New York Medical College - Fleuroscope Yearbook (Valhalla, NY)

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' ETIOLOGY OF SYPHILIS The developments of concepts as to the cause of syphilis provides a fascinating chapter in the history of the disease. Before the role of bacteria and other infectious organisms in disease was understood, notions on the etiology of syphilis were indeed fantastic. ln the 18th century an astrologic origin was postulated. Some claimed a dietary origin, others attributed it to poisoning. The teachings of the versa- tile Paracelsus on the subject were most novel: The French Disease Csyphilisl derives its origin from the coitus of the leprous Frenchman with an impudent female, who had venereal Bubas, and after that infected everyone that cohabitated with her: and thus from the Leprosy and venereal Bubas, the French Disease arising, infected the whole world with its contagion, and in the same manner as from the coitus of a Horse and Ass the race of Mules is produced. Syphilis generally became recognized as a disease of venereal origin, but for a long time was confused with gonorrhea. Much of this confusion was due to the heroic but misleading experiment of Iohn Hunter. Hunter con- tended that gonorrhea was a mucous membrane manifestation of the same virus which when affecting the skin caused syphilis. He subjected himself to a skin inoculation of pus from a case of gonorrhea and developed syphilis. What Hunter failed to realize was that the source of infection suffered from a concomitant syphilis. The Hunterian concept was finally destroyed by the work of Phillippe Ricord H8389 in distinguishing the two diseases. The recent history in the development of syphilology is well known to all. The epoch making work of Pasteur stimulated the search for the bacterial cause of syphilis. In 1903, Metchnikoff, though failing. to find the organism, demonstrated that the disease could be transmitted to the higher apes. He also showed that the organism was microscopic in size since it did not pass through a porcelain filter. It remained for Schaudinn and Hoffman in 1905 to find the Treponema pallidum by use of dark field illumination. In 1906 Wasserman perfected the diagnostic test for syphilis. Closely succeeding each other came the important developments of salvarsan by Ehrlich in l9lO, the discovery of Treponema in paresis by Noguchi in l9l3, and the culturing df the organism by the latter scientists. CURES FOR SYPHILIS Men soon began to grope for a cure. Mercury became the sheet anchor in the treatment of syphilis. It is said that Europe was acquainted with the use of Mercury by the Arabian empiricists. Diaz de Isla, in 1521, is accredited with being the first European physician to employ mercury as a cure. How- ever, the drug was so misused that most patients preferred the disease to the cure. The patient was frequently annointed from head to foot with mercury ointment, the drug being pushed to salivation. Others accompanied vigorous mercurial inunctions with fasting. In Shakespear's time fumigation with mer- cury vapor, sweating and diets were popular. The victim entered a tub into which cinnabar was thrown on a hot dish. The dramatist refers to this pro- cedure in Timon of Athens CIV Ill-9-92l: One hundred sixty -SGVGI1

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Syphilis received its name from Fracastorius who in 1521 wrote a poem entitled Syphilis Sive Morbus Galliousf' a portion of which reads as follows: A Shepherd once tdistrust not ancient farnel Possessed these downs and Syphilis was his name. A thousand heifers in these vales he fed A thousand ewes to those fair rivers led From his the malady received its name. Heretofore, the stigma of dissemination was passed from nation to nation. The appearance of syphilis on the European coast enhanced the lexicon of national rivalry with pelvic phraseology. Fracastorius in shifting the burden of the source to the mythological swineherd Syphilis contributed to much inter- national accord, if not to the poetic art. . SYPHILIS IN HISTORY AND LITERATURE The role of syphilis in modern history is of great significance, a signifi- cance rarely emphasized by the non-medical historian. Its presence as an ever hovering pall of death and destruction penetrated the lives, customs, literature and politics of men. Syphilis spared neither rich nor poor. A list of historic figures who were syphilitic can fill an international who's who. The college of luetic notables can claim such men as Francis I of France, Benve- nuto Cellini, Louis XIV, Henry VIII, and Ivan the Terrible of Russia. One can not help marvelling how the course of history might have been altered by a course of arsenicals. The imprint of the disease is found in classical literature. Thus Rabelais, Ben Iohnson and Shakespeare are replete with references to the malady. Shakespeare showed an acute understanding of the disease and its manifestations. References as to origin, symptoms or cure are found in King Lear, As You Like It, Henry V, Pericles, Measure for Measure, Loves' Labour Lost, Timon of Athens, I-Ienry IV, Troilus and Cresidef' and I-Iamlet : in Timon of Athens CIV III 168-1837 the great master exhibits keen knowledge of the disease: Consumption sow In hollow bones of manl strike their sharp skins And mar man's spurring. Crack the 1awyer's voice That he may never more false title plead Nor sound his quillets shrilly: hoar the flames That scolds against the quality of flesh And not believe himself: down with the nose Down with it flat, take the bridge quite away Of him that, his particular to foresee Smells from the general weal: Make Curled-Pate ruiiians bald An-d let the unscarred braggarts of the war Derive some pain from you: Plague all That your activity may defeat and quell The service of all erection. There's more gold: Do you damn other, and let this damn you And ditches grave you alll One hundred sixty-six

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Give them diseases, leaving with thee their lust For tubs and baths: bring the dawn rose-cheeked youth To the tub-fast and the diet. Since it was firmly believed that syphilis originated in the New World, physicians of the day cast about for a remedy indigenous to America. For a long time guaiac held sway over Venus's bower. Fracastorius hailed it as a sovereign remedy. A popular medical book for laymen, published in the American colonies 117309, entitled Every Man His Own Doctor, or the Poor Planter's Physician prescribed a very exhausting regimen consisting of: 1. Prophylactic Cal Not ever venture upon strange women, especially upon Ethiopiansf' tbl Be very careful of catching cold. tcl Live not too near a swamp. 2. Dietary Cal Abstinence from meat and strong drink. 3. Specific C27 Decoction of tal Bark of Sumac Root. Inner Bark of Pine. Bark of Spanish Oak. Pushed to the point of emesis. ibl Two pills made of turpentine and deer's dung in equal quan- tities. Iohn Bartram, a botanist and colleague of Benjamin Franklin, prescribed lobelia in 1751. Maris futile ingenuity extended equally in the direction of prophylaxis. The first mechanical preventive was suggested by the ingenious Fallopius in his work De lviorbo Gal1ico, published in 1564. Fallopius elaborated the theory that .... this decay originates from the communication of diseased corpuscles which are drawn through the pores of the glans and produce dis- ease .... He therefore, urged votaries of Venus to protect the glans with a cloth impregnated with marvellous decoction containing guaiac, aloes, wine among other preposterous ingredients. Modern investigators in disease pro- phylaxis may well maintain a bashful silence in view of Fallopius's claims of 1000 successful trials and no failures. Daniel Turner writing of Syphilis in 1717, in the American Colonies, suggested the condom as a prophylactic. This is probably the earliest reference in literature to this article. While mechanical and medical methods of prophylaxis offer some hope of decreasing the in- cidence of syphilis, the only logical plan for eradication and prevention lies in the elimination of foci of infection. Herein however, there is a tremendous Public Health problem. One hundred sixty-eight