<%@LANGUAGE="JAVASCRIPT" CODEPAGE="CP_ACP"%> Nina Stoyan-Rosenzweig Submission
From social stigma to hereditary disease to Phil the sore- changing narratives of syphilis

Nina Stoyan-Rosenzweig

We tend to see narratives as linear stories with beginnings, middles, and ends that describe the events in a life or in someone’s illness. But it can be helpful too to see narratives as a system of meaning, and as a system of meaning that applies not just to individuals but also to diseases. Illnesses, therefore, can have their own narratives, their own meanings that represent knowledge of the etiology of disease but also the symbolic and moral ideas constructed around the illness. Understanding disease narratives can help physicians, since patients may have different narratives concerning illness than physicians. Such a situation can create tension when these narratives clash, when a physician sees as negative disease a condition that patients may view as a divine gift. But societies also may have specific narratives associated with specific diseases, and patient and physician may bring to a diagnosis a wealth of similar moral, social, historical, and historical associations. These narratives may be held in common by doctor and patient, or different groups may construct their own stories. But such narratives also may change over time, in response to a variety of events. There are a number of images, ranging from a textbook illustration of congenital syphilis, excerpts from the movie Are You Fit to Marry, WWII advertisements focused on slowing the rate of venereal infection, Nazi race hygiene propaganda, and public health cartoons that show how syphilis was and currently is understood, and these will be discussed against the disease’s biological and historical background.


Disease narratives, the way in which a society constructs categories, symbols, and meaning for different diseases, reflect social structure as well as the biology of the disease- how rapidly it is transmitted, what happens to the infected and how they are treated by other members of society reflect social structure while the biology of the disease can determine how it is transmitted, how it acts on the body, and how it may in fact change society due to its prognosis. Diseases, therefore, come to have social meanings as well as physical realities. Both the social meaning and the physical realities can change over time, however. Diseases may mutate; the afflicted may develop immunities to the microbe, changing diets may make certain diseases more or less prevalent, while changing environments may also alter the prevalence of disease. Of course, changing social structure may also change the meaning of the disease. In this way, diseases such as end stage renal disease may vanish with perfection of dialysis; bulimia may become possible with greater privacy in homes and indoor plumbing, masturbation may transform from a sin to a disease to normal activity . It is interesting, in this regard, to see how medical discoveries can alter almost completely, the meaning- particularly the capacity for horror- that certain diseases are capable of inducing. Polio, cholera, and smallpox, all diseases at one point capable of inspiring fear and scapegoating are now either gone from the world stage or are largely controlled through vaccination, sanitation and rehydration therapy. The bubonic plague, believed to have decimated a third of the European population in 1348, has become endemic in burrowing rodent populations in the southwest- trips to national parks may be interrupted if there are outbreaks among the prairie dogs. But its presence is almost ignored, and the disease seems to coexist with humans with only occasional incidence of infection- readily checked by antibiotics.

Syphilis, known as the Great Imitator, was once one of the most greatly feared diseases, and certainly one that inspired potent imagery. It also has inspired a great deal of historical interest. There is close to a cottage industry among scholars of Karen Blixen as they argue whether her syphilis was eradicated by treatment or whether her health problems later in life were due to the return of the syphilis. There is a cottage industry among scholars who argue whether the disease originated in the New World and was taken to Europe by Columbus’ men or whether it had its origins in Europe. So great is this interest in syphilis that writers review the health of historical figures in an attempt to determine whether they were syphilis sufferers. Was Nietszche’s mental condition due to tertiary neurosyphilis? Was Beethoven’s Ninth Symphony composed just at the onset of neurosyphilis, when there is supposedly a burst of creativity and before the creative powers are destroyed? Was Bram Stoker’s “The Lair of the White Worm” a description of syphilitic infection? Certainly if the latter is true it is only one example of potent imagery associated with the disease.

Perhaps more potent was the belief, based on the observation of congenital syphilis, that syphilis infected the germ cells and tainted the blood line, resulting in the permanent introduction of syphilis into the hereditary material. Thus it was believed the sins of the fathers were avenged to the tenth generation, and that treatment would not eradicate the disease. In addition, however, many, Adolf Hitler included, believed that syphilis was a Jewish disease capable however of infecting the bloodline of the body politic. Although present in German society and thus not confined to Hitler, Jews were associated with syphilis in many ways. In fact, it “was actually understood as a Jewish disease as early as its first modern outbreak in the fifteenth century ,” and according to Gilman, the signs of syphilis on the Jew, or at least the image of the Jew were a sign of diseased soul. The spread of syphilis therefore was associated with Jews who not just were thought to show the disease on their countenance, but also were thought to carry syphilis in their heredity. Eradicating syphilis would require eradicating the Jewish race, or vice versa. By these means, Jews were seen and represented visually as being one of the “germs” infecting the body of the German body politic. Incidentally, Hitler is one of the historical figures who are believed by some to have suffered from syphilis.


But this imagery has been transformed in the fifty years since the introduction of penicillin. Now syphilis, particularly the tertiary form, has almost vanished from the world stage. Rather, and in a manner perhaps unthinkable to syphilitics 75 years ago, syphilis has been tamed into a mild and even humorous cartoon character- resembling the California raisin icon- used by public health authorities to combat rising primary infections. Thus the syphilis narratives are transformed, the disease largely stripped of its symbolic meaning. That such a change occurs is not unusual. This transformation occurs regularly as diseases either are amenable to treatment, or simply become familiar to sufferers. Thus, early epidemics of Bubonic Plague led to great familiarity with death and its sway over humanity, responsible in large part for the ubiquitous presence of the “Dance of Death” imagery. Too, the hold of plague on the imagination remained powerful, but the terror, at least the historical memory of the disease, is associated with the first outbreak in 1348. In fact, plague continued to revisit Europe approximately once every twenty years for centuries. With the exception of the Great London Plague in 1665 this pattern of revisitation seems lost; it was the first terrifying outbreak that was so memorable. After the disease became more familiar it lost its preeminent position as a source of terror. Diseases that are relatively new and potent tend to attract greater attention; thus while polio affected far fewer people than tuberculosis, cancer, or heart disease, as a relatively new epidemic infection affecting children it quickly caught the public’s attention and contributions to fight polio far outstripped other fund raising efforts.

There are of course aspects of diseases that give them this greater symbolic and even hysterical potency. These include relative newness, nature of the symptoms, the manner of transmission, who may be affected, and apparent place of origin. The biology of the Treponema bacterium clearly contributed to syphilis’ symbolic potency. The disease is typically sexually transmitted; such diseases tend to carry with them a social stigma. Whether of course the presence of a sexually transmitted disease leads society to view sexual promiscuity as a sin or whether they reinforce existing ideas is an open question. But socially transmitted diseases do provide evidence of sexual activity. Whether the disease is a relatively mild stigma or a terrible, disquieting one, however, depends on the symptoms of the disease. Gonorrhea, for instance, although a common sexually transmitted disease, never inspired the same dread as syphilis. Although it could lead to blindness in newborns- exposure to the bacteria in the birth canal- and sterility through pelvic infections in women, its other symptoms might seem relatively mild by comparison to syphilis. Syphilis appears first as a sore or chancre, then as a rash sometimes accompanied by mild fever. Untreated syphilis then enters a third phase of symptom-free latency which may last for many years. Some infected people never develop the symptoms of tertiary syphilis, when the bacteria attack various organs. Others may suffer degeneration of the heart and/or nervous system including paresis, blindness, and deafness. It is this continuing degeneration after a period of latency that perhaps has made syphilis so terrifying, but the fact that syphilis is often passed from mother to infant also increases the danger associated with the disease. Thus the disease attacks the innocent as well as the sinner, often causing in the infant or child the same degeneration as in the adult.


The history of syphilis also is interesting, though of course knowledge of that history may not always have contributed to syphilis imagery. The disease appeared in Europe in the 1490s, at approximately the same time as Columbus’ men returned from the New World. It quickly spread through Europe and into China, and its symptoms were somewhat different than today. Rather than undergoing a latency period, it was “an epidemic, rapid and mortal illness. ” It was, therefore, a dramatic illness seen by Erasmus as among the most horrible of diseases. At first its appearance was traced to Naples and it was known as “the Neapolitan disease.” Later it came to be known as the French disease, although Europeans soon noted that its virulent appearance coincided with the reappearance of Columbus. Clearly, the early virulence and lessening of symptoms seems to indicate a new disease operating in a “virgin” population, where over time the disease may evolve lesser virulence or the population greater immunities. Syphilis also is compatible with the forms of infectious disease then present in the Americas, where a related skin ailment known as yaws existed prior to Columbus. There is, however, evidence in early skeletons that syphilis was found in Europe before 1495. Whether its early virulence was due to its arrival from the Caribbean or to a mutation in an existing disease is unclear. What seems clear is the fact that a sudden and dramatic appearance of an infectious disease from the outside gave it additional terror while its association with a foreign and/or despised group made it seem more alien and perhaps even degenerate. The debate over new or old world origins has continued ever since, but the association of the disease with “somewhere else” gave it a sense of being foreign and somehow alien.


Images:

Are You Fit To Marry?- This silent movie from the 1910s (re-released in the 1920s) was originally made to support the euthanasia of infants practiced by a prominent physician. The film shows an anti-hero whose family lineage was contaminated several generations ago when his ancestor had sexual intercourse with a maid. The movie stipulates that this anti-hero should not marry because he carries in his blood the taint introduced so many years ago.
Congenital syphilis- depicting infection of the innocent, this medical image comes from a textbook
Infection in the body politic image from Robert Proctor’s Racial Hygiene: Medicine under the Nazis (1989)- Nazi race hygiene propaganda shows the way in which infectious germs- Jews, dollars, and pounds are infecting the blood of the German people.
WWII ads- from a Florida county public health department scrapbook, these advertisements show how avoiding the dangers of syphilis (and gonorrhea) were made part of the war effort.
Phil the Sore- http://www.stopthesores.org/ Phil The Sore is a cartoon image of a syphilis chancre, whose purpose is to educate the public, particularly gay men, of the increased incidence of syphilis.