Syphilis and Its (In)Visibility
The closing decades of the nineteenth century brought an intensification of popular and medical debates about syphilis, which were accompanied by a number of aesthetic and political problems concerned with its cross-media evocation. Changes in the structure of medicine allowed for a formation of syphilology as a separate branch of inquiry in France and contributed to a more systematic work on the disease’s pathology, aetiology and history across Europe. In Britain, popular debates about the Contagious Diseases Acts (1864, 1866, 1869), the repeal campaigns (1870-85), along with growing concerns about the future of the nation, as well as the rise of feminist, purity and eugenic movements drew attention to the socio-cultural, economic and political impact of the disease. As a result of these developments, syphilis celebrated an unprecedented appearance in a variety ofmedia, from medical treatises, atlases and museums to decadent and New Woman writing. Patrick Wald Lasowski highlights the phantasmatic ubiquity of syphilis in the French literature of the fin de siecle and links it to the issues of visibility and visualization that lie at the core of modernity: “[a]veu- glante Syphilis dans le faux jour de l’anxiete, du phantasme, du desir: c’est bien elle le monstre au creur du labyrinthe des idolatries ou la modernite se cherche” (1982: 10). Although the cultural resonance of the disease has been more readily discussed in the French context, I argue that the oxymoronic potency of syphilis was critical in addressing the exigencies of British modernity.
The ambiguous character of syphilis and the efflorescence with which its metaphors spread at the time were partly due to the tentative character of knowledge about the disease. With Philippe Ricord and Jean Alfred Fournier in France, Rudolf Virchow and Robert Koch in Germany and Jonathan Hutchinson in Britain, the nineteenth century saw an intensification of medical debates on the provenance, prevention and treatment of venereal diseases. This development was partly due to the shift in the structure of medicine, which brought with itself a transformation in the conceptualization of diseases. Besides advancements in the domains of surgery and pathology, the implementation of anaesthesia and antisepsis, along with sanitary developments, were a great improvement in the second half of the nineteenth century (Morris 1897: 740, 753). A more precise diagnosis became possible with the help of new technologies: from an improved stethoscope, ophthalmoscope, photography and X-rays, to instruments that allowed one to see inside the body, such as the otoscope and laryngoscope, to new procedures of measuring and graphically representing bodily functions with the help of haemocyt- ometers and sphygmographs (Bynum 2006: 167-75). These developments fostered professional specialization and cooperation between medical practitioners and technical experts, so that “[t]he doctor’s simple use of his five senses at the bedside was being replaced by a much more collective enterprise” (174-5). Scientific advancements in microbiology and pharmacology, together with a growing emphasis on the “physiology of disease” (165), and an increasing popularity of germ theory (Rosenberg 1997: 242) obviously also transformed diagnostic procedures and technologies. In this climate “[d]octors (and politicians) were being asked to change their models of thought and to reconceptualize decades of cultural, clinical, and epidemiological experience” (Bynum 2006: 130), thus reshaping the face of modern medicine and its socio-cultural impact.
These scientific and technological innovations were being implemented, if to varying degrees, in the three institutional orders of medicine: schools, hospitals and research institutes (Bynum 2006: 135). The institutionalization that medicine was undergoing at the time went hand in hand with the increasing influence of regulatory bodies (The General Medical Council) and acts (Anatomy Act 1832, Medical Act 1858, Public Health Act 1872) on the shape of the field.7 Such professionalization of medicine, a growing specialization of hospitals and an increasing importance of the laboratory in the practice of diagnosis also ameliorated the popular image and social function of doctors and allowed them to exert influence on new social policies (Hardy 2001: 14), whereby medicine became more closely entwined with the nation state (Bynum 2006: 229). At the same time, with public health legislation (1860) and national public health reform (1872), the British state started moving towards a centralized organization of public health (Hardy 2001: 29).
With these changes underway, the branch of medicine preoccupied with skin diseases also went through a period of rapid development. For historian Claude Quetel, the year 1879 marks the turning point in the study of venereal diseases. As the first chair of syphilology was set up in France (Quetel 1990: 136), vigorous debates were taking place in clinical and microbiological circles in Britain, Germany and Austria. In the same year, Jonathan Hutchinson delivered his famous lecture on “Syphilis as an Imitator” before the British Medical Association, in which he highlighted the propensity of the disease to mimic the symptomatology of other ailments, a characteristic that made its diagnosis a particularly difficult feat. Also in the 1870s, microscopists continued the search for the causative organism of syphilis, thus furthering the microbiological studies that Friedrich Wilhelm Felix von Barensprung and Rudolf Virchow had initiated in the 1850s. Elie Metchnikoff and Emile Roux began experiments on primates, Francis Henry Welch described a relation between syphilis and aortic aneurysms and Fournier intensified his work on the relationship between general paralysis of the insane (GPI) and syphilis. It is the latter area ofstudy which underwent the most prominent development (G. Davis 2008: 83).8 Gayle Davis regards the period from the 1880s to the 1930s as “the critical period not only in the medical understanding of both syphilis and GPI, but also in the shaping of neurosyphilis as a disease group” (2008: 16). The breakthrough in the work on syphilis came with Fritz Schaudinn and Erich Hoffmann’s discovery of the causative agent Spirochaeta pallida (Treponema pallidum) in 1905 and with August von Wassermann’s serodiagnostic work, which led to the development of an antibody test for syphilis.
These fast developments and the changing makeup of medicine fostered a proliferation of rivalling discourses around syphilis. Interestingly, both the more progressive views of the experts and the rather ossified beliefs of many practitioners of the medical “fringe” highlighted the link between syphilis and its precarious (in)visibility, emphasizing the importance of seeing and optical apparatuses to the study of the disease and stressing the difficulty involved in its recognition and diagnosis.9 A specimen of the fossilized attitude, Dr Rumler’s fifteenth edition of The Venereal Diseases Arising from Contagion and the Principles of their Treatment Popularly Described (1902) illustrates to what extent the disease was embedded in a discourse of (in)visibility:
Fostered in the disaster-breeding bosom of worthless love, and received in the moment of highest delight, the syphilitic virus incubates that poisonous seed, whose destruction-bearing fruits, disregarded at their origin, secretly develop their many-armed germs in the organism, and break out afresh in the most manifold forms, while the bearer of the poison already believed that he could count himself among the fortunately cured. Constantly the poisonous seed, driven from its external seat by ignorant empirics, breaks forth again afresh in other places, and finally permeates the whole organic tissues of the patient, who often, knowing nothing of the ememy [sic] that is gnawing at his vitals, sees one organ after another attacked, and destroyed, and himself given over to the most frightful sufferings and tortures. Whatever the hospitals of great cities, the abodes of misery and the lurking-places of vice have to show of repulsive and horrifying patients, the unfortunate ones, who, covered with the most frightful eruptions, ugly scars, and enormous ulcers, the face full of pustules, suppurating nodules and loathsome scabs, not unfrequently deprived of the light of their eyes, emaciated to a skeleton, with their flaby [sic], earthy-gray skin hanging loosely around their fleshless bones, who far from human society waste away on the rack of despair [... ]. But not alone into the hospitals, haunts of vice and the huts of misery does this disease enter, it also sneaks, like a thiefin the night, into the palaces of the rich, nor revealing its existence until it has conjured up misery and shame for noble families. (59; my emphasis)
Premised on the association between syphilis and sinfulness, Rumler’s narrative follows a clear trajectory: from the invisibility of the “virus” to the horrifying appearance of the symptoms; from a reckless moment of delight to armies of suffering, infected patients. Coupled with the invocation of the democratic character of the disease, this visually highly evocative passage bears an obvious moralist message as it issues a warning to all ranks of society. Rumler’s description blends the social, geographical and corporeal levels of the (in)visibility of the disease: these are the battlefields on which syphilis communicates its presence. At the same time, the passage raises questions concerning the state of Rumler’s knowledge, especially his association of the orgasmic moment of sexual fulfilment with the onset of the disease, and the mode of its communication: his ekphrastic attempts at visualizing the progress of syphilis. It exemplifies the difficulties and complexities characteristic of the acts of syphilis evocation and shows their political potency.
The difficulties in the recognition and classification of syphilis and the intrinsically imitative character of the disease, highlighted by nineteenth- century practitioners, were accompanied by an intensification of debates over syphilis in non-medical circles. This was partly due to the repercussions of the implementation of the Contagious Diseases Acts and partly to the growing significance of discourses around individual and national degeneration. In the atmosphere of post-Darwinian thought, eugenic and social purity movements were born which had the regeneration of the British race on their agenda and which fought to eliminate the atavistic element in society, be it venereal disease, alcoholism or prostitution. In this climate, syphilis became a useful rhetorical tool in social purity campaigns. The elimination of the moral double standard and men’s abuse of women through prostitution, alongside rescue work, was crucial for such bodies as The Social Purity Alliance (1873), the Ladies National Association, the White Cross League (1891) and the Church of England Purity Society (Jeffreys 1997: 7-13). Harriet Martineau, Elizabeth Blackwell and Josephine Butler continued to chastise governmental social policies and fought to reform health and welfare provision. Reports on the CD Acts made the discussion about venereal diseases a legitimate subject of public debate and parliamentary concern by influencing its “official epistemology,” an effect unintended by the parliament (Townsend 1999: 44). As these public and parliamentary debates brought to light the disease that had hitherto been a matter of secrecy and privacy, and thus made it visible, they also produced contradictory, imaginary and lived, spaces of syphilis.
The topicality of syphilis was also due to fundamental social, technological and political changes. British modernity fostered a readjustment of sensitivities as a result of a number of socio-political and economic developments. The Great Depression (1873-96) was accompanied by the acceleration of growth, intensification of consumerism and the onset of a large-scale leisure culture. The birth of socialism and unionism, partially in response to the strikes, riots and anxieties brought about by the Great Depression, was instrumental in the critique of capitalism and its insistence on the ethics of self-development. An apparent loosening of mores and reforms in daily routine also encouraged changes in the standing of minority groups. These changes must be seen in the context of the panEuropean fear of degeneration, concomitant with growing xenophobia and a continued urge to assert Britain’s international supremacy, despite the (financial) fiasco of the Boer War (1899-1902) and the problems with the African colonies. Rural depopulation, fiscal surplus and the growing importance of the working classes further contributed to these transformations. In this climate, syphilis was increasingly perceived as one of the factors of (national) degeneration, as such publications as Fournier’s Syphilis Hereditaire Tardive (1886) and L’Heredite Syphilitique (1891) solidified the link between the disease and the physical and moral makeup of future generations. The belief in the hereditary character of the disease generated fears about the future of the family and the whole nation. These anxieties were intertwined with stigmatization practices and with the issues of civic responsibility as they drew attention to the inadequacies of the systems of health provision.
All in all, the development in clinical and laboratory medicine, the rise in syphilography as a medical specialization, the growing knowledge about the aetiology of the disease, along with the popular and legal debates on the future of the nation, made syphilis a highly discussed, albeit extremely sensitive and cautiously approached, topic. These changes underway, the disease gained in visibility across a variety of media. While historians of medicine regard the inter-war period as the most medially productive phase in the visualization of syphilis (Quetel 1990: 159), the fin de siecle offered a similarly potent arena for the media depiction and exploration of the disease, especially as the intertwining ofvisual culture, medicine and public health became tighter. Indeed, in his introduction to Imagining Illness: Public Health and Visual Culture, David Serlin maintains that “[t]he relationship between public health and visual culture found its most potent manifestation in the late nineteenth century, the period in which the management of epidemics and the implementation of hygiene paradigms became central fixtures of the modern nation-state” (2010: xxi). This interweaving was partly responsible for the heightened media visibility of syphilis.
Medical experts in Britain popularized French, American, German and East European publications on the disease. The proponents of modern syphilology in Britain and America themselves produced a sizeable body of literature on the subject, be it monographs (A. Cooper 1895, Hutchinson 1887, Bulkley 1894, Lambkin 1905, Morton 1902), medical atlases (Hutchinson 1878-88, 1894, Fox 1881), or articles in medical journals. Series of lectures, presentations and symposia in Britain and continental Europe contributed to the dissemination of knowledge about the disease and fostered professional exchange on the international level. In 1899 and 1902, the first and second international conference on the treatment and prevention of venereal diseases in Europe took place (Goens 1995: 163). Photographs, prints, coloured plates, sketches and museum narratives, next to patients’ bodies, spirit specimen and wax models, gave syphilis a tangible appearance in medical circles.
These artefacts infiltrated into public consciousness with the help of anatomy museums and exhibitions, which brilliantly integrated syphilis- ridden bodies into their collective narratives of vice and virtue (for example, the Liverpool Museum of Anatomy). Such visual narratives, along with existing oral traditions (for instance, the sea shanties), were an integral part of the folk mythology that had arisen around the disease. Also, the atmosphere of unrest accompanying the publication of naturalist, social-hygienic and decadent literature across Europe was echoed on the British Isles. French influences included Joris-Karl Huysmans’s decadent novel A Rebours (1884), naturalist fiction of Guy de Maupassant, such as “Lit No. 29” (1884) and “Le Horla” (1885) and social-hygienic literature such as Eugene Brieux’s drama Les Avaries (1901). Stimuli also came from German literature: Oskar Panizza’s Das Liebeskonzil (1894) and Thomas Mann’s Buddenbrooks (1901). Most visibly, these influences materialized in the British response to Henrik Ibsen’s Ghosts (1881).10 It is not a coincidence that, with its potent but ambiguous imagery and its insistence on the unspeakable, Ibsen’s Ghosts is reputed as the “locus classicus” of syphilitic insanity (Showalter 1986: 105) and a prime site of the tensions that the disease had inspired.
Syphilis was also evoked in visual arts across Europe. It was referenced in the art of Edvard Munch, Christian Krohg, Henri de Toulouse-Lautrec, Stanislaw Wyspianski, Joaquin Sorolla y Bastida and in the posters of Ramon Casas. In Britain, the literary medium most readily explored the quizzical intertwining of visibility and invisibility in the cultural production of syphilis. The symbolic power of syphilis was explored both in the eugenic novels of Sarah Grand or Emma Frances Brooke as well as in Oscar Wilde’s, Bram Stoker’s, Robert Louis Stevenson’s or H. G. Wells’s fiction. The proliferation of various discourses and media negotiations of syphilis shows the “extent to which the disease was culturally debated at the time” (Smith 2004: 95).
Medical, parliamentary, feminist and social purity debates made syphilis appear with particular force, but also not free of contradictions, across a number of media, thus making it a particularly suitable trope for the discussions of personal, national and imperial identities. Contemporary criticism recognizes the ambiguities in the cultural production of syphilis but, apart from spotlighting this complex dis- cursivity, it has not taken any steps to explore its implications. This book sets out to address this desideratum as it explores, in a non- essentialist way and with a broader thematic spectrum, the multimedia landscape of syphilis at the fin de siecle. A rethinking of the relationship between syphilis and its (in)visibility can be helpful not only in revising many of the socio-political, economic and cultural debates of the late nineteenth century. It can also help shed light on our positioning vis-a-vis the Victorians and on our continuing over-willingness to bar from view the topic of (venereal) disease. In this sense, then, the book belongs to the purview of medical humanities, which helps historicize and shed light on various ways of knowledge production and structures of discrimination as well as on the ethics of ‘reading’ (Cole et al. 2015a).