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Exploring the Darker Side of Everything

Syphilis: The Disease that Changed Europe

In the late 15th Century, Europe was consumed by an itch. What began as a mild irritation in the nether regions, soon turned into an unpleasant pain that could be felt in joints throughout the body. This often led to skin inflammation, hideous scabs, swellings and a whole lot worse. At its worst, flesh could simply drop off the body, leaving the sufferer horribly disfigured, and even killing many as this new mystery illness swept through the continent.  

The disease quickly became known as the ‘French disease’ to many, though the Russians decided to call it the ‘Polish disease’, the Dutch labelled it, the Spanish disease’, the French called it the ‘Neopolitan disease’ and the Turkish just named it the ‘Christian disease’. 

Everybody blamed everybody else, but its rapid spread around Europe showed just how intimately connected Europeans were with one another. This was the first major outbreak of a sexually transmitted disease – and today, we call it syphilis.

Syphilis 

Model of a head of a person with tertiary (gummatous) syphilis, Musée de l'Homme, Paris
Model of a head of a person with tertiary
(gummatous) syphilis, Musée de l’Homme, Paris

Often referred to as the great imitator because of its insidious likeness to numerous other diseases, syphilis began rampaging across Europe in the late 15th Century and has never really stopped. It is a disease that still kills roughly 100,000 people each year, though, with modern medicine, particularly penicillin, that number is far lower than it could be, but also higher than it really should be – which I’ll get to later in the video. 

Syphilis is a nasty disease often transmitted through unprotected sex, but can also be passed from mother to baby through what is termed congenital syphilis. Its more common transmission route and development involves four different stages which occur one after the other if left untreated; primary, secondary, latent, and tertiary.  

If you are going to get syphilis, it’s best to keep it in the primary stage, where a usually painless sore typically appears on the body, often on the penis or around the vagina. This normally occurs between 10 days and 90 days after exposure and can last for 3 to 6 weeks before disappearing with or without treatment. For those in the modern era, who receive treatment, that is often the end of the syphilis adventure, however, for those who don’t receive treatment, or for the millions who experienced the disease before effective treatments, this is just the start of a very uncomfortable road ahead.   

The secondary stage overlaps with the first and involves rashes appearing between 2 and 8 weeks after the sore from the primary stage appears, coupled with a wide variety of possible symptoms such as a fever, sore throat, the feeling of weakness around the body and weight loss. After around 2 months the rashes typically clear up, though the patient still remains highly contagious. 

The latent stage essentially involves no visible signs that the patient is suffering from syphilis and is also referred to as the hidden stage. This can last anywhere from one to twenty years and the disease very much stays active every step along the way.  

The final, and by far the most destructive stage of syphilis, is the tertiary stage which itself can be divided into three; Gummata, which are large sores inside the body or on the skin, Cardiovascular syphilis, which affects the heart and blood vessels and Neurosyphilis, which affects the nervous system. 

The good news for those that reach this lofty peak of syphilis is that it is no longer contagious, the bad news is that parts of your face can fall off and you might well die. Mortality rates for syphilis have varied widely throughout history with figures anywhere from 8% all the way up to 58%, with males overall more likely to die than women.    

Emergence 

There is some debate surrounding the origin of syphilis but these arguments are typically divided into two theories, the Colombian theory and the pre-Columbian theory. 

The Colombian theory suggests that syphilis was transported to Europe by members of Christopher Colombus’s crew after returning from the New World. The Columbian Exchange was a term used to describe the enormous exchange of goods, animals, plants, food, metals, people and culture that began in the 15th Century between Europe and the Americas. As we now know, part of this exchange also included numerous diseases that savaged the Americas, including smallpox, bubonic plague, chickenpox, cholera, the common cold, diphtheria, influenza, malaria, measles, scarlet fever, typhoid, typhus and tuberculosis. 

It was a dizzying concoction of hellish diseases heading east to west, but the Columbian theory states that syphilis was one of the few diseases, that we know at least, to head in the opposite direction. This idea was supported by the 538 skeletal remains found in the Dominican Republic which showed characteristics of the treponemal disease in 6–14% of the afflicted population – effects attributed to syphilis. These deaths occurred years before the first outbreak in Europe, with Columbus and his men returning to the Old World three years before the first outbreak in Naples in 1495. 

The pre-Columbian theory suggests that syphilis had been in Europe all along, but was either diagnosed as something else, perhaps leprosy or that there were in fact different strains present and that the arrival of the intercontinental explorers back on European shores and the first major outbreak was purely coincidental.

There is actually some evidence for this theory also, with skeletons from Pompeii and Metaponto in Italy found with damage similar to that caused by congenital syphilis, while 14th Century skeletons found in Austria appeared to show the same thing.  

This is one argument that probably won’t ever be fully answered and has led to a combination theory being proposed that has suggested that both could be accurate and that a highly contagious version of the disease may have passed across the Bering Strait into the Americas thousands of years ago and never completely died out. So yes, maybe Columbus and his merry men did bring something back with them, but yes, something similar may have been around in Europe and Asia for thousands of years also.  

Naples 1495      

If there’s any doubt of the ultimate origin of syphilis, the first major outbreak has always been clear. In 1494, amid your typical in-fighting between European leaders, Charles VIII, King of France invaded Italy with a force numbering around 25,000 men. They swept through down the Italian boot with breathtaking speed and equally blood-curling savagery. By February 1495, the invading army had reached the gates of Naples, where they entered unopposed. And as you might imagine for a group of soldiers who had been on the move for months, the French men celebrated with great gusto and the local brothels saw a rip-roaring trade. 

Charles VII wasn’t particularly interested in hanging around for very long and soon turned for France once again, his men weighed down by the spoils of war, but also something altogether less desirable. Within a matter of weeks after the fall of Naples, a mystery disease began rippling through the French ranks. What began as genital ulcers soon developed into rashes and muscle and joint pain. The French were engaged in a final battle on Italian soil, but with significant numbers too weak to put up much of a fight, they just about staggered away without much of their stolen loot. 

In terms of spreading a disease, you really can’t do much better than soldiers returning from a military campaign. Though they were certainly aware of it as they made their way back up through France, at this stage, almost nothing was known about this new disease, including how it was spread. Once they returned home, and no doubt partook in plenty of carnal exploration, it spread like wildfire and by the end of 1495, the disease had swept across France and into parts of Germany and Switzerland. 

The Spread   

Considering how syphilis was spread, primarily through unprotected sex, and when you think about just how much unprotected sex was going during the late 15th Century and early 16th Century, it’s not difficult to see how this disease rampaged across the world with breathtaking speed. 

By 1497, much of England and Scotland was experiencing cases, and just three years later, in 1500, Scandinavia, Hungary, Greece, Poland, and Russia had been consumed by the epidemic. Syphilis had barrelled around to all corners of Europe and it appeared nowhere was free of the disease.  

But this was also a time of glorious exploration when trade routes were being blazed across the oceans and relationships were being forged with distant lands and their people. And once again, what better way to spread a highly infectious disease, than through horny sailors who, after weeks or months at sea, sought the nearest brothel after landing and so passed syphilis from one continent to another with remarkable efficiency.

As I said right at the start of the video, this new disease didn’t immediately have a name, so different nations used it as a way to exercise their xenophobia. If you weren’t too keen on the Spaniards at the time, why not name that crotch raw disease after them – as the Dutch did. But just about everybody did it and this wasn’t constrained to nationalities, with the Turks referring to it as the Christian disease and Muslims further east placing the blame squarely at the door of the Hindu population. This use of the disease in a derogatory way can partly be explained by how the disease was transmitted. Sex-hungry men and prostitutes provided the intricate web that eventually stretched around the world and because of this, those suffering from the illness were typically stigmatised and seen as immoral and unclean.  

One of the earliest neutral names used was ‘the great pox’ as a way of differentiating it from smallpox because it had similar symptoms – although smallpox was always far deadlier than syphilis, so the name didn’t really make a lot of sense.        

We see the first mention of the word syphilis in a poem penned by Italian physician and poet Girolamo Fracastoro in 1530, titled Syphilis sive morbus gallicus (Syphilis or The French Disease). In it, a young shepherd with the unfortunate name Syphilus becomes the first person on Earth to contract this new disease which had been sent by the God Apollo as punishment for Syphilus’ disobedience. There’s nothing quite like the fear of eternal damnation to make you keep your pants on is there? This name was later changed ever so slightly when Fracastoro wrote a book on contagious diseases and the name has stuck ever since. 

While much of the mystery around syphilis remained, by the 16th Century, physicians had a good idea of how it was spreading, which led to the attempted clampdown on prostitution and sex outside marriage in many parts of Europe. Henry VIII, that good upstanding beacon of monogamy, did his utmost to close down the brothels and bathhouses in London, while in other countries, tighter regulations surrounding prostitution were brought in, but was often little more than firing any prostitutes who exhibited symptoms while completely turning a blind eye to the legions of men who were also spreading the disease.  

It’s worth mentioning that in this early stage many remained completely against syphilis even being treated. Some considered it as a divine punishment for sin and were more than happy to let God’s messy work play out. This began to change towards the end of the 16th Century and thankfully clear heads emerged who saw it as part of their Hippocratic oath to treat all diseases without prejudice.       

Early Treatments

While syphilis is still present today, its reputation as a savagely mysterious nose-losing disease has softened considerably over the years. But for hundreds of years, people groped around in the dark for anything that might be able to help. 

Mercury, which had also been used for leprosy, was first used as a treatment for syphilis in 1496. This continued for centuries with steadily differing methods of administering it, ranging from simply rubbing it on the patient’s skin or drops in the mouth to the more complex fumigation, which saw mercury vaporized and the resulting steam sent up into a small box where the patient laid patiently. This might sound like a strangely soothing Swedish sauna, but with side effects including gum ulcers and loose teeth, this isn’t something you should try anytime soon.     

The discovery of guaiacum as cure for syphilis, after Stradanus, 1590
The discovery of guaiacum as cure for syphilis, after Stradanus, 1590

Another treatment that emerged in the 16th Century was the use of Guaiacum, a plant native to the Caribbean that was brewed into a hot drink and consumed by the patient. This had very little to do with any notable evidence and more to do with the fact that it came from the same place that syphilis was said to have come from, the Americas, and many believed that surely nature would provide a cure to such a horror in the same place it had originated from. 

But there was no cure for syphilis and treatments often did little more than slow the illness down. Over time, however, the disease did lose some of its deadly edge and by the 17th Century, syphilis had become less virulent and less lethal, but could still leave a nasty mark. 

As I mentioned earlier, it was common for certain facial features to appear to drop off as a result of disfigurement. A nasal collapse, as you might gather, was not a pretty sight and you can only imagine living with such a mark of shame that everybody assumed came from your sexual deviancy. It didn’t take long for artificial noses to be introduced and the 16th Century saw some pioneering work in facial reconstruction using a method known as a free flap, which was some of the earliest known surgical examples of moving tissue from one part of the body to another.  

The Modern Age

So as we arrive in the 20th Century, syphilis was certainly much less of a menace than it had been over the previous four centuries. Calculating historical syphilis cases is notoriously difficult, not least because many did what they could to hide the illness, but one study from Britain that focused on the northern city of Chester in the 18th Century found that around 8% of the population under 35 had contracted the disease, while in rural areas, that number was closer to 1%. 

By the late 18th Century it was thought roughly 1 in 5 Londoners had contracted syphilis by their mid-thirties, with the study stating that syphilis and other STIs were particularly high among 

“young, impoverished, mostly unmarried women, either using commercial sex to support themselves financially or in situations that rendered them vulnerable to sexual predation and assault like domestic service”  

In 1905, German duo Fritz Schaudinn and Erich Hoffmann first identified Treponema Pallidum, the organism that causes syphilis, and from there, things began to move quickly. The first effective treatment for syphilis, arsphenamine, was discovered by Sahachiro Hata in 1909 and was on the market within a year. 

The discovery of penicillin in 1928 would be the biggest step forward in the fight against syphilis but it wasn’t until 1943 that successful trials were held at the U.S Marine Hospital on Staten Island in New York. Over eight days, four patients were injected with penicillin at regular intervals and just like that, the first cure for syphilis had arrived. 

But that hasn’t been the end, far from it. As I mentioned earlier, syphilis still kills around 100,000 people each year, and that’s certainly not constrained to poorer, less developed nations. The United States and Europe still see syphilis deaths each year, but numbers do pale in comparison to the pre-penicillin days when the disease had a fatality rate of around 10% over a 40-year period. 

Despite there being a certified cure, this disease has still cast a dark shadow in the second half of the 20th Century, though not quite the same way as before. The United States holds the dubious distinction of being caught not once but twice being involved in some truly villainous activities involving syphilis. ‘The Tuskegee Study of Untreated Syphilis in the Negro Male’ was a study done between 1932 and 1972 in which black men in the United States were told they were being treated for ‘bad blood’ when in fact the aim of the study was simply to track the progress of syphilis if left untreated. And remember, 10 years after the study began, penicillin was then a certified cure for the disease that many in the study continued to suffer for years – and presumably spread the disease to others.  

But if you thought that was bad, the Guatemala Syphilis Experiments actually involved U.S doctors purposely infecting soldiers, prostitutes, prisoners and mental patients with syphilis and other sexually transmitted diseases in Guatemala between 1946 and 1948 – leading to at least 83 deaths. This was all funded by a grant from the U.S. National Institutes of Health to track the effects of the diseases and involved 1,308 people. It took until 2010 for a formal apology to be issued from the U.S government in response to what Guatemala has called a crime against humanity.  

Now, it’s not entirely clear what the end goal of these experiments were. If we were to retain some hope over the soul of mankind – and after a video all about syphilis why not a little positivity – we could say that these studies may have been done with some horribly twisted notion of how to fight this disease that was still killing scores at the time. But if that was the case, and researchers simply wanted to track the course of the disease, the fact it was only done on minorities, or those who weren’t even American citizens, paints a nasty racist image.     

There is also another very dark edge to this matter. During World War II, a Japanese medical unit actively experimented on humans with syphilis, as well as other diseases, to gauge the possibility of it being used as a weaponized disease. After the war, much of their findings were handed over to the Americans, who suddenly also took a keen interest. Now, as far as we know, there’s never been a serious attempt to weaponize syphilis, but let’s be honest, if I was to say that both the U.S and the Soviet Union did it during the Cold War, it probably wouldn’t be a huge surprise. Thankfully these kinds of experiments are now well behind us, but their purpose still remains mysterious and deeply controversial.     

Today, the fear of syphilis has diminished dramatically, especially in comparison to the new kid on the block HIV. But this is one disease that isn’t going away, and if anything, is on the rise once again. Around the turn of the millennium, syphilis cases had sunk to an all-time low in the United States, but since then, almost every year has seen a steady increase, with roughly 119,000 in 2019 alone. 

Syphilis devastated Europe and affected much of the world over several centuries, but did eventually lead to a more concerted effort to tackle sexually transmitted diseases and to do away with the stigma that became attached to them. This was the great itch of the late 15th Century and one we continue to battle even to this today. 

Sexually transmitted infection – Wikipedia

Stages of Syphilis | Michigan Medicine (uofmhealth.org)

Syphilis – Wikipedia

History of syphilis – Wikipedia

Brief History of Syphilis (nih.gov)

Syphilis: The Painful History of an Odd Bug | Everyday Health                  

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