Syphilis  

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Train wreck at Montparnasse (October 22, 1895) by Studio Lévy and Sons.
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Train wreck at Montparnasse (October 22, 1895) by Studio Lévy and Sons.

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The disease has been known under many names during history, including the "French disease", "Great Pox", and "The Black Lion." Syphilis has had a prominent role in history and literature for the last several hundred years. The route of transmission of syphilis is almost always by sexual contact. However, there are examples of congenital syphilis via transmission from mother to child in utero. The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult. In fact, the disease was dubbed the "Great Imitator" because it was often confused with other diseases, particularly in its tertiary stage.

Contents

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."

  • The "Columbian Exchange theory" holds that syphilis was a New World disease brought back by Columbus and Martin Alonso Pinzon. They cite documentary evidence linking crewmen of Columbus's voyages to the Naples syphilis outbreak of 1494. 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, Alabama. 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. From this centre, the disease swept across Europe. As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months." In addition, the disease was more frequently fatal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today." 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,Template:Citation needed by rubbing it on the skinTemplate:Citation needed 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.

Known and suspected notable syphilis-infected people in previous centuries

Keys: S - suspected case; - died of syphilis

Syphilis in art and literature

Art

The artist Kees van Dongen produced a series of illustrations for the anarchist publication L'Assiette au Beurre showing the descent of a young prostitute from poverty to her death from syphilis as a criticism of the social order at the end of the 19th century.

The artist Jan van der Straet, also known as Johannes Stradanus or simply Stradanus, painted a scene of a wealthy man receiving treatment of syphilis with the tropical wood guaiacum sometime around 1580. The title of the work is "Preparation and Use of Guayaco for Treating Syphilis." That the artist chose to include this image in a series of works celebrating the New World indicates how important a "cure" (however ineffective) for syphilis was to the European elite at that time. The richly colored and detailed work depicts four servants preparing the concoction while a physician looks on, hiding something behind his back while the hapless patient drinks.

Classic and antique literature

Delicado also featured the effects of syphilis in his Portrait of Lozana: The Lusty Andalusian Woman (1528).

There are references to syphilis in William Shakespeare's play Measure for Measure, particularly in a number of early passages spoken by the character Lucio. For example, Lucio says "[...] thy bones are hollow"; this is a reference to the brittleness of bones engendered by the use of mercury which was then widely used to treat syphilis.

In Shakespeare's play Othello, the clown at the beginning of Act III makes jest of Cassio, who is leading a musician troupe for Othello, by asking him if he had just arrived from Naples and playing with his nose. (Alluding to the reputation of Naples of being a likely place to contract syphilis, which eats away at the bridge of the nose.)

Francisco de Quevedo puns in his Buscón about a nose entre Roma y Francia meaning both "between Rome and France" and "between dull and eaten by the French illness".

Jonathan Swift's poetry mentions syphilis as a condition of prostitution which reaches the highest ranks of society. See, for example, "A Beautiful Young Nymph Going To Bed" and "The Progress of Beauty".

William Hogarth's works frequently show his subject's infection with syphilis. Two examples are A Harlot's Progress and Marriage à-la-mode. In both instances it is used to indicate the moral profligacy of the infected.

Some critics have argued that the character of Edward Rochester's first wife, Bertha, in Charlotte Brontë's novel Jane Eyre, suffers from the advanced stages of syphilitic infection, general paresis of the insane, and point to corroborative evidence within the text to substantiate this view.

The novel Candide by Voltaire describes Candide's mentor and teacher, Pangloss, as having contracted syphilis from a maidservant he slept with; the syphilis has ravaged and deformed his body. Pangloss explains to Candide that syphilis is 'necessary in the best of worlds' because the line of infection - which he explains - leads back to Christopher Columbus. If Columbus had not sailed to America and brought back syphilis, Pangloss states, the Europeans would not have been able to enjoy 'New World wonders' such as chocolate. (One of the purposes of the novel was to satirize Leibniz's philosophy as Pangloss's disingenuous rose-tinted viewpoint.) Pangloss eventually loses an eye and an ear to the syphilis before he is cured.

Also, in Charles Dickens' novel Tale of Two Cities, references are made that allude to the main character, Sydney Carton, having syphilis.

In Eça de Queiroz's novel written in 1870, "The Mystery of the Sintra Road", some of the characters have syphilis, and it plays an important role in the plot of a recent movie adaptation.

Henrik Ibsen's once-controversial play Ghosts has a young man who is suffering from a mysterious unnamed disease. Though it is never named, the events of the play make it plain that this is syphilis, an inheritance from his dissolute father. However, the young man's mother remains unaffected - this is because it is possible for a woman to carry syphillis and transmit it to her child in the womb without exhibiting any noticeable symptoms. Dr. Rank in Ibsen's play A Doll's House also has inherited syphilis.

Modern literature

Unnamed American medical students described syphilis in a series of early 20th-century American limericks, using medical terminology to ghastly comic effect in the Journal of the American Medical Association January 1942.

Thomas Disch in his novel Camp Concentration describe a fictional strain of syphilis that enhances intelligence but is lethal.

In Thomas Mann's novel Doktor Faustus, the Faust character, Adrian Leverkühn, acquires his genius for musical composition from the neurological effects of syphilis.

In Dick Francis' novel, Bonecrack the character Enso Rivera is suffering from megalomania caused by syphilis.

Neal Stephenson's trilogy The Baroque Cycle has multiple characters and historical figures who have syphilis, most notably James II of England and Jack Shaftoe; the latter is cured of the disease by running a high fever.

In Leonard Cohen's second novel Beautiful Losers, the character F. is described in detail as having the terminal stages of syphilis.

In Christina Garcia's novel "Dreaming in Cuban," Felica contracts syphilis from her unfaithful husband. The syphilis and her family history lead Felica down a path towards insanity.

In Ken Follett's novel "A Dangerous Fortune," the wealthy Edward Pilaster contracts syphilis from his frequency of using brothels. When Edward's cohort Micky Miranda finds out, it looks as though his diabolical plans may have a snag.

In Josilyn Jackson's novel "Between, Georgia", the protagonist Nonny Frett suffers from syphilis from a cheating husband she can't seem to rid herself of.

Film, Television and Stage

Miss Evers' Boys is a 1992 stage play written by Dr. David Feldshuh based on the true story of the decades-long Tuskegee syphillis experiment. The play was subsequently adapted into a 1997 HBO TV movie directed by Joseph Sargent and starring Alfre Woodard and Laurence Fishburne. The film was nominated for eleven Emmy Awards and won in four categories, including Outstanding Made for Television Movie.

In Akira Kurosawa's Japanese movie "The Quiet Duel"(1949) Toshirô Mifune plays a doctor who gets infected with Syphilis while operating on a soldier. the Duel is between him and his disease

In big budget Spanish film Alatriste, the main character finds the love of his life, actress María de Castro, dying in a hospital for syphilitics. It is implied that she caught the disease from an affair with Philip IV of Spain.

In the Masterpiece Theatre version of Bram Stoker's "Dracula", Arthur Holmwood, whose father dies of syphilitic insanity, enlists the services of Count Dracula in hopes of curing his congenital syphilis.

The character of Darla in Buffy the Vampire Slayer and Angel is a colonial-era prostitute dying of syphilis when she is made into a vampire by the Master. Also in Buffy the Vampire Slayer, the character of Xander contracts syphilis when cursed by a Native American vengeance spirit in the fourth season of the show.

The character of George in Grey's Anatomy got syphilis after sleeping with Nurse Olivia, who got it from sleeping with Alex first.

In an episode of House M.D., an elderly patient is diagnosed with syphilis after a large personality change.

In an episode of Law & Order: SVU, a man with late-stage syphilis goes on a killing spree, because the disease has affected his brain and driven him insane. Ultimately, he is confined in a psychiatric hospital "until such time as he is deemed competent to stand trial." (i.e., for the rest of his life, since the neurological damage is permanent and his psychosis is incurable, even if the infection has been stopped by antiobiotic treatment.)

In the A&E film She's Too Young, one of the three main characters admits to possibly contracting syphilis from having sex with numerous males. Throughout the rest of the film, the school in which the main characters attend becomes the site of a syphilis outbreak.

Warner Bros.' 1940 film, Dr. Ehrlich's The Magic Bullet, depicts the story of the German physician, Dr. Paul Ehrlich (Edward G. Robinson), whose work led to a cure for syphilis.




Unless indicated otherwise, the text in this article is either based on Wikipedia article "Syphilis" or another language Wikipedia page thereof used under the terms of the GNU Free Documentation License; or on original research by Jahsonic and friends. See Art and Popular Culture's copyright notice.

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