- The Washington Times - Sunday, January 19, 2003

POX: GENIUS, MADNESS, AND THE MYSTERIES OF SYPHILIS
By Deborah Hayden
Basic Books, $27.50, 379 pages
REVIEWED BY ELIZABETH M. WHELAN

Deborah Hayden, an independent scholar specializing in the history of medicine, has written a riveting, eye-opening book on a topic we hear little about today: syphilis, often called "The Great Imitator" because it mimicked so many other diseases, making diagnosis a real challenge.
Syphilis, the author reminds us, can be a truly devastating disease, causing spectacular damage to most of the victim's internal organs, including the brain, heart, eyes, blood vessels, and bones. While it is a rare disease today (despite disturbing reports of a surge in cases among gay men in San Francisco), and it is easily treated now with penicillin, the picture was considerably grimmer prior to the 1943 introduction of the life-saving antibiotic.
Indeed, the author estimates that by the turn of the 20th century, perhaps 15 percent of the adult population in major cities like Paris and London was infected with syphilis. Prostitutes played a major role in transmission. The author tells us that during one military confrontation between France and Spain (date not revealed), the Spanish deported substantial numbers of prostitutes to France under the rationale that food supplies were short, and they needed to cut down on their population. In reality, these women were infected with syphilis and were sent over to the enemy camp (where they were happily received) to spread it, making this an early example of bioterrorism.
Readers are first given an in-depth discussion of the clinical course of this disease and its distinct phases, the first sign is generally a lesion, usually on the genitals. A secondary phase occurs some 6 -8 weeks later, characterized by weight loss, fever, sore throat. There follows a few or even many years of what appeared to be an asymptomatic condition. Victims and their doctors often just thought the disease had spontaneously disappeared. It had not. During this quiet phase, latent syphilis was viciously attacking the body.
But it is this third stage that gets the most attention in "Pox." Here, as insanity and paralysis set in, the victim also often experiences multiple episodes of extreme, creative euphoria, joyous energy, and new visions. Given the psychological effects in the final phase, the author hypothesizes that many well-known historical figures suffered from syphilis and that the disease affected their work and behavior.
Did Ludwig Von Beethoven (l770-1827) suffer from syphilis? Noting that there is "hot debate" among syphilologists on this matter, the author explores the available evidence. By examining private diaries, letters, and other personal papers, she makes a pretty convincing case that Beethoven was indeed infected, most likely by a prostitute. Did Beethoven, she wonders, create his famous "Ode to Joy," part of the Ninth Symphony (his last complete one), as a result of being in a syphilis induced state of euphoria?
Chapter by chapter she gives us personal views of the lives and works of historical figures who may have had syphilis, including Mary and Abraham Lincoln, Vincent Van Gogh, and Oscar Wilde. Perhaps the most fascinating piece of medical-historical detective work appears in her final chapter, wherein she makes the case that Adolf Hitler may well have had syphilis.
This was a disease that one did not speak of in polite society. It was referred to by euphemisms, and diagnoses were kept confidential, sometimes with disastrous effects. We read of small-town physicians, aware that a young man had syphilis but, feeling bound to protect patient confidentiality, failing to communicate this information to a bride-to-be. In more than one case those same physicians saw infected children born to these couples.
It was surely a disease for which the primary route of transmission sexual intercourse was well known. But that only added even more shame and disgrace to the ailment. What was a young husband, who became infected by a prostitute after marriage, to do about his wife? Tell her? This would make for some pretty rocky marital relations. The author tells us one option here for these straying husbands was to trick the wives into "treatment." Treatment during the l800s and right up until the age of antibiotics frequently meant ingesting toxic amounts mercury, a therapy fraught with major side effects.
We learn that husbands frequently conspired with their physicians to bring wives in for evaluation for "anemia" which would then be treated with a preparation that, unbeknown to the missus, was mercury. An enterprising corporation came up with yet another option: They sold mercury-laced chocolates for the little lady at home medication disguised as a thoughtful gift.
"Pox" is based on in-depth, painstaking research, but the text is highly readable and will be of interest to medical historians, public health professionals and anyone else who loves a good mystery story, one in which evidence is meticulously identified and evaluated, leading to a well-informed guess about who did or did not suffer from this ghastly disease, one that manifested itself in both creative and destructive behavior.

Elizabeth M. Whelan is president of the American Council on Science and Health



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