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Syphilis is a disease frequently shrouded in many levels of mystery. It appeared suddenly in Europe in the late 1400s as a highly virulent and often fatal disease, a disease that could give Ebola a run for its money when it comes to sheer grotesque-ness. Victims may be covered with pustules from head to toe, diseased flesh peeled from their bodies, and patients may be in agonizing pain for weeks or months prior to death. However, after this inauspicious beginning, syphilis seems to have become less virulent, and instead shifted in presentation to more of the chronic disease that we know it as today.
Syphilis is caused by a bacterium called a spirochete: a twisted corkscrew-like organism named Treponema pallidum. The disease itself has been known by many names over the centuries, including “Morbus Gallicus” (“The French Disease”) and the Great Pox, to distinguish it from other diseases such as smallpox. It’s also known as “The great imitator,” due to the non-specific symptoms it frequently causes.
Illness caused by T. pallidum is typically divided into three stages: primary, secondary, and tertiary. Shortly after initial infection, a lesion may appear on the genitalia; typically, these will resolve on their own in another few weeks’ time. During the secondary phase, which can occur weeks or months later, a rash may appear on the body, typically over the extremities and frequently including the palms of the hands and soles of the feet. Myriad other manifestations may also present at this point, making the diagnosis of syphilis (especially without the characteristic rash) difficult in the centuries prior to identification of the causative spirochete. Tertiary syphilis, then, would frequently manifest a year to ten years (but sometimes as long as 50) after the initial infection. This also was difficult to definitively diagnose, as symptoms could include effects in a number of bodily systems, including the cardiovascular, digestive, and nervous system. The best-known tertiary effect include late stages of neurosyphilis, which can result in blindness, dementia, and paralysis.
In times gone by, just like today, acquisition of sexually transmitted diseases carried a stigma. This stigma, combined with the difficulty of making an accurate syphilis diagnosis (especially prior to the 1900s, but even after identification of the causative organism, diagnostic tests could still show false negatives), has resulted in quite a bit of rumors swirling around famous historical figures: had they been infected with syphilis? Hitler is but one of the historical figures investigated in Deborah Hayden’s Pox: Genius, Madness, and the Mysteries of Syphilis. More below…
Hayden pulls together an impressive list of historical figures that, for one reason or another, have been suspected having been infected with T. pallidum. This includes Christopher Columbus, who (along with his sailors) is suspected of bringing syphilis to the Old World from the New during his voyages; Beethoven; Abraham and Mary Todd Lincoln; van Gogh; Nietzsche; James Joyce; and Hitler, among others (though one missed was Shakespeare, the subject of speculation in a 2005 Clinical Infectious Diseases article). Speculation about many of them is based on a few things they frequently had in common. One, rumors at the time of syphilis specifically, or mention of some “dread disease” that was kept secret from the general public. Two, evidence of treatment with drugs used at the time for the disease, including mercury, arsenic, and other toxic chemicals–or evidence of symptoms characteristic of initial infection with the bacterium. (Luckily today, syphilis is highly treatable with simple penicillin injections). Three, history of chronic illnesses: pain, lethargy, sometimes the more characteristic paralysis and insanity that could manifest in the tertiary stages. Four, evidence from the possible victim themselves–hints in their writings, their paintings, their compositions that may be clues to their own personal sufferings.
Hayden draws on a vast array of material to analyze the case for each figure. In each instance, she recognizes the difficulty of a retrospective diagnosis, especially of “the great imitator.” It can be easy to read too much into rumor and innuendo, or to over-interpret the author’s own works in the light of syphilis; the use of mercury and other “curative” chemicals can cause some of the same symptoms as syphilis itself; and syphilis itself can manifest in many different ways, so no universal trajectory of infection could be looked to for comparison. Additionally, the long latency period makes diagnosis difficult as well, as it can be from years to decades between initial infection and tertiary syphilis (or death from the infection). Therefore, each case is cautiously presented, and the evidence for and against a syphilis diagnosis is laid out without necessarily any conclusion as to the definitive diagnosis.
One drawback to the book is that Hayden does seem to assume the reader will already have quite a bit of familiarity with the historical figures she introduces. Therefore, in my opinion she’s a bit scant on the background for some of them, and specifically, why we should care if they had syphilis or not. Now admittedly, I was a science major in college and didn’t get nearly as much coursework in arts as I’d have liked, but I consider myself to have somewhat of a rounded education and know bits and pieces about classical music. However, reading about Guy de Maupassant, I didn’t know before why I should care about him, and I still don’t know. Similarly for Karen Blixen, for whom she gives one introductory paragraph on the significance of her life (and part of that is simply that she married her cousin and became a baroness). So she was the inspiration for wrote “Out of Africa”–…and? Hayden is long on the medical evidence, but short on the significance for many of the chapters.
Still, Pox is an interesting read. Like Diamond’s Guns, Germs, and Steel, Hayden suggests ways that this infectious disease may have influenced the course of history. For example, several sources have suggested that Hitler (if indeed, he was infected with syphilis) traced his own infection to a Jewish prostitute he visited during his youth. If not for that chance encounter–if not for that infection–could the course of history have changed? Simplistic, to be sure, but an intriguing hypothesis nonetheless.
Image from http://www.cdc.gov/nchstp/od/tuskegee/images/sf1ep.jpg
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