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

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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

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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-A PUBLIC HEALTH PROBLEM Modern syphilology shows a definite trend toward improvement in the medical management of the disease. However, we cannot boast of equally brilliant results in the complex sphere of Public Health and social relations. A rational scheme of defense against syphilis can be evolved. We must not be content with the former inadequate methods of control and patiently wait until the entire race becomes syphilized perhaps and immunity gradually becomes established. The older police methods of restriction and control of prostitution have not shown very encouraging results even in countries with strong centralized government, and such procedures as licensure and periodic physical examination of prostitutes have not been effective. A practical immediate method of control has been reached in New York City and in many other cities by the establishment of clinics for free treatment of venereal disease and the issuance of free drugs to doctors treating infectious cases. But unless a vigorous educational program is simultaneously carried on we can never hope for any measure of success, and success is likely to be in direct ratio to the degree in which we can dispel the clouds of ignorance, misconception and false sentiment which now surround it. Dr. Williams, former Surgeon-general of the U. S. Public Health Service has stated that A campaign of education should begin with the practicing physician who too often neglects to instruct his patient of the seriousness of the disease and oftener neglects to report the case to the local health authorities so that it may be controlled in the same way that a case of contagious disease of childhood is controlled. A certain automatic limitation of the disease is effected by the conjoint used of the Wasserman test and salvarsan therapy to infectious cases. There is no question that if the many agencies where people register for one reason or another were required, by sanitary code regulation, to demand a certificate of Wasserman negativity, the advance in the control of syphilis would be significant. In minimizing the danger to the community from prostitution, we are ostrich-like hiding our heads from a real menace. There is no denying the fact that the prostitute is the chief source of infection in syphilis. To eradicate prostitution, which has its roots in the dawn of antiquity, is no easy matter. Devices innumerable have been tried, but met with rapid failure. Prostitution in our day, as always, is in essence a product of economic underprivilege and social malajustment due to the disintegration of the home under the economic impact of modern industrial civilization. Therefore, the major battle against this social evil will be won when society can elevate the economic level of the broad body of people. For many years the public health aspect has been the private domain of moralists and politicians. It is only in the past few years that preventative work has found its way into the more effective machinery of medico-social organization. The trend in present day medicine for cooperation between doctor and clinic, as well as between doctor and doctor, will also reduce the ubiquity of syphilis in the United States. Here is a campaign against a disease whose fate lies in our hands, and by joining forces with each other and with public health authorities, there is no reason why it should not become a venerable member of our list of vanishing diseases. One hundred sixtynine