The changing pattern of epidemic diseases or diagnostic categories characteristic of the Renaissance is almost as striking as the transformation of art, science, and scholarship. Although leprosy did not entirely disappear, and waves of plague continued to break over Europe, diseases previously rare, absent, or unrecognized—such as syphilis, typhus, smallpox, and influenza—became major public health threats. Many diseases are worthy of a full biography, but none raises more intriguing questions than syphilis, the ''Scourge of the Renaissance.'' Because syphilis is a sexually transmitted disease, it is a particularly sensitive tracer of the obscure pathways of human contacts throughout the world, as well as the intimate links between social and medical concepts.
In mocking tribute to Venus, the Roman goddess of love, the term venereal has long served as a euphemism in matters pertaining to sex. But in an era that prides itself on having won the sexual revolution, the more explicit term sexually transmitted disease (STD) has been substituted for venereal disease (VD). Any disease that can be transmitted by sexual contact may be considered a venereal disease. A more restrictive definition includes only those diseases that are never, or almost never, transmitted by any mechanism other than sexual contact. Until the second half of the twentieth century, syphilis and gonorrhea were considered the major venereal diseases in the wealthy, industrialized nations, but the so-called minor venereal diseases—chancroid, lympho-granuloma venereum, and granuloma inguinale—also cause serious complications. Scabies and crab lice gain membership in the club if the less rigorous definition of STD is accepted. Additional modern members of the STD club are genital herpes, trichomoniasis, nongono-coccal urethritis, and AIDS. Genital herpes was winning its battle to become the most feared venereal disease in the United States until the 1980s, but since then AIDS has emerged as the great modern plague.
Despite the antiquity of references to venereal diseases, many Renaissance physicians were convinced that syphilis was unknown in Europe until the end of the fifteenth century; others argued that there was one venereal scourge as old as civilization that appeared in many guises, including those known as gonorrhea and syphilis. The confusion is not surprising, as a brief overview of the natural history of the major venereal diseases will indicate. A specific differential diagnosis of syphilis or gonorrhea cannot be based on symptoms alone. In the twentieth-century laboratory, a tentative diagnosis of syphilis can be confirmed by the Wassermann blood test, but for gonorrhea, confirmation requires identification of Neisseria gonorrhoeae, a small gramnegative gonococcus discovered by Albert Neisser (1855-1916) in 1879.
Gonorrhea is generally recognized as the oldest and probably most common venereal disease. Galen may have given this ancient illness its common name; gonorrhea actually means ''flow of seed.'' Colloquial names include clap, dose, strain, drip, and hot piss. Symptoms of gonorrhea usually appear about three to five days after infection, but the incubation period may be as long as ten days. Pain, burning, and the discharge of pus from the urethra are usually the first symptoms noticed in males. Eventually, inflammation may obstruct the flow of urine and lead to a life-threatening stricture of the urethra. Surgeons attacked the problem with sounds (curved metal rods) to stretch the narrowed channel and catheters to provide relief from retention of urine. Avicenna introduced medicines into the bladder with a silver syringe, and, for good measure, inserted a louse in the urethra. (If a louse was not available, a flea or bug might do equally well.) Sedatives and opiates provided some relief from pain and anxiety, but for psychological impact, nothing could surpass quack remedies containing various dyes that caused the patient to pass technicolor waters.
In women, gonorrhea is often a silent infection that insidiously attacks the internal organs, leading to peritonitis, endocarditis, arthritis, ectopic pregnancies, spontaneous abortions, stillbirths, chronic pelvic inflammatory disease, and sterility. Infants can acquire gonorrheal infection of the eyes during birth. To prevent this form of blindness, Karl Siegmund Crede, at the Lying-In Hospital in Leipzig, introduced the application of silver nitrate to the eyes of newborns. Less frequent complications—skin lesions and arthritis, conjunctivitis, endocarditis, myocarditis, hepatitis, meningitis—can occur in men and women if the gonococcus becomes widely disseminated via the bloodstream. Many patients treated for arthritis and gout were probably suffering from gonococcal infections.
Public health authorities once thought that penicillin would eradicate gonorrhea, but in the late twentieth century gonorrhea was still the most common venereal disease and the most prevalent bacterial disease on earth. Penicillin-resistant strains have become so common since they were discovered in the 1970s that this antibiotic is no longer used for gonorrhea treatment. Trends in the development of antibiotic-resistant strains of the gonococcus provide no grounds for optimism. New ''superstrains'' have appeared throughout the world. By 2002, strains of both fluoroquinolone and multidrug resistant gonorrhea migrated from Asia to Hawaii to California. Previously, gonorrhea could be treated with single-dose therapy using fluoroquinolones or cephalospo-rins. In some regions, 60 to 80 percent of gonorrhea cases are resistant to fluoroquinolones. Treatments that alleviate symptoms without curing the infection are particularly troublesome, because patients who mistakenly think they are cured can easily infect others.
Syphilis, which is caused by a spirochetal bacterium known as Treponema pallidum, has been called the great mimic because in the course of its development it simulates many other diseases. Syphilitic lesions can be confused with those of leprosy, tuberculosis, scabies, fungal infections, and various skin cancers. Before the introduction of specific bacteriological and immunological tests, the diagnostic challenge of syphilis was reflected in the saying ''Whoever knows all of syphilis knows all of medicine.'' Untreated syphilis progresses through three stages of increasing severity. A small lesion known as a chancre is the first sign. The chancre may become ulcerated or disappear altogether. The second stage may include fever, headache, sore throat, a localized rash, skin lesions, patchy bald spots, swollen and tender lymph nodes, sore mouth, and inflamed eyes. Symptoms may appear within weeks or months of infection and subside without treatment. During the third stage, chronic obstruction of small blood vessels, abscesses, and inflammation may result in permanent damage to the cardiovascular system and other major organs. Neurosyphilis causes impaired vision, loss of muscular coordination, paralysis, and insanity. A syphilitic woman may experience miscarriages or stillbirths, or bear a child with impaired vision, deafness, mental deficiency, and cardiovascular disease.
If diseases were catalogued in terms of etiological agents instead of means of transmission, syphilis would be described as a member of the treponematosis family. The treponematoses are diseases caused by members of the Treponema group of spirochetes (corkscrew-shaped bacteria). Although these microbes grow slowly, once established in a suitable host they multiply with inexorable patience and persistence. Syphilis is one of the four clinically distinct human treponematoses; the others are pinta, yaws, and bejel. In terms of microbiological and immunological tests, the causative organisms are virtually identical, but distinct differences are readily revealed in naturally occurring infections.
Some bacteriologists believe that pinta, yaws, bejel, and syphilis are variants of an ancestral spirochete that adapted to different patterns of climate and human behavior. According to what is generally known as the unitary theory, the nonvenereal treponematoses are ancient diseases transmitted between children. As people migrated to temperate areas and covered themselves with clothing, nonvenereal transmission was inhibited. Under these conditions, many people reached adulthood without acquiring the immunity common in more primitive times. Pinta, a disease endemic in Mexico and Central America, is characterized by skin eruptions of varying color and severity. Until Treponema carateum was discovered, pinta was classified among the fungal skin diseases. Yaws, a disease caused by Treponema pertenue, flourishes in hot, moist climates. Like syphilis, yaws leads to destruction of tissue, joints and bone. Bejel, or nonvenereal endemic syphilis, is generally acquired in childhood among rural populations living in warm, arid regions. Like syphilis, bejel has a latent phase, and afflicted individuals may be infectious for many years.
Despite advances in understanding the treponematoses, medical historians are no closer to a definitive account of the origin of syphilis than medical authorities are to eradicating STDs. Reliable accounts of syphilis first appear in the sixteenth century, when the affliction that marked its victims with loathsome skin eruptions was known by many names. The French called it the Neapolitan disease, the Italians called it the French disease, and the Portuguese called it the Castilian disease. In India and Japan, it was called the Portuguese disease, and the names Canton disease, great pox, and lues venereum were also used. The name used today was invented by Girolamo Fracastoro (Latinized as Fracastorius; 1478-1553), an Italian physician, scientist, mathematician, astronomer, geologist, and poet. In Syphilis, or the French Disease (1530), Fracastoro created the story of Syphilis the shepherd, who brought about the first outbreak of the scourge by cursing the sun. To punish men for this blasphemy, the sun shot deadly rays of disease at the earth. Syphilis was the first victim of the new pestilence, but the affliction soon spread to every village and city, even to the king himself.
Examining the historical evidence concerning the origin of syphilis is like entering a labyrinth. If we include the speculations of Fracastoro, his contemporaries, and subsequent medical writers, we come up with many theories but no definitive answer to the question raised in the sixteenth century: What causes presided at the origin of syphilis? Sixteenth-century medical astrologers traced the origin of the new venereal scourge to a malign conjunction of Jupiter, Saturn, and Mars in 1485 that produced a subtle poison that spread throughout the universe, unleashing a terrible plague upon Europe. Followers of astrology might still argue that this theory has never been disproved, but more scientifically plausible theories are still hotly debated.
The so-called Columbus Theory of the origin of syphilis is based on the fact that the New World was the source of plants and animals previously unknown to Europeans. Many Renaissance physicians, therefore, assumed that the great pox was one of the new entities imported from the New World to the Old World by Columbus and his crew. The fifteenth century was a time of great voyages, commercial expansion, and warfare, during which previously isolated peoples were suddenly immersed in a globalized germ pool. Many epidemic diseases flourished under these conditions, but it was syphilis that became known as the ''calling card of civilized man.''
Much circumstantial evidence supported the Columbus Theory: the timing of the voyages, the dispersal of the crew, their transformation from sailors to soldiers, their presence in areas where the disease was first reported, the testimony of physicians, the subsequent spread of syphilis, and its changing clinical pattern. Indeed, some historians blamed the physical and mental deterioration of Columbus on syphilis, although other explanations are equally plausible. While evidence for the Columbus Theory can be assembled in a fairly convincing package, it is important to remember that coincidence must not be confounded with cause. Moreover, the diagnostic value of documents designed to link ''evil pocks'' to immorality, human afflictions, and messages from God is somewhat suspect.
Rodrigo Ruiz Diaz de Isla (1462-1542), a Spanish physician, was probably the first to assert that members of the crew of Columbus had imported syphilis to Europe from the West Indies. In a book not published until 1539, de Isla claimed that in 1493 he had treated several sailors with a strange disease characterized by loathsome skin eruptions. Additional support for the Columbus Theory is found in reports written in 1525 by Gonzalo Hernandez de Oviedo y Valdez, Governor of the West Indies. According to Oviedo, sailors infected in the New World had joined the army of Charles VII at the siege of Naples (1494). When the French army was driven out of Italy in 1495, infected troops and camp followers sparked epidemics throughout Europe.
The Columbus Theory requires, at the very least, conclusive proof of the existence of syphilis in the New World before 1492. Unequivocal evidence of syphilis in Europe before the voyages of Columbus would disprove this theory. However, given the difficulties inherent in paleopathology, the diagnostic evidence for syphilis in pre-Columbian America and Europe remains problematic and the debate among historians continues. The problem is compounded by a recent tendency to blur distinctions between syphilis and nonvenereal treponemal infections.
The so-called Leprosy Theory is based on the possibility that syphilis, the great mimic, might have hidden itself among the legions of medieval lepers. References to ''venereal leprosy'' and ''congenital leprosy'' in Europe before 1492 are compatible with this theory, but all medieval allusions to a connection between leprosy and sex must be examined cautiously. According to a related sixteenth-century suggestion, the new venereal scourge was a hybrid produced by sexual intercourse between a man with leprosy and a prostitute with gonorrhea. To determine whether some of those who were called lepers were actually suffering from syphilis, scientists have looked for syphilitic lesions in bones found in leper cemeteries. The evidence remains ambiguous.
Another hypothesis known as the African or Yaws Theory essentially reverses the Columbus Theory. According to this theory, syphilis was one of the many disasters Europeans brought to the New World by merging the germ pools of Africa and Europe in the Americas. With Native Americans brought to the verge of extinction by smallpox and other foreign diseases, Europeans were importing African slaves into the New World within 20 years of the first contacts. If Africans taken to Europe and the Americas were infected with yaws, changes in climate and clothing would have inhibited nonvenereal transmission of the spirochete. Under these conditions, yaws could only survive by becoming a venereal disease.
If true, the African Theory would explain the apparent relationship between the appearance of syphilis and the adventures of Columbus and his crew. It would also provide a form of intercontinental microbiological retribution with a fitting lesson about the evils of slavery. However, this theory is based on rather weak and controversial circumstantial evidence. Given the antiquity of interchanges between Europe and Africa, yaws could have been introduced to Egypt, Arabia, Greece, and Rome from Africa centuries before the voyages of Columbus. Therefore, some other spark would be needed to trigger the fifteenth-century conflagration. Partisans of various theories have presented many ingenious arguments, but the evidence does not yet seem totally compelling. The question of the origin of syphilis is further complicated by confusion between gonorrhea and syphilis in the early literature.
Whatever the source of syphilis, Fracastoro believed that in its early stage, the disease could be cured by a carefully controlled regimen, including exercises that provoked prodigious sweats. Once the disease had taken root in the viscera, a cure required remedies almost as vile as the disease. In another flight of fancy, Fracastoro told the story of a peaceful gardener named Ilceus who was stricken with a terrible disease as punishment for killing a deer sacred to the Greek god Apollo and his sister Diana. The gods had sworn that no remedy would be found within their realm, but Ilceus journeyed to a cavern deep within the bowels of the earth. Here, he was cured when the resident nymphs plunged him into a river of pure quicksilver (mercury).
Unlike the nymphs, doctors liked to combine mercury with other agents, such as lard, turpentine, incense, lead, and sulfur. Perhaps the most bizarre prescription was that of Giovanni de Vigo (1450-1525) who added live frogs to his quicksilver ointment. Fracastoro preferred a remedy rich in mercury, black hellebore, and sulfur. Covered with this mixture, the patient was wrapped in wool and kept in bed until the disease was washed out of the body in a flood of sweat and saliva. An alternative method of curing by emaciation involved spartan diets, purges, sudorifics, and salivation induced by mercury. If this 30-day regimen did not cure syphilis, it would certainly do wonders for obesity.
Mercury became so intimately linked to the venereal scourge that quacksalvers used mercury as an operational definition for syphilis; if mercury provided a cure, the patient was syphilitic. The link between syphilis and mercury probably resulted from the belief that mercury cured diseases of the skin. Reasoning by analogy from the effectiveness of mercurial ointments for scabies and other skin disorders, doctors assumed that mercury would also triumph over syphilitic ulcers. In any case, syphilis made it possible for quacksalvers to acquire so many patients they were able to achieve the dream of the alchemists—the transmutation of mercury into gold. Patients undergoing mercury inunction sat in a tub in a hot, closed room where they could be rubbed with mercury ointments several times a day. Those who would rather read Shakespeare than ancient medical texts will find many references to the torments of syphilis and the ''tub of infamy.'' Other references to ''rubbing and tubbing'' indicate that this form of treatment was very well known. If the association between syphilis and mercury had not been so completely forgotten by the end of the twentieth century, the Moral Majority would certainly have demanded censorship of the Mother Goose rhyme ''Rub-a-dub-dub, three men in a tub..."
Unequivocal proof of mercury toxicity is rather recent, but suspicions about the dangers of quicksilver were not uncommon among Renaissance practitioners. Bernardino Ramazzini (1633-1714) devoted a chapter of his great treatise On the Diseases of Workers to ''diseases of those who give mercurial inunction.'' As Ramazzini so aptly put it, the lowest class of surgeons performed mercury inunction because the better class of doctors would not practice ''a service so disagreeable and a task so full of danger and hazard.'' Realizing that no fee could compensate for loss of their own health, some quacksalvers made their patients rub each other with mercurial ointments. By the early nineteenth century, some critics of mercurial remedies realized that excessive salivation and ulcers in the mouth were signs of ''morbid mercurial irritation,'' rather than a sign that syphilis had been cured.
Even physicians who regarded mercury as a marvelous remedy were not about to let patients escape their full therapeutic arsenal. Syphilitics were dosed with brisk purgatives, clysters, sudorifics, and tonics, and subjected to bizarre dietary restrictions. Many therapeutic regimens, including that of Fracastoro, emphasized heat, exercise, and sweating. Indeed, ''fever therapy,'' also known as therapeutic hyper-thermia, was used for both syphilis and gonorrhea well into the twentieth century. Experiments on therapeutic hyperthermia utilized tuberculin, bacterial vaccines, fever cabinets, and malaria. During the first half of the twentieth century, malaria fever therapy was used in the treatment of patients with advanced neurosyphilis. Paretic patients were given intravenous injections of blood infected with Plasmodium vivax or P. malariae (the causative agents of relatively benign forms of malaria), resulting in fevers as high as 106 degrees Fahrenheit. After about 12 cycles of fever, some blood would be taken for further use and the patient would receive quinine to cure malaria. Physicians maintained favored strains of malaria by transmitting the infection from patient to patient. Theories of fever have undergone many changes since antiquity, but the significance of fever in disease is still an enigma. The rationale for fever therapy is that high body temperature must be a defense mechanism that destroys or inhibits pathogenic microbes before they kill the host. Elevation of body temperature is, however, not without risk. Not surprisingly, after undergoing therapeutic hyperthermia, many patients suffered from disorientation and other unpleasant side effects.
During the first phase of the syphilis epidemic, the only serious challenge to mercury treatment was a remedy known as guaiac, or Holy Wood. Guaiac was obtained from evergreen trees indigenous to South America and the West Indies. To explain the discovery of this remedy, Fracastoro, who had recommended vigorous exercise, sweating, and mercury, provided an appropriate myth about a group of Spanish sailors who observed natives of the New World curing syphilis with Holy Wood. According to the Doctrine of Signatures, if syphilis originated in the New World, the remedy should be found in the same region. Imported Holy Wood became the remedy of choice for physicians and their wealthy clients, while mercury remained the remedy of the poor. Attacking those who prescribed Holy Wood, Paracelsus complained that wealthy merchants and physicians who were deluding the sick by promoting expensive and useless treatments had suppressed his work on the therapeutic virtues of mercury.
One of the most influential and enthusiastic of the early anti-mercurialists, Ulrich Ritter von Hutten (1488-1523), was a victim of both the venereal disease and the noxious cures prescribed by his physicians. In 1519, von Hutten published a very personal account of guaiac and syphilis. Having suffered through eleven cures by mercury in nine years, von Hutten claimed that guaiac had granted him a complete and painless cure. He urged all victims of the venereal scourge to follow his example. However, he died only a few years after his cure, perhaps from the complications of tertiary syphilis.
Of course there were many minor challenges to mercury and Holy Wood, including preparations based on gold, silver, arsenic, lead, and dozens of botanicals. Holy Wood retained its popularity for little more than a century, but mercury was still used as an antisyphilitic in the 1940s. As humoral pathology gradually gave way to a pathology based on the search for localized internal lesions, copious salivation was no longer interpreted as a sign of therapeutic efficacy, and milder mercurial treatments gained new respect. Because of the unpredictable nature of syphilis, case histories could be found to prove the efficacy of every purported remedy.
Perhaps the long history of the medical use of mercury proves nothing but the strong bond between therapeutic delusions and the almost irresistible compulsion to do something. Quicksilver therapy for syphilis has been summed up as probably the most colossal hoax in the history of medicine. With the medical community and the public convinced that mercury cured syphilis, it was almost impossible to conduct clinical trials in which patients were deprived of this remedy. However, the Inspector General of Hospitals of the Portuguese Army noticed an interesting unplanned ''clinical test'' during British military operations in Portugal in 1812. Portuguese soldiers with syphilis generally received no treatment at all, while British soldiers were given vigorous mercury therapy. Contrary to medical expectation, the Portuguese soldiers seemed to recover more rapidly and completely than their British counterparts. About a hundred years later, Norwegian investigators provided further support for therapeutic restraint in a study of almost two thousand untreated syphilitics. In 1929, follow-up studies of subjects in the 1891-1910 Oslo Study indicated that at least 60 percent of the untreated syphilitics had experienced fewer long-term problems than patients subjected to mercury treatments.
Evaluating remedies for venereal disease was also complicated by widespread confusion between gonorrhea and syphilis. Many physicians assumed that gonorrhea was essentially one of the symptoms of syphilis and that, therefore, mercury was an appropriate treatment for all patients with venereal disease. In the eighteenth century, eminent British surgeon and anatomist John Hunter (1728-1793) attempted to untangle diagnostic confusion between gonorrhea and syphilis by injecting himself (or, according to a less heroic version of the story, his nephew) with pus taken from a patient with venereal disease. Unfortunately, Hunter's results increased the confusion, because he concluded that gonorrhea was a symptom of syphilis. In retrospect, his results are best explained by assuming that his patient had both syphilis and gonorrhea.
Philippe Ricord (1799-1889), author of A Practical Treatise on Venereal Diseases: or, Critical and Experimental Researches on Inoculation Applied to the Study of These Affections, is generally regarded as the first to separate syphilis and gonorrhea. His work brought the term "syphilis" into greater use as a replacement for the nonspecific lues venerea. According to Ricord, the primary symptom of syphilis was the chancre and only the primary chancre contained the "contagion" of syphilis. Because he could not find an animal model for syphilis, and he believed that it was unethical to conduct experiments on healthy humans, Ricord tested his doctrine on patients who were already suffering from venereal disease. Using a technique he called ''autoinoculation,'' Ricord took pus from a venereal lesion and inoculated it into another site to see whether the lesion could be transferred. Although Ricord argued that his experiments proved that only pus from a primary syphilitic chancre produced a chancre at the site of inoculation, many other physicians reported that secondary syphilis was contagious.
All lingering doubts as to the distinction between syphilis and other venereal diseases were settled at the beginning of the twentieth century with the discovery of the ''germ of syphilis'' and the establishment of the Wassermann reaction as a diagnostic test. In 1905, Fritz Richard Schaudinn (1871-1906) and Paul Erich Hoffmann (18681959) identified the causal agent of syphilis, Spirochaeta pallida, which was later renamed Treponema pallidum. Hideyo Noguchi (1876-1928) quickly confirmed the discovery. Diagnostic screening was made possible in 1906 when August von Wassermann (1866-1925) discovered a specific blood test for syphilis. The Wassermann reaction redefined the natural history of syphilis, especially secondary and tertiary stages, and latent and congenital syphilis. Wassermann and his coworkers, who embarked on their research with assumptions that later proved to be incorrect, have been compared to Columbus, because they unexpectedly arrived at a remarkable new destination while searching for something quite different. Use of the Wassermann blood test as a precondition for obtaining a marriage license was widely promoted during the early twentieth century as a means of preventing the transmission of syphilis to children. Advocates of eugenics saw these tests as part of their
campaign to prevent the birth of defective children. When Noguchi demonstrated T. pallidum in the brains of paretics (patients suffering from paralytic dementia), the natural history of syphilis was complete, from initial chancre to paralytic insanity and death. At the time that Noguchi established the link between T. pallidum and paresis, patients with this form of insanity accounted for about 20 percent of first admissions to the New York State Hospitals for the mentally ill. Such patients generally died within five years.
Shortly after the identification of Treponema pallidum and the discovery of a sensitive diagnostic test, new drugs allowed public health officials to launch campaigns dedicated to the eradication of the venereal diseases. Prevention through abstinence or chastity had, of course, always been a possibility, but the ''just say no'' approach has never prevailed over the STDs. Condoms had been promoted as implements of safety since the seventeenth century, but sophisticated observers ridiculed these devices as ''gossamer against disease'' and ''leaden against love.'' In 1910, when Paul Ehrlich (1854-1915) introduced the arsenical drug Salvarsan, it became possible to see syphilis as a microbial threat to the public health, rather than divine retribution for illicit sex. Success in finding a specific remedy for syphilis was made possible when Sakahiro Hata (1873-1938) developed a system to test drug activity in rabbits infected with the spirochetes. Paul Ehrlich had been testing a synthetic arsenical compound called atoxyl against the trypanosomes that cause sleeping sickness. Atoxyl destroyed trypano-somes in the test tube, but it caused blindness in human beings. By synthesizing related arsenical compounds, Ehrlich hoped to create one that was lethal to trypanosomes and safe for humans. Derivative number 606, synthesized in 1907, proved to be a ''charmed bullet''—it was effective against the spirochetes of syphilis, but relatively safe for people.
Salvarsan helped physicians and patients think of syphilis as a medical rather than a moral problem, but the transition was difficult and slow. Despite advances in treatment, attitudes towards venereal disease had hardly changed since 1872 when Dr. Emil Noeggerath shocked his colleagues at a meeting of the American Gynecological Society by openly declaring that some 90 percent of sterile women were married to men who had suffered from gonorrhea. Presumably the good doctors were shocked by Dr. Noeggerath's direct discussion of venereal disease, not by his statistics. When Salvarsan and other drugs proved effective in curing the major venereal diseases, the righteous worried that God would have to find some other punishment for immorality. According to those who persist in seeing disease as punishment for individual and collective sin, genital herpes and AIDS, viral diseases beyond the reach of antibiotics, were sent to serve this purpose.
The trade name Salvarsan reflected the high hopes the pharmaceutical industry and the medical community had for the new remedy. Moralists, quacks, and those who made fortunes by defrauding victims of venereal diseases denounced Ehrlich's ''modified poison.'' The majority of physicians, however, welcomed Salvarsan along with mercury as ''destroyers of spirochetes.'' Though some physicians optimistically predicted that Salvarsan would eradicate the disease, more cautious or prescient observers warned that syphilis was likely to thwart such therapeutic illusions.
After a significant decline in the incidence of the disease during the 1950s, rates of infection began to climb again in the 1960s. While AIDS hysteria eclipsed other public health problems in the 1980s, the Centers for Disease Control continued to report an increase in primary and secondary syphilis. Certainly, the persistence of gonorrhea and syphilis—despite Salvarsan, penicillin, venereal disease control programs, case finding and tracing of sexual contacts, premarital testing, endless moralizing and preaching, and educational campaigns—does not promote optimism about the control of AIDS, the new ''venereal scourge.'' Both AIDS and syphilis present fascinating biological puzzles that require an understanding of social and environmental forces, as well as microbiology and immunology. Indeed, it is almost impossible to resist drawing parallels between syphilis, with its five hundred year history, and AIDS, which has been known as a diagnostic entity only since the 1980s. Fears, prejudice, and lack of effective or enlightened medical and public responses typify the reaction to both diseases. In particular, the history of the infamous Tuskegee Study is indicative of the way in which deep social and cultural pathologies are revealed through the stigmata of specific diseases.
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