Abstract
Objectives: Syphilis has changed the course of history, shaped the path of medicine and had more influence on psychiatry than any other illness. This paper, part two of a two-part series, investigates the historical, social and cultural aspects of the interaction of syphilis and psychiatry.
Conclusion: By the end of the 19th century, social changes such as population growth, mass migration from Eastern Europe and technological developments led to a great rise in syphilis. By 1900, it was estimated that 5–20% of the population of Europe and the USA had, or would have, syphilis. By 1914, there were over 100 000 new cases and 3 million cases of syphilis in Great Britain. There was a constant interaction between syphilis, prostitution and sexual crime; it was the likely motivation for the Jack the Ripper murders, if not many in the next century. The idea of hereditary syphilis fitted perfectly into the theory of degeneration and coursed through psychiatry and caught the attention of Adolf Hitler, facilitating his antisemitic paranoia. Psychiatric progress passed to the German school, led by Kraepelin who did his first research into the symptoms and course of neurosyphilis. In 1906, Wasserman's serological test for syphilis showed that latent lesions could be present. Any doubt about the cause of syphilis was finally eliminated when Noguchi and Moore demonstrated the presence of treponema pallidum in paretic brains in 1913.Citation German academic psychiatry defined psychiatric practice for the next century but malariotherapy, the first physical treatment in psychiatry, was announced by Julius Wagner-Juarreg in Vienna in 1917, bringing hope to the incurable and destroying the climate of therapeutic nihilism that haunted psychiatry. The first trial of malariotherapy in Australia was done by Reginald Ellery at Mont Park Hospital In 1927 in Melbourne. The discovery of penicillin was a caesura, ending malariotherapy and leading many to regard syphilis as a nigh-extinct illness, but this turned out to be an illusion. Syphilis is returning in new forms in tandem with the AIDS epidemic. Written-off endlessly by its obituarists, syphilis abides.
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ACKNOWLEDGEMENTS
This paper and the companion preceding paper is the third part in a trilogy on syphilis. It is impossible to write a review of this kind without being greatly indebted to the many historians and writers who have documented syphilis and the world it inhabits; mention should be made of the work of Edward Shorter, Ed Brown, Magda Whitrow, JT Crissey, C Quetel and Roy Porter.
For extirpating some of my more egregious howlers, thanks to Milton Rose and Johan Schioldan; and to Ed Brown for extra information on Bayle.
I have done my best to list all references, but apologize for any unintentional omissions. I take full responsibility for the final result.
The idea for this trilogy arose from discussion with Charles Van Onselen on his truly spectacular The Fox and the Flies. Such fortune falls to a peripatetic writer psychiatrist but once a lifetime, for which I am truly grateful.