Syphilis, sex and psychiatry, 1789-1925: Part 1.

OBJECTIVES

Syphilis has changed the course of history, shaped the path of medicine and had more influence on psychiatry than any other illness. This paper, part one of a two-part series, investigates the historical, social and cultural aspects of the interaction of syphilis and psychiatry.

CONCLUSION

Syphilis did not manifest as a psychiatric illness until the French Revolution. At the time, the Pinel School was focussing on the environment and moral therapy. Bayle, who made the first discovery of the cause of a psychiatric disease - chronic arachnoiditis - paid the price for his discovery by being driven from psychiatry. The 19th century led to the rise of a new medical polymath: the syphilologist - a specialist in every aspect of a disease that showed a remarkable capacity to affect every organ and tissue in the body and produce symptoms resembling other illnesses. The field was dominated by Frenchmen, Philippe Ricord and Alfred Fournier, and Englishman Jonathan Hutchinson. A middle-class illness, neurosyphilis struck at the heart of the class interests - property. This reeked havoc with the family business or finances, causing considerable distress to their relatives. General paresis of the insane became associated in the public eye with creative, intellectual or philosophical activity. It affected a long list of artists, writers and musicians, including Oscar Wilde, Robert Schumann, Baudelaire, Schubert and Ivan the Terrible. While the features of syphilis were delineated, confirmation remained elusive and neurosyphilis continued to hide its secrets. It remained the grand cause that defined psychiatry and it was not until the middle of the 20th century that it ceased to play a part in the daily life of doctors in psychiatric wards.