The results of my investigations regarding the origin of syphilis all point to a single extremely important fact—namely, that in the case of syphilis, and as regards the “old world,” we have to do with a specific disease of modern times, which made its first appearance at the end of the fifteenth century, and of the previous existence of which, even in the most distant prehistoric times, not the minutest trace remains. This view was held by very eminent physicians, even before the publication of my own critical work, based upon entirely new sources of study. Among these authorities I may mention Jean Astruc and Christoph Girtanner, in the eighteenth century; in the nineteenth century, the Spanish army surgeon Montejo, and of German physicians, above all, Rudolf Virchow, A. Geigel, von Liebermeister, C. Binz, and P. G. Unna. The great philosopher Arthur Schopenhauer held the same view.[312]
Ricord, the celebrated French syphilologist, spoke once of a romance of syphilis which still remained to be written. I should rather compare it with a drama, the separate acts of which are centuries. Of this drama, four acts have already been played. At the present moment we find ourselves at the beginning of the fifth act. Thus, we have an entire century before us, in which, with all the powers placed at our disposal by scientific medical research, by practical therapeutics, and by hygiene in association with social measures, we must work to this end, that this fifth act shall also be the last, as it is in the case of a proper drama.
The history of syphilis has remained so long obscure, because, until the time of Philipp Ricord—that is to say, until the beginning of the second half of the nineteenth century—the three venereal diseases, syphilis, or lues, the so-called soft chancre (venereal ulcer or chancroid), and gonorrhœa, were regarded as essentially one disease; whereas we know to-day that syphilis is a specific infective disease of a constitutional character, which permeates the whole body, and must be absolutely distinguished from the other venereal diseases, these latter being purely local in character. This earlier belief in the identity of all venereal infections, an error held even by so great an authority as John Hunter, who was misled by falsely interpreted experiments, renders it necessary that the historical side of the question should be considered also from this point of view.
If gonorrhœa and chancroid were of a syphilitic nature, then certainly syphilis must have existed from very early times. It would not be difficult to refer to syphilis some descriptions and accounts of diseases of the genital organs given by the ancient and medieval writers. It was the progressive enlightenment regarding the essential differences between the three venereal diseases which first proved the untenability of such opinions; we were further assisted by the knowledge of pseudo-venereal and pseudo-syphilitic diseases which we have obtained from modern dermatology. Moreover, in the old world syphilitic bones belonging to ancient or medieval times have never been discovered.[313] The first syphilitic bones date from after the time of the discovery of America. They appear, above all, after the outbreak of the great epidemic of syphilis which followed the Italian campaign of King Charles VIII. of France, in the years 1494 and 1495; it was then that syphilis first became diffused in the old world.
In my work on “The Origin of Syphilis” (Jena, 1901),[314] I have adduced proof, basing my views upon the criticism of older opinions, and assisted by the utilization of very abundant new sources of material, that syphilis was first introduced into Spain in the years 1493 and 1494 by the crew of Columbus, who brought it from Central America, and more especially from the island of Hayti; from Spain it was carried by the army of Charles VIII. to Italy, where it assumed an epidemic form; and after the army was disbanded the disease was transported by the soldiers to the other countries of Europe, and also was soon taken by the Portuguese to the Far East, to India, China, and Japan. At the time of its first appearance in the old world, syphilis was extraordinarily virulent. All the morbid phenomena produced by the disease had a more rapid and violent course than at the present day; the mortality was much higher; the consequences, even when a cure was effected, were much more severe. This virulence of syphilis at the time of its first introduction can only be explained, in accordance with our modern views of the nature and mode of appearances of the disease, by the fact that the nations of the old world (who, nota bene, were all attacked with equal intensity) had, until that time, been completely free from syphilis. All classes of the people and all nations were visited by syphilis to an equal extent and with the same violence.
Even to-day we observe everywhere, when syphilis is introduced into regions which have hitherto been free from the disease, that it has the same acute course, the same violence of morbid manifestations, that characterized its first appearance in Europe. In the four centuries that have elapsed since its introduction into Europe there has occurred a gradual mitigation of the syphilitic virus, or rather a certain degree of immunization of European humanity against the disease. Speaking generally, syphilis has to-day—in comparison with that earlier time—a relatively mild course. To this point we shall return later.[315]
The two other venereal diseases, gonorrhœa and chancroid, unquestionably existed in Europe in the days of antiquity. But they also are specific infective diseases, and are only produced by the virus peculiar to each, just as syphilis has its own peculiar virus.
Ricord (1800-1889), in the years 1830 to 1850, proved the complete diversity of syphilis and gonorrhœa, established the doctrine of the three stages of syphilis—primary, secondary, and tertiary—and, finally, taught us to distinguish the soft, non-syphilitic chancre (chancroid) from the hard, syphilitic chancre. Virchow, in his celebrated essay on “The Nature of Constitutional Syphilitic Affections” (Virchow’s Archiv, 1858, vol. xv., p. 217 et seq.), then threw a clear light on the peculiar course of constitutional syphilis and on the causes of the occasional disappearance and sudden reappearance of the morbid phenomena. Hitherto, however, our knowledge of venereal diseases had rested on an extremely insecure foundation; and the truly scientific study of the subject may be said to have begun in the year 1879, with Albert Neisser’s epoch-making discovery of the gonococcus as the specific exciting cause of gonorrhœa. In the years 1889 to 1892 there followed the discovery of the bacillus of chancroid by Ducrey and Unna, by means of which discovery the complete distinction between the soft and the hard chancre was definitely proved; and, finally, the three years 1903 to 1906 were characterized by remarkable discoveries, the full importance of which is not as yet fully realized, regarding the nature of the syphilitic virus. In the year 1903 Eli Metchnikoff succeeded in transmitting syphilis from human beings to apes, and thus laid the foundation for progressive research regarding syphilis by means of experiments on animals; this was carried further by Lassar, by the inoculation of the syphilitic virus from one ape to another, and also by A. Neisser in his experimental researches in Java;[316] and in March, 1905, the Berlin protozoologist Fritz Schaudinn, since prematurely lost to the world of science, published his first studies on the probable exciting cause of syphilis, the so-called “spirochæte pallida.” Numerous subsequent investigations have established the connexion between this spirilla-form, belonging to the order of protozoa, and syphilitic disease. In this way we have been brought notably nearer to the discovery of the certain cure of syphilis and to the discovery of means of immunization against the disease. In this direction quite new views are opening before our eyes.[317] Numerous ideas suggested by recent discoveries in the province of syphilitic research are described in the admirable essay by J. Jadassohn, “Contributions to Syphilology,” published in the German “Archives for Dermatology and Syphilis,” 1907. Cf. also the account of the recent doctrines regarding syphilis by P. G. Unna and Iwan Bloch, “Die Praxis der Hautkrankheiten,” pp. 548-592 (Vienna and Berlin, 1908).
When some day humanity has been freed from the “sexual plague,” from the hydra of venereal diseases, and when a monument is erected to the liberators, four names will there be commemorated: Ricord, Neisser, Metchnikoff, and Schaudinn!
After these preliminary remarks on the nature of venereal diseases, I proceed to a short description of them, and I begin with the most dangerous of all the venereal diseases, syphilis.[318]