Origin, spread and discovery by
Rembrandt van Rijn, circa 1665–67, oil on canvas. De Lairesse, himself a painter and art theorist, had congenital syphilis that deformed his face and eventually blinded him
Paleopathologists have known for decades that syphilis was present in the Americas before European contact. The situation in
Afro-Eurasia has been murkier and caused considerable debate. According to the Columbian theory, syphilis was brought to Spain by the men who sailed with
Christopher Columbus in 1492 and spread from there, with a serious epidemic in
Naples beginning as early as 1495. Contemporaries believed the disease sprang from American roots, and in the 16th century physicians wrote extensively about the new disease inflicted on them by the returning explorers. Most evidence supports the Columbian origin hypothesis. However, beginning in the 1960s, examples of probable
treponematosis—the parent disease of syphilis,
bejel, and
yaws—in skeletal remains shifted the opinion of some towards a "pre-Columbian" origin. A 2024 study published in
Nature supported syphilis having first emerged among humans in the Americas in the mid-
Holocene. When living conditions changed with urbanization, elite social groups began to practice basic hygiene and started to separate themselves from other social tiers. Consequently, treponematosis was driven out of the age group in which it had become endemic. It then began to appear in adults as syphilis. Because they had never been exposed as children, they were not able to fend off serious illness. Spreading the disease via sexual contact also led to victims being infected with a massive bacterial load from open sores on the genitalia. Adults in higher socioeconomic groups then became very sick with painful and debilitating symptoms lasting for decades. Often, they died of the disease, as did their children who were infected with congenital syphilis. The difference between rural and urban populations was first noted by Ellis Herndon Hudson, a clinician who published extensively about the prevalence of treponematosis, including syphilis, in times past. The importance of bacterial load was first noted by the physician Ernest Grin in 1952 in his study of syphilis in Bosnia. The most compelling evidence for the validity of the pre-Columbian hypothesis is the presence of syphilitic-like damage to bones and teeth in medieval skeletal remains. While the absolute number of cases is not large, new ones are continually discovered, most recently in 2015. At least fifteen cases of acquired treponematosis based on evidence from bones, and six examples of congenital treponematosis based on evidence from teeth, are now widely accepted. In several of the twenty-one cases the evidence may also indicate syphilis. before
his crucifixion. From a French
book of hours, In 2020, a group of leading paleopathologists concluded that enough evidence had been collected to prove that treponemal disease, almost certainly including syphilis, had existed in Europe prior to the voyages of Columbus. There is an outstanding issue, however. Damaged teeth and bones may seem to hold proof of pre-Columbian syphilis, but there is a possibility that they point to an endemic form of treponemal disease instead. As syphilis, bejel, and yaws vary considerably in mortality rates and the level of human disease they elicit, it is important to know which one is under discussion in any given case, but it remains difficult for paleopathologists to distinguish among them. (The fourth of the treponemal diseases is
pinta, a skin disease and therefore unrecoverable through paleopathology.) Ancient
DNA (aDNA) holds the answer, because just as only aDNA suffices to distinguish between syphilis and other diseases that produce similar symptoms in the body, it alone can differentiate
spirochetes that are 99.8 percent identical with absolute accuracy. Progress on uncovering the historical extent of syndromes through aDNA remains slow, however, because the bacterium responsible for treponematosis is rare in skeletal remains and fragile, making it notoriously difficult to recover and analyse. Precise dating to the medieval period is not yet possible but work by Kettu Majander et al. uncovering the presence of several different kinds of treponematosis at the beginning of the early modern period argues against its recent introduction from elsewhere. Therefore, they argue, treponematosis—possibly including syphilis—almost certainly existed in medieval Europe. Despite significant progress in tracing the presence of syphilis in past historic periods, definitive findings from paleopathology and aDNA studies are still lacking for the medieval period. Evidence from art is therefore helpful in settling the issue. Research by Marylynn Salmon has demonstrated that deformities in medieval subjects can be identified by comparing them to those of modern victims of syphilis in medical drawings and photographs. One of the most typical deformities, for example, is a collapsed nasal bridge called
saddle nose. Salmon discovered that it appeared often in
medieval illuminations, especially among the men tormenting Christ in scenes of the crucifixion. The association of saddle nose with evil is an indication that the artists were thinking of syphilis, which is typically transmitted through sexual intercourse with promiscuous partners, a mortal sin in medieval times. It remains mysterious why the authors of medieval medical treatises so uniformly refrained from describing syphilis or commenting on its existence in the population. Many may have confused it with other diseases such as leprosy (
Hansen's disease) or
elephantiasis. The great variety of symptoms of treponematosis, the different ages at which the various diseases appear, and its widely divergent outcomes depending on climate and culture, would have added greatly to the confusion of medical practitioners, as indeed they did right down to the middle of the 20th century. In addition, evidence indicates that some writers on disease feared the political implications of discussing a condition more fatal to elites than to commoners. Historian Jon Arrizabalaga has investigated this question for
Castile with startling results revealing an effort to hide its association with elites. The first written records of an outbreak of syphilis in Europe occurred in 1495 in
Naples, Italy, during a French invasion (
Italian War of 1494–1495). The disease reached
London in 1497 and was recorded at St Bartholomew's Hospital as infecting 10 out of the 20 patients. In 1530, the pastoral name "syphilis" (the name of a character) was first used by the Italian physician and poet
Girolamo Fracastoro as the title of his
Latin poem in
dactylic hexameter, (
Syphilis or The French Disease), describing the ravages of the disease in Italy. In Great Britain it was also called the "Great Pox". In the 16th through 19th centuries, syphilis was one of the largest public health burdens in
prevalence, symptoms, and disability, although records of its true prevalence were generally not kept because of the fearsome and sordid status of
sexually transmitted infections in those centuries. At the time the
causative agent was unknown but it was well known that it was spread sexually and also often from mother to child. Its association with sex, especially
sexual promiscuity and
prostitution, made it an object of fear and revulsion and a taboo. The magnitude of its morbidity and mortality in those centuries reflected that, unlike today, there was no adequate understanding of its
pathogenesis and no truly effective treatments. Its damage was caused not so much by great sickness or death early in the course of the disease but rather by its gruesome effects decades after infection as it progressed to
neurosyphilis with
tabes dorsalis.
Mercury compounds and isolation were commonly used, with treatments often worse than the disease. The first effective treatment for syphilis was
arsphenamine, discovered by
Sahachiro Hata in 1909, during a survey of hundreds of newly synthesized organic
arsenical compounds led by
Paul Ehrlich. It was manufactured and marketed from 1910 under the trade name
Salvarsan by
Hoechst AG. This
organoarsenic compound was the first modern
chemotherapeutic agent. During the 20th century, as both
microbiology and
pharmacology advanced greatly, syphilis, like many other infectious diseases, became more of a manageable burden than a scary and disfiguring mystery, at least in
developed countries among those people who could afford to pay for timely diagnosis and treatment. Penicillin was discovered in 1928, and effectiveness of treatment with
penicillin was confirmed in trials in 1943, Many famous historical figures, including
Franz Schubert,
Arthur Schopenhauer,
Édouard Manet, and
Guy de Maupassant are believed to have had the disease.
Friedrich Nietzsche was long believed to have gone mad as a result of
tertiary syphilis, but that diagnosis has recently come into question.
Arts and literature The earliest known depiction of an individual with syphilis is
Albrecht Dürer's
Syphilitic Man (1496), a woodcut believed to represent a
Landsknecht, a Northern European
mercenary. The myth of the or "poison women" of the 19th century is believed to be partly derived from the devastation of syphilis, with classic examples in literature including
John Keats' . The Flemish artist
Stradanus designed a print called
Preparation and Use of Guayaco for Treating Syphilis, a scene of a wealthy man receiving treatment for syphilis with the tropical wood
guaiacum sometime around 1590.
Tuskegee and Guatemala studies poster about syphilis c. 1940 The "Tuskegee Study of Untreated Syphilis in the Negro Male" was an infamous, unethical and racist
clinical study conducted between 1932 and 1972 by the
U.S. Public Health Service. Whereas the purpose of this study was to observe the
natural history of untreated syphilis, the African-American men in the study were told they were receiving free treatment for "bad blood" from the United States government. The Public Health Service started working on this study in 1932 in collaboration with
Tuskegee University, a
historically black college in Alabama. Researchers enrolled 600 poor, African American
sharecroppers from
Macon County,
Alabama in the study. Of these men, 399 had contracted syphilis before the study began, and 201 did not have the disease. communication of
diagnosis, and accurate reporting of test results. Similar experiments were carried out in
Guatemala from 1946 to 1948. It was done during the administration of American President
Harry S. Truman and Guatemalan President
Juan José Arévalo with the cooperation of some Guatemalan health ministries and officials. Doctors infected soldiers, prostitutes, prisoners and
mental patients with syphilis and other
sexually transmitted infections, without the
informed consent of the subjects and treated most subjects with
antibiotics. The experiment resulted in at least 83 deaths. In October 2010, the U.S. formally apologized to Guatemala for the ethical violations that took place. Secretary of State
Hillary Clinton and Health and Human Services Secretary
Kathleen Sebelius stated "Although these events occurred more than 64 years ago, we are outraged that such reprehensible research could have occurred under the guise of public health. We deeply regret that it happened, and we apologize to all the individuals who were affected by such abhorrent research practices." The experiments were led by physician
John Charles Cutler who also participated in the late stages of the Tuskegee syphilis experiment.
Names Syphilis was first called or the "great pox" by the French. Other historical names have included "button scurvy", sibbens, frenga, and dichuchwa, among others. Since it was a disgraceful disease, the disease was known in several countries by the name of their neighbouring, often hostile country. The English, the Germans, and the Italians called it "the French disease", while the French referred to it as the "Neapolitan disease". The Dutch called it the "Spanish/Castilian disease". To the Turks it was known as the "Christian disease", whilst in India, the Hindus and Muslims named the disease after each other. ==References==