POX: Genius, Madness, and the Mysteries of Syphilis

 
POX:
Genius, Madness, and the Mysteries of Syphilis

 



Contact Deb    debhayden/at/sbcglobal.net





C.G. Jung called Nietzsche's syphilis "The Poison of the Darkness." Isak Dinesen called hers "Life's bitter secret." POX explores this dark secret in the days before penicillin.




POX: Genius, Madness, and the Mysteries of Syphilis

ISBN 0-465-02881-0


Praise for Pox . . .


“POX brings out the extraordinary range of symptoms that syphilis can have, how it affected innumerable lives (including those of many famous artists and savants), and how it is still very much around, and not just a historical curiosity. It is excellently researched and vividly written, and Hayden's passion for the topic shines through on every page.”

—Oliver Sacks, MD, The Man Who Mistook his Wife for a Hat


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QUICK LINKS


Articles by Deb:


Pain and Shame-The Triumph of the Pox-- New Statesman 12 May 2003


Alas Poor York: Digging up the Dead to Make Medical Diagnoses -- PLOS (Public Library of Science Medicine, March 2005


Interview:


Link to BBC Interview 19 May 2003


Article about Hitler:


BBC article March 12, 2003


Amazon and Barnes and Noble links:


Link to Amazon.com POX listing

Link to Barnes and Noble POX listing


San Francisco Weekly Cover story:


Peter Byrne’s article “Disease Detective,” San Francisco Weekly 15 January, 2003


British Medical Journal review


Youtube section of Andy Webb’s “High Hitler”-- History Channel


COMMENTS ON POX:


"POX...presents the fascinating thesis that many eminent figures in history very likely suffered from syphilis and that the disease may explain at least some aspects of their behavior, their career decisions and how they accomplished their feats of divinity or defiance.”

— Natalie Angier, New York Times


“ …a repository of all that had been forgotten about a sinister bacterium and the disease that was its legacy. If Oscar Wilde was correct when he said that ‘history is merely gossip,’ then POX is history at its best.”

— Philip Mackowiak, MD The New England Journal of Medicine


“A riveting, eye-opening book. . . POX will be of interest to anyone who loves a good mystery story.”

—Elizabeth M. Whelan, The Washington Times



“POX breaks new ground by casting syphilis — up to a point— as a romantic pathogen, as tuberculosis was long seen to be. . . . Hayden’s book is a worthy addition to the literature of plague. Her research is exemplary, and from the evidential point of view her accounts are definitive.”

—Hugh Pennington, MD, The London Review of Books


“In POX the author posits who among those still known to us might have had syphilis. . . . this well-researched book is welcome.”

—George E. Ehrlich, MD, JAMA: The Journal of the

American Medical Association


“Abraham Lincoln, Adolf Hitler, Friedrich Nietzsche, Oscar Wilde, Ludwig van Beethoven, Vincent van Gogh, . . . many noted historical figures have joined the furtive queue at the STD clinic. So claims . . . Deborah Hayden, shining a light on the dark secrets of 14 famous names from the 19th and early 20th centuries.”

—John Bonner, New Scientist


“Intellectually transformative—POX radically and permanently alters one’s view of many historical titans. And, as if that weren’t enough, it is a wonderfully engrossing read, taking readers on a delicious detective hunt of the first order.”

—Irvin Yalom, MD, Love’s Executioner



“Hayden’s carefully researched book is destined to become a classic of short biography in the newly emerging field of ‘medical symbiotics.”

—Lynn Margulis, author of Acquiring Genomes: The Theory of the Origin of the Species.


“POX is a bombshell that blows open the question of the place of syphilis in the highest reaches of history.”

—Rudolph Binion, author of Hitler Among the Germans


“This fluently written book makes for an engaging read.”

—Edward Shorter, MD, Nature Medicine


“…often fascinating — like poring through people’s lives with a microscope”

—Dallas Morning News


“…morbidly fascinating historical profile."

-Kirkus Reviews


“Hayden pulls together fascinating medical histories. . . Her arguments . . . are sure to provoke debate.”

-Publishers Weekly


"…a fascinating account …any book that combining genius, madness, sex, and disease is bound to find an audience."

-Library Journal


“POX breaks new ground in the fields of medical history and biography . . . Hayden presents 15 historical celebrities, including Beethoven, Nietzsche, Lincoln, and her pièce de résistance, Hitler.”

-Peter Byrne, S.F. Weekly


“Is it possible for a book to be too entertaining?”

—South Florida Sun Sentinel


“Deborah Hayden attempts to put words to the unmentionable, pursuing a disease whose most recognizable attribute is that it can’t be recognized.”

—Bookforum


“provocative and controversial”

—The Tennessean


“A good read for anyone who loves a skillfully guided tour through a new, important and fascinating subject. It combines original thinking with smooth narrative. Two thumbs up!”

—Thomas P. Lowry, MD, The Free Lance Star


“Hayden has written vividly and with clarity about the nature of the disease. In each of her cases she has convincingly, to this non-medical reader, demonstrated the validity of her suggested diagnoses.

—Oscholars: The Internet Journal of Oscar Wilde News


“In a world filled with the fear of AIDS and SARS and in a culture fascinated with Hollywood’s version of the forensic sciences, POX is a curious, compelling read.”

—Times Union


“Deborah Hayden has combined a talent for explaining complicated medical studies with a historian’s determination to force the privacy of the past in writing a most valuable book.

—Baton Rouge Advocate


“A unique historical perspective for the current epidemic of AIDS.”

—Whole Earth Magazine


“Deborah Hayden is a genuinely original thinker and a beautifully lucid writer.”

—William Schaberg, author of The Nietzsche Canon


“A tour de force that will make readers recognize the impact infectious diseases have on individuals, society, now and throughout history.”

-Norbert Hirschhorn, MD, Yale University School of Medicine


“An extraordinary journey with the spirochete through the lives and works of some of history’s most famous and infamous characters. Hayden is not afraid of traveling through unchartered and dangerous terrain.”

-Ashley Robins, MD, University of Cape Town, South Africa



REVIEWS(or excerpts):

Kirkus

Publishers Weekly

Booklist

Los Angeles Times

Sunday Times, Irish edition

The London Times

The Free Lance Star, Fredericksburg, VA

Oscholars (Wilde web journal)

The New England Journal of Medicine

Nature Medicine

Cerebrum

The London Review of Books


-- SEE MORE UNDER "QUICK LINKS"


For readers' comments, click "From Readers" page above


KIRKUS REVIEW December 2, 2002


The Great Pox . . . is given a clinical but--how could it be otherwise?--morbidly fascinating historical profile by independent scholar Hayden, who proceeds to do some medical detective work in identifying famous people who may have carried the spirochete to their graves.


The nasty little parasite entered the history books, Hayden conjectures (with evidence), when Columbus returned from the New World and launched the European syphilis epidemic of 1493. (The lepers thought the syphilitics smelled so bad they wouldn't have them in their neighborhoods). Left untreated, as it essentially was until penicillin, syphilis is a chronic, inflammatory, relapsing disease that goes into hiding throughout the body--brain, eyes, temporal arteries--after the initial sores disappear. It then reasserts itself by delivering severe headaches and gastrointestinal pains, blindness and deafness, paralysis, and insanity, yet sometimes also ecstasy and fierce creativity. Hayden traces attempts to counteract the disease--which, since methods included dousing with mercury, arsenic, and bismuth, were equally terrible (and ineffective)-in a voice both serious and wonderfully understated: one of the "warning signs" of tertiary syphilis, she explains, is the sensation of being serenaded by angels. After the cultural and medical groundwork has been laid, Hayden asks "delicate questions" about a number of historical figures. She examines the possibility that Beethoven and van Gogh were victims--possible cases that are hotly contested. It would be a miracle if Flaubert didn't have syphilis, and in Oscar Wilde's case, he said and did so many bizarre things that it's hard to judge. Hayden presents the facts and lets the readers decide whether Nietzsche, Baroness Blixen, Schubert, Baudelaire, and Hitler may have been candidates.


Pox is free of judgment, but the reader can't help but feel that safe sex never seemed a better idea.


(Illustrations) (Agent: Rosalie Siegel International Literary Agent)


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From PUBLISHERS WEEKLY December 9,2002


Few would argue that some of Hayden's subjects, like Flaubert and Karen Blixen (subject of the movie OUT OF AFRICA), suffered from the disease. Her arguments for others, like the Lincolns and Beethoven, are sure to provoke debate. Hayden pulls together fascinating medical histories. . . Readers will be divided on whether or not they are convinced by Hayden's arguments, but with the reemergence of syphilis in many urban populations, the subject is sure to attract attention.



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BOOKLIST, American Library Association


More than 500 years after the great European-American encounter, scholars still debate whether syphilis was America's thank-you to Europe, especially for Christopher Columbus. Hayden presents an exhaustively researched case for syphilis taking its maiden voyage to Europe "aboard" Columbus' crew. Thus launched, pox, as it was called, so took Europe by storm that by the nineteenth century, according to some estimates, more than 15 percent of European men were infected. Of the wide variety of "cures," many, including mercury, were arguably worse than the disease. Until penicillin in the late 1940s, none actually cured it. After a tour through syphilis' grisly history, Hayden presents case studies of various nineteenth- and twentieth-century luminaries rumored to have been syphilitic. The well-documented accounts allow readers to draw their own conclusions about men as diverse as Beethoven, Flaubert, Lincoln, and Hitler. There aren't many books about syphilis, and aside from those about the Tuskegee syphilis experiment, few are more interesting. An if-you-read-one-book-about kind of book. --Donna Chavez


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'Poison of darkness' under microscope

01/31/2003 Los Angeles Times


For 500 years a specter haunted the marriage bed. It turned sex into shame, pleasure into guilt, painful life into often early death: the dreaded syphilis. Believed to have been brought from the New World to the Old by Columbus and his crew, it burst upon the European consciousness in the French siege of

Naples in 1495. From that time until 1943, when penicillin was used to cure it, it was the most feared of all the diseases begotten in the act of love.


Now it has been supplanted by AIDS (in the spread of which untreated syphilis assists) as the most gruesome possible consequence of the most

joyful, necessary and natural of all human activities. But the record of itshistory remains a window into how a transmittable little bacterium with a twisting propellant tail reacted with unsuspecting mankind and deeply affected both human behavior and mankind's perception of itself.


Deborah Hayden, an independent scholar and marketing executive, peers through this window to bring us an imaginative if speculative account of the

malady that Carl Jung called "the poison of the darkness." She concentrates on those aspects of syphilis that so intrigued the 19th and early 20th

centuries, the connection among syphilis, madness and genius. Those connections were not much remarked on until the Romantic movement in the arts cultivated the notions of the solitary "genius" and his potential

for possession by the diabolical. Faust became the dominant symbol, as profoundly expressed by Thomas Mann in his 1947 novel "Doctor Faustus," in

which a German composer, standing as an emblem for his nation, after a glancing encounter with an infected prostitute, makes a deal with the devil

to compose brilliant music in exchange for his own dissolution and death.The affinity of syphilis with so many other diseases -- it was named the

"Great Imitator" by a 19th century doctor -- and its ability to produce in its victims moments of great excitement and creativity led to speculation

about who, among the great men of the time, might have had syphilis. With the determination of a detective to whom no detail is too small to consider,

Hayden combs the published sources and constructs her list.


"Today," she writes, "there is general agreement that Baudelaire, Flaubert, Maupassant, Schubert, Schumann and Blixen [Baroness Blixen, the writer Isak

Dinesen] had syphilis. Most concur about Nietzsche. But there is hot debate over Beethoven, Wilde, Joyce and Hitler. The question has been discreetly

avoided for the most part with Mary and Abraham Lincoln, and it has not been considered seriously in the copious Van Gogh medical scholarship, where 152 diagnoses vie for attention." Hayden devotes a separate chapter to each of these candidates.


Hayden says candidly that "the reader looking for proof in the contentious cases will find none. The old syphilologists knew that the Pox was identified by the cumulative weight of many 'suspicion arousers' -- that is, by circumstantial evidence." The burden of proof is of course made all that much harder by the shame the disease usually produced. Sufferers concealed it from their families and

friends; discreet physicians left it off the death certificates.


Hayden's book is thorough but, as she admits, " 'Pox' will require careful attention on the part of the reader to keep track of information about the

names and dates of syphilis. And the detective skill of a syphilologist will be required in deciding who did and who did not have it beyond a reasonable

doubt."


"Pox" requires a sound stomach to read through the symptoms of syphilis presented matter of factly in all their gore. Nevertheless the book holds

the reader's attention. Nearly all the people she writes about enriched human experience. How much of their talent was due to their disease, how

much in spite of it? Though the answers are not knowable, the questions are worth asking. Hayden lays the groundwork for asking them. --- Anthony Day

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Sunday Times, Irish Edition, March 02, 2003


Joyce and Wilde ‘driven’ by syphilis


TWO of Ireland’s most famous literary figures, James Joyce and Oscar Wilde, secretly had syphilis, according to a new book on the disease. Much of the authors’ writing was influenced by the illness, researchers suggest. Pox: Genius, Madness and the Mysteries of Syphilis claims that Ulysses, Joyce’s most famous work, is in part an account of the night he was infected, although the author’s family has rejected the theory as “absurd”. It also proposes that Wilde’s A Picture of Dorian Gray was a parable for the disease that was destroying his body. The research draws on letters Joyce exchanged with a friend to pin down the night in 1904 when he most likely contracted the disease. It also concludes that he may have infected Nora Barnacle, his wife, and believed he had passed the disease on to one of his daughters. Deborah Hayden, who lectures on syphilis at the University of California San Francisco, said Joyce’s previous biographers had ignored evidence of the author’s illness out of deference to his memory. She said: “Having syphilis was a source of great shame in those days and Joyce would never have mentioned it. There was, however, a pattern of acquired syphilis running through Joyce’s adult life and it was a major theme in his work.” When syphilis affects the lower spinal nerves it causes paralysis, and a shuffling gait. Joyce had those symptoms. Hayden carried out her own research in collaboration with Professor Kathleen Ferris, formerly at Lincoln Memorial University, who has collated Joyce’s correspondence, medical records and the papers of friends and other biographers. In her evidence on Joyce, Hayden posits letters exchanged between the writer and his friend Oliver St John Gogarty, a doctor Joyce met at medical school. In March 1904 Gogarty wrote to Joyce: “Congratulations that our holy mother has judged you worthy of the stigmata . . . If I would venture an opinion — you have got a slight gleet from a recurrence of original sin. But you’ll be all right. When next mounting be careful not to wish eternal blasting as the process is intermittent.” A later letter to Joyce from Gogarty contains references to “poxed”, discomfort when urinating, and mercury — which was then used to treat syphilis. Hayden also points out that, later in 1904, Joyce had “diverse pains and complaints at that time that point to secondary syphilis: rheumatism, tonsillitis, colitis and ‘nerves’”. Bob Joyce, the author’s grand-nephew, dismissed the claims, saying : “It’s pure speculation. Most people with a knowledge of Joyce would just laugh at it. “I don’t think anyone could prove one way or the other if he had syphilis. We have learned to ignore an awful lot of what is said about Joyce by so-called experts.” The case for Wilde’s having had syphilis is less clear. Hayden traces a series of health problems suffered by the author, all of which she says are consistent with progressive syphilis. Hayden says Wilde probably caught the disease from the “one and only campus prostitute” at Oxford University, and may have passed it on to his wife, Constance, who died of spinal paralysis. -- Jonathan Leake, Science Editor, and Jan Battles


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The Times, London edition


March 12, 2003


Was syphilis the demon that drove Hitler mad?


HITLER may have been dying of syphilis when he committed suicide in his Berlin bunker, according to a new book that could explain his mental decline in the final months of the Second World War.

New analysis of the records kept by Hitler’s doctors has revealed that he suffered from many of the most characteristic symptoms of tertiary syphilis, and that he was treated regularly with drugs that were commonly prescribed for the sexually transmitted disease.


The controversial diagnosis, which would cast new light on the dictator’s behaviour, from his sexual frigidity to his paranoiac rages, is advanced in Pox: Genius, Madness and the Mysteries of Syphilis, by Deborah Hayden, an American historian. Although it may never be possible to prove that Hitler was syphilitic, the balance of evidence suggests the disease as the most likely explanation for the wide range of health problems that afflicted him, particularly in his last years.


“If Hitler’s life is looked at through the selective lens of a possible diagnosis of syphilis, one clue leads to another and then another until a pattern of progressive disease emerges,” said Ms Hayden, a former lecturer on the history of the disease at the University of California at San Francisco. “Syphilis must be considered in our understanding of Hitler’s career, his motivations, the events of World War Two, and even the Holocaust.”


The theory that Hitler had syphilis has been advanced before, most notably by the Nazi-hunter Simon Wiesenthal, but has generally been rejected for lack of proof. Ms Hayden has amassed an unprecedented wealth of circumstantial evidence, although she accepts that the diagnosis will never be irrefutable.


“This is not definitive proof, but I think there is a preponderance of circumstantial evidence,” she said. “It certainly might have affected his mind, and if he knew or thought he had it, and didn’t have long to live, it may have accelerated the war effort.”


Aside from the well-known mania of his last years, which would be consistent with the mental effects of the parasite, Hitler had an abnormal heartbeat that points towards syphilitic aortitis. Notes kept by Theo Morell, his physician, show that he had an accentuated or “tympanic” second sound to the heartbeat, which is often caused by syphilitic damage to the aorta.


Dr Morell’s records of drug treatment show that from 1941 Hitler received regular injections of iodide salts, a standard 1940s therapy for cardiac syphilis. He had lesions on his shins so painful that they sometimes prevented him from wearing boots, and suffered intermittently from encephalitis, dizziness, flatulence, neck pustules, chest pain, gastric pain and restrictive palsies — all are associated with the disease.


A knowledge that he carried the disease would explain his lack of sexual interest towards his long-term consort and eventual bride, Eva Braun, and his devotion of 13 pages of Mein Kampf to syphilis. “The question of combating syphilis should have been made to appear as the task of the nation,” he wrote.


Hitler’s very appointment of Dr Morell in 1936, Ms Hayden suggests, is significant. The doctor, a dermatologist, was one of Germany’s leading experts on the disease.


Several contemporary rumours held that Hitler contracted syphilis from a prostitute in Vienna in 1908 or 1910. Some accounts suggested that the prostitute was Jewish. Ms Hayden said that these were probably hearsay, but that Hitler did write in Mein Kampf that the Jews were responsible for spreading the disease.


More plausible are reports that Hitler was given the diagnosis at a German field hospital in 1918, when he was recovering from a gas attack. Heinrich Himmler, the SS chief, may have destroyed copies of his medical records.


Robert Berger, a cardiac surgeon at Harvard Medical School in Boston, said that Hitler’s symptoms could indicate a diagnosis of syphilis. “The picture is consistent with syphilis, although it is not definitive. Each of the symptoms and treatments fits.”


Rudolph Binion, Professor of History at Brandeis University in Massachusetts and author of Hitler Among the Germans, said that the diagnosis would fit with almost every aspect of Hitler’s known medical symptoms and behaviour. “While it’s impossible to diagnose with 100 per cent surety, she has an extremely presumptive case. It falls in very much with a case of textbook syphilis,” he said.


However, Sir Ian Kershaw, Professor of History at Sheffield University and one of Hitler’s most authoritative biographers, said that he was unconvinced. Rumours of Hitler’s condition were based on “dodgy hearsay”, he said, adding: “I remain heartily sceptical.”


Disease of the great and not so good


SYPHILIS is thought to have originated in the Americas and to have begun its spread around the world after Columbus’s voyage in 1492 (Mark Henderson writes).


The first epidemic broke out in Europe in 1494, spread at least in part by French troops retreating from the siege of Naples, giving rise to its first nicknames: “the disease of Naples” and “the French pox”.


Voltaire had his own views on its national origins. “The first fruit the Spaniards brought from the New World was syphilis,” he wrote.


Syphilis may have been in Europe before Columbus, although it became commonplace only with the arrival of new strains from the New World. Female bones dug up in a churchyard in Rivenhall, Essex, in 2001 that have been dated to between 1290 and 1445, show characteristic syphilitic damage.


Whatever its provenance, the disease began to sweep through the European population in the 16th century, and there is good evidence that it afflicted Charles VIII and Francis I of France and Ivan the Terrible of Russia. Mary Tudor may have had the congenital version, inherited from her father, Henry VIII.


At its peak in the 19th century, syphilis may have affected as many as 15 per cent of the adult population of Europe and North America, according to Deborah Hayden’s book. The disease, which is caused by the parasite Treponema pallidum, has largely died out since the development of penicillin in the 1940s. --Mark Henderson, Science Correspondent


Pox in the Past.

Deborah Hayden: POX Genius, Madness and the Mysteries of Syphilis. New York: Basic Books 2003. ISBN 0-465-02881-0. $27.50 US


Stephen Benson



The past few years have seen a number of books, aimed at a general audience, focussing on the history of particular diseases, such as Dormandy's The White Death on tuberculosis and Porter and Rousseau on gout. But while these have concentrated largely on the history of attitudes to, and the understanding and eventual cure of, the particular disease, with some reference to famous sufferers, Deborah Hayden in Pox: Genius, Madness and the Mysteries of Syphilis at least points us beyond this, to the impact the illness had on the life and work of famous historical figures.

Her purpose is threefold: to chart the spread of the disease and the fight against it; to identify famous people who may be judged to have suffered from it; and to raise the question of the extent to which suffering from the disease impinged on their lives, ideas and works.


In the first two of these tasks she succeeds admirably. Writing for the non-medic and indeed not a physician herself, she demonstrates an impressive grasp of the medical sources in describing the progress of the disease. Syphilis, while recognised early on as being a worldwide scourge, defies easy identification. Known as 'the great imitator', it mimics in all its stages, from the first genital lesion through its horrific later progress, many other conditions, which inhibits easy diagnosis. It carries an obvious social stigma, which prevents public identification. It can remain latent for years, go into remission, and thus mislead sufferers and later historians that it has 'disappeared'. Crucially its effects are both physical and psychological. In its later stages, as the sufferer heads towards general paralysis of the insane, mood shifts become extreme 'as euphoria, electric excitement, bursts of creative energy and grandiose self-reflections alternate with severe, often suicidal depression'. Paradoxically, since 1943, when penicillin was discovered to be an effective treatment of the disease, fewer doctors have been in a position actually to observe the later stages and can in Hayden's view therefore easily be mislead.


A chronic invalid can apparently suffer a series of unrelated conditions, which only a specialist or perhaps, a medical sleuth like Hayden can link to provide a diagnosis of syphilis. This of course carries its own dangers. To Hayden a catalogue of illnesses can prove to her, for example, that Abraham Lincoln's wife Mary was a sufferer. Few readers of her book will be in a position conclusively to accept or reject her arguments. She it is who lists the determining symptoms. She it is who tots them up in a particular case and pronounces her verdict -- all very self-fulfilling. But having said that, her arguments and analyses are convincing and importantly, where there is room for doubt, she acknowledges it openly and lays out the alternative diagnoses.


In a series of brief and entertaining chapters she considers the cases of Beethoven, Schubert, Schumann, Baudelaire, Abraham Lincoln and his wife Mary, Flaubert, Maupassant, van Gogh, Nietzsche, Wilde*, Karen Blixen, Joyce and Hitler and hypothesises that they all suffered from syphilis. By focussing mainly on their medical histories, which in most cases are extensively documented, she does give greater prominence and focus to an aspect of her subjects' lives and deaths which may have either been neglected by other biographers or not linked in this way.


However, if that were all, it is arguably no more significant than saying that the subject had blue eyes or suffered a withered right arm. It might merit no more than a footnote and indeed she berates Ellmann for doing just this with his treatment of Wilde's suspected syphilis in his biography. Where the fun starts, but also where medical history becomes potentially over-simplistic speculation is when one attempts to link this to an interpretation of the subjectís ideas or artistic output. How far was the nature of Schubert's later works coloured by his contemporaneous medical condition? Is Dorian Gray 'one of the most poignant portrayals of the fears of the secret syphilitic'? Was Hitler's attitude to the Jews mainly or partly determined by the syphilis he may have picked up from a Jewish prostitute in Vienna in 1908?


Hayden recognises the seductiveness as well as the dangers of this line of investigation and to be fair, makes only modest claims for her hypotheses -- but these are the questions which linger in the mind of the reader who otherwise might become surfeited, if that is the right word, by the repeated and detailed descriptions of the sufferings of her subjects. Hayden has written vividly and with clarity about the nature of the disease. In each of her cases she has convincingly, to this non-medical reviewer, demonstrated the validity of her suggested diagnoses. The larger question demands much more detailed analysis than she has inclination or space for. Hayden is too intelligent a guide to suggest a monocausal explanation of her subjects' lives but she has made an intriguing case for treating their syphilis with a great deal more attention.


*Chapter XVII is devoted to Wilde.


Stephen Benson read Modern History at Magdalen College, Oxford. He is currently Appeals Director at the Royal College of Physicians in London.


NEW ENGLAND JOURNAL OF MEDICINE June 19, 2003


Deborah Hayden's Pox: Genius, Madness, and the Mysteries of Syphilis is the biography of an infection that has fascinated and frustrated clinicians for more than half a millennium. The book is a repository of all that had been forgotten about a sinister bacterium and the disease that was its legacy. It is also a compendium of what Hayden refers to as the "veiled revelation" of syphilis that can be found in the intimate details of the lives of famous people if one searches with sufficient determination and vigor. Most of all, the book provides fodder for the imagination.


Envision a book, written by the owner of a direct-marketing firm, about the history, microbiology, pathogenesis, clinical manifestations, diagnosis, and treatment of one of humankind's most enigmatic disorders. The author has no formal medical training but has gleaned sufficient expertise in syphilology from lavishly illustrated 19th-century and early-20th-century medical books "written in language remarkably accessible to the layperson" to qualify her to lecture clinicians and peer-reviewed medical journals about what she calls "faulty assumptions about a disease no longer familiar in clinical practice." Imagine that same authority examining the case histories of scores of illustrious personalities through "the selective lens of a possible diagnosis of syphilis" and, time and again, finding evidence of the one disease she knows in depth.


Imagine a concept that Hayden calls "creative euphoria," whereby "the syphilitic was often rewarded, in a kind of Faustian bargain for enduring the pain and despair, by . . . electrified, joyous energy when grandiosity led to new vision." Beethoven had it. Guy de Maupassant did too. In fact, Hayden says that "Maupassant's literary leap from mediocrity in 1876 to the supreme mastery of the short story in 1880 might have been the result of a tremendous stimulation of the brain cells" by what biographer Robert Sherard refers to as "myriads of spiral-shaped germs darting to and fro." Because Vincent van Gogh committed suicide, says Hayden, we do not know whether he experienced "the ecstasy and the misery of the stage that precedes paresis when he painted with such intensity in the last months of his life." One must wonder whether Michelangelo's agony and ecstasy represent another example of creative euphoria. Friedrich Nietzsche's syphilis has yet to be confirmed under "the selective lens of presumptive diagnosis," says Hayden. However, the books about syphilis that Hayden relied on to write Pox tell us, she says, "that the last expressions of sanity before paretic dementia sets in can be characterized by mystical vision, messianic prophecy, grandiose self-definition, clarity of expression, and extreme disinhibition, while all the time maintaining exquisite precision of form." Could one ask for a better description of Nietzsche's later works?


Oscar Wilde seems to have been denied the benefit of syphilitic euphoria, most likely, Hayden says, because it was "effectively doused by a liter of brandy a day." But not Karen Blixen, who wrote Seven Gothic Tales, Winter's Tales, and Out of Africa under the pseudonym Isak Dinesen. Syphilis, she maintained, sold her soul to the devil for the ability to tell stories.


Now imagine a pale, fragile bacterium that can dictate why great people do what they do, thereby determining the course of world events. That bacterium may have caused Flaubert to become a writer instead of a lawyer and Hitler to accelerate his war effort beyond reason at the end, for fear that his heart might at any moment balloon with a fatal luetic aneurysm.


Finally, imagine a book dedicated to bringing syphilis in from the wings of biography, a book in which evidence obtained from fourthhand accounts, legend, and works of fiction is piled so high on the side of the great pox that even a negative Wassermann test cannot tip the balance in favor of some other disorder. Imagine how difficult it must be to diagnose in a patient a disease other than the "Great Imitator" if it is the only disease you know. For if your foremost assets as a self-made syphilologist are zeal, passion, and persistence in the pursuit of an illness that defies diagnosis at every stage, you are bound to find syphilis wherever you look: in Baudelaire, Schubert, Schumann, Joyce, Columbus, Daudet, Poe, Gaugin, Churchill (Randolph), Al Capone, Ivan the Terrible, Manet, Idi Amin, Darwin, Donizetti, Dostoyevsky, Lenin, Meriwether Lewis, Mozart, Robert Mugabe, Napoleon, Paganini, Rabelais, Stalin, Tolstoy, and Woodrow Wilson. You will see it in any idiosyncracy — Mary Todd Lincoln's shopping compulsion and Honest Abe's melancholia and hypochondriasis — and in any poor, departed soul whose death has generated even a hint of diagnostic confusion.


If you can imagine those things, then you have an idea of what awaits you in Pox: Genius, Madness, and the Mysteries of Syphilis. Exotic flowers of speculation bloom luxuriantly here. If Oscar Wilde was correct when he said that "history is merely gossip," then Pox is history at its best.


Philip A. Mackowiak, M.D.

Veterans Affairs Maryland Health Care System

Baltimore, MD 21201


NATURE MEDICINE


The funny thing about syphilis is that it was historically more a middle-class disease than one that affected the working class.. . . Hayden, a freelance scholar with no medical background, has done a creditable job of working up syphilology, a medical specialty that today has virtually ceased to exist. She sets out to retrospectively diagnose the famouse, armed with a good understanding of the characteristic signs. Her list includes some candidates whose syphilitic infections have long been known: Franz Schubert, Charles Baudelaire and French novelist Guy d Maupasssant. But there are some surprises on the list for whome she makes a plucky case: Abraham Lincoln and his wife, Oscar Wilde and James Joyce.


The biggest fish in Hayden's net is Hitler, although she fails to conclusively demonstrate that neurosyphilis was the basis of his aberrant behavior and bizarre medical ailments. She takes on literally hundreds of monographs and mounts a brave case, concluding that there is 'enough evidence to warrant reopening the file.' At least Hayden rescues Hitler from the hands of the psychoanalysts who had held hi in durance with speculative diagnoses related to his toilet training.


The book is a good read that readers with an interest in history might think of dragging along to the beach.


The idea that the canon of creativity in Western society is modeled by pathology tugs at our curiosity. Hayden's book is reminiscent of Kay Redfield Jamison's Touched with Hire: Manic-Depressive Illness and the Artistic Temperament, which suggested that much of English literature was dictated by the vagaries of manic-depressive illness. Living up to that promise, this fluently written book makes for an engaging read.


Edward Shorter, Hannah Professor of Medicine at the University of Toronto.


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LONDON REVIEW OF BOOKS 9/11/03 (excerpt)


Deborah Hayden's book reminds us of the havoc sypilis wrecked in the pre-penicillin era, and examines its effects onthe lives of hte famous, on computers, poetes and writers: Beethoven, Schubert, Schumann, Baudelaire, Flaubert, Maupassant, Wilde, Nietzsche, Joyce, Karen Blixen, van Gogh. Hayden reminds us, too, that politicians -- Abraham Lincoln and his wife -- can, like anyone else, catch sexually transmitted diseases. Her approach is profitable and her choice of sufferers sensible: many of them left records of their views -- and fears-- about syphilis and its effects on their thinking, so that her accounts are more than just clinical studies. Inevitably, her case histories have a strong forensic flavor. She has had to arrive at conclusions about the syphilitic status of her subjects on the basis of incomplete and circumstantial evidence, and under the handicao of denial and concealment; most people no dot publicly, or even privately, admit to a syphilitic past.


POX breaks new ground by casting syphilis --up to a point--as a romantic pathogen, as tuberculosis was long seen to be.


Towards the end of her book, Hayden skilfully dissects the many attempts to show that Hitler suffered from syphilis. Her verdict is 'not proven'. But whether or not he did have it, there can be no doubt that his end was hastened by its defeat at the hands of penicillin. After the drug's introduction in 1943, the priority destination for the scarce supplies was not soldiers wounded on the battlefield but those wounded in the brothels. Their rapid return to the front line made a massive contribution to Allied military manpower after D-Day. Hayden has done a good job of analysing cases of syphilis among the famous: the full story of its inpact on ordinary people remains to be told.


Hugh Pennington, author of WHEN FOOD KILLS. Professor of bacteriology at Aberdeen University