic Illustrations of Cutaneous Syphilis / by George Henry Fox.” Accessed January 6, 2022. https://wellcomecollection.org/works/n9wpy5qe.
Lues Venerea (‘Lues’ being the Latin name for plague, and ‘Venera’ connected with sex) took the world by storm from the late 15th century onward.[7] Earlier STI’s like gonorrhea had been blamed on women as the source, and syphilis was no different. According to Mary Spongberg, one of the earliest theories regarding the aetiology of the disease suggested that the poison was introduced to men through menstrual blood.[8] Thomas Sydenham posited that syphilis was caused when a "Common Woman has kept company with many Men, that their seeds (which are different, and often times of opposite qualities) being mixed in that womans Womb".[9] This misogyny coloured the treatment and ideas relating to its prevention well into the 19th century, and its effects can still be observed today.
Paleopathologists and historians debate the origin of peste cruelle (16th c Italian), and have for hundreds of years.[10] According to Mary Spongberg, there is written evidence for dates as early as 2637 BC in China. [11] Syphilis, in its later stages, can affect not only the soft tissue of the body (skin, organs), but the skeletal system as well, which is where paleopathologists enter the debate. In hereditary cases, the damage caused by the disease can affect a child’s development, right down to the teeth. In the late 1800s, one man, Jules Parrot, who spent his life as a dedicated pediatrician treating children with congenital syphilis, thought that he saw the signs of Hutchinson's teeth (see below) on a 7th c mandible (see below).[12] He supposed that this meant that syphilis was a “Prehistoric Disease”. Though in actuality, it seems that the original owner of the mandible had simply had periods of nutritional stress in childhood, and a large degree of tooth wear/ Parrot illustrates how long we have been debating the origin of the disease, and how similar symptoms cause misdiagnosis.
Parrot's illustration of his discovery of "ancient syphilis". compare this to the next set of illustrations, and note how unlike them it is.Source: Parrot J: Une maladie préhistorique. Revue
Scientifique de la France 1882;30:110–113.
Illustrations of syphilitic defects dubbed "Hutchinson's teeth", after the man who first wrote about them- from Hutchinson's own work.Source: Wellcome Collection. “Syphilis / by Jonathan Hutchinson.” Accessed January 6, 2022. https://wellcomecollection.org/works/gt7mnhav.
The Great Imitator, syphilis is a sexually transmitted infection caused by Treponema pallidum. It earned the title of Great Imitator because its symptoms align with a myriad of other diseases.[13] Symptoms can range anywhere from malais, depression, cutaneous (skin) lesions, fever, nasal discharge, to, in later stages, paralysis and death.[14] These varied symptoms mean that though syphilis is curable in the modern world, it can often be misdiagnosed. People who are HIV positive are a particularly high risk group, and they are at particular risk for central nervous system involvement, which can present with symptoms similar to meningitis, often leading to misdiagnosis. [15], [16], Essentially, the immunosuppression caused by HIV allows for a veritable playground for syphilitic infection.
Both syphilis and HIV have a similar stereotypical patient; visibly recognisable by their signs and symptoms, and sexually deviant.[17] According to Gilman, early depictions of sufferers show the disease as sent from heaven, a rhetoric echoed in the early years of the AIDS crisis.[18] One of the earliest titles awarded to syphilis was flagitium Dei, or a “scourge of G-d”.[19] The idea that one was punished by G-d for impurity with a deadly disease is one that echoes from syphilis’ past into the more modern rhetoric surrounding HIV.
Women, already viewed as inherently pathological, were considered to spontaneously generate the pustolae malae (evil pustules, 16th/17th c).[20],[21], Its symptoms were treated with mercury, because similar skin afflictions had been treated with preparations that used it since the medieval period. Paracelsus, a noted physician, based his treatment of syphilis on the study of alchemy, and posited that at the right dosage, mercury would cure syphilis without poisoning the patient. This, in part, was due to the reasoning that “like cures like”. Mercury poisoning and tertiary syphilis share many of the same symptoms, and by that logic, it was a perfect cure. [22]
Paracelsus’ thought of ‘like curing like’ is sometimes credited with the origin of homeopathy, but it also led to more sinister “cures” for syphilis. It was specifically promiscuous women who were blamed for the spontaneous generation of syphilis, and therefore the cure was thought to potentially be held in the body of a pure one. This ‘ignorant superstition’ led to the sexual assault of children up through the first half of the 20th century.[23] The belief that an adult woman was inherently tainted, but that a child could hold the ‘virgin cure’ is one of the most horrifying misogyny- informed ideas through the early history of syphilis. The pervasiveness and longevity of this folk-remedy shows the trauma that syphilis inflicted on society throughout history.
Protecting oneself from infection by venereal disease was discussed in medical texts from at least the 1560s. Dr Gabriele Falloppio, of fallopian tube fame, proposed that one could apply a special sheath of fabric impregnated with various substances (wine, guaiacum wood shavings, copper specks, mercury precipitate, ashes of antler of a deer, etc.) to the glans penis post coitus, thereby preventing infection from venereal disease. He claimed that none of the 1100 men who used this ‘plan B’ method contracted syphilis.[24] This linen sheath has often been misinterpreted as the first mention of a more modern condom. However, Fallopio’s prophylactic illustrates that fewer than 100 years after syphilis was first observed in Europe, anxieties about its spread were such that 1,100 men were willing to use experimental preventatives to protect themselves. Syphilis was just that scary.
The leftmost condom is probably the most similar to what Faloppio describes, though it is a 1930's creation.Source: “Sex Hasn’t Changed Much over the Years. Fortunately Condoms Have | Science Museum Group Collection.” Accessed January 6, 2022. https://collection.sciencemuseumgroup.org.uk/objects/co8179378/sex-hasnt-changed-much-over-the-years-fortunately-condoms-have-poster-sexually-transmitted-infection-condom.
This constant fear of infection led to a deeper understanding of the spread of disease, a positive note in the sea of negativity surrounding syphilis research and cures. As previously stated, for the first three centuries of its spread, women were thought to be the source of syphilitic infection. In the 18th century, doctors began to debate the precise ways in which women were transmitting the disease. In fact, some hypothesised that discharge from a woman’s body was more infectious than obvious chancres! [25] In other words, women could be diseased without appearing to be diseased. This supported the misogynistic idea of the inherent pathological nature of the female body. [26] However, in 1905, Treponema pallidum (the bacterium that causes syphilis) was discovered by Schaudinn & Hoffmann.[27] The true cause of ignota pestis (Italian, 15th century) had been discovered. This did not stop debates about the method of infection, however, both Dr George Henry Fox, and Dr.’s Baldwin and Learned describe infection via shared toothbrush, cup, or pipe! [28], [29]
Society has evolved around syphilis, and because of syphilis. It has led to some of the most horrifyingly misogynistic ideas, practices, and reforms throughout the centuries. Just as a skeleton shows syphilitic scars, so too does society. Names of other diseases have changed due to syphilis’ existence, women have been blamed for the spread of the disease, and xenophobia is shown in something as simple as the title imposed upon it. It is important that historians acknowledge and understand these deep pock marks in order to more deeply understand the past.
Footnotes
[1] Shima, Noriaki, et al. “Hair Testing for Drugs in the Field of Forensics.” YAKUGAKU ZASSHI, vol. 139, no. 5, May 2019, pp. 705–13. DOI.org (Crossref), https://doi.org/10.1248/yakushi.18-00166-4.
[2] Harper, Kristin N., et al. “The Origin and Antiquity of Syphilis Revisited: An Appraisal of Old World Pre-Columbian Evidence for Treponemal Infection.” American Journal of Physical Anthropology, vol. 146, no. S53, 2011, pp. 99–133. Wiley Online Library, https://doi.org/10.1002/ajpa.21613.
[3] Arora, Natasha, et al. “Origin of Modern Syphilis and Emergence of a Pandemic Treponema Pallidum Cluster.” Nature Microbiology, vol. 2, no. 1, Dec. 2016, pp. 1–6. www.nature.com, https://doi.org/10.1038/nmicrobiol.2016.245.
[4] Baldwin, Lauris Blake, and Larned, Ezra Read. Syphilis in Dentistry. United States, Colegrove, 1903. Pg 22.
[5] Society, Microbiology. “The Great Pox.” Accessed December 14, 2021. https://microbiologysociety.org/publication/past-issues/the-mobile-microbe/article/the-great-pox-mobile-microbe.html.
[6] Ibid.
[7] Asfiya, Amina, Malcolm Pinto, and ManjunathM Shenoy. “‘A Night with Venus, a Lifetime with Mercury’: Insight into the Annals of Syphilis.” Archives of Medicine and Health Sciences 6, no. 2 (2018): 290. https://doi.org/10.4103/amhs.amhs_131_18.
[8] Spongberg, Mary. Feminizing Venereal Disease: The Body of the Prostitute of Nineteenth-Century Medical Discourse. Macmillan, 1997. Open WorldCat, http://site.ebrary.com/id/10612753.
[9] Salmon, William, SALMON, William, M.D, and Sydenham, Thomas. New Method of Curing the French Pox. Written by an Eminent French Author; with the Practice and Method of M. Blanchard [Blankaart,] as Also Dr Sydenham's Judgment on the Same [?]. To Which Is Added Annotations and Observations by W. Salmon. (Some Curious Problems,) Etc. 1690.
[10] Abel, Ernest Lawrence. “Syphilis: The History of an Eponym.” Names 66, no. 2 (April 3, 2018): 96–102. https://doi.org/10.1080/00277738.2017.1415522.
[11] Spongberg
[12] Parrot. “Une Maladie Préhistorique.” La Revue scientifique de la France et de l’étranger : revue des cours scientifiques, July 1882. https://gallica.bnf.fr/ark:/12148/bpt6k215099h.
[13] Domantay-Apostol, Genevieve P., et al. “Syphilis: The International Challenge of the Great Imitator.” Dermatologic Clinics, vol. 26, no. 2, Apr. 2008, pp. 191–202. DOI.org (Crossref), https://doi.org/10.1016/j.det.2007.12.001.
[14] Ibid.
[15] Hobbs, Emily, Jaime H. Vera, Michael Marks, Andrew William Barritt, Basil H. Ridha, and David Lawrence. “Neurosyphilis in Patients with HIV.” Practical Neurology 18, no. 3 (June 1, 2018): 211–18. https://doi.org/10.1136/practneurol-2017-001754.
[16] Golden, Matthew R., Christina M. Marra, and King K. Holmes. “Update on Syphilis: Resurgence of an Old Problem.” JAMA 290, no. 11 (September 17, 2003): 1510. https://doi.org/10.1001/jama.290.11.1510.
[17] Gilman, Sander L. “AIDS and Syphilis: The Iconography of Disease.” October 43 (1987): 87–107. https://doi.org/10.2307/3397566.
[18] Ibid.
[19] Abel
[20] Spongberg
[21] Abel
[22] Whysner, John. The Alchemy of Disease: How Chemicals and Toxins Cause Cancer and Other Illnesses. New York: Columbia University Press, 2020.
[23] Davidson, Roger. “"This Pernicious Delusion": Law, Medicine, and Child Sexual Abuse in Early-Twentieth-Century Scotland.” Journal of the History of Sexuality 10, no. 1 (2001): 62–77. https://doi.org/10.1353/sex.2001.0006.
[24] Amy, Jean-Jacques, and Michel Thiery. “The Condom: A Turbulent History.” The European Journal of Contraception & Reproductive Health Care 20, no. 5 (September 3, 2015): 387–402. https://doi.org/10.3109/13625187.2015.1050716.
[25] Spongberg
[26] Ibid.
[27] Souza, Elemir Macedo de. “Há 100 Anos, a Descoberta Do Treponema Pallidum.” Anais Brasileiros de Dermatologia 80, no. 5 (October 2005): 547–48. https://doi.org/10.1590/S0365-05962005000600017.
[28] Fox, Dr. George Henry. Photographic Atlas of the Diseases of the Skin : A Series of Ninety-Six Plates, Comprising Nearly Two Hundred Illustrations, with Descriptive Text, and a Treatise on Cutaneous Therapeutics. Vol. 4. Philadelphia ; London : J.B. Lippincott, 1905.
[29] Baldwin MD, L. Blake, and Ezra Learned MD. Syphilis in Dentistry . Chicago: Colegrove , 1903.