Deborah Hayden, Pox: genius, madness, and the mysteries of syphilis, New York, 2004, 379 pages, 0-465-02882-9

Reviewed by Dr Gayle Davis

At the end of the nineteenth century, syphilologist Alfred Fournier estimated that 15 per cent of the population of Paris was infected with syphilis. Left untreated, as it essentially was before penicillin, syphilis is a chronic relapsing disease that goes into hiding throughout the body after the initial sores disappear, only to reassert itself as it begins its damaging spread through the internal organs, producing gastrointestinal pains, blindness and deafness, paralysis or insanity. And yet, we have almost no patient accounts of what it was like to contract such a horrific disease. Even the word ‘syphilis’ was taboo, too shameful to record in anything other than the most euphemistic of terms. Hayden’s book is thus a welcome addition to the scanty literature currently available on the historical experience of this fascinating disease. It is also timely since syphilis is resurgent in both America and Britain.

The book begins by providing an historical, cultural and medical outline of the disease itself from 1493, the disputed beginning of the syphilis epidemic in Europe courtesy of Columbus’ adventures in the New World, to 1943, when the first case of syphilis was successfully treated with penicillin. As a neat potted history of the origins of syphilis in Europe, one could do much worse. Moreover, the author brings the historical debate nicely up to date by incorporating recent paleo-anthropological findings from the study of unearthed bones. The next, and more substantial, section investigates the theme of syphilitic infection through biographical analysis of fifteen historical figures known or suspected to have attended the STD clinic. Employing retrospective diagnosis, Hayden suggests that many prominent nineteeth- and twentieth-century political, intellectual and cultural figures – as diverse as Beethoven and James Joyce – were afflicted with the disease. She then, more interestingly, explores how knowledge of infection might have shaped their life histories and may explain some aspects of their behaviour or creative endeavours. Her medical sleuthing leads her to some interesting conclusions. Oscar Wilde’s Picture of Dorian Gray was a parable for the writer’s secret struggle with syphilis; while Hitler’s paranoid behaviour and profound hatred of the Jews only really make sense in the context of his medical history, his physical and mental decline ‘consistent with the ravages of tertiary syphilis’. (p.299)

The thesis is an interesting one, but the foundations of proof that Hayden provides are shaky. Under the admittedly heavy handicap of denial and concealment which has persistently accompanied this disease, the argument is built on a structure of circumstantial evidence and conjecture that historians will undoubtedly find flimsy. Concluding her fifty-page chapter on Hitler, as one example, Hayden states: ‘There is no definitive proof that Adolf Hitler had syphilis, any more than there is undeniable evidence that he did not.’(p.302) While she does not allow this lack of evidence to spoil a good story, such sentiments rather undermine the power of the author’s argument. She asserts that although syphilis is explicitly mentioned in the memoirs, biographies or even medical records of these figures only rarely, you can make a convincing case for a diagnosis if you are alert to the right clues. Of course one might alternatively hypothesize that we could find anything should we look hard enough. Looking at the evidence through such a selective lens is a highly dubious enterprise, while retrospective diagnosis is itself much frowned upon and discredited as anachronistic by most historians. In order to be a helpful addition to medical history, such a discussion would require much more evidence than Hayden is able to provide. And even if she manages to convince us of the diagnosis, the author fails to persuade the reader that the syphilis really affected the stance or output of most of these characters. She significantly weakens her argument when, for example, she concludes her chapter on Beethoven by stating: ‘It goes without saying that it makes not the slightest difference, at least to the music, if Beethoven’s complaints were due to spirochetes or to a hangnail.’(p.88)

Hayden writes vividly and with clarity in a generally engaging and accessible style. She brings us an intriguing if highly speculative account which manages effectively to introduce naïve modern readers to the social and medical history of a disease that affected millions of people in the cruellest of ways before penicillin. Her book is an interesting biography of an infection that has fascinated and frustrated clinicians for half a millennium. It should prove to be an entertaining read for the lay reader with a casual interest in history and medicine, and might possibly be of interest also to the contemporary clinician who is unlikely ever to see a case of tertiary syphilis in this post-penicillin era. However, it is not a work ideally suited to the medical historian. It is up to the reader to decide whether or not they are convinced by her arguments.

Dr Gayle Davis

Centre for the History of Medicine

University of Glasgow