For over four hundred years after its dramatic appearance in Europe in 1495, there was no cure for syphilis and treatments were both few and largely ineffective.
Treating syphilis
Syphilis was such a deeply unpleasant disease that many were prepared to endure harsh treatments in the hope of achieving some relief from it.
Guaiacum, also known as ‘Holy Wood’, was probably the first significant treatment. Preparations made from this plants’ resinous gum acted as purgatives – inducing sweating, vomiting, diarrhoea and urination. It was hailed as a ‘blood cleanser’, flushing the sickness out of the body. For many years large amounts of the drug were shipped into Europe from South America, but it gradually fell out of favour as it became clear that ultimately, it just didn’t work! Its place was taken by the substance that would dominate the treatment of syphilis for centuries – mercury.
Science Museum Group
Science Museum Group
“One night with Venus, a lifetime with Mercury.”
The pioneering Swiss physician Paracelus (1493-1541) was advocating mercury as early as 1530 and it was already used to treat other diseases – including leprosy. As mercury use increased, different methods for administering it emerged. It could be applied to the skin as an ointment, swallowed as a pills, drunk as an elixir or even injected in solution. Fumigation therapies also became popular, during which syphilitic patients might sit in an enclosed space exposed to mercury vapours for days at a time. One method even involved the patient sitting atop a commode beneath which a block of cinnabar (a naturally occurring mix of mercury and sulphur) was placed on a hot iron. Either way, such treatments were often expensive and thereby restricted to the few who could afford them. A disease that may have been caught during a brief sexual liaison could result in months, even years of such treatment regimens – hence the popular phrase ‘One night with Venus, a lifetime with Mercury’.
Like guaiacum, mercury prompted bodily reactions that might suggest disease was being purged out of it. Again, patients would sweat profusely and produce excessive amounts of saliva and urine. But with no modern clinical studies of this historic treatment, any positive effects of mercury are hard to assess. Some historians think that it may occasionally have halted the disease in the first stage and sometimes reduced the impacts of the deadly third stage. However, it seems more likely that any of the ‘cures’ associated with mercury treatment were largely down to the natural dormant phases of the disease. Mercury is also highly toxic, so could cause dreadful side effects. These included organ failure, nerve damage, tooth loss and severe skin ulcers. Numerous patients died as a result of the mercury treatment they were receiving rather than the disease itself. Despite such risks, mercury would remain a popular treatment for syphilis from the 16th century, through to the 19th and even into the early decades of the 20th.
One night with Venus a lifetime with mercury Gallery
‘The Martyrdom of Mercury’ – syphilitic patients shown undergoing various mercury-based treatments, London, 1709.
© Wellcome Collection
Earthenware drug jar for mercury pills, Italy, 1731-1770.
Science Museum Group Collection
Syphilis in the Victorian era
By the mid-Victorian period, the health and behaviours of citizens and the consequences these could have on wider society were subject to growing interest and intervention. Both to those in authority and those campaigning for social reforms. In the UK, syphilis remained a serious ongoing health crisis in the eyes of the medical community, but one that continued to be viewed as symbolic of a wider ongoing moral crisis. One that was closely associated with another great ‘social evil’ – prostitution. The two were certainly linked, but any public blame for the spread of syphilis tended to be one-sided. Where there was sympathy, it was largely with the male clients rather than the predominantly poor, working-class women who had often turned to prostitution to make ends meet.
© Wellcome Collection.
© Wellcome Collection. Image source for Young woman with syphilis, 1898. © Wellcome Collection.
Medical statistics on the number of syphilis cases across the population further raised the alarm. However, it was the impact of syphilis and other sexually transmitted infections (STIs) on the British armed forces that was of most concern. So much so, that it prompted one of the most notorious pieces of Victorian legislation. Authorities had become convinced of the need for action, for what they described as the ‘sanitary supervision of common prostitutes’. Not only subjected to moral judgement, they wanted these women to be subjected to official control and regulation.
© Wellcome Collection
© Wellcome Collection Image source for Two men are approached by a prostitute, depicted as a clothed skeleton holding a painted mask, France, 1830.
The Contagious Diseases Acts
The Contagious Disease Act of 1864 aimed to control soldiers’ and sailors’ relationships with prostitutes as a way of reducing levels of STIs. But under the Act, the powers of which were extended in the following years, women were the sole target. It allowed for the registration, arrest and invasive medical examination of any woman suspected of being a prostitute. If found to be carrying syphilis or other venereal diseases they would also be confined to special medical institutions – known as ‘lock’ hospitals – sometimes for many months. Those refusing to be examined faced up to six months hard labour in prison. The Act required no such compliance by any men.
The legislation became a focus of protest for social reformers, but also ordinary members of the general public outraged by the draconian ways it treated women. After several years of campaigning, the Acts were finally repealed in 1886, by which time public disapproval was shifting more towards the often affluent men who were continuing to exploit impoverished women.
Wikipedia Commons
Wikipedia Commons Image source for Poster advertising a public meeting in Wigan to promote the repeal of the Contagious Diseases Act, 1881.
New understanding and new treatments
The decades from the 1880s through to the 1930s saw great strides in the scientific understanding of disease. A key moment for syphilis came in 1905 with the identification of the bacteria responsible by German scientists Fritz Schaudinn and Erich Hoffmann. The following year, an antibody test for diagnosing syphilis was developed by another German – August Paul von Wassermann. Although results from the Wassermann Test could be ambiguous, from the late 1930s many US states introduced regulations requiring couples applying for a marriage licence to take the test. A licence would only be issued if both were syphilis-free. Not until the 1970s did such laws begin to be repealed and only in 2012 did the last state, Mississippi, no longer required these premarital blood tests. Today, they still remain in place in several countries around the world.
With better understanding of the disease came more effective treatments. Arsphenamine, a drug originally known as ‘compound 606’, was first created in 1907 in the laboratories of Paul Ehrlich. Two years later, one of Ehrlich’s research team – the Japanese scientist Sahachiro Hata – observed its anti-syphilitic properties. By 1910, it was being marketed as Salvarsan, effectively the first real cure for the disease.
Ehrlich believed it fulfilled his concept of the ‘magic bullet’ – a drug that could kill specific micro-organisms without harming the body itself. Not that Salvarsan couldn’t have some pretty nasty side effects, such as liver damage, headaches and vomiting. It was also quite an unstable drug, which medical staff found difficult to prepare. And while effective against the early stages of syphilis, for those in the final tertiary stage its impact was limited. Despite such limitations it remained the treatment of choices until the 1940s
New Treatments
Test tube for Wassermann test in wooden case, British, early 20th century
Science Museum Group
Poster reminding Americans to be examined for sexually transmitted diseases before marriage, c1944.
Wellcome collection
Three life-size wax legs showing stages in the successful treatment of ulcers caused by secondary stage syphilis with Salvarsan, probably made in Germany, 1910-1920
Science Museum Group‘A Cause of Military Inefficiency’
The repeal of the Victorian Contagious Diseases Acts was celebrated by many, but the stated reason for their introduction remained a problem. Syphilis and other venereal diseases – such as gonorrhoea – continued to be a drain on military resources. And despite the arrival of more effective treatments, across the fighting nations it was a major cause of missing manpower in both the First and Second World Wars.
Between 1914-1918, there were over 400,000 hospital admissions from the British Army for venereal diseases, including syphilis. It’s been estimated that around 5% of all those who served in Britain’s forces during the war became infected – taking each of them away from their duties for potentially several weeks at a time. Syphilis was the most serious venereal infection, but if treated early with Salvarsan its harmful effects might be limited. As such, men were not so much punished for contracting it, but rather for concealing they had it.
During both wars the realities behind the high levels of infections in the military could not be ignored. But be it through dire warnings of the moral and physical consequences of a lack of self-control, the rollout of health education programmes and early treatment centres, fines and imprisonment or the provision of licensed brothels and free condoms, military authorities trod an inconsistent path when confronting the issue.
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The arrival of Penicillin
The development of penicillin during the Second World War had a dramatic impact on the syphilis story. By 1947 it was the standard treatment and a highly effective cure, with the antibiotic reducing case numbers in the UK by 90% within ten years. But it was the withholding of this cure that was central to a clinical study that became a byword for racist and unethical experimentation. The Tuskegee Syphilis Study ran from 1932 to 1972 and involved nearly 400 impoverished African-American men living in the US State of Alabama. The men had been diagnosed with latent syphilis, meaning they had the infection but were yet to show obvious symptoms. The purpose of the study was to follow the effects of the disease when left untreated. Not that the men were ever informed that they had syphilis, they were simply told they had ‘bad blood’.
For taking part, the men got free meals and medical treatment for minor ailments at Tuskegee University’s clinic. Although any treatments for their ‘bad blood’ were actually placebos or mineral supplements, even after the arrival of penicillin. Nothing was to interfere with the research, and it was even ensured that men drafted for Second World War service stayed at home to remain part of the study instead.
Science Museum Group
Science Museum Group
Following a public outcry, the study was finally ended in 1972. In the course of four decades, over a 100 men had died of the disease or related complications while 40 wives had been infected and over a dozen children born with congenital syphilis. Barely 70 of the original participants were still alive. They eventually received some financial compensation and in 1997, then US President Bill Clinton finally gave an official apology, declaring that “what the United States government did was shameful”.
Wikipedia Commons
Wikipedia Commons Image source for Black and white image of doctor drawing blood from a patient as part of a syphilis study
The persistence of syphilis
Wellcome Collection
Wellcome Collection Image source for Sexual health poster in french waring people about syphilis and to be cautious.
The ‘Great Pox’ and mercury ‘cures’ may seem like ancient history as cases of syphilis are considerably fewer now than in pre-penicillin days. But across much of the world those numbers have been on the rise again. Globally, over 7 million new cases were reported in 2020, and in 2023 the UK recorded its highest levels for 75 years. Penicillin remains an effective cure, but there seem to be a range of factors contributing to this ongoing increase.
The disruption to general health services and in particular to STI prevention resources during the COVID-19 pandemic is believed to have had a major impact. Likewise, inequalities in testing access, language barriers and the traditional stigma associated with syphilis may also explain the far higher rates in minority and immigrant groups, who often live in the most impoverished urban areas. Women in such communities are particularly vulnerable and cases of congenital syphilis in their children have also increased significantly.
Inevitably, personal behaviours are still central to the global status of syphilis. For example, researchers have recorded sharp rises in cases amongst men who have sex with men. They propose this has much to do with a reduction in condom use, which for many years has been a key form of protection against human immunodeficiency virus (HIV), the virus that can cause another STI – AIDS. A result of HIV increasingly being seen as a manageable, chronic condition rather than the untreatable disease it once was. Similarly, recent research in Japan has suggested a direct link between rising syphilis cases and the increased use of dating apps by young heterosexual men and women.
Today syphilis can be cured, but it hasn’t gone away.
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