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Syphilis A Short Biography Andrew P. Zbar Syphilis Andrew P. Zbar Syphilis A Short Biography 123 AndrewP. Zbar University of Melbourne Melbourne, VIC,Australia ISBN978-3-031-08967-1 ISBN978-3-031-08968-8 (eBook) https://doi.org/10.1007/978-3-031-08968-8 ©TheEditor(s)(ifapplicable)andTheAuthor(s),underexclusivelicensetoSpringerNature SwitzerlandAG2022 Thisworkissubjecttocopyright.AllrightsaresolelyandexclusivelylicensedbythePublisher,whether thewholeorpartofthematerialisconcerned,specificallytherightsoftranslation,reprinting,reuseof illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmissionorinformationstorageandretrieval,electronicadaptation,computersoftware,orbysimilar ordissimilarmethodologynowknownorhereafterdeveloped. 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ThisSpringerimprintispublishedbytheregisteredcompanySpringerNatureSwitzerlandAG Theregisteredcompanyaddressis:Gewerbestrasse11,6330Cham,Switzerland To the spirit of Paul Ehrlich (1854–1915) who towered above others through his industry, the fertility of his mind and in how he conducted himself against prejudice. Foreword Andrew Zbar opens his treatise with a question: Why write a book about syphilis? Initially,Ithoughtthiswasmerelyrhetorical,togetthenarrativerolling.Butas the story of syphilis unfolds I realized this is a genuine enquiry, directed towards himself, and asked on behalf of the reader. The book itself becomes the answer. Andyetitismorethanabook;theauthorhaselevatedthesubjecttobeworthy of a ‘biography’, which, on the face of it, is a huge anthropomorphic leap for a bacterium, let alone a disease. Biographies are often written about great men and women, however, a quick scan of any reputable bookshop shelf will reveal that many, perhaps most, of the subjects of biographies are nowhere near as famous as syphilis. There are other biographies that hone in on the darker side of humanity and have as their subject true monsters—again syphilis is not out of place here. This is a ‘short’ biography and cannot rival, in girth at least, those Winston Churchill door-stoppers that thump onto desks every couple of years. But it is a thoroughandincisiveexposéofatrulyremarkablelife-formthathasinfluencedand even devastated the lives of any number of people who wind up the subject of a publishedbiography.Syphilismaynotbeaperson,butitisanintimatecompanion ofhumanity,inmanywaysunchanging,yetcapriciousenoughtofightbackwhenit seems not far from being silenced. While, personally, we would not choose the intimate company of the subject of this biography, we can enjoy vicariously many happy hours amongst these pages. Zbarstartswiththeoriginsofthediseasethathasalonghistoryofcontroversy. He deftly avoids getting bogged down with the ‘who brought it back from where, and then gave it to whom’ argument. Huge volumes of toner have been consumed arguingabouttheancientEuropean(orevenolder,African)originofthediseaseas an alternative to the often-quoted arrival of syphilis from the Americas more than five centuries ago. Instead we first join the author on this journey in the company of the well-connected Girolamo Fracastoro. It was this Italian poet/physician who vii viii Foreword put the disease on the map, both metaphorically and literally, (achieving the latter by placing the blame at the feet of the French in the timeless xenophobic way we like naming diseases—the morbus Gallicus). Next,weareinvitedtoseethemanyguisesofsyphilisthroughahistoricalprism usingmagnificentdescriptionsfromthepast.Theillustrationsarecarefullyselected butitisthewrittenrecordthatbringsthediseasetolife.Syphilis,asthedescriptions attest, is truly versatile, ‘malignant, occult and insidious’. With every scientific discoveryof medical importance, there isoften great hopeand ambitiousplans for disease eradication. Syphilis has had its share of pharmaceutical over-reachers, where a little knowledge quickly turns into arrogant bravado. And after hubris, failure often follows at great cost to reputations, but much more important to the poorpatientswhohavefollowedtheseleadersdownaroadofquackeryoftenoutof desperation and blind hope. But in the middle of the last century, there arrived a great white powder to usher in the antibiotic era, and luckily for us penicillin remains the first choice of treatment for many serious illnesses including syphilis. In the fifth chapter, we are shown the impact of syphilis on the arts both at a personal and cultural level. In the recording of stories about infectious diseases throughtheages,theword‘romance’hasoftenbeenhitchedtotuberculosis,though giventhemodeoftransmissiononemightthinkthatsyphilisisabetterfit.Intruth,I thinkweshouldleavethe‘R’wordwellawayfrombothofthem.Andyetsyphilis has inspired a tremendous wealth of writing, from literature to satirical scorn, and portraiture, from epic canvasses to humorously vulgar cartoons making for a great and terrible record of a dreadful scourge. Finally, there is, what will for many be the most important biographical details ofthedisease—thepoliticsofsyphilis.Thereisapowerfulnaturalforcethatdraws infectious diseases physicians, microbiologists and epidemiologists to calamitous infectionsespeciallyiftheycauselargeoutbreaksofgreatmorbidity.Itcanappear, totheunbiasedobserver,atleastabituncaring,however,overwhelminglythestudy of infectious diseases is undertaken with best intentions and by good people. But Tuskegee is now synonymous with one of the most heinous cases of medical malfeasanceinhistoryandnowhasapermanentplaceinmedicalethicspedagogy, toremind us,emphatically,whatnottodo.Itwasaterribleironythatthosewhom thefoundersofthatInstitutesetouttobestserve,werethemostbesetvictimsofthis wrongdoing. The story has been often told but in this chapter the misadventure is clearlylaidbare underfourappositeheadingscalledthe‘Medical’,the‘Folkloric’, the ‘Factual’ and the ‘Racial Tuskegee’. Throughout the author takes a cool historian-scientistapproach; butwe can sense (andwe share) his patent disgust. Foreword ix Sowheredoesthisbookgointhelibrary?History?Science?Medicine?Itactually doesn’treallymatter,what’simportantisthatthequestionthatopenedproceedings hasbeenanswered:Whywriteabookaboutsyphilis?Becauseitisfascinating. (…and by the way, it goes in the Biography section.) Adam Jenney, M.B.B.S., Ph.D., F.R.A.C.P., F.R.C.P.A. Head, Microbiology Unit The Alfred Hospital Monash University Melbourne, Australia Preface Why write a book about Syphilis? Ifwearetoexamineanyinfectiousdisease,thematerialaspectsofitsidentification, its growth in culture, the clinical manifestations, its fastidious microbiological needs and habits and its treatment, are the domain of the scientist and the doctor. That too today along with the molecular information of its genetic backbone that has sequenced its unique genome. But the historical fingerprint of any disease like Syphilis can be found in its communicability, something more defining that lies outside the organism itself. Although it emerged in its most virulent form in the Renaissance,itisperhapsmoreimpressionablyalignedwiththeVictorianera(like another disease Tuberculosis) and it is through this association that it has become inculcated into the romantic literature and with its veil of secrecy, transcended social class. This book is aimed at the presentation of more than the history of Syphilis as a distinct bacterium. I have entitled it a biography in order to render it more of an intimate account of its emergence and impact and to establish that connection between the organism itself and the social responses it provoked. Both most assuredly contribute to its definition. Chapter 1 examines the origins of European Syphilis,stillsomewhatshroudedinmysteryandfirstlamentedinthepoetryofthe Renaissance physician Girolamo Fracastoro (1478–1553). Chapter 2 considers the protean manifestations of disease and focuses on bizarre neuropsychiatric expres- sionsoflateSyphilis.Chapter3relatesthehistoryofthelaboratorydiagnosisofthe disease and the quest for definitive anti-Syphilis therapy chronicling those who hitched their medical wagon to the curative properties of mercury, a drug-metal rooted in the era of alchemy and wizardry. Chapter 4 illustrates the impact of Syphilisonliteratureandinthearts,detailingthequirkynotablehistoryofsomeof its more renowned victims, both assured and presumptive. Chapter 5 deals with thosewhoseprime interest inSyphiliswasacademicbutwhoseambitions clouded theirgoalsleadingthemtobehaveinthemostunethicalmannerinordertoachieve their aims. xi xii Preface The Canadian physician Sir William Osler, (1849–1919) oneofthefoundersof JohnsHopkinsHospitalinBaltimoreandoneofthemosthighlycitedofphysicians hadoftbeenquotedassayingKnowsyphilisinallitsmanifestationsandrelations, andallotherthingsclinicalwillbeaddeduntoyou.Thestatementisastruetoday asiteverwas,justnotasrelevantinanagewheretheprevalenceofdiseaseisone wherethereisadiminishinglawofreturns.1Syphilismaynothavekilledasmany people as the ‘white plague’ Tuberculosis but for the French medical historian Claude Quétel it has caused the blackest ink to flow.2 As a disease, many of its representative specimens may now sit in museums calling to us with 500 years of collective memory but still it endures. Melbourne, Australia Andrew P. Zbar 1American,Canadian,EnglishandAustralasianmedicineholdsasoftspotforOslerparticularly ashetookupapostafterBaltimoreastheRegiusChairofMedicineatOxfordandthenreceiveda baronetcy.Oslerthroughhisaphorismsandpronouncementswas,onemightsuggestpreoccupied with his importance and hisverbal legacy donating hispersonal library to McGill University in MontrealontheprovisothattheydubittheBibliothecaOsleriana.Asafoundingmemberofthe AmericanAnthropometricSocietythelastthingOslerdidwastowillhisbraintothegroup(now heldattheWistarInstitutePhiladelphia)whereitresideswiththebrainsofthephysiciansWilliam PepperandPhillipLeidy,thepalaeontologistsJosephLeidyandEdwardDrinkerCopeand(until thebrainwasdroppedbyatechnician)thepoetWaltWhitman. 2ClaudeQuétel.TheHistoryofSyphilis.JohnsHopkinsUniversityPress.1990;p2.