MEDICAL MATTERS:Chapter and verse on origins of sex disease, writes MUIRIS HOUSTON
“Know syphilis in all its forms and manifestations and all things in Medicine will be known unto you”
– Sir William Osler
(1849 – 1919)
OSLER’S WORDS of wisdom were undoubtedly accurate when sexually transmitted diseases were more common; however, you would be hard pressed to find a medical student or young doctor in the developed world who has seen an advanced case of syphilis.
The reason for Osler’s statement was that, before the advent of antibiotics, syphilis spread in four stages throughout the body: primary, secondary, latent and tertiary. Caused by the spirochaete Treponema pallidum, it can mimic many other diseases and earned the title “the great imposter” because of this.
Primary syphilis is characterised by the development of a painless skin lesion at the site of transmission after an incubation period of three-six weeks. Secondary syphilis develops about four-10 weeks after the appearance of the primary lesion. During this stage, the spirochaetes multiply and spread throughout the body leading to malaise, fever, muscle pain, joint inflammation, swollen glands and a rash.
Latent syphilis is a stage at which the features of secondary syphilis have resolved; about one-third of untreated latent syphilis patients go on to develop tertiary syphilis, with the infection remaining dormant in the remainder.
Tertiary syphilis affects the cardiovascular system in 80-85 per cent of cases and causes neurosyphilis in about 10 per cent. This stage develops over months to years and involves slow inflammatory damage to a range of tissues.
Almost certainly brought to Europe by Spanish sailors returning with Christopher Columbus from his first transatlantic expedition, syphilis spread across the continent in 1493. Much was written about it, with one school of thought blaming the outbreak on a particular planetary alignment, while those of a more scientific bent thought it was spread by personal contact.
My interest in the origins of syphilis was sparked by a recently published book Medieval and Hippocratic Medicine in Verse by Cuimin T Doyle, emeritus professor of pathology at University College Cork. It features a translation of Girolamo Fracastoro’s 1530 poem on syphilis – what he called “the French disease” (Morbus Gallicus). Amazingly, the poem is three books long, combining poetic lyricism with an acute observation of the symptoms.
Fracastoro, a medical graduate of the University of Padua, describes the disease’s skin manifestations vividly:
“Here pustules in the form of acorns swell’d,
In form alone, for these with stench are filled,
Whose ripeness is corruption, that in time,
Disdain confinement, and discharge the slime;
Yet oft the foe would turn its forces back,
The brawn and inmost muscles to attack,
And pierce so deep, that the bare bones have been
Betwixt the dreadful fleshy breaches seen.”
In his commentary, Doyle notes the various treatments for syphilis. A diet of fish, fowl and herbs was combined with bloodletting from the median vein. Bleeding was thought to eliminate poisons from the body and to help balance the “humours”, while various dressings, pastes and liniments were applied.
Although Fracastoro favoured using an extract of the guaiac tree, mercury was the preferred treatment for syphilis until well into the 20th century.
Once penicillin was discovered, the spread of syphilis was finally controlled but the disease was not eradicated. Syphilis remains prevalent in many developing countries and in some areas of North America, Asia and Eastern Europe. The highest rates are in South and Southeast Asia, followed closely by sub-Saharan Africa.
Prof Cuimin T Doyle has published a second book, Healing Hands: From the Cradle to the Grave, an anthology of medical poetry. Both books are available from kennys.ie and at UCC and UCD bookshops at a cost of €15.