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Bulletin of the History of Medicine 78.2 (2004) 493-494
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Deborah Hayden's book begins with an intriguing, presumably fictional account of one person's subjective experience of syphilis during the nineteenth century: "patched with leeches, shocks and spas" (p. xii), the narrator describes the emotional upheaval and loneliness of life with the disease. A skillful writer, Hayden sets out to explore how people reacted to their experience of this stigmatized disease before the age of antibiotics. Her goal is worthwhile and her prose graceful, but her research and conceptualization of the study are sufficiently flawed to undermine the book's usefulness to either a general audience or specialists in medicine or history.
The book is divided into four parts: the disease, the nineteenth century, the twentieth century, and finally, "pox gallery." In part 1, Hayden explains the clinical symptoms of syphilis, as well as its history from the first European epidemic of 1494-96 through the invention of antibiotics. She seems unaware of the problems of studying syphilis in the early modern period, foremost among them that the medical diagnosis of "syphilis" did not exist at the time. Furthermore, she takes sixteenth-century statements about the disease literally, rather than examining the cultural context of disease and health. Instead of explaining that Europeans associated Jews and prostitutes with disease in general, she refers to reports about Jews bringing typhus and about prostitutes in Naples spreading syphilis as simple observations. Finally, she cites only English-language scholarship, virtually all secondary sources—a serious limitation for a book that focuses primarily on continental Europe. As a history of syphilis and an introduction to [End Page 493] the disease her book is a step backward, for it ignores the complexities of interpretation and presents myths and assertions as facts.
The heart of the book is part 2 on the nineteenth century, since the original impetus for Hayden's research came from reading about Nietzsche's struggles with syphilis. Her approach is biographical, with separate chapters devoted to an assortment of famous people, from Franz Schubert to Abraham Lincoln to Vincent van Gogh—the common thread being the possibility of their having been infected with syphilis. To her credit, she does acknowledge the difficulty of providing a retrospective diagnosis of syphilis. Difficulties aside, however, she then proceeds to provide medical histories of each individual, concluding always that syphilis was at least a possible diagnosis. The result is a series of banal miniportraits, in which the subject's creativity and reactions disappear behind the medical diagnosis.
Although Hayden acknowledges that syphilis alone does not explain the art and literature created by these individuals, her refusal to place her subjects in a broader context creates the impression that syphilis was the only influence on their lives. Thus, Schubert leaves us with a musical record of what it was like to live with syphilis in "his death-ridden, deeply brooding, romantic music" (p. 96); and Robert Schumann, of the fine line between madness and genius. Absent from Hayden's analysis is the impact of major cultural movements, notably romanticism. More problematic is her "pox gallery," a list of famous people rumored to have had syphilis (Ivan the Terrible, Goya), which contributes nothing to her overall argument and relies on rumors recorded by others.
Ultimately, Hayden fails to explain how her subjects reacted to syphilis, since many of them were either unaware that they had the disease (if they in fact had it), or thought they had been cured, or left no record of their reactions. But she does succeed in the important task of reminding readers that syphilis infected large numbers of people before the age of antibiotics: despite its social stigma, the disease was steadfastly egalitarian, infecting the ranks of the high-born as well as social outcasts.