A Brief History of Syphilis
When I was twelve, I decided that I was suffering from congenital syphilis. My mother had always encouraged me to read her medical textbooks in the hope that I might become a doctor. With the approach of puberty, I tired of memorising the names of bones and turned my attention to the horrible things that might go wrong with my own internal organs. I got the idea of syphilis by looking at photographs of teeth. They looked rather like mine. Nearly half a century later, I am willing to allow that my diagnosis may have been made without full consideration. I can also rejoice that an already suffering world has not been made still worse by my entry into the medical profession. I remain, even so, interested in syphilis – though almost certainly in my case from a distance.
The disease first came to notice in 1495. Charles VIII of France had invaded Italy the previous year. His general objective was to take Naples for use a base in a renewal of the Crusades. In February 1495, he did take Naples, and his army spent several weeks in a riot of celebration. They had much sex with the local prostitutes, the local men with theirs. Shortly after, a new and terrible disease broke out among the soldiers. Many became so ill, they were unable to fight. Charles retreated to France, where he disbanded his army – an army largely of mercenaries. These returned home. Within a few years, the new disease had spread to every part Europe and every part of the world visited by Europeans. Charles himself may have died from the disease in 1498.
Gathered from various sources, my understanding of syphilis runs as follows. It is caused by transmission of the spirochete Treponema pallidum. The most common form of transmission is sexual intercourse, though it can also be spread from mother to baby and by various contacts with infected bodily fluids. It passes typically through four stages. In its primary stage, which emerges a few weeks after infection, syphilis is evidenced by a rash of hard and painless sores in the genital region. Within a few months, a secondary stage emerges, of which the symptoms are a painful rash over much of the body, together with fevers. The disease is most infectious in this stage. After this, it passes into its latent stage, when it vanishes altogether in around two-thirds of cases, leaving various degrees of immunity to further infection. In the remaining third of cases, it eventually passes to its tertiary stage, in which the flesh and organs are ravaged. Blindness and madness are typical effects, followed by early death.
These facts are based on observations of the disease during the past hundred years. They tell us little about its impact in the early sixteenth century, when it took hold among populations that had no acquired immunity. New diseases are always the most virulent. They spread rapidly, and sweep away multitudes. Sometimes, they burn out, their human fuel exhausted, and have no further impact. More often, they stabilise and remain as a minor irritant – a minor irritant, I should add, in overall terms – among the descendants of those with enough immunity not to be killed in the first outbreak.
And the first outbreak was fearsome. One of its early victims was Ulrich von Hutten (1488-1523), a German scholar and nobleman who took the Lutheran side in the Wars of Religion. His De Morbo Gallico (1519) is one of the first patient narratives. Even then, the disease was beginning to stabilise in its relationship with its victims. But he says, looking back a few years:
Now also began the Enquiry of the Physicians, who searched not so much for proper remedy, as for the Cause; for they cared not even to behold it, much less at the first to touch one infected; for truly when it first began, it was so horrible to behold, that one would scarce think the Disease that now reigneth, to be of the same kind. They had boils that stood out like acorns, from whence issued such filthy stinking matter, that whosoever came within the Scent, believed himself infected. The Colour of these was of a dark Green, and the very Aspect as shocking as the Pain itself, which yet was as if the Sick had lain upon a fire.
He continues with an enumeration of the symptoms as they took him:
After this [other symptoms] there will appear some small Holes and Sores, turning cankerous and fistulous, which the more putrid they grow, the more they will eat into the Bones, and when they have been long corrupted the Sick grow lean, his Flesh wasting away, so that there remaineth only the Skin as a Cover for them: And by this many fall into Consumptions, having their inward parts corrupted.
Those of us who remember the aids epidemic of the 1980s, or have read about it, can imagine the moral impact of syphilis. Of course, it struck prostitutes and their clients. But it also struck the married and apparently chaste. It struck monks and priests and bishops, whose vows had supposedly raised them above fleshly temptations. It struck kings and their ministers. It made the young and beautiful into heaps of rotting filth. The Late Middle Ages were a time of broad tolerance in sexual matters. They were not uniformly tolerant, and there were bursts of puritanism. Even so, it was accepted that human nature had a sexual aspect. This was expressed in the arts and in social relationships. The arrival of syphilis created mutual suspicion. It led to a growing puritanism in morals. Brothels were closed or tightly-regulated. As a means of limiting temptation, mixed bathing was outlawed. Bathing of most kinds went into decline, and people remained dirty by the standards of our grandparents for the next three hundred years. Stanislav Andreski believed that it was the claim of a supernatural origin for syphilis that led to the witch-mania of the sixteenth century.
A further consequence of syphilis was the invention of condoms. Only in the nineteenth century did these come into use as a means of birth control. Until then – made of fine linen or sheep gut – they were used to minimise contact during sex.
But I turn to belief about the causes. Our ancestors knew less than we do about the natural sciences. But they were not stupid. It was a simple induction to decide that the disease was spread by sexual intercourse. Again, see Hutten:
[I]t is this Disease in our Days ariseth not, unless from infection from carnal Contact, as in copulating with a diseased Person, since it appears now that young Children, old Men and others, not given to Fornication or bodily Lust, are very rarely diseased: Also, the more a Man is addicted to these Pleasures, the sooner he catcheth it….
This being said, the educated mind of his age thought in terms of a hierarchy of causes – the product of a servitude to Aristotle men had not yet shaken off. As heirs of the great Scientific Revolution, our interest in nature is a matter of hypotheses, suggested by earlier experiment, and tested by further experiment. Syphilis is a disease caused by germs that are spread by sexual intercourse. This being established, we look to the matter of prevention or cures. We may ask whether it came from the New World, or if it was a disease native to Europe that just happened to mutate into something deadly in the 1490s. But final causes we leave to philosophers and priests whom no one reads. Hutten’s comment on sex comes in the first chapter of his book, in which he discusses the history and names of the disease. He devotes a whole chapter to possible causes, in which he says nothing more about sex. Instead, he mentions corrupted air and water, and astrological portents, and imbalances of the humours – anything but sex with a person already infected.
As said, men before the seventeenth century thought in Aristotelian terms. The Greeks were not ignorant of inductive reasoning, but were more interested in metaphysics. It was agreed that events might have an immediate cause, and that this could be discovered by looking at the known facts. But the main research was into the final causes, which would discover the true nature of reality and its relationship with God. The doctors asked if syphilis was a punishment from God, and otherwise if it was a product of environmental causes, or of some pre-existing weakness in its victims.
A further point is that much of their inductive reasoning was based on an imperfect gathering of facts, and then by the arrangement of these facts in the light of false assumptions. Their theory of the humours, which they took from Galen was entirely false. Sadly, it was developed and advanced with great subtlety; and there is no theory so false that it cannot be surrounded with enough rescue hypotheses to make it explain whatever facts are observed. Their miasma theory, of an invisible mist evidenced by foul smells, was based on some inductive reasoning. The Black Death – that is, the bubonic plague – had not been spread by physical contact. Often, the companions of the infected were spared. Often, those who shut themselves away were infected. The miasma theory seemed to explain that disease. It even suggested actions that lessened the chance of further outbreaks. Well into the nineteenth century, vast sanitation projects were carried through in the belief that cleansing cities of filth would remove the causes of bad air. Where syphilis was concerned, the doctors grudgingly admitted the evidence of their senses. They recommended continence. But their main interest lay in arguing the toss between false theories that did nothing to suggest an effective cure.
So far as cures were concerned, mercury soon emerged as the consensus. Mercury paste was applied to sores. Mercury vapour was inhaled. Mercury was put in drinks. Mercury enemas were flushed into the bowels of victims and kept there. It was agreed that mercury could be poisonous. At the same time, it was mostly agreed that mercury was an effective cure.
Before I started looking into the materials for this article, I was inclined to dismiss the treatment with a sneer. How could a very toxic metal cure anyone of a bacterial infection? It could certainly kill. I believe Schubert might have lived into his fifties had he not taken his syphilis to the doctors. Instead, he drank mercury chloride and was dead at 31. Surely, the alleged cures were due to the fact that untreated syphilis goes into its latent stage, and often never returns?
On the other hand, opinions on the Internet are mixed. Some writers claim it was a useless poison, others that it did produce cures if given in small doses at the primary stage of syphilis. All I can say is that mercury remained the standard treatment into the twentieth century, and that the first undeniable cure, Salvarsan, was a controlled dose of arsenic, another metallic poison.
We are lucky to have been born into an Age of Science. Untreated, syphilis can still be a terrible affliction. But its treatment with antibiotics is cheap and simple, and mostly without side-effects. Nearly all sexual diseases can be cured. In all cases, there are simple precautions that do little to reduce sexual pleasure, but that prevent the spread of disease. Many years ago, a friend told me he had caught syphilis from a casual encounter. I shrugged, and asked what pills he was taking, and for how long. For some people, venereal diseases remain a cause of shame. I once stood outside a pox clinic. Everyone coming out had a furtive look on his face. But we have come a long way from the sad writings and desperate hopes of Ulrich von Hutten.
I hardly ever worry nowadays about congenital syphilis. All else aside, my teeth have worn down an eighth of an inch since 1972, and they no longer have what that textbook called “the characteristic notches of the congenital syphilitic.”
 Ulrich von Hutten, De Morbo Gallico, 1519. There is a first edition of the Latin text on Google Books, and an English translation from 1730 at the Internet Archive. I have compared the two works, and they largely correspond. I therefore quote from the English translation, p.3. Citation: A Treatise of the French Disease, Published above 200 Years Past, by Sir Ulrich Hutten, K. of Almeyn in Germany, translated by Daniel Turner, John Clarke, London, 1730.
 Ibid., pp.5-6
 Hutten, op. cit., p.4.
 On the other hand, the decline of bathing and even washing after about 1500 was linked to fears that opening the pores with hot water might let in the dreaded miasma – even that a layer of dirt would protect against it.