Can you close your eyes without falling over?
- Pox: Genius, Madness and the Mysteries of Syphilis by Deborah Hayden
Basic Books, 379 pp, £20.99, January 2003, ISBN 0 465 02881 0
Syphilis and the League of Nations have more in common than you might think. Both were dumped into the dustbin of history in the 1940s: syphilis by penicillin, the League of Nations by the Second World War. But the connection goes further than chronological coincidence. Before the war, the League took a deep and direct interest in syphilis, with its Health Organisation arranging conferences on the laboratory diagnosis of the disease. These were not talking shops. Technical experts met in Copenhagen in 1923 and 1928, and in Montevideo in 1930, to test large numbers of blood samples in the laboratory, to evaluate methods of treatment and to compare their findings with clinical diagnoses.
There were good reasons for the Health Organisation to have acted in this way. At that time, chronic syphilis could be difficult to diagnose, because the damage it did to sufferers’ skin, bones, brain, nerves and blood vessels was very similar to that caused by an enormous variety of other diseases. ‘Know syphilis . . . and all things clinical will be added unto you,’ the great Sir William Osler had said. But it was vital to get things right. Drugs were available, but they were dangerous and expensive. In the untreated, symptoms could disappear quickly, as the organism went to ground, only to re-emerge randomly and unpredictably decades later, to cause madness, paralysis, blindness, attacks of excruciating pain and death.
With the coming of penicillin, syphilis collapsed as a killer; its cause, the bacterium Treponema pallidum, is still exquisitely sensitive to the drug – more so than any other organism. The disease itself survives, however, even in countries like Britain which have effective health systems. In London, most syphilis sufferers are white HIV-positive males between the ages of 25 and 44 who have attended sex-on-premises bars; in the jargon of the GUM (genito-urinary medicine) clinic, a majority are MSM – men who have sex with men.
So, although syphilis is a shadow of its former self, it has not gone away, just like another ‘old’ pathogen, tuberculosis, the decline of which has been reversed since HIV began turning off immune systems and drug-resistant mutants were encouraged by poorly administered therapy. Forgetting about traditional adversaries makes it easier for them to return. Deborah Hayden’s book reminds us of the havoc syphilis wreaked in the pre-penicillin era, and examines its effects on the lives of the famous, on composers, poets and writers: Beethoven, Schubert, Schumann, Baudelaire, Flaubert, Maupassant, Wilde, Nietzsche, Joyce, Karen Blixen, van Gogh. Hayden reminds us, too, that politicians – Hitler, Abraham Lincoln and his wife – can, like anyone else, catch sexually transmitted diseases. Her approach is profitable and her choice of sufferers sensible: many of them left records of their views – and fears – about syphilis and its effects on their thinking, so that her accounts are more than just clinical studies. Inevitably, her case histories have a strong forensic flavour. She has had to arrive at a conclusion about the syphilitic status of her subjects on the basis of incomplete and circumstantial evidence, and under the handicap of denial and concealment; most people do not publicly, or even privately, admit to a syphilitic past.