In the early 20th century, a scourge like no other had taken root deep in society. Early symptoms were relatively mild — rash, painless lumps, fever and ulcers — but months, even years later people succumbed to the disease’s deadly embrace. It was so deadly that sufferers happily signed on to barbaric tortures disguised as treatment just to sidestep what they knew to be a painful, protracted death.
I am talking, of course, about syphilis.
The story of syphilis in the early 20th century is an amazing journey from complete unknown to virtually-perfect cure. It went from a scourge that was incurable even with the most toxic remedies in the late 1800s to a simple injection just 50 years later. From deadly disease to mild annoyance in less time than it takes to build a Spanish cathedral.
In short, it was a medical miracle.
The advent of penicillin may have put a halt to all of the insane-sounding treatments that we tried for syphilis, but the legacy of miracle cures lives on. The 20th century was littered with diseases that suddenly went from death sentences to an uncomfortable conversation with your GP.
The problem is that 100 years’ later we are still looking for the next miraculous breakthrough.
And it’s looking less and less likely that we will ever find one.
At the advent of the 20th century, syphilis was a hot topic. No longer the killer pandemic of the 16- and 1700s, it was nevertheless a debilitating disease that was almost ubiquitous with insanity and death. Many — if not most — psychiatric hospitals had entire wards full of people experiencing the depredations of tertiary syphilis, watching in horror as their faces melted off and they slowly slid into paralytic insanity.
It was, by all accounts, a bit unpleasant.
And to make matters worse, the only commonly-used treatments were almost as bad as the disease itself. Part of the problem was that syphilis was primarily considered a moral failing — since it’s primarily sexually transmitted, and the only people who have sex outside of marriage are evil sinners, the major problem was a lack of self-control. Things like public whippings were not uncommon, and supposed ‘cures’ often consisted of literal tortures, with sufferers burned, bled, and even drowned to punish them for their sins. And to top it all off, the only medicine available was mercury.
Yes, the poisonous kind.
Needless to say, being burned, drowned, bled and poisoned did not actually cure syphilis.
So what happened? What caused the tide to turn?
Arsenic Isn’t All That Much Better
When your options are a) die a horrible death or b) eat mercury for years and then die a horrible death, you’ll try just about anything else.
Enter, arsenic therapy.
Arsenic is well-known for being a nasty poison that can easily kill you, but one of its most interesting applications was as the first modern drug. Although we knew that arsenic could kill syphilis for some time, it wasn’t until 1907 that a preparation was produced that wouldn’t be fatal to the person as well as the disease. People around the world were soon enjoying the slightly-better-than-syphilis effects of modern(ish) medicine.
At least they weren’t insane and dying.
The only issue was that, well, arsenic is still a poison. Even this ‘safe’ version could still kill you, causing your cells to wither and die, with side-effects both numerous and seriously nasty. It was better than mercury — which, remember, didn’t work at all — but it was still a horribly painful way to try and cure a disease.
Which led researchers to look for a safer method. In 1917, they found what they had been looking for.
When Malaria Is Better
A doctor called Julius Wagner-Juaregg had been trying to cure syphilis for some time. While the arsenic treatments were now widely used and usually quite effective at early-stage syphilis, for people who reached the latter stages of the disease — where the whole body is infected — there were no effective cures.
And, remember: arsenic. Not the nicest stuff.
But Wagner-Juaregg had heard a number of interesting case-studies: people who were psychotic and raving, got infected with malaria, and came out of their fevers miraculously sane. In 1917, he decided to test this theory by injecting malarial blood into nine of his patients.
Instead of dying, they were miraculously cured.
Well, not all of them. Of the nine, one died, two stayed psychotic, four improved only to relapse, and two actually got better.
But you have to remember: the cure rate for late-stage syphilis at this point was virtually 0. Going from that to almost 20% totally cured was nothing short of miraculous. It was enough to win Wagner-Juaregg the 1927 Nobel prize for medicine and physiology, and to almost overshadow his later fulsome support of the Nazi party*.
In the intervening decades, scientists kept researching the cause of this amazing recovery. It was eventually hypothesized that the fever was the main reason that people recovered — perhaps the syphilis was literally ‘burned out’ of the brain by malaria — and so a variety of methods of inducing high fevers were tried out. This actually led to the first trials of electroshock therapy; the idea was that passing an electrical current through the brain would have the same effect as a high fever, and amazingly enough people seemed to respond.
But electroshock therapy was still pretty awful, particularly back in the 30s. Which brings us to one of humanity’s most fortunate accidents.
Penicillin could arguably be described as one of the greatest of all human discoveries**. It’s certainly the hero in our story. In 1907, syphilis went from an untreatable death sentence to a treatable but still horrifying disease. In 1917, late-stage syphilis was finally no longer the end: suddenly, there was hope. But when penicillin came around in 1943, the game really changed.
Syphilis was suddenly a truly curable disease.
Having an infection went from a lifetime of anguish to a quick series of antibiotics. You could walk into a doctor’s office and walk out cured.
It was, quite literally, a miracle.
Almost 100 years on and the story of syphilis has become the holy grail of medical advances. Where before doctors looked for small improvements, we now look for mammoth leaps. Instead of minor increments, everyone wants the silver bullet that will banish a disease once and for all. We look back on the medical advancements of the 20th century — antibiotics, anesthesia, transplant surgery — and try to apply the same rubric to the ailments of our brave new world.
Sometimes the lessons we take from history are the wrong ones.
You see it every time someone writes a blaring headline in a tabloid newspaper. There’s never talk of tiny steps forward. The cry of the modern media is “Miracle Cure”, “Medical Breakthrough”, “Life-Saving Therapy”, and it’s not just because their job is to get your attention. We all want to see diseases wiped out, not slowly improved on.
But the problem is, there are no miracle cures. The immense breakthroughs of the 20th century are long gone, and we are increasingly left with diseases for which we know the causes and the solutions, and none of them are easy.
Take diabetes. Diabetes has become one of the biggest sources of poor health in the world. Depending on where you live, between 1 in 20 and 1 in 10 people that you know will probably have diabetes.
And the most recent medical research into diabetes is…not that impressive. I’m not belittling the science — people are discovering amazing and wonderful things — but the end results are basically minor improvements on already-existing drugs. Compare that to the early 1900s, when diabetes went from a death sentence to a treatable condition with the invention of injectable insulin.
Which brings us to the most depressing part of this story.
We can already stop most diabetes. It’s a largely preventable disease. Simple population programs aimed at weight management have been shown to make a huge dent on diabetes in the community. Things like mass education, sugar taxes, citywide cycle paths, and better walkability could halt the diabetes epidemic in its tracks.
Basically, you tell people to live healthily and then make it easy for them to do so.
This is simple, yes, but horribly expensive and politically difficult. It’s not a pill, you can’t take two daily with food and medicate diabetes away. It will take massive transformations to make a dent in the rate of diabetes, because the basic changes we need like “make walking/cycling easier than driving” take billions of dollars and decades of work.
And really, who wants to put in the effort? It sounds grimy and dirty and full of sweaty arses. Much better to take a pill and wish our problems away.
This is true of so many of our modern medical disasters. Rising rates of asthma? Let’s fix air pollution. Heart disease? We need to change an entire world’s eating habits. Depression? Lung cancer? COPD? The list of problems that we already know how to (largely) prevent goes on.
There is no magic wand.
But that doesn’t stop us from wanting one.
We’ve reached the end. This is where I tell you how you can fix it. I’ll give you a simple, one-line message and you can go away with a cheerful veneer of happiness knowing in your heart that it can’t be that simple.
Which is bollocks, frankly.
There is no easy solution. We are all culpable in the inane cycle that sees every tiny step forward as a medical marvel. Every time someone writes an article that takes a mundane study in mice and declares it to be a breakthrough in the war on cancer, we get further away from the truth.
Much better to take a pill and wish our problems away
It’s been almost a century since we cured syphilis. It hasn’t gone away, but the problems that it causes have gone from a terrible blight to a manageable annoyance. Dying from syphilis is now more about access to medical services than it is about the disease itself.
But the message that we can cure anything lives on. We hope and strive for an unreachable goal, a perfect pill that will make all our problems disappear, even as the real solutions lie quietly ignored in the too-hard basket. We greet every slightly positive study with an effusive welcome, write absurdly happy articles proclaiming its endless wonder, all the while ignoring the endless evidence we have that that’s not how it works at all.
Broccoli cures cancer. Broccoli causes cancer. Barley pasta will prevent heart attacks. These are the brainless imaginings of a collective consciousness that craves a quick fix.
There haven’t been any miracles in medicine for decades. The low-hanging fruit of the 20th century are long gone. Modern progress is less about definitive cures and more about restructuring our society so that less people get sick in the first place.
So next time someone talks about a miracle cure, take a skeptical view. Whether it’s a new fad diet that apparently rids you of all body fat and makes you look like Pete Evans***, or a new therapy that’s going to cure all cancer in 10 years’ time, take a step back and evaluate.
Chances are it’s not as amazing as it first appears.
*Yes, despite pioneering a cure for a terrible disease, Wagner-Juaregg also happily endorsed Hitler and his murdery government. It turns out that even great doctors can be horrendous people.
**It depends, of course, on your definition of discovery. Penicillin would probably tell us that it’s been around for donkey’s years thank, you very much, if it could talk, which it can’t, so I guess we can say whatever we like.
***Note: this is a negative side-effect. It’s unsure whether Pete himself wants to look like Pete Evans.