Archives of Medicine and Health Sciences

MEDICAL HISTORY
Year
: 2018  |  Volume : 6  |  Issue : 2  |  Page : 290--292

‘A night with venus, a lifetime with mercury’: Insight into the annals of syphilis


Amina Asfiya, Malcolm Pinto, Manjunath M Shenoy 
 Department of Dermatology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India

Correspondence Address:
Dr. Manjunath M Shenoy
Department of Dermatology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka
India

Abstract

Syphilis is a sexually transmitted disease caused by the spirochaete Treponema pallidum. Being a disease whose existence spans several centuries, it has a rich and interesting historical background. The article attempts to explain the milestones in origin, spread, and treatment aspects related to syphilis.



How to cite this article:
Asfiya A, Pinto M, Shenoy MM. ‘A night with venus, a lifetime with mercury’: Insight into the annals of syphilis.Arch Med Health Sci 2018;6:290-292


How to cite this URL:
Asfiya A, Pinto M, Shenoy MM. ‘A night with venus, a lifetime with mercury’: Insight into the annals of syphilis. Arch Med Health Sci [serial online] 2018 [cited 2020 Aug 13 ];6:290-292
Available from: http://www.amhsjournal.org/text.asp?2018/6/2/290/248657


Full Text



 Introduction



Syphilis was defined by Stokes as “an infectious disease caused by Treponema pallidum, systemic from the outset, characterized by florid manifestations on the one hand and years of complete asymptomatic latency on the other, capable of involving practically every organ in its course, simulating almost every disease in the field of medicine and surgery, transmissible to the offspring in man, transmissible to certain laboratory animals, and treatable to the point of presumptive cure.”[1] The present article aims to provide an insight into the history of origin, spread, and treatment modalities for syphilis over the years.

 Speculation on the Emergence and Spread of the Disease



“He who knows syphilis knows medicine”

– Sir William Osler

Even after several centuries of existence of the disease, the exact origin of syphilis is still an enigma. The “Columbian hypothesis” and the “Pre-Columbian hypothesis” are the two schools of thought regarding its origin. The Pre-Columbian hypothesis supports the claim that along with other treponemal diseases, syphilis was prevalent in Old as well as the New World. However, Europeans often misdiagnosed syphilis as leprosy. It was believed that syphilis emerged from other nonvenereal treponemes (pinta, yaws, and endemic syphilis) as a result of mutations and climatic changes along with the cultural variations in the diverse populations. The Columbian hypothesis advocates that syphilis was unintentionally brought from the New World by Christopher Columbus and members of his crew after his voyage from the Americas in 1493.[2] The spread of syphilis in the European continent is largely attributed to the siege of Naples in 1495. By the end of the 15th century, the epidemic of syphilis had spread to France, Germany, Switzerland, England, and Scotland.[3] The early 16th century saw the emergence of syphilis in Britain, Greece, Hungary, Scandinavian countries, and Russia. The Europeans introduced syphilis to India in 1498 as a part of world expedition. Finally, the disease reached Africa, China, and Japan by 1520.

 Syphilis-Sobriquets over the Decades



From time immemorial, syphilis has been a greatly feared and dreaded disease. It has been called as the “Scourge of the Renaissance,” “The Great Pox,” to differentiate it from the prevailing “Small Pox.” Perhaps, the most interesting sobriquets attributed to syphilis include naming the disease after the enemy country reflecting the prevailing political tensions around that time. Thus, it was called ‘French disease’ by the Italians, the British and Germans, ‘Neapolitan disease’ by the French, ‘Polish disease’ by the Russians, ‘German disease’ by the Poles, ‘Spanish disease’ by the Portuguese and the Danish, the Turks called it the ‘Christian disease’ and in Japan it was called ‘Chinese Pox’.[4]

Jean Fernelius coined the term “lues venera,” Lues (Latin) for plague, venera connected with sex. Girolamo Fracastoro, in his poem “Syphilis sive Morbus Gallicus,” described a shepherd named Syphilus who was afflicted with the dreaded disease as a punishment for insulting the Greek God Apollo.[5] However, it was not until the early 19th century that the name syphilis was used regularly. Because of its myriad manifestations and resemblance to other clinical conditions, it has been aptly called as “The Great Masquerader or Imitator.”

 Discovery of the Cause



For several decades, all sexually transmitted infections were believed to be a single disease entity. It was not until the 16th century that differentiation between syphilis, chancroid, and gonorrhea as distinct ailments was made. In 1767, John Hunter, a famous Scottish anatomist and surgeon, conducted an experiment in which he inoculated the urethral secretions of a patient suffering from gonorrhea into the prepuce of a healthy individual. This resulted in the individual developing syphilis; hence, Hunter concluded that syphilis resulted from gonorrhea. However, Hunter did not know that the patient was suffering from both syphilis and gonorrhea.[6] This experimentation led to a delay in recognition of syphilis and gonorrhea as two distinct diseases. Ricord in 1831 showed that gonorrhea and syphilis are two separate conditions and occur only after contact with the respective affected individuals.[7] The credit of discovery of the causative organism of syphilis goes to Schaudinn and Hoffmann in 1905. They named the organism as Spirochaeta pallida, which was later changed to T. pallidum. Landsteiner in 1906 introduced dark-field microscopy for the demonstration of spirochete. In 1910, the first serological test for syphilis, Wasserman reaction was described by August Wasserman, and in 1949, T. pallidum immobilization test, which was the first specific test for syphilis, was developed by Nelson and Mayer.

 Historical Treatments for Syphilis



“A mixture of biniodide of mercury, potassium iodide and syrup of sarsaparilla, called the syphilitic cocktail, became particularly popular”

– Rasmussen[8]

Although originally no effective treatment for syphilis was available, a variety of treatment modalities were tried over the period. In 1497, mercury was first used to treat syphilis by Giorgio Sommariva of Verona. It was given orally, by injunction, inhalation, or injection. These mercurial treatments were given for a long period, sometimes lifelong, hence giving rise to the popular saying “A Night with Venus, a Lifetime with Mercury” [Figure 1]. The 16th century saw the introduction of Gaiac, also known as holy wood by Ulrich Von Hutten. The decoction from guaiac tree was boiled and patient was told to take the mixture for 30 days. This procedure was carried out in a heated room after wrapping the patients in blankets to cause perspiration. However, it was not effective as a cure. Potassium iodide was tried along with mercury for the treatment of late syphilitic lesions in 1854. Later on, bismuth salts were introduced which were less toxic and had a stronger bactericidal effect than mercury. Paul Ehrlich [Figure 2] in 1909 discovered the “magic bullet” – compound 606 – arsphenamine which he constituted into a drug called Salvarsan.[9] Based on the observation that fever improved symptoms of tertiary syphilis, Wagner-Jauregg introduced pyrotherapy, which involved inducing malaria by Plasmodium vivax.[10] The breakthrough in the treatment of syphilis was the discovery of penicillin by Sir Alexander Fleming in 1928. Mahoney, Arnold, and Harris succeeded in treating syphilis in 1943 with penicillin. Thus, the widespread production of penicillin after World War II contributed to the control and effective treatment of syphilis.{Figure 1}{Figure 2}

 Syphilis and Science: Entangled in Controversy



“The past is never dead. It's not even past”

– William Faulkner[11]

The Tuskegee syphilis study is arguably the most notorious, unethical study of the 20th century. It was conducted by the U.S. Public Health Service in collaboration with the prestigious Tuskegee University, Alabama. The aim of the study was to determine the natural course of untreated syphilis in African-American men. The 622 participants were promised free meals, medical care, and burial insurance in return. They were told that the study would last for 6 months, but it went on for 40 years (1932–1972). None of the African men were told that they were suffering from syphilis; instead, they were said to have had “bad blood.” The study was embroiled in controversy due to ethical considerations. Even after penicillin was available for effective treatment of syphilis, it was withheld from the patients. None of the patients were aware that penicillin was available as an effective cure for syphilis. Finally, the study ended after its unethical methods were exposed by Peter Buxtun. In 1997, President Bill Clinton formally apologized about the Tuskegee study on behalf of the U.S. Government.[12]

 Conclusion



The advent of penicillin in 1943 helped in the control and spread of syphilis over the past decades. However, a resurgence of syphilis along with rise in congenital syphilis has been noticed in the recent years among the developed countries [Figure 3]. This may be attributed to the high-risk sexual activity, increased numbers of men who have sex with men, and growing number of HIV cases. Hence, adequate screening in high-risk groups, effective prevention strategies, education on behavioral changes, and high index of suspicion are needed for the elimination of syphilis.[13],[14]{Figure 3}

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Nishal PK, Kapoor A, Jain VK, Dayal S, Aggarwal K. Changing trends in acquired syphilis at a tertiary care center of North India. Indian J Sex Transm Dis AIDS 2015;36:149-53.
2Farhi D, Dupin N. Origins of syphilis and management in the immunocompetent patient: Facts and controversies. Clin Dermatol 2010;28:533-8.
3Frith J. Syphilis – Its early history and treatment until penicillin, and the debate on its origins. J Mil Veterans Health 2012;20:49-58.
4Rothschild MB. History of syphilis. Clin Infect Dis 2005;40:1454-63.
5Tampa M, Sarbu I, Matei C, Benea V, Georgescu SR. Brief history of syphilis. J Med Life 2014;7:4-10.
6Qvist G. John Hunter's alleged syphilis. Ann R Coll Surg Engl 1977;59:206-9.
7Singh AE, Romanowski B. Syphilis: Review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev 1999;12:187-209.
8Adam Perkovic A. The Changing treatments for syphilis. In: Herring A, editor. Damage Control: The Untold Story of Venereal Disease in Hamilton. Ontario: Department of Anthropology, McMaster University; 2014. p. 8-15.
9Gelpi A, Tucker JD. After Venus, mercury: Syphilis treatment in the UK before Salvarsan. Sex Transm Infect 2015;91:68.
10Gartlehner G, Stepper K. Julius Wagner-Jauregg: Pyrotherapy, simultanmethode, and ‘racial hygiene’. J R Soc Med 2012;105:357-9.
11Conner DM. Remembering the Tuskegee Syphilis Experiment 45 Years Later: Racism and Medical Denial; 2017. Available from: https://www.huffingtonpost.com/entry/remembering-the-tuskegee-syphilis-experiment-45-years_us_590485d8e4b03b105b44b8d6. [Last updated on 2017 Jun 01; Last accessed on 2018 Nov 17].
12Reverby SM. More than fact and fiction. Cultural memory and the Tuskegee syphilis study. Hastings Cent Rep 2001;31:22-8.
13Stamm LV. Syphilis: Re-emergence of an old foe. Microb Cell 2016;3:363-70.
14Willeford WG, Bachmann LH. Syphilis ascendant: A brief history and modern trends. Trop Dis Travel Med Vaccines 2016;2:20.