Syphilis History

Origins

Three theories on the origin of syphilis have been proposed. It is generally agreed upon by historians and anthropologists that syphilis was present among the indigenous peoples of the Americas before Europeans traveled to and from the New World. However, whether strains of syphilis were present in the entire world for millennia, or if the disease was confined to the Americas in the pre-Columbian era, is debated.

The "pre-Columbian theory" holds that syphilis was present in Europe before the discovery of the Americas by Europeans. Some scholars believe its symptoms were described by Hippocrates in Classical Greece in its venereal/tertiary form. There are other suspected syphilis findings for pre-contact Europe, including at a 13–14th century Augustinian friary in the northeastern English port of Kingston upon Hull. This city's maritime history, with its continual arrival of sailors from distant places, is thought to have been a key factor in the transmission of syphilis. Carbon-dated skeletons of monks who lived in the friary showed bone lesions that supporters say are typical of venereal syphilis, although this is disputed by critics of this theory. Skeletons in pre-Columbus Pompeii and Metaponto in Italy with damage similar to that caused by congenital syphilis have also been found, although the interpretation of this evidence has been disputed. Douglas Owsley, a physical anthropologist at the Smithsonian Institution, and other supporters of this idea say that many medieval European cases of leprosy, colloquially called ''lepra'', were actually cases of syphilis. Although folklore claimed that syphilis was unknown in Europe until the return of the diseased sailors of the Columbian voyages,
... syphilis probably cannot be "blamed"—as it often is—on any geographical area or specific race. The evidence suggests that the disease existed in both hemispheres from prehistoric times. It is only coincidental with the Columbus expeditions that the syphilis previously thought of as "lepra" flared into virulence at the end of the fifteenth century.
Lobdell and Owsley wrote that a European writer who recorded an outbreak of "lepra" in 1303 was "clearly describing syphilis." This theory is supported by genetic studies of venereal syphilis and related bacteria, which found an intermediate disease between yaws and syphilis in Guyana, South America.
Finally, historian Alfred Crosby suggests both theories are partly correct in a "combination theory". Crosby says that the bacterium that causes syphilis belongs to the same phylogenetic family as the bacteria that cause yaws and several other diseases. Despite the tradition of assigning the homeland of yaws to sub-Saharan Africa, Crosby notes that there is no unequivocal evidence of any related disease having been present in pre-Columbian Europe, Africa, or Asia.

Crosby writes, "It is not impossible that the organisms causing ''treponematosis '' arrived from America in the 1490s...and evolved into both venereal and non-venereal syphilis and yaws." However, Crosby considers it more likely that a highly contagious ancestral species of the bacteria moved with early human ancestors across the land bridge of the Bering Straits many thousands of years ago without dying out in the original source population. He hypothesizes that "the differing ecological conditions produced different types of treponematosis and, in time, closely related but different diseases."]]

While working at the Rockefeller University (then called the Rockefeller Institute for Medical Research) in 1913, Hideyo Noguchi, a Japanese scientist, demonstrated the presence of the spirochete ''Treponema pallidum'' in the brain of a progressive paralysis patient, proving that ''Treponema pallidum'' was the cause of the disease. Prior to Noguchi's discovery, syphilis had been a burden to humanity in many lands. Without its cause being understood, it was sometimes misdiagnosed and often misattributed to damage by political enemies.

Some famous historical personages, including Charles VIII of France, Hernando Cortez of Spain, Adolf Hitler, Benito Mussolini, and Ivan the Terrible, were alleged to have had syphilis. Guy de Maupassant and possibly Friedrich Nietzsche are thought to have been driven insane and ultimately killed by the disease. Al Capone contracted syphilis as a young man. By the time he was incarcerated at Alcatraz, it reached its third stage, ''neurosyphilis'', leaving him confused and disoriented. Syphilis led to the death of artist Edouard Manet and artist Paul Gauguin was also said to have suffered from syphilis. Composers who succumbed to syphilis included Hugo Wolf, Frederick Delius, Scott Joplin, Gaetano Donizetti, and possibly Franz Schubert and Niccolò Paganini.

Mental illness caused by late-stage syphilis was once one of the more common forms of dementia. This was known as the general paresis of the insane. One suspected example of syphilis was the insanity of noted composer Robert Schumann, although the precise cause of his death has been disputed by scholars.

The Russian author Leo Tolstoy suffered from syphilis during his youth, which was treated using contemporary arsenic treatment. A recent article in the ''European Journal of Neurology'' (June 2004) hypothesized that the founder of communism in Russia, Vladimir Ilyich Lenin, died of neurosyphilis.

From 1932–1972, the U.S. Public Health Service conducted what became known as the Tuskegee Study of Untreated Syphilis in the Negro Male (also known as the Tuskegee Syphilis Study or the Tuskegee Experiment). It was a clinical study, conducted in Tuskegee. Nearly 400 poor, mostly illiterate, African-American men with syphilis were deliberately and systematically denied effective treatment so that researchers could observe the natural progression of the disease when left untreated. The controversy over the unethical behavior of the researchers conducting this study eventually led to major changes in how patients are protected in clinical studies.

European outbreak

The first well-recorded European outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops besieging Naples. The French may have caught it via Spanish mercenaries serving King Charles of France in that siege. The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease.

Researchers concluded that syphilis was carried from the New World to Europe after Columbus' voyages. The findings suggested Europeans could have carried the nonvenereal tropical bacteria home, where the organisms may have mutated into a more deadly form in the different conditions and low immunity of the population of Europe. Syphilis was a major killer in Europe during the Renaissance.

History of treatments

There were originally no effective treatments for syphilis. The Spanish priest Francisco Delicado wrote ''El modo de adoperare el legno de India'' (Rome, 1525) about the use of ''Guaiacum'' in the treatment of syphilis. He himself suffered from syphilis. Another common remedy was mercury: the use of which gave rise to the saying "A night in the arms of Venus leads to a lifetime on Mercury". It was administered multiple ways including by mouth, by rubbing it on the skin and by injection. One of the more curious methods was fumigation, in which the patient was placed in a closed box with his head sticking out. Mercury was placed in the box and a fire was started under the box that caused the mercury to vaporize. It was a grueling process for the patient and the least effective for delivering mercury to the body. The use of mercury was the earliest known suggested treatment for syphilis. This has been suggested to date back to ''The Canon of Medicine'' (1025) by the Persian physician, Ibn Sina (Avicenna)., although this is only possible if syphilis existed in the Old World prior to Columbus (see Origins section). Giorgio Sommariva of Verona is recorded to have used it for this purpose in 1496.

As the disease became better understood, more effective treatments were found. The first antibiotic to be used for treating disease was the arsenic-containing drug Salvarsan, developed in 1908 by Sahachiro Hata while working in the laboratory of Nobel prize winner Paul Ehrlich. This was later modified into Neosalvarsan. Unfortunately, these drugs were not 100% effective, especially in late disease. It had been observed that some who develop high fevers could be cured of syphilis. Thus, for a brief time malaria was used as treatment for tertiary syphilis because it produced prolonged and high fevers (a form of pyrotherapy). This was considered an acceptable risk because the malaria could later be treated with quinine, which was available at that time. This discovery was championed by Julius Wagner-Jauregg, who won the 1927 Nobel Prize for Medicine for his work in this area. Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. These treatments were finally rendered obsolete by the discovery of penicillin, and its widespread manufacture after World War II allowed syphilis to be effectively and reliably cured.

History of diagnosis

In 1906, the first effective test for syphilis, the Wassermann test, was developed. Although it had some false positive results, it was a major advance in the prevention of syphilis. By allowing testing before the acute symptoms of the disease had developed, this test allowed the prevention of transmission of syphilis to others, even though it did not provide a cure for those infected. In the 1930s the Hinton test, developed by William Augustus Hinton, and based on flocculation, was shown to have fewer false positive reactions than the Wassermann test. Both of these early tests have been superseded by newer analytical methods.

Notable syphilis-infected people in history

Keys: S—suspected case; †—died of syphilis

Endre Ady (1877-1919), Hungarian poet †
Maurice Barrymore (1849–1905) actor †
John Batman (1801–1839), founder of Melbourne †
Charles Baudelaire (1821–1867), poet †
Karen Blixen (1885–1962), writer
Manuel Maria Barbosa du Bocage (1765–1805), poet †
Napoleon Bonaparte (1769–1821), emperor of France S
António Botto (1897–1959), poet
Camilo Castelo Branco (1825–1890), writer
Beau Brummell (1778–1840), fashion arbiter
Al Capone (1899–1947), gangster †
Henry Stuart (1545–1567), second husband of Mary Queen of Scots
Frederick Delius (1862–1934), composer †
Gaetano Donizetti (1797–1848), composer
Bedřich Smetana (1824–1884), composer †
Paul Gauguin (1848–1903), painter †
Heinrich Heine (1797–1856), poet †
Henry VIII (1491–1547), king of England S
Ivan the Terrible (1530–1584), Czar of Russia
Scott Joplin (1867/8–1917), composer †
John Keats (1795–1821), poet S
William Lobb (1809–1864), plant collector S
Édouard Manet (1832–1883), painter †
Guy de Maupassant (1850–1893), writer †
Friedrich Nietzsche (1844–1900), philosopher S
Jack Pickford (1896–1933), actor †
Martin Alonso Pinzon (1441–1493) captain of ''Pinta'' †
Leo Tolstoy (1828–1910), writer S
Theo van Gogh (1857–1891), art dealer †
Vincent van Gogh (1853–1890), painter S
Oscar Wilde (1854–1900), writer S
Eugen Sandow (1867–1925), bodybuilder S
Franz Schubert (1797–1828), composer S
Henri de Toulouse-Lautrec (1864–1901), painter †
John Wilmot (1647–1680), writer †
Hugo Wolf (1860–1903), composer †
Mikhail Vrubel (1856–1910), painter
Kostas Karyotakis (1896–1928), Greek poet
Lord Randolph Churchill (1849–1895), British politician, father of Winston Churchill
Harry Nelson Pillsbury (1872–1906), chess master †
Adolf Hitler (1889–1945), politician S
Eleanor of Toledo (1522-1562), Duchess of Florence S