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Syphilis has a remarkable history,[1] about which it is worth while to say a few words. Many people think of the disease as at least as old as the Bible, and as having been one of the conditions included under the old idea of leprosy. Our growing knowledge of medical history, however, and the finding of new records of the disease, have shown this view to be in all probability a mistake. Syphilis was unknown in Europe until the return of Columbus and his sailors from America, and its progress over the civilized world can be traced step by step, or better, in leaps and bounds, from that date. It came from the island of Haiti, in which it was prevalent at the time the discoverers of America landed there, and the return of Columbus's infected sailors to Europe was the signal for a blasting epidemic, which in the sixteenth and seventeenth centuries devastated Spain, Italy, France, and England, and spread into India, Asia, China, and Japan.
[1] For a detailed account in English, see Pusey, W. A.: "Syphilis as a Modern Problem," Amer. Med. Assoc., 1915.
It is a well-recognized fact that a disease which has never appeared among a people before, when it does attack them, spreads with terrifying rapidity and pursues a violent and destructive course on the new soil which they offer. This was the course of syphilis in Europe in the years immediately following the return of Columbus in 1493. Invading armies, always a fruitful means of spreading disease, carried syphilis with them everywhere and left it to rage unchecked among the natives when the armies themselves went down to destruction or defeat. Explorers and voyagers carried it with them into every corner of the earth, so that it is safe to say that in this year of grace 1917 there probably does not exist a single race or people upon whom syphilis has not set its mark. The disease, in four centuries, coming seemingly out of nowhere, has become inseparably woven into the problems of civilization, and is part and parcel of the concerns of every human being. The helpless fear caused by the violence of the disease in its earlier days, when the suddenness of its attack on an unprepared people paralyzed comprehension, has given place to knowledge such as we can scarcely duplicate for any of the other scourges of humanity. The disease has in its turn become more subtle and deceiving, its course is seldom marked by the bold and glaring destructiveness, the melting away of resistance, so familiar in its early history. The masses of sores, the literal falling to pieces of skeletons, are replaced by the inconspicuous but no less real deaths from heart and brain and other internal diseases, the losses to sight and hearing, the crippling and death of children, and all the insidious, quiet deterioration and degeneration of our fiber which syphilis brings about. From devouring a man alive on the street, syphilis has taken to knifing him quietly in his bed.
Although syphilis sprang upon the world from ambush, so to speak, it did the world one great service--it aroused Medicine from the sleep of the Middle Ages. Many of the greatest names in the history of the art are inseparably associated with the progress of our knowledge of this disease. As Pusey points out, it required the force of something wholly unprecedented to take men away from tradition and the old stock in trade of ideas and formulas, and to make them grasp new things. Syphilis was the new thing of the time in the sixteenth century and the study which it received went far toward putting us today in a position to control it. Before the beginning of the twentieth century almost all that ordinary observation of the diseased person could teach us was known of syphilis. It needed only laboratory study, such as has been given it during the past fifteen years, to put us where we could appeal to every intelligent man and woman to enlist in a brilliantly promising campaign. For a time syphilis was confused with gonorrhea, and there could be no better proof of the need for separating the two in our minds today than to study the way in which this confusion set back progress in our knowledge of syphilis. John Hunter, who fathered the idea of the identity of the two diseases, sacrificed his life to his idea indirectly. Ricord, a Frenchman, whose name deserves to be immortal, set Hunter's error right, and as the father of modern knowledge of syphilis, prepared us for the revolutionary advances of the last ten years.
There is something awe-inspiring in the quiet way in which one great victory has succeeded another in the battle against syphilis in the last decade. If we are out of the current of these things, in the office or the store, or in the field of industry and business, announcements from the great laboratories of the world seldom reach us, and when they do, they have an impractical sound, an unreality for us. So one hears, as if in a speaking-tube from a long distance, the words that Schaudinn and Hoffmann, on April 19, 1905, discovered the germ that causes syphilis, not realizing that the fact contained in those few brief words can alter the undercurrent of human history, and may, within the lives of our children and our children's children, remake the destiny of man on the earth. A great spirit lives in the work of men like Metchnikoff and Roux and Maisonneuve, who made possible the prophylaxis of syphilis, in that of Bordet and Wassermann, who devised the remarkable blood test for the disease, and in that of Ehrlich and Hata, who built up by a combination of chemical and biological reasoning, salvarsan, one of the most powerful weapons in existence against it. Ehrlich conceived the whole make-up and properties of salvarsan when most of us find it a hardship to pronounce its name. Schaudinn saw with the ordinary lenses of the microscope in the living, moving germ, what dozens can scarcely see today with the germ glued to the spot and with all the aid of stains and dark-field apparatus. After all, it is brain-power focused to a point that moves events, and to the immensity of that power the history of our growing knowledge of syphilis bears the richest testimony.
The simple device of talking plain, matter-of-fact English about a thing has a value that we are growing to appreciate more and more every day. It is only too easy for an undercurrent of ill to make headway under cover of a false name, a false silence, or misleading speech. The fact that syphilis is a disease spread to a considerable extent by sexual relations too often forces us into an attitude of veiled insinuation about it, a mistaken delicacy which easily becomes prudish and insincere. It is a direct move in favor of vulgar thinking to misname anything which involves the intimacies of life, or to do other than look it squarely in the eye, when necessity demands, without shuffling or equivocation. On this principle it is worth while to meet the problem of a disease like syphilis with an open countenance and straightforward honesty of expression. It puts firm ground under our feet to talk about it in the impersonal way in which we talk about colds and pneumonia and bunions and rheumatism, as unfortunate, but not necessarily indecent, facts in human experience. Nothing in the past has done so much for the campaign against consumption as the unloosing of tongues. There is only one way to understand syphilis, and that is to give it impartial, discriminating discussion as an issue which concerns the general health. To color it up and hang it in a gallery of horrors, or to befog it with verbal turnings and twistings, are equally serious mistakes. The simple facts of syphilis can appeal to intelligent men and women as worthy of their most serious attention, without either stunning or disgusting them. It is in the unpretentious spirit of talking about a spade as a spade, and not as "an agricultural implement for the trituration of the soil," that we should take stock of the situation and of the resources we can muster to meet it.
+The Confusion of the Problem of Syphilis with Other Issues.+--Two points in our approach to the problem of syphilis are important at the outset. The first of these is to separate our thought about syphilis from that of the other two diseases, gonorrhea, or "clap," and chancroids, or "soft sores," which are conventionally linked with it under the label of "venereal diseases."[2] The second is to separate the question of syphilis at least temporarily from our thought about morals, from the problem of prostitution, from the question as to whether continence is possible or desirable, whether a man should be true to one woman, whether women should be the victims of a double standard, and all the other complicated issues which we must in time confront. Such a picking to pieces of the tangle is simply the method of scientific thought, and in this case, at least, has the advantage of making it possible to begin to do something, rather than saw the air with vain discussion.
[2] The three so-called venereal diseases are syphilis, gonorrhea, and chancroid or soft ulcer. Gonorrhea is the commonest of the three, and is an exceedingly prevalent disease. In man its first symptom is a discharge of pus from the canal through which the urine passes. Its later stages may involve the bladder, the testicles, and other important glands. It may also produce crippling forms of rheumatism, and affect the heart. Gonorrhea may recur, become latent, and persist for years, doing slow, insidious damage. It is transmitted largely by sexual intercourse. Gonorrhea in women is frequently a serious and even fatal disease. It usually renders women incapable of having children, and its treatment necessitates often the most serious operations. Gonorrhea of the eyes, affecting especially newborn children, is one of the principal causes of blindness. Gonorrhea may be transmitted to little girls innocently from infected toilet seats, and is all but incurable. Gonorrhea, wherever it occurs, is an obstinate, treacherous, and resistant disease, one of the most serious of modern medical problems, and fully deserves a place as the fourth great plague.
Chancroid is an infectious ulcer of the genitals, local in character, not affecting the body as a whole, but sometimes destroying considerable portions of the parts involved.
Let us think of syphilis, then, as a serious but by no means hopeless constitutional disease. Dismiss chancroid as a relatively insignificant local affair, seldom a serious problem under a physician's care. Separate syphilis from gonorrhea for the reason that gonorrhea is a problem in itself. Against its train of misfortune to innocence and guilt alike, we are as yet not nearly so well equipped to secure results. Against syphilis, the astonishing progress of our knowledge in the past ten years has armed us for triumph. When the fight against tuberculosis was brought to public attention, we were not half so well equipped to down the disease as we are today to down syphilis. For syphilis we now have reliable and practical methods of prevention, which have already proved their worth. The most powerful and efficient of drugs is available for the cure of the disease in its earlier stages, and early recognition is made possible by methods whose reliability is among the remarkable achievements of medicine. It is the sound opinion of conservative men that if the knowledge now in the hands of the medical profession could be put to wide-spread use, syphilis would dwindle in two generations from the unenviable position of the third great plague to the insignificance of malaria and yellow fever on the Isthmus of Panama. The influences that stand between humanity and this achievement are the lack of general public enlightenment on the disease itself, and public confusion of the problem with other sex issues for which no such clean-cut, satisfactory solution has been found. Think of syphilis as the wages of sin, as well-earned disgrace, as filth, as the badge of immorality, as a necessary defense against the loathesomeness of promiscuity, as a fearful warning against prostitution, and our advantage slips from us. The disease continues to spread wholesale disaster and degeneration while we wrangle over issues that were old when history began and are progressing with desperate slowness to a solution probably many centuries distant. Think of syphilis as a medical and a sanitary problem, and its last line of defense crumbles before our attack. It can and should be blotted out.
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