The Great Deceiver

Guy de Maupassant was arguably one of the greatest writers of his generation. His short stories and novels continue to mesmerize readers with his gripping description of human nature at its best and worst. By the 1880s, his health began to decline and his writing became darker and more shocking. As his depression deepened, his friends began to be concerned by his odd behaviour. It isn't known exactly when Maupassant contracted syphilis, but the progression of the disease followed the classic pattern almost exactly. By 1892, he had become delusional and, believing that flies were devouring his brain, attempted to shoot himself. When that failed, he then attempted to drive a letter opener into his throat. He was committed to a private asylum on the following day and died raving just a few months later. He was 43 at the time of his death, a phenomenal writing career cut tragically short.

Although its exact origin continues to be a matter of speculation, syphilis (caused by the spirochete Treponema pallidum) was first identified in the early sixteenth century and the number of cases swelled to epidemic proportions quickly. Being a sexually transmitted disease added to the stigma and helped ensure that its sufferers remained marginalized by mainstream medicine. The actual incidence of syphilis cases remains a matter of speculation but what is clear is that there was a tremendous upsurge in admission to insane asylums in most of the industrialized world between 1800 and 1900. While different diagnoses were given to these countless patients, one of the most common causes appears to have been syphilis (earning it the title of "The Great Deceiver"). Initial infection of syphilis is often ignored following a minor flare-up of symptoms (which may well go unnoticed) but the syphilis spirochetes can remain in the bloodstream for decades afterward. While syphilis sufferers may never develop symptoms, the spirochetes often end up attacking the meningeal lining of the central nervous system. It is during this phase (also known as neurosyphilis) that the disease can manifest itself in various psychiatric symptoms. Grandiosity and mania are common features and were often misdiagnosed in the 19th century. The illness would then progress either towards primary infection of the spinal cord (tabes dorsalis) with bizarre gait and pain to the abdomen or primary infection of the brain. It was in this form (also known as General Paresis of the Insane) that dementia and psychosis would become most prominent. For every case in which a clear diagnosis could be made (such as Maupassant), there were countless others in which syphilis involvement could be only suspected (there were no reliable tests available). The disease was always terminal.

It was not until 1906 that the first truly effective test for syphilis was developed and the true incidence of syphilis cases in psychiatric hospitals was properly recognized. While syphilis cases were treated by different means (including being infected with malaria, a "fever cure" that earned its discoverer a Nobel prize in medicine), it was not until 1910 that a Berlin physician named Paul Ehrlich and his team developed a compound named "Salvarsan" that blocked the development of syphilis. Salvarsan, an arsenic compound, represented a way of preventing syphilis from advancing to the neurosyphilis stage but was only only a preventative, not a cure. It was with the discovery of penicillin in 1929 (which was not actually used to treat syphilis until 1943) that the trend towards psychiatric hospitalization of neurosyphilis cases began to be reversed. In the decades that followed, neurosyphilis cases became relatively rare and easily treated.

And yet...

Neurosyphilis hasn't gone away. In fact, there has been an upsurge of cases since the 1980s as antibiotic-resistant strains of syphilis become more widespread. It has also become more common in HIV-positive cases and may consititute one of the primary causes of HIV dementia. Neurosyphilis is also a likely factor in the skyrocketing incidence of HIV dementia that has been observed in many Third World countries where AIDS remains unchecked and proper medications are in short supply

We definitely haven't seen the last of the Great Deceiver.