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Home arrow Language & Literature arrow Syphilis in Victorian Literature and Culture: Medicine, Knowledge and the Spectacle of Victorian Invisibility

Syphilis Concepts

Concepts of syphilis are varied, dynamic, historical and culture-specific. This study attends to this variety rather than assuming the existence of a universal and a-historic entity ‘syphilis’ which answers to some imaginary ideal of pure science.3 Medical lexica, manuals and encyclopaedia published in the late nineteenth century contain a number of terms used with reference to syphilis, which have a distinguished denotative and connota- tive meaning. Next to such terms as primary, secondary, tertiary, congenital and hereditary syphilis, George M. Gould’s The Student’s Medical Dictionary (1900: n. pag.) mentions: “Syphilis insontium,” that is, the disease “acquired in an innocent manner,” “Syphilis Marital,” which can be “acquired in lawful wedlock,” or “Syphilis oeconomica,” describing transmission through eating, drinking or using contaminated articles. “Syphilis technical” is used when the disease has been “acquired in following one’s profession,” “Syphilis venereal,” on the other hand, refers explicitly to the disease “acquired in illegitimate sexual intercourse” (Gould 1900: n. pag.). This systematic terminology is imbued with moralist views, which have the distribution of blame at their core and reek of judgmentalism. Even when freed from above adjectival determinants, the term syphilis unites a number of interrelated cultural and medical beliefs.

Surveying the early terminology used to name what we in retrospect call syphilis, contemporary researchers stress the creative designation of the disease. In his detailed study of the origins of syphilis, Der Ursprung der Syphilis: Eine medizinische und kulturgeschichtliche Untersuchung (1901: 297-305), renowned German dermatologist and sexologist Iwan Bloch also offers a classification of the ancient and modern terminology used in relation to the disease. Named after its alleged country of origin (“Morbus Gallicus,” “The French Disease”), it was also often termed after its symptoms that were combined with the land ofits origin (“Variola Gallica,” “Poxae Hispanienses,” “Dolor frangitiosus”). It was described in terms of the body parts it affected and the ways in which it was transmitted (“Lues venereal,” “Malum aphrodisiacum,” “Luxus”) as well as after certain saints (“Morbus St. Rochi,” “Morbus St. Moni”). Finally, individual nations developed an extensive, idiosyncratic terminology, of which “Morbus burdigalensis,” “French Pest,” “Spanish Sickness” and the “secret disease” are but a few examples used in Great Britain. Bloch contrasts these older designations with the term “syphilis” - most commonly used among the learned in the nineteenth century (Bloch 1901: 297-305).4

Today, like in Victorian medical dictionaries, the etymology of the term “syphilis” is marked as unknown. The name is reported to have been used for the first time by the Italian physician Girolamo Fracastoro in his 1530s publication Syphilis sivo morbus Galicus (Bloch 1914a: 28, Spitzer 1955: 269). The three-volume poem offers a captivating “aetiological myth” of the disease, which promises to explain its provenance (G. L. Hendrickson 1934: 527-8). The account of the origins of syphilis is woven into an exploration narrative describing the adventures of a Columbus-like expedition among the natives of the “Western Islands” (526). In the third book of his poem, Fracastoro relates the travellers’ encounter with local inhabitants who perform a curious sacrificial ritual to avert the danger of a specific disease. What ensues is the story of Syphilus, a shepherd, who, enraged by the long draught, turns against the God of the Sun and convinces his comrades to hail the king of the country instead. His disobedience incurs the gods’ wrath and causes them to send an unknown ailment on Syphilus (Fracastoro 1911: 55). This early account thus frames syphilis as the gods’ punishment for sins as it produces rather than elucidates the etymology of the term.

In his 1934 article, “The ‘Syphilis’ of Fracastoro: With Some Observations on the Origin and History of the Word ‘Syphilis’,” G. L. Hendrickson suggests that studies of syphilis etymology often fall prey to the assumption that the name of the disease has been derived from that of the character in Fracastoro’s poem. On the basis of the aetiological myth of the disease and with reference to other early sources, he forwards two speculations: either Fracastoro used a term that was in local circulation but unrecorded or he introduced the word himself (G. L. Hendrickson 1934: 530). In his 1955 article “The Etymology of the Term ‘Syphilis’,” Leo Spitzer offers another explanation according to which syphilis could be an abbreviation of the Greek terminus ^sp-oainsXaq ‘St. Anthony’s fire, the rose’” (271). While he is aware of the hypothetical character of this argument, he contends that his theory would explain “the paradox [... ]: syphilis would be at the same time a coinage of Fracastoro’s and an alteration of a term existing before him” (272). Although offering varying explanations, both scholars agree as to the derivative character of Fracastoro’s term.5 Fracastoro’s introduction of the name did not rule out the nomenclature that had hitherto been used to describe the ailment; rather, it added to the repertoire of the terms used. According to Hendrickson, it was only in the mid-nineteenth century that the name “syphilis” gained momentum and began to be more commonly used in professional circles and by the lay public (1934: 542). A comparison of the successive editions of dictionaries and medical lexica supports this claim and indicates that it was growing in importance already in the early decades of the nineteenth century. John Quincy’s Lexicon Physico-Medicum: Or, A New Medical Dictionary defines “syphilis” as a subsidiary “[t]erm used for the Lues Venerea” (1794: 772), which is the main designation of venereal disease. In contrast, in Robert Hooper’s 1817 edition of Quincy’s Lexicon-Medicum: A New Medical Dictionary “syphilis” is the main entry (789-94), with a number of other terms like “Morbus Gallicus,” “Morbus Indicus” (511) and “Neapolitanus Morbus” (527) scattered across the dictionary.

Readers looking for “Venereal Disease” or “Lues Venerea” are referred to the entries “Syphilis” and “Gonorrhea” (849, 457).

This varying taxonomy and its changing application make clear that the concept of syphilis merges a number of historically specific ideas. In Genesis and Development of a Scientific Fact (1935), in which he inspects the nature of scientific knowledge and the processes that participate in its production, Polish-Jewish philosopher Ludwik Fleck surveys the historical development and shifting significance of the concept of syphilis, only to ascertain that “‘syphilis as such’ does not exist” (1981: 39). The denial of syphilis’s existence is by no means a denial of the disease. Rather, Fleck uses the statement to emphasize the historicity of the construct and its dynamic and changeable nature. The provocation “syphilis as such does not exist” highlights what is characteristic of general knowledge and what Adrian Wilson terms as the “erasure-of-history”: a deliberate obliteration of the dynamics and historical specificity of concepts for the general public (2000: 275).

Using syphilis as his prime example, Fleck also shows the significance of the “thought collective” and the “thought style” to the state of knowledge. A thought collective is for him a group of people engaged in intellectual interaction, while a thought style is the current system of knowledge, the “stock of knowledge and level of culture,” which places constraints on the subjects and practices of (scientific) inquiry (Fleck 1981: 39). Although the thought collective can contribute to the development of knowledge, its success is only possible to the extent that it moves within the limits prescribed by existing thought styles. Cognition is dependent on their interaction:

The self-contained nature of the system as well as the interaction between what is already known, what remains to be learned, and those who are to apprehend it, go to ensure harmony within the system. But at the same time they also preserve the harmony of illusions, which is quite secure within the confines of a given thought style. (38)

Fleck expands the dualistic model of the interaction between the subject and object of science with the state of general knowledge in which the processes of cognition take place. This conceptualization of cognition accounts for the persistence of a certain notion of syphilis and its variations in a specific cultural context (38-9).6

Fleck isolates four historically distinct traditions of thought whose interaction had produced twentieth-century understandings of syphilis. The concept had evolved “from the mystical, through the empirical and generally pathological, to the mainly etiological” (1981: 19). Referencing the earliest documented occurrence of syphilis in the fifteenth century, Fleck ascertains that the then dominant systems of astrology and religion determined the understanding of the disease and branded it with “[t]he stigma of fatefulness and sinfulness” (3). The woodcut attributed to Albrecht Durer and printed together with Sebastian Brant’s 1496 text combines these attitudes. It references both the astrological constellation that was held responsible for the outbreak of the epidemic and the moral implications of the disease in the depiction of the sufferer who has been variously interpreted as both a “Frenchman” and a “victim of the signs of the zodiac” (Gilman 1987: 92). This “ethical-mystical” approach to syphilis was accompanied by an “empirical-therapeutic” attitude, which linked the concept of the disease to the possibilities of its treatment (Fleck 1981: 5). According to Fleck, as mercury was considered a remedy for a number of skin diseases at the time, it can only be regarded as secondary to the definition of syphilis. These two approaches, although highly incompatible, merged together with time (5).

A further development in the conceptualization of the disease came with an early recognition of its pathogenetic character. While in the early treatises, which adhere to the then prevalent theory of humours, syphilis was considered as producing a “change in blood” (Fleck 1981: 11), the notion of “syphilitic blood” became highly popular only in the late nineteenth century (13). It was also the time when aetiological studies concerning the causation and origination of the disease were intensified, with Schaudinn’s isolation of the causative agent as a historic breakthrough. This aetiological approach to the disease constitutes the fourth strand of thought which participated in the process of defining syphilis (14). These conceptual tendencies have to be regarded as existing in parallel but in varying accentuations so that while one of them gains in prominence, it does not negate the existence of all the others.

With a number of developments in ocular technologies and with the recognition of syphilology as a discipline proper, professional knowledge about syphilis was in a state of flux in the last decades of the nineteenth century. Although continuous attempts were directed at finding the causative organism, Schaudinn’s discovery only came in 1905 and the rethinking of syphilis as a result of Wasserman serological test was under way only after 1906. Medical dictionaries, manuals and lexica published between 1880s and 1906 map out the certainties of medical knowledge but also register the qualms that plagued the medical profession.7 Such publications accept new ideas less readily than medical journals and can be seen as sources of the general expert knowledge pertaining to the aetiology, pathology, treatment and classification of syphilis.

Although George Gould’s popular The Student’s Medical Dictionary (1900) records attempts at finding a syphilis “bacillus,” it does not offer any definite cause of the disease (n. pag). It indicates sexual contact as the major mode of transmission but accepts the possibility of infection through “incidental” contact with the carrier of the disease or through the consumption of food and drink in an infected household. The 1874 edition of Robley Dunglison’s Medical Lexicon: A Dictionary of Medical Science mentions “contact of parts that are only lined with a thin epidermis” as a possible way of transmission (1012). Gould’s dictionary also offers a detailed description of the primary sore, attending to the time of its appearance and microscopic characteristics, and gives an account of the clinical development of the disease by drawing attention to its three stages: primary, which refers to the occurrence of the primary chancre; secondary, characterized by the appearance of mucous patches, skin eruptions, sore throat, etc.; and tertiary, in which “gumma and severe skin-lesions” appear (1900: n. pag.). Whereas the period between the appearance of the primary chancre and the cutaneous eruptions of secondary syphilis is six weeks in average, the latent phase between the secondary and tertiary symptoms is described as variable. Dunglison’s Medical Lexicon lists mercury and iodine of potassium as the two most often used medications, with the specification that the former is by far “esteemed to be best remedy” (1874: 1012). Gould’s dictionary also brings up an “obscure” relation of syphilis to specific disorders of the nervous system, for instance, locomotor ataxia and paretic dementia (1900: n. pag.). Focusing on the commonly accepted characteristics of the disease, these dictionary entries necessarily veil the developments in specialized studies of the disease, be they related to its transmission or its connection to other disorders. As instances of vademecum knowledge, they offer a selective and ordered “critical synopsis” for general specialists of the esoteric circle of syphilologists, while erasing the debates that came into full view in medical journals (Fleck 1981: 118).

In spite of these general assertions, one has to keep in mind that the ideas concerning syphilis transmission, its causative organism, its pathological development in patients and its relation to other ailments were highly unstable and continuously contested at the time. While Jonathan Hutchinson published a study of the disease based on his observations in London hospitals and in his private practice in 1887, Dr Joseph Hermann, surgeon to the Viennese Royal Hospital, was certain that “constitutional syphilis does not exist,” which he illuminated in his 1890 publication bearing precisely this title (Fleck 1981: 5). Even those who regarded syphilis as an individual illness did not necessarily agree about its pathology and ways of treatment:

The concept of syphilis, then, was still vague and incomplete. [... ] [It] still remained too variable, and not sufficiently entwined or interwoven within the fabric of contemporary knowledge to be considered finally established with a firmly based, objective existence, and thus to appear as an undoubtedly “real fact.” (Fleck 1981: 6)

Professional debates encompassed a number of interconnected issues related to the character of the disease, some of the most important being: the gender patterning in its ‘hereditary’ transmission, conjugal relations and family planning, national and local preventive practices, institutionalization and treatment of patients, development of medical facilities and educational bodies. These debates, which fuelled heated public discussions, were themselves influenced by existing social and national concerns.

This conceptual complexity of syphilis is embodied in the multimedia landscape of the late nineteenth century. That is why it is of importance to attend to the various spaces of syphilis visualization, whatever the mode of this visualization. This also entails an inquiry into the metaphorical production of the disease. Although Susan Sontag famously called for a metaphor-free environment as a platform for “the most truthful way of regarding illness - and the healthiest way of being ill” (1978: 3), the study of metaphors has received wider recognition, for instance in the context of an individual experience of illness (Mattingly 2000, Mattingly and Garro 2000, Charon 2006, Kirmayer 2008). Whether it has been conceptual poverty or linguistic creativity that can be held accountable for the names given to syphilis over the centuries, it is undeniable that the condition was from the very outset metaphorically charged, a fact that cannot be disregarded in a study of nineteenth-century visualizations of syphilis. Deborah Lupton lists various uses of diseases as tropes in literature, indicating their rhetorical function in the exposition of moral, psychological or emotional dilemmas (2003: 55). She also insists on recognizing and analyzing the dynamic character of the relations between metaphors and diseases: while diseases call for other semantic domains through which they become intelligible, so the disease itself can become a reference field for other entities (59). In this context, verbal metaphors are as significant as the iconography of the disease: both are indicative and generative of the cultural and political systems that breed them.

According to Sontag, what is metaphorically productive is the mystery of a disease. As soon as its aetiology has been discovered, it no longer offers such a fertile ground for metaphors (1978: 5). In this line of thought, she argues that the metaphorical productivity of syphilis was restricted: “[i]n its role as scourge, syphilis implied a moral judgment (about off-limits sex, about prostitution) but not a psychological one” (39). Its ‘vulgarity’ was the sole creative ground in its metaphorical use: “[s]yphilis was limited as a metaphor because the disease itself was not regarded as mysterious; only awful” (59). Undoubtedly valuable, Sontag’s argument is based on the false premise that the aetiology of the disease was clearly established at the time. Even though medical knowledge of the ailment improved considerably at the turn of the century and although there existed a number of “proto-ideas” which explained certain processes (Fleck 1981: 23-7), there were still numerous dark areas in its study, which encouraged the production of a motley welter of metaphors. Syphilis produced a rich visual culture of which metaphors were just one instantiation.

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