Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
 Instructor:    Dr. Barbara J. Becker

Lecture 9.  Syphilis.


Treponema pallidum

  • first observed by Fritz Schaudinn (1871-1906) in March 1905
  • fragile organism
  • must be transferred through intimate contact
  • reproduces slowly -- divides every 30 hours compared to every 20-30 minutes for most bacteria

The Treponematoses:
Syphilis and the Syphilis-Like Diseases
Venereal Syphilis
Non-venereal Syphilis
The spirochete is called Treponema...
[The spirochetes are identical even under the electron microscope; they differ mainly in the disease they produce in man and experimental animals.  The Wassermann and other tests on serum, including specific tests, are positive in all, without differences.  All are equally treatable with penicillin and other antibiotics.]
Infection usually starts in...
but may 
be congenital:
seldom or never
probably never
Transmitted by contact with, or between...
mouth or skin
Individual sores are infectious for...
a few months
a few months
a few months
many years
The sick person may transmit the disease for....
3-5 years
3-5 years
3-5 years
many years
[symptoms disappear but may reappear later]
probably absent
First sore is usually on...
skin of legs
exposed skin
Involvement of bone:
Involvement of heart, brain, and other organs:
mild or absent
Original environment:
Favoring climate
cool, any
warm, any?
The Course of the Disease
Primary venereal syphilis--

Within 3-4 weeks following contact, lesion, called a chancre, forms at the point of inoculation.

Chancre grows over period of days or weeks from small pimple to size of marble. 

Breaks down on top and forms an ulcer.

Lymph nodes in the groin become enlarged.

Chancre heals completely, even without treatment. 

Secondary venereal syphilis--

About 6 weeks later, a generalized skin rash appears. 

This rash also heals without treatment.

Tertiary venereal syphilis--

A latent phase then ensues which may last from two to 20+ years.

Preserved skull of a woman who died in 1796 showing the disfiguring effects of the disease in its tertiary phase.

Lest you imagine that the 18th century drawing over-dramatizes the grotesque aspects of tertiary syphilis, compare it with a photograph taken of a modern day victim.


When confronted by the challenge of treating this new disease, physicians turned to the theory of four humors.  Too much phlegm was most often blamed for the pox.  To reduce the excess phlegm physicians recommended a variety of treatments to promote spitting and/or sweating.

But syphilis arrived in the Old World at a time when the unerring authority of Greek knowledge was under scrutiny.  In Lecture 6 we introduced Paracelsus (1493-1541), the enigmatic German practitioner who questioned the idea that health and disease was a matter of a one-size-fits-all humoral balancing act.  He wrote:

If the physician is to understand the correct meaning of health, he must know that there are more than a hundred, indeed more than a thousand, kinds of stomach; consequently, if you gather a thousand persons, each of them will have a different kind of digestion, each unlike the others.  One digests more, the other less, and yet each stomach is suitable to the man it belongs to....  Therefore the various dietary prescriptions should be observed not only for the sake of recovery from illness but also for the sake of prescribing one's health.  There are a hundred forms of health in the liver; each man has a different one.  It follows that no one drinks the same amount as another, that no one has the same thirst as another; this is explained by the diverse kinds of health, which must not be described as illnesses.

Paracelsus listed five principles or influences that can act alone or in complex combinations to cause disease:

  • the stars
  • poisons
  • disintegration of the natural constitution
  • spiritual causes
  • divine causes

To find an effective remedy for a patient's illness, Paracelsus told physicians to look beyond the obvious symptoms to the disease itself:

For there is no sickness against which some remedy has not been created and established, to drive it out and cure it.  There is always some remedy a herb against one disease, a root against another, a water against one, a stone against another, a mineral against one, a poison against another, a metal against one, something else against another.

The nature and force of a disease must be discovered by their cause and not by their symptoms ... for we must not merely extinguish the smoke of the fire but the fire itself.  If we want the earth to produce better grass, we must plow it, and not merely tear out the bad grass.  Similarly the physician ... should direct his thought to the origin of the disease, and not only to that which his eyes see.  For in this he would see but the symptoms and not the origin....

In Paracelsus's view, reducing a patient's excess phlegm would do little to cure the disease.  "A good remedy was worth as much a thousand years ago as it is now," he wrote, "and a bad remedy was then as worthless as it is now....  The tares among the corn are as old as the corn, nevertheless, they cannot be used instead of the corn.  In my opinion, the world should awaken to this fact, and because the good surpasses the bad in worth, we should abandon the bad...."

A key element in Paracelsus's approach to health and disease was his belief that man is a microcosmic reflection of the macrocosm at large:

The mysteries of the Great and the Little World [macrocosm/microcosm; universe/man] are distinguished only by the form in which they manifest themselves; for they are only one thing, one being.  Heaven and earth have been created out of nothingness, but they are composed of three things -- mercury, sulfur, and salt ....  Of these same three things the planets and the stars consist; and not only the stars but all bodies that grow and are born from them.  And just as the Great World is thus built upon the three primordial substances, so man -- the Little World -- was composed of the same substances.  Thus man, too, is nothing but mercury, sulfur, and salt.

For this reason, remedies for what ails the world within us are to be found in the world around us:

Everything external in nature points to something internal; for nature is both inside man and outside man....  [T]here is in the world a natural order of apothecary's shops, for all the fields and meadows, all the mountains and hills are such shops.  Nature has given us all of them, from which to fill our own shops.  All nature is like one single apothecary's shop, covered only with the roof of heaven; and only One Being works the pestle as far as the world extends.  But man has such a shop only in part, not wholly; he possesses something, not everything.  For nature's apothecary's shop is greater than man's.

To prescribe well, a physician must learn "where nature has her pharmacies, where her virtues have been written down, and in what boxes they are stored."  Thus Paracelsus found nature's remedy for syphilis:

Quicksilver manifests itself in three forms.  In the first it is still unborn; in the second it is as it is in itself; in the third it appears such as it has been prepared by the alchemist's art....  Upon these three forms of manifestation of mercurius, or quicksilver, is based the cure of the French disease.

Paracelsus was not the only one advocating the use of mercury as a remedy for syphilis.  It had served as the basis of medicines long used by Arab physicians to treat skin disorders and rashes.  Mercury's use appealed to Galenists as well since it induces copious salivation (a classic sign of mercury poisoning) thus helping the patient to expel excess phlegm.

Mercury and its Compounds

Despite its reputation as a dangerous poison, mercury's ability to make patients sweat and salivate profusely encouraged medical practitioners to prescribe it as a treatment for syphilis:

Mercury metal

• "quicksilver"
• "argentum vivum"

Mercuric oxide

"red precipitate" •
"angelical powder" •

Mercurous chloride

• "calomel"
• "sweet mercury"

Sinabar is a deadly medicine made halfe of quicksilver, and halfe of brimstone by Art of fire....  I know the abuse of these ... medicines hath done unspeakable harme in the common-wealth of England, and daily doth more and more, working the utter infamy and destruction of many an innocent, man, woman, and child....


The perfect cure proceeds from thee,
For Pox, for Gout, for Leprosie,
For scabs, for itch, of any sort,
These cures with thee are but a sport.

--The Surgeons Mate (1617) by John Woodall  (c. 1556-1643)

Mercuric sulfide

Cinnabar (mercuric sulfide) is a natural ore from which mercury can be readily obtained.

"For a little pleasure, a thousand pains"
Mercury (and other materials) were thrown onto charcoal to generate fumes to cause the patient to sweat out the pox's toxins.
Mercury mixed with honey, brandy, aloe, myrrh, sulfur, camphor, fried earthworms, ground live frogs ... (you name it) ... to make an ointment that could be applied topically to lesions and sometimes more generally to the skin

Woodcut (1498), right:  physician applies ointment (possibly a mercury-based compound) on pustules.


Mercury's risks encouraged a search for alternatives.  The bark of the guaiacum, a tree native to the West Indies, was introduced to Europe in 1519 by Ulrich von Hutten (1488-1523). 

Guaiacum was believed by many to be a good natural cure because the tree grew in the land where the disease was thought to have originated.

Because it stimulated salivation and sweating when ingested, guaiacum bark was believed to be as effective as mercury, but without the dangerous side effects.

Guaiacum flower

Guaiacum fruit and seed

Guaiacum trunk

Guaiacum bark

I must now sing of the Gods' great gifts and of the sacred tree [guaiacum] brought from an unknown world, which alone has moderated, relieved and ended suffering....

Syphilis sive morbus Gallicus [Syphilis, or the French Disease] (1530) by Girolamo Fracastoro (c.1478-1553)

Woodcut, right:  Title page illustration depicting guaiacum as the "tree of life [lignum vitae]; the leaves of the tree are for the health of the peoples; a blessed fruit" from pamphlet entitled "Concerning the way in which the wood from the West Indies may be prepared.  It is a curative remedy for every plague and every incurable malady" (1529) by Francisco Delicado

Guaiacum treatment

• break wood into small pieces or grind powder

• mash 1 lb of wood with 8 lbs of water for a day and a night

• simmer slowly in well-covered vessel filled 2/3 full

• simmer till reduced by half (do NOT boil)

• skim foam and apply to syphilitic sores

• drink remaining liquid

Preparing and administering guaiacum.

Tobacco being a common herbe, which (though under divers names) growes almost every where, was first found out by some of the barbarous Indians, to be a Preservative, or Antidot against the Pockes, a filthy disease, whereunto these barbarous people are (as all men know) very much subject, what through the uncleanly and adust [parched; sallow; melancholy] constitution of their bodies, and what through the intemperate heate of their Climate:  so that as from them was first brought into Christendome, that most detestable disease, so from them likewise was brought this use of Tobacco, as a stinking and unsavourie Antidot, for so corrupted and execrable a Maladie, the stinking Suffumigation whereof they yet use against that disease, making so one canker or venime to eate out another.

A Counterblaste to Tobacco (1604) by King James I (1566-1625)

For centuries, mercury remained the treatment of choice for many medical practitioners (and charlatans).

Title page illustration from Venus Belegert en Ontset... (1685) by the Dutch physician, Steven Blanckaert (1650-1702).  Physicians are pictured using a variety of methods to expose syphilitic patients to the healing effects of mercury.

Go to:
  • "Syphilis Victims in U.S. Study Went Untreated for 40 Years" (July 26, 1972), by Jean Heller
  • "Survivor of '32 Syphilis Study Recalls a Diagnosis" (July 27, 1972), by James T. Wooten
  • The Belmont Report (1979), by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research
  • Presidential Apology (1997), to African-American participants in the "Tuskegee Study of Untreated Syphilis in the Negro Male"
  • "U.S. Apologizes for Syphilis Tests in Guatemala" (October 1, 2010), by Donald G. McNeil, Jr. with contributions from Elisabeth Malkin.
Weekly Readings
Lecture Notes