SYPHILIS

As is the case with many diseases that afflicted (and continue to afflict) European populations, the early names of syphilis reflected contemporary understandings of the origins of the disease. The disease has been traced back to French military campaigns in Italian lands, and more specifically to the Neapolitan excursions of Charles VIII (r. 1483–1498) in 1495. The subsequent demobilization of mercenaries facilitated the rapid spread of the disease throughout Europe. Dynastic loyalties influenced whether one referred to it as the "French" or "Neapolitan" disease. In the early sixteenth century a controversy arose as to whether the introduction of syphilis in Europe should be regarded as one of the major consequences of the Spanish conquest of the Americas; thus, occasionally, it was described as the "American" disease. Still others referred to syphilis simply as the "pox," conjuring up the physical manifestations of the disease that began on the genitals and that eventually spread over the entire body.

No matter how they named it, syphilis inspired fear and dread among sixteenth-century Europeans. They considered it worse than leprosy and the plague. Although they understood the link between sexual activity and infection, and developed therapies (a combination of mercury and the wood extract guaiac, applied either as an ointment or through friction) aimed at alleviating symptoms, Europeans often resorted to draconian measures. The city of Paris forbade the treatment of syphilis at the centrally located Hôtel Dieu; the stricken homeless population was driven out of Paris, and the poor were placed in barns located in outlying areas of the city. After the initial and rapid spread of syphilis in sixteenth-century Europe, rates of infection appear to have abated, which may account (in part) for a waning interest in the disease among medical authorities until the end of the eighteenth century. In this space created by medical neglect, charlatans and quacks arrived with their various remedies, eagerly embraced by Europeans searching for a quick and effective cure.

syphilis in nineteenth-century europe

More surprising is the notable absence of syphilis in the medical advances that characterized nineteenth-century Europe. Apart from the important work of Philippe Ricord (1800–1889), who distinguished gonorrhea from syphilis, few doctors placed syphilis at the center of their research, and medical curricula largely ignored it. By contrast, syphilis figured prominently in a European social imagination—a veritable "bourgeois obsession"—that gave expression to a growing anxiety about the vexed relationship between individual liberty and social order. That obsession drew upon purported links between sex, prostitution, and the spread of syphilis. The prostitute, who lived outside the regulated contexts of marriage and family, and who separated sexual pleasure from the social functions of procreation, was seen as exercising an excessive and dangerous freedom. She lured unsuspecting single men away from the strictures of duty, risked the fortunes amassed by married men, and in doing so threatened the very institutions and values of society. In ways both figurative and material, syphilis embodied these dangers posed by the prostitute. It was she who spread the disease to unsuspecting men, in turn threatening the lives of innocent fiancées, moral wives and mothers, and future unborn generations.

The social imaginary of syphilis developed most precociously in France. Its influence was felt afar, made evident in the international recognition accorded to the work of the French social observer and hygienist Alexandre Parent-Duchâtelet (1790–1836). In his 1836 study De la prostitution dans la ville de Paris Parent-Duchâtelet set out in excruciating (although far from convincing) detail the characteristics of prostitutes that defined them a "race apart" and a veritable "counter society": their distaste for work, their love of luxury, and their unfortunate family origins. He also described the peculiar regulation of prostitution adopted by French authorities. Recognizing the limitations of recourse to individual liberty or legislative pronouncement as effective strategies for addressing the problems posed by individual freedom, the French devised an extralegal regulatory system drawing on the cooperation of police and doctors. Prostitutes associated with "tolerated" houses were subject to weekly brothel medical examinations for syphilis. If infected, they were sent to Saint-Lazare, an institution that served as a prison and a hospital, and which combined curing and physical as well as moral discipline in the "treatment" of prostitutes supposedly suffering from syphilis. Prostitutes who were registered with the police authorities but who worked independently of tolerated houses were required to seek out the services of municipal dispensaries; they carried a card detailing their medical histories, while medical information pertaining to women associated with the tolerated houses was maintained by the brothel-keeper.

The British dealt with the problem of the relationship between syphilis and prostitution in slightly different ways. Defending (and defensive of) their time-honored commitment to individual liberty, British officials and social observers deplored the French toleration of brothels, which in their view recognized prostitution and thus perpetuated (rather than prevented) the demoralization of women. They also criticized the association of dispensaries and hospitals with prisons, because (in their view) it addressed the social problems involved in the spread of syphilis at the expense of depriving women of their civil rights. But prostitutes had been treated in British "lock hospitals" since the 1770s, and new hospitals were created during the first three decades of the nineteenth century. Like their French counterparts, these hospitals confined prostitutes to specific sections, restricted their mobility and access to visitors, required them to stay until "cured" or at least until no longer contagious, and wedded medical care to disciplinary and moralizing activities. Between 1864 and 1869 the government passed three Contagious Diseases Acts. Originally designed as exceptional legislation to deal with the problem of syphilis affecting soldiers in military districts in England and Ireland, the purview of the Acts was soon after extended to other areas. A rigorous and coercive regulation of syphilis in British colonial territories such as India and Hong Kong predated the passage of the CD Acts and persisted long after their repeal in the 1870s and 1880s. In those territories, the social anxieties conjured up by the interrelated problems of syphilis and prostitution dealt, above all, with the colonial prostitute and the threat she posed to the British soldier, settler, and "race."

toward a new regulation of syphilis

The repeal of the CD Acts in England between 1870 and 1886 reflected the influence of the protest mounted against the regulation of prostitution and syphilis there by moral and Christian reformers such as Josephine Butler (1828–1906). Butler's criticisms gained attention in France as well, although French interest in reform was due in large part to the Republican ascendancy beginning in the 1870s and 1880s. French politicians, doctors, and social observers focused on the problem of regulating syphilis and prostitution as part of a larger criticism of the abuses perpetuated by the authoritarian Second Empire. They debated the relative merits of two alternatives: abolishing regulation altogether, and replacing it with new, more individualistic initiatives aimed at moral education and the promotion of early marriage, or elaborating a "neoregulationism" devoid of the abusive intrusions of police authority and carefully restricted to the medical question of diagnosing and treating syphilis. Neoregulationism emerged victorious.

The French medical community supported the alternative of neoregulationism. Indeed, that alternative owed much to the enhanced status of syphilis in French medicine at the end of the nineteenth century: the recognition of syphilology as a medical specialty and its inclusion in departments of dermatology, advances in understanding the different stages of syphilis and its connection to general paralysis, the "humanization" of syphilis treatment through its integration into general hospital care, and the creation of national leagues and international studies devoted to the problem of the disease. Many of these accomplishments became associated with the work of Alfred-Jean Fournier, "the new pope of syphilography." For all of Fournier's scientific preoccupation with syphilis, however,

his work and the efforts of other neoregulationists more generally betray a deep reservoir of social anxiety that shaped the contours of interest in syphilis in fin-de-siècle France.

Fournier's articulation of the venereal peril was informed by an entirely new configuration of social concerns at the turn of the century, most importantly the influence of social Darwinism, worries about declining birth rates, and growing fears about the degeneration of the French "race." In the face of these threats, the specter of syphilis loomed even larger than it had in the 1830s and 1840s. Failing to distinguish between the possibility of hereditary and congenital syphilis, Fournier highlighted the deleterious consequences for babies born of sexual relations between prostitutes and their unsuspecting clients. Of more serious import, Fournier did not limit the effects of syphilis to sexual activity. Glassblowing, tattooing, and improperly cleaned medical instruments all provided conduits for the non-venereal transmission of syphilis, although both forms of the diseases contributed to the "peril." (The Russian venereologist Veniamin Tarnovsky [1839–1906] likewise distinguished between venereal and non-venereal syphilis, but in this case the distinction appears to have emphasized the dangers of illicit sexual relations—and social relations more generally—that characterized the industrial and urban centers of liberalizing Imperial Russia.) Despite their avowed commitment to reducing the role of police in the regulation of syphilis, Fournier and other neoregulationists retained their focus on the social threats posed by prostitutes, now with a new (and perhaps more insidious) twist: the objective was no longer to protect society by excluding or marginalizing the prostitute, but rather to "normalize" her, with the support of medical knowledge and according to the needs and dictates of society.

The twentieth century set the stage for many of the discoveries that we now associate with the scientific diagnosis and treatment of syphilis: the identification of its cause (Treponema pallidum) by Erich Hoffmann and Fritz Schaudinn in 1905, the recognition of the diagnostic value of the Wassermann Test in 1906, and the introduction of penicillin in the 1950s. The benefits of these discoveries notwithstanding, an understanding of the problem of syphilis has continued to be refracted through the prism of social issues. Vichy France linked syphilis to the problem of Jews and "aliens"; in the early twenty-first century, syphilis conjures up the dangers of international tourism and promiscuity. In this regard, syphilis offers a telling instance of the difficulty encountered in separating the scientific understanding of disease from the elaboration of social values. As such, syphilis also represents the important and enduring role for historical scholarship in understanding the contours of disease and societal responses to it.

See alsoButler, Josephine; Prostitution; Public Health; Science and Technology; Sexuality.

bibliography

Aisenberg, Andrew. "Syphilis and Prostitution: A Regulatory Couplet in Nineteenth-Century France." In Sex, Sin, and Suffering: Venereal Disease and European Society, since 1870, edited by Roger Davidson and Lesley A. Hall, 15–28. London and New York, 2001.

Corbin, Alain. Women for Hire: Prostitution and Sexuality in France after 1850. Translated by Alan Sheridan. Cambridge, Mass., 1990.

Engelstein, Laura. The Keys to Happiness: Sex and the Search for Modernity in Fin-de-Siècle Russia. Ithaca, N.Y., 1992.

Levine, Philippa. Prostitution, Race, and Politics: Policing Venereal Disease in the British Empire. New York, 2003.

Quétel, Claude. The History of Syphilis. Translated by Judith Braddock and Brian Pike. Baltimore, Md., 1990.

Walkowitz, Judith R. Prostitution and Victorian Society: Women, Class, and the State. Cambridge, U.K., and New York, 1980.

Andrew Aisenberg