THE DOCTOR'S BAG

A NIGHT WITH VENUS, A LIFETIME WITH MERCURY

Venereal Disease in the Old West - Part 1: Syphilis - The Great Pretender

By Keith Souter, aka CLAY MORE

WARNING! THIS ISSUE OF THE BLOG MAY NOT BE FOR THOSE OF A SENSITIVE DISPOSITION. 

THERE ARE MEDICAL DESCRIPTIONS OF SOME OF THE CONDITIONS THAT TRULY RUINED THE LIVES OF MANY MEN AND WOMEN IN THE OLD WEST. 

IF YOU ARE SUCH A SENSITIVE SOUL, THEN PLEASE, READ NO FURTHER!

Hurdy-Gurdy Girls and good times
Saloons, cat-houses, brothels, they all feature in the novels and movies about the Old West.

The girls who worked in the saloons and dance-halls were employed to entertain the clientele, to sit and chat, bring good luck and generally enhance the time spent there. Sometimes they were called hurdy-gurdy girls, because of the hurdy-gurdy organs that were often used. In their brightly colored ruffled dresses they would sing or dance with customers. They earned commissions and they would stay sober despite all of the drinks they were bought, by the expedient move of actually just drinking cold tea or some other disguised, but non-alcoholic drink. Although they were usually talked about disparagingly, they usually made good money and were treated with respect. They were not by and large prostitutes. At least, not in the up market saloons.

Yet 'soiled doves', as prostitutes were called plied their trade in less salubrious establishments, or in brothels, so called cat-houses, or in their own cabins and cribs in downtown 'entertainment' parts of the camps, towns or cities. It was a dangerous way to make a living.

Julia Bulette, (known as Jule) Virginia City's  legendary prostitute 'with a heart of gold' was one such soiled dove who met a tragic end. She was born in London in 1832, of French ancestry and emigrated to New Orleans, where she married. Her marriage did not last and she travelled, eventually arriving in Nevada.  There she set herself up as a high class courtesan in Virginia City, earning a substantial amount of money from her services, sufficient to set up an impressive brothel which she called Julia's Palace. She became a madam and employed girls from San Francisco, all of whom were expensively dressed in Paris fashions. Food and wine were available. She became a local celebrity (for she did many good works in the city) and she was made an honorary member of Virginia Engine Number 1. Her photograph above shows her with  the fireman's helmet at her side.

Yet she died tragically, brutally murdered and robbed. A French drifter called John Millain was hanged for her murder in 1868. One of those who witnessed the execution was Mark Twain.

Venereal disease - the other great danger
 In the old West there was a sort of chivalry in that women working as prostitutes were still accorded respect by their customers, as exemplified by Julia Bulette. Yet  danger was always (and still is) a potential problem for anyone working in the sex trade. More dangerous, of course were the venereal infections. And one of the main problems was that their nature was not understood. Prostitutes risked contracting venereal disease from their clients, just as their clients risked contracting it after a visit.

There are several types of venereal disease, but the two most common are syphilis and gonorrhoea. Both have been around for millennia and have caused much morbidity and mortality. In this blog we shall look at Syphilis. Another time we will

Syphilis - the great pretender
Apart from HIV, which is a real problem today, syphilis is a potentially devastating illness to contract. At least it was in days before we developed antibiotics. Even now, unless it is detected and diagnosed it can go underground and cause significant health problems years later.

It has had various common names over the years, like 'the pox,' 'syph,' 'the French Disease' or 'bad blood.' It has also been called 'Cupid's disease.' In bygone days doctors made reputations for themselves by curing cases and by writing learned tomes, such as the above one of  1739.

There are two theories about the origin of syphilis. The first is called the Columbian Hypothesis, which suggests that syphilis existed in the Americas and was brought back to Europe and thence to the rest of the world by the crew of Christopher Columbas. The second is the Pre-Columbian hypothesis that suggests it already existed, but was not recognised.

It was first described when it became rife in the French army in the fifteenth century, hence its name as the French Disease.

The earliest known illustration of syphilis, from Vienna, 1496

The thing about this condition is that when it becomes clinically manifest, it can mimic many other diseases. It was called the Great Pox to differentiate it from smallpox.

It has three main  stages, although the secondary and tertiary stage s are separated by a latent phase.

Primary syphilis 
One or more chancres (an ulcer or a swelling or sore) appears at the site of the infection, either the genitals or in or around the mouth. This occurs between 10 and 90 days after sexual contact with an infected person. It may look horrific, yet can be surprisingly painless. It lasts for about a two to six weeks and then just disappears. It is highly infectious at this stage.



Secondary syphilis


This phase starts anywhere between a few weeks and six months of exposure and lasts for up to three months. It includes fever, lymph gland swelling, mainly in the groins, but also under the arms and in the neck. There may be skin rashes which can mimic virtually any skin condition. Classically there is a rosy rash on the palms of the hands and the soles of the feet. There may also be weight loss, general malaise, nausea, joint pains and so on. You can see why it was called 'the great pretender,' because it pretends to be other conditions and it fooled many doctors. This is also a highly infectious period.







Latent phase
After the secondary phase, the condition mysteriously disappears. Or rather - it doesn't always! It just seems to have gone - no thanks to the treatments that were given in days gone by, although the doctors  would probably have claimed success and enhanced their reputations.  This latent period could last for  few months or anything up to fifty years! Following this, if one is unlucky, it enters its most dangerous stage. The good thing is that it becomes non-infective.


Tertiary syphilis

This is when syphilis again pretends to be other conditions, all of them serious. About a third of people who contract syphilis will develop these complications.

 There are  several main syndromes of tertiary syphilis:

• General paresis of the insane - essentially this is a disorder of the nervous system leading to dementia and paralysis. It comes on 10 -30 years after infection. It is thought that Guy de Maupassant, Friedrich Nietzsche had it, and possibly also Vincent Van Gogh and Flaubert. Sadly, it was the ultimate fate of many soiled doves and a good number of their clientele.

• Tabes Dorsalis - another neurological problem. The posterior or dorsal columns of the spinal cord get damaged, leading to imbalance, an ataxic gait (a movement disorder), shooting pains in the limbs. It can develop into paralysis and dementia also.

• Gummatous disease - here large tumour-like (not malignant) lesions grow on any part of the body

• Cardiovascular syphilis - all manner of degenerative heart problems can occur leading to heart failure 

Congenital syphilis

Unfortunately, syphilis can be passed on in pregnancy if the mother has secondary syphilis. It could go on to cause problems for the child. It could affect the liver and spleen, or go on to affect other organs, the skeleton and the teeth. The classic appearance is of a saddle nose deformity, cleft palate, deafness, blunted front teeth and several other potential problems. Of course, stillbirth would also be possible. 

Gerard de Lairesse (1606-1669), by Rembrandt. He was an artist who suffered from congenital syphilis, causing classic facial deformities, including the saddle nose. He went blind as a result of the condition. 

A lifetime of mercury

And here we come to the treatment of this awful condition. 

In the sixteenth and seventeenth centuries various herbal preparations were advocated. Guaiacum was used as was heartsease, or wild pansy. The main treatment, however, was mercury. The most usual way of using it was by using an ointment of calomel, which was rubbed on the chancres or ulcers.

Calomel is a powder of mercurous chloride. It certainly does have anti-inflammatory properties and may have helped, but the main disappearance of the lesions would be down to the natural history of the condition as I have outlined above. The lifetime of mercury could relate t people going back for more and more of it when different manifestations occurred.

Calomel could also be taken internally. It would produce what seemed to be a detoxification reaction. That is, the patient would salivate, perspire, feel dry, want to vomit and purge their bowels. Of course, they were not detoxifying at all, they were experiencing a reaction to the calomel. Yet there would be some anti-inflammation and that might shorten the stage that they were in, but it would not get rid of it. Nor would it stop them from being infective in either the primary or secondary stages.

Of course, since it was realised that sexual contact was the cause, although the way in which the disease was transferred from person to person was not realised, here was a tendency to treat the genital area itself. For men this might include having some mercuric compounds syringed up the urethra of the penis. This was certainly done in the treatment of gonorrhoea - of which we shall speak in a later article.

Following on from the idea of getting rid of a toxin it was also thought that you could sweat it out. People would be swaddled in a hot room to induce a high temperature and a perspiration reaction. Adding mercury to the equation, by heating it in the room to produce some mercury vapour for the patient to inhale and be bathed in.

Decades later, doctors even started to infect patients with malaria because the high fevers were found to benefit those patients with tertiary syphilis. There was a significant risk in this, of course, since malaria is a dangerous condition. The justification was that by then it had been discovered that quinine could counter malarial symptoms.

Later in the nineteenth century it was discovered that other metals and their salts also had anti-inflammatory actions. Interestingly, arsenic was used in small doses in syphilis and in many other conditions. Indeed, in 1908 the  first truly effective drug against syphilis was an an organo-arsenical salt, called Salvarsan.



The causative organism
The germ theory that developed in the closing decades of the nineteenth century was followed by discoveries of the infecting organism in many conditions. In 1905 Fritz Schaudinn and Erich Hoffman discovered that a microscopic organism called Treponema pallidum caused syphilis. It is a spirochete, which is a type of spiral shaped bacterium. Then in 1906 August Paul von Wassermann developed his test, the Wasserman Reaction, or WR, which gave doctors a means of testing for the condition. It is still in use today.

Treponema pallidum - the spiral shaped organisms that cause syphilis


In 1908 Salvarsan was developed by Sahachiro Hata and patients suffering from this horrid condition had some hope of cure.

Syphilis today
It remains to be said that syphilis is still a threat to the health of many millions of people throughout the world, although some 90 per cent occur in the developing world. Prevention is still the best answer, which means people practising safe sex, or abstaining.

To be continued......