A few weeks ago I attended the annual BSHS conference at the University of St Andrew’s and, like a number of other delegates, I am now blogging about some of the work I presented. I know it has taken awhile to put this post together and my only excuse is that, in the interim, I have been somewhat preoccupied with submitting my PhD thesis.
To premise, the story of English syphilisation is only one part of a much larger and complex debate encompassing many important issues and questions including the treatability of syphilis, the ethics of human experimentation in the nineteenth century, and nascent ideas of disease transmission. Although conducted against the backdrop of the notorious Contagious Diseases Acts, English syphilisation has been largely forgotten by historians. Yet it is an important case study.
I shall be thinking more about these and other related issues as I turn this paper into an article for publication so do please let me know if you have any comments or suggestions.
So, what exactly was syphilisation?
Syphilisation was an experimental process requiring the repeated inoculation of syphilitic matter in persons already suffering from syphilis. Syphilisation commenced by making three punctures on either side of the chest and inserting infective matter that was taken from a primary syphilitic ulcer or from the artificial sores produced in a person already undergoing syphilisation. If these punctures developed pustules after three days, three more inoculations on the torso were made from these original pustules. The whole procedure was then repeated (…and repeated …and repeated …and repeated) each time taking infective matter from the last formed pustules, until a positive reaction could no longer be produced on the torso of the patient. However, syphilisation did not end there. Once the patient’s torso had been thoroughly syphilised, the whole procedure was repeated on the arms and thighs until, again, no positive reaction could be produced.
It was a procedure pioneered in the 1840s by French clinician, Joseph-Alexandre Auzias-Turenne. Drawing upon the theory that underpinned Jenner’s smallpox vaccine, Auzias-Turenne inoculated his subjects with successively weaker doses of syphilitic matter. The theory was that, eventually, the subject would become immune to reinfection. This infective matter could be taken from their own sores or those of other syphilitic patients. However, the Paris Academy of Medicine was highly critical when Auzias-Turenne presented his findings. Debate raged and in the end, the experimental inoculation of human subjects was criticised as a gross breach of accepted ethical practice and the entire process of syphilisation was debunked (by the French, at any rate).
(For more about these French experiments see the work of, among others, Alex Dracobly)
Yet this did not stop James Lane and George Gascoyen, surgeons to the London Lock Hospital, from experimenting on twenty-seven male and female patients between 1865 and 1867. It took between three and four months for each patient to be syphilized. Each received between 102 and 468 inoculations. It took, on average, three weeks for the sores produced from inoculation to heal and every patient was permanently scarred. It was hoped that the result of these many painful and disfiguring inoculations would be local and general immunity against reinfection.
How do we know this? Because in 1867 Lane and Gascoyen presented their findings to the Medico-Chirurgical Society. The following diagram, taken from their report, gives you some idea of how extensively patients were inoculated.
Apart from their report there is little sense of patient experiences of syphilisation. We see patients only through the clinical gaze of Lane and Gascoyen. Some chose to terminate their treatment and leave the Lock Hospital prematurely, suggesting that they were able to exercise some autonomy over their treatment. But it must be remembered that these patients were suffering the distressing effects of primary, secondary, or tertiary-stage syphilis. Many nineteenth-century patients so feared the debilitating and dangerous side effects of mercurial treatments that they were prepared, perhaps out of desperation, to try other, less orthodox therapies.
The rise of germ theory and the identification of the causative microorganism of syphilis, the spirochæte, in 1905, revolutionised the way clinicians thought about the pathology, aetiology, and transmission of syphilis. Lane and Gascoyen’s experiments demonstrated a nascent awareness of the effects of syphilis, and the body’s ability to fight infection, at a pathogenic level. The very act of inoculation demonstrated that Lane, Gascoyen, and the clinicians who had preceded them, had already begun to think of infection as being caused by the transmission of a pathogen in the form of infective matter. The idea of inoculation as a potential reactive therapeutic mechanism persisted. It did, for instance, have important implications for vaccine therapy, including antigonococcal vaccines, that were being developed in the first decade of the twentieth century and were responding to infection at a microbial level.
In the end, syphilisation raised more questions than it answered. Lane and Gascoyen were divided over the question of whether syphilisation had any tangible therapeutic benefit. But they both agreed that any benefit derived from syphilisation ‘would not sufficiently compensate’ for its protractedness, painfulness, and the permanent scarring inflicted upon patients.
Both Lane and Gascoyen admitted that syphilisation ‘evoked extreme hostility’ in England and had therefore never previously been thoroughly trialled. Yet in contrast to the flood of French criticism that followed Auzias-Turenne’s experiments, their work appears to have gone largely unremarked in the English medical press. The fact that they were able to perform such experiments, and the fact that these experiments attracted such little professional consternation, highlighted a lack of nineteenth-century regulation over experimental practices and a lack of ethical consideration beyond a basic awareness of the need to obtain patient consent.