The Syphilis Pandemic Prior to Penicillin: Origin, Health Issues, Cultural Representation and Ethical Challenges
DOI:
https://doi.org/10.2340/actadv.v104.34879Keywords:
Ethics, Medical, History of Medicine, Medicine in the Arts, Pandemics, SyphilisAbstract
Syphilis is currently a treatable disease, with a low incidence in most developed countries, although the prevalence has increased recently, especially among men-who-have-sex-with-men. In many of the least developed countries, however, syphilis is still a major health problem, although the problem is not comparable to the desperate situation worldwide less than 80 years ago. At that time, and for many centuries previously, syphilis dramatically affected the lives and health of individuals and threatened the well-being of many societies. This review examines the aetiology, transmission, and many manifestations of syphilis from a historical perspective, emphasizing morbidity, treatment, psychosocial and cultural manifestations, as well as ethical issues uncovered in the clinical search for knowledge about the manifestations of the disease.
Downloads
References
Meyerhoff E. Letter: The great imitator. Can Med Assoc J 1976; 114: 503.
Morton RS. Syphilis in art: an entertainment in four parts. Part 1. Genitourin Med 1990; 66: 33-40.
https://doi.org/10.1136/sti.66.1.33 DOI: https://doi.org/10.1136/sti.66.1.33
Morton RS. Syphilis in art: an entertainment in four parts. Part 2. Genitourin Med 1990; 66: 112-123.
https://doi.org/10.1136/sti.66.2.112 DOI: https://doi.org/10.1136/sti.66.2.112
Morton RS. Syphilis in art: an entertainment in four parts. Part 3. Genitourin Med 1990; 66: 208-221.
https://doi.org/10.1136/sti.66.3.208 DOI: https://doi.org/10.1136/sti.66.3.208
Morton RS. Syphilis in art: an entertainment in four parts. Part 4. Genitourin Med 1990; 66: 280-294.
https://doi.org/10.1136/sti.66.4.280 DOI: https://doi.org/10.1136/sti.66.4.280
Jedidi H, Laverdeur C, Depierreux-Lahaye F, Beckers A. Une petite histoire de la syphilis La maladie à travers l'art et l'artiste. Rev Med Liege 2018; 73: 363-369.
Bento Loyens MM. Morbus Gallicus and social stigma through the ages: evidence in paintings and sculptures. (Dissertation). Porto: University of Porto, Portugal, 2022, 67 pages.
Tognotti E. The rise and fall of syphilis in renaissance Europe. J Med Humanities 2009; 30: 99-113.
https://doi.org/10.1007/s10912-009-9079-3 DOI: https://doi.org/10.1007/s10912-009-9079-3
de Melo FL, de Mello JC, Fraga AM, Nunes K, Eggers S. Syphilis at the crossroad of phylogenetics and paleopathology. PLoS Negl Trop Dis 2010; 4: e575.
https://doi.org/10.1371/journal.pntd.0000575 DOI: https://doi.org/10.1371/journal.pntd.0000575
Armelagos GJ, Zuckerman MK, Harper KN. The science behind pre-columbian evidence of syphilis in Europe: research by documentary. Evol Anthropol 2012; 21: 50-57.
https://doi.org/10.1002/evan.20340 DOI: https://doi.org/10.1002/evan.20340
Vahlquist A. [Skin diseases in an art historical perspective]. Läkartidningen 2022; 37: 1168-1171 (in Swedish).
Baker BJ, Armelagos GJ. The origin and antiquity of syphilis: paleopathological diagnosis and interpretation. Curr Anthropol 1988; 29: 703-738.
https://doi.org/10.1086/203691 DOI: https://doi.org/10.1086/203691
Luger A. The origin of syphilis. Clinical and epidemiologic considerations on the Columbian theory. Sex Transm Dis 1993; 20: 110-117.
https://doi.org/10.1097/00007435-199303000-00010 DOI: https://doi.org/10.1097/00007435-199303000-00010
Giacani L, Lukehart SA. The endemic treponematoses. Clin Microbiol Rev 2014; 27: 89-115.
https://doi.org/10.1128/CMR.00070-13 DOI: https://doi.org/10.1128/CMR.00070-13
Tampa M, Sarbu I, Matei C, Benea V, Georgescu SR. Brief history of syphilis. J Med Life 2014; 7: 4-10.
Arora N, Schuenemann VJ, Jager G, Peltzer A, Seitz A, Herbig A, et al. Origin of modern syphilis and emergence of a pandemic Treponema pallidum cluster. Nat Microbiol 2016; 2: 16245.
https://doi.org/10.1038/nmicrobiol.2016.245 DOI: https://doi.org/10.1038/nmicrobiol.2016.245
Majander K, Pfrengle S, Kocher A, Neukamm J, du Plessis L, Pla-Diaz M, et al. Ancient bacterial genomes reveal a high diversity of treponema pallidum strains in early modern Europe. Curr Biol 2020; 30: 3788-3803.e10.
https://doi.org/10.1016/j.cub.2020.07.058 DOI: https://doi.org/10.1016/j.cub.2020.07.058
Morton RS. St Denis patron saint of syphilitics. Br J Vener Dis 1961; 37: 285-288.
https://doi.org/10.1136/sti.37.4.285 DOI: https://doi.org/10.1136/sti.37.4.285
Knell RJ. Syphilis in renaissance Europe: rapid evolution of an introduced sexually transmitted disease? Proc Biol Sci 2004; 271: S174-S176.
https://doi.org/10.1098/rsbl.2003.0131 DOI: https://doi.org/10.1098/rsbl.2003.0131
Whitty CJ. Erasmus, syphilis, and the abuse of stigma. Lancet 1999; 354: 2147-2148.
https://doi.org/10.1016/S0140-6736(99)11155-3 DOI: https://doi.org/10.1016/S0140-6736(99)11155-3
Eppenberger P, Galassi F, Rühli F. A brief pictorial and historical introduction to guaiacum - from a putative cure for syphilis to an actual screening method for colorectal cancer. Br J Clin Pharmacol 2017; 83: 2118-2119.
https://doi.org/10.1111/bcp.13284 DOI: https://doi.org/10.1111/bcp.13284
Frith J. Syphilis - its early history and treatment until penicillin, and the debate on its origins. J Mil Veterans' Health 2012; 20: 49-58.
O'Shea JG. 'Two minutes with Venus, two years with Mercury' - mercury as an antisyphilitic chemotherapeutic agent. J R Soc Med 1990; 83: 392-395.
https://doi.org/10.1177/014107689008300619 DOI: https://doi.org/10.1177/014107689008300619
Zuckerman MK. More harm than healing? Investigating the iatrogenic effects of mercury treatment on acquired syphilis in post-medieval London. Open Archaeol 2016; 2.
https://doi.org/10.1515/opar-2016-0003 DOI: https://doi.org/10.1515/opar-2016-0003
Szreter S, Siena K. The pox in Boswell's London: an estimate of the extent of syphilis infection in the metropolis in the 1770s†. Econ His Rev 2021; 74: 372-399.
https://doi.org/10.1111/ehr.13000 DOI: https://doi.org/10.1111/ehr.13000
Goldblatt S. Relation between syphilis and tuberculosis in the negro. Arch Dermatol Syphilol 1939; 40: 792-802.
https://doi.org/10.1001/archderm.1939.01490050108009 DOI: https://doi.org/10.1001/archderm.1939.01490050108009
Källmark H. Eine statistische Untersuchung über Syphilis (thesis). Uppsala University and Lifförsäkrings-Aktiebolaget Thule, 1931.
Ayres W. The treatment of syphilis, with special reference to the best methods of administering mercury. The Lancet 1901; 148: 1037-1040.
https://doi.org/10.1016/S0140-6736(01)01434-9 DOI: https://doi.org/10.1016/S0140-6736(01)01434-9
Bruusgaard E. Über das Schicksal der nicht spezifisch behandelten Luetiker. Arch Derm Syph (Wien) 1929; 157: 309-332.
https://doi.org/10.1007/BF01959543 DOI: https://doi.org/10.1007/BF01959543
Harrison LW. The Oslo study of untreated syphilis, review and commentary. Br J Vener Dis 1956; 32: 70-78.
https://doi.org/10.1136/sti.32.2.70 DOI: https://doi.org/10.1136/sti.32.2.70
Gjestland T. The Oslo study of untreated syphilis; an epidemiologic investigation of the natural course of the syphilitic infection based upon a re-study of the Boeck-Bruusgaard material. Acta Derm Venereol 1955; Suppl 34: 3-368; Annex I-LVI.
Rolleston JD. Veneral disease in literature. Br J Vener Dis 1934; 10: 147-174.
https://doi.org/10.1136/sti.10.3.147 DOI: https://doi.org/10.1136/sti.10.3.147
Rahikainen A. Kingdom of contagion [Smittans rike]. Stockolm: Natur och kultur; 2021, 276 pages (in Swedish).
Gilfoyle TJ. Prostitutes in history: from parables of pornography to metaphors of modernity. Am Hist Rev 1999; 104: 117-141.
https://doi.org/10.2307/2650183 DOI: https://doi.org/10.2307/2650183
Freed LF. The Medico-soclal and medico-sociological control of venereal disease. South Afr Med J 1953; 27: 686-692.
Obladen M. Curse on two generations: a history of congenital syphilis. Neonatology 2013; 103: 274-280.
https://doi.org/10.1159/000347107 DOI: https://doi.org/10.1159/000347107
Arnold SR, Ford-Jones EL. Congenital syphilis: a guide to diagnosis and management. Paediatr Child Health 2000; 5: 463-469.
https://doi.org/10.1093/pch/5.8.463 DOI: https://doi.org/10.1093/pch/5.8.463
Rac MWF, Stafford IA, Eppes CS. Congenital syphilis: a contemporary update on an ancient disease. Prenat Diagn 2020; 40: 1703-1714.
https://doi.org/10.1002/pd.5728 DOI: https://doi.org/10.1002/pd.5728
Thyresson N. From French disease to AIDS. Chapters from the history of venereal diseases in Sweden [Från Fransoser till AIDS. Kapitel ur de veneriska sjukdomarnas historia i Sverige]. Stockholm: Carlsson; 1991, p. 1-183 (in Swedish).
Vernon G. Syphilis and salvarsan. Br J Gen Pract 2019; 69: 246.
https://doi.org/10.3399/bjgp19X702533 DOI: https://doi.org/10.3399/bjgp19X702533
Brown EM. Why Wagner-Jauregg won the Nobel Prize for discovering malaria therapy for general paresis of the insane. Hist Psychiat 2000; 11: 371-382.
https://doi.org/10.1177/0957154X0001104403 DOI: https://doi.org/10.1177/0957154X0001104403
Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health 1997; 87: 1773-1778.
https://doi.org/10.2105/AJPH.87.11.1773 DOI: https://doi.org/10.2105/AJPH.87.11.1773
Miles TP, McBride D. World War I origins of the syphilis epidemic among 20th century black Americans: a biohistorical analysis. Soc Sci Med 1997; 45: 61-69.
https://doi.org/10.1016/S0277-9536(96)00316-4 DOI: https://doi.org/10.1016/S0277-9536(96)00316-4
Roy B. The Julius Rosenwald Fund syphilis seroprevalence studies. J Natl Med Assoc 1996; 88: 315-322.
Gill DG. Syphilis in the rural negro. South Med J 1932; 25: 985-990.
https://doi.org/10.1097/00007611-193209000-00023 DOI: https://doi.org/10.1097/00007611-193209000-00023
White RM. Unraveling the Tuskegee study of untreated syphilis. Arch Intern Med 2000; 160: 585-598.
https://doi.org/10.1001/archinte.160.5.585 DOI: https://doi.org/10.1001/archinte.160.5.585
Rockwell DH, Yobs AR, Moore MB, Jr. The Tuskegee study of untreated syphilis; the 30th year of observation. Arch Intern Med 1964; 114: 792-798.
https://doi.org/10.1001/archinte.1964.03860120104011 DOI: https://doi.org/10.1001/archinte.1964.03860120104011
Olansky S, Harris A, Cutler J, Price E. Untreated syphilis in the male Negro: twenty-two years of serologic observation in a selected syphilis study group. AMA Arch Derm 1956; 73: 516-522.
https://doi.org/10.1001/archderm.1956.01550050094017 DOI: https://doi.org/10.1001/archderm.1956.01550050094017
American Medical Association. Supplementary report of the Judicial Council. Principles of medical ethics of the American Medical Association. JAMA 1946; 132: 1090.
https://doi.org/10.1001/jama.1946.02870490070032 DOI: https://doi.org/10.1001/jama.1946.02870490070032
Sternberg TH, Leifer W. Treatment of early syphilis with penicillin. JAMA 1947; 133: 1-5.
https://doi.org/10.1001/jama.1947.02880010003001 DOI: https://doi.org/10.1001/jama.1947.02880010003001
Rose AS, Solomon HC. Penicillin i the treatment of neurosyphilis: a study of one hundred cases followed twelve months or more. JAMA 1947; 133: 5-10.
https://doi.org/10.1001/jama.1947.02880010007002 DOI: https://doi.org/10.1001/jama.1947.02880010007002
Platou RV, Hill AJ, Jr., Ingraham NR, Goodwin MS, Wilkinson EE, Hansen AE, et al. Early congenital syphilis; treatment of two hundred and fifty-two patients with penicillin. JAMA 1947; 133: 10-16.
https://doi.org/10.1001/jama.1947.02880010012003 DOI: https://doi.org/10.1001/jama.1947.02880010012003
Reverby SM. Examining Tuskegee. The infamous syphilis study and its legacy. Chapel Hill, NC: University of North Carolina Press; 2009, 416 pages.
Gamble VN. A legacy of distrust: African Americans and medical research. Am J Prev Med 1993; 9: 35-38.
https://doi.org/10.1016/S0749-3797(18)30664-0 DOI: https://doi.org/10.1016/S0749-3797(18)30664-0
Brandt AM. Racism and research: the case of the Tuskegee Syphilis Study. The Hastings Center Report 1978; 8: 21-29.
https://doi.org/10.2307/3561468 DOI: https://doi.org/10.2307/3561468
Paul C, Brookes B. The Rationalization of unethical research: revisionist accounts of the Tuskegee Syphilis Study and the New Zealand "Unfortunate Experiment". Am J Public Health 2015; 105: e12-19.
https://doi.org/10.2105/AJPH.2015.302720 DOI: https://doi.org/10.2105/AJPH.2015.302720
Clearing the myths of time: Tuskegee revisited. Lancet Infect Dis 2005; 5: 127.
https://doi.org/10.1016/S1473-3099(05)01286-7 DOI: https://doi.org/10.1016/S1473-3099(05)01286-7
Blum HL, Barnett CW. Prognosis in late syphilis. Arch Intern Med 1948; 82: 393-409.
https://doi.org/10.1001/archinte.1948.00020040073005 DOI: https://doi.org/10.1001/archinte.1948.00020040073005
"Ethically Impossible": STD Research in Guatemala from 1946 to 1948. Washington, DC: Government Printing Office; 2011, 220 pages.
Kaempffert W. Notes on science: syphilis prevention. New York Times 1947; April 27: E9.
Rodriguez MA, García R. First, do no harm: the US sexually transmitted disease experiments in Guatemala. Am J Public Health 2013; 103: 2122-2126.
https://doi.org/10.2105/AJPH.2013.301520 DOI: https://doi.org/10.2105/AJPH.2013.301520
Spector-Bagdady K, Lombardo PA. US Public Health Service STD experiments in Guatemala (1946-1948) and their aftermath. Ethics Hum Res 2019; 41: 29-34.
https://doi.org/10.1002/eahr.500010 DOI: https://doi.org/10.1002/eahr.500010
Reverby SM. 'Normal exposure' and inoculation syphilis: PHS 'Tuskegee' doctors in Guatemala, 1946-48 and at Sing Sing Prison, Ossining, New York, 1953-54. Rochester, MN: American Association for the History of Medicine Annual Meeting; 2010.
https://doi.org/10.1017/S0898030610000291 DOI: https://doi.org/10.1017/S0898030610000291
Department of Health, Education, and Welfare. The Belmont Report: Ethical principles and guidelines for the protection of human subjects of research. Washington, DC: Department of Health, Education, and Welfare; 1978.
Vollmann J, Winau R. Informed consent in human experimentation before the Nuremberg code. BMJ 1996; 313: 1445-1449.
https://doi.org/10.1136/bmj.313.7070.1445 DOI: https://doi.org/10.1136/bmj.313.7070.1445
Dingwall R, Rozelle V. The ethical governance of German physicians, 1890-1939: are there lessons from history? Journal of Policy History 2011; 23: 30-52.
https://doi.org/10.1017/S0898030610000308 DOI: https://doi.org/10.1017/S0898030610000308
Katz J. The Nuremberg Code and the Nuremberg Trial: a reappraisal. JAMA 1996; 276: 1662-1666. DOI: https://doi.org/10.1001/jama.276.20.1662
https://doi.org/10.1001/jama.1996.03540200048030 DOI: https://doi.org/10.1001/jama.1996.03540200048030
WMA's Declaration of Helsinki serves as guide to physicians. JAMA 1964; 189: 33-34.
https://doi.org/10.1001/jama.1964.03070130073046 DOI: https://doi.org/10.1001/jama.1964.03070130073046
Stary A. The changing spectrum of sexually transmitted infections in Europe. Acta Derm Venereol 2020; 100: adv00114.
https://doi.org/10.2340/00015555-3470 DOI: https://doi.org/10.2340/00015555-3470
Published
How to Cite
License
Copyright (c) 2024 Lisa Ekselius, Bengt Gerdin, Anders Vahlquist
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
