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Certain early writers suggested that syphilis infected ancient Chinese dynasties, whilst others claim priority for the afflicted populus of the early Romans, alleging that Augustus Caesar was afflicted by hereditary syphilis. But these suppositions are unconfirmed. The sailors with Columbus in 1493 were said to have brought the disease to Spain. It is certain that the Spanish fleet, when they fought for their ruler Alfonso II against the French forces of Charles VIII of France in 1494–5, heavily infected the peoples of Naples. The illness spread rapidly around Europe and mercenaries who in 1496 joined Perkin Warbeck in Scotland and with the support of James IV of Scotland invaded England, bore both arms and thegrandgore (Old French. grand gorre: grand great + gorre syphilis) as it was called.1 In 1497 the Minutes of the Town Council of Edinborough ( Phil. Trans. XLII. 421) recognised: “This contagious sickness callit the Grandgor.”
The infective and contagious nature of the disease were recognised. The Burgh of Aberdeen issued a ruling that “all licht (loose) women decist fra thar vicis and syne of venerie.” A grandgore act was passed in September 1497. There was a suspected endemic of syphilis (treponarid) in 16th century Norway.2
The name syphilis came into common usage. It came from a Latin epic poem Syphilis, sive Morbvs Gallicvs, written by Girolamo Fracastoro or Hieronymus Fracastorius(1483–1553). In his work De contagione et contagiosis morbis, he discussed the nature and the spread of infectious diseases, foretelling the germ theory of disease. A physician, astronomer, and poet of Verona, Fracastoro’s poem was written in two volumes, 1525, and in a third published five years later. In 1686 Nahum Tate translated it with the titleSyphilis: or, a Poetical History of the French Disease.. The term syphilis was employed systematically by Fracastoro in his treatise De Contagione ii. xi. (1546).
It tells the tale of a brave sailor who navigated a route westward from Spain to “a mighty island in the middle of the sea”. The crew shot a flock of colourful birds on the island of Ophir, which belonged to the Sun God. One of the flock escaped and prophetically warned:
“Nor end your sufferings here; a strange Disease,
And most obscene, shall on your Bodies seize . . .”
In Book III, the subject of the poem, the shepherd Syphilus, blasphemes and offends the Sun God. He becomes the first sufferer of the disease.
“ . . .From whence this Malady its birth receiv’d,
And first th’offending Syphilus was griev’d,
Who rais’d forbidden Altars on the Hill,
And Victims bloud with impious Hands did spill;
He first wore Buboes dreadfull to the sight,
First felt strange Pains and sleepless past the Night;
From him the Malady receiv’d its name.”
Book III, 321–32.
In the first book the poem points to the latent, incubation period between acts of venerie, and the onset of the primary stage characterised by the genital chancre. Fracastoro observes the lessening of symptoms with the passage of time. In the second book he describes the infective nature of the semen: seminaria contagiosum, which logically informs his advice on prevention. Treatment with mercurials, and with guaiac obtained from the sacred wood of the American Indians is included in his consideration of a variety of regimens.
The source of the name syphilus is disputed; it has been suggested that it is a corrupt mediaeval form of Sipylus, the son of Niobe (so called after a mountain) in Ovid.3 Niobe was in Greek legend, the daughter of Tantalus, supposed to have been changed into stone while weeping for her children. The alleged origins of syphilis were reflected in its many other names: the Spanish pockes; the Neapolitan itch; morbus Gallicus, the French disease; and pockis (pocks or pox). Pock-royal was the satirical name for a pustule of the great pox (syphilis) as opposed to the small pox. The association with illicit intercourse and the notion of sin was well described in 1662 by W Gurnall : “What a beauty Man was, till he was pock-broken (if I may say so) by sin.”4 Pockwood was the wood of a tree of the genus Guaiacum, in use for the cure of syphilis in the 16th century.
Many euphemisms developed to conceal the sinful rewards of venery. It is still referred to as “Lues” from lues the plague and Lues venerea (syphilis). Spirochaetes, twisted, coiled organisms were described in 1876, being found in Weil’s disease, relapsing fever, and in syphilis. The more specific name treponemawas coined in German by F Schaudinn in 1905,5 from the word for thread. The specific disease was caused by Treponema pallidum (Spirochaete pallida) and communicated by sexual connection or accidental contact (acquired form) or by infection of the child in utero (congenital form).
Three stages of the disease were distinguished, primary, secondary, and tertiary syphilis; the first characterised by chancre in the part infected, the second by affections of the skin and mucous membranes, the third involving the aortic valve, bones, muscles, and brain. Diagnosis remained difficult for it is a multisystem disease, “the great mimicker.” August Paul Wassermann (1866–1925) devised a test for syphilis in 1906, in which antibodies to the organism were detected by a complement fixation test. John Kolmer (1886–1962), an American pathologist, modified the test using beef heart cardiolipin as the antigen. Many more “specific tests” evolved.
During the first half of the 19th century, the authorities on the treatment of syphilis by mercury compounds were divided into mercurialists and non-mercurialists. Iodopin was introduced at the turn of the 20th century. By 1910 Arsphenamine (Salvarsan) was used by Paul Ehrlich for use in syphilis and yaws.6 In the pre-penicillin era, Julius Wagner Ritter von Jauregg (1857–1940) introduced malariatherapy in 1918.