Editing Syphilis (section)

=== Origin, spread and discovery ===
[[Image:Rembrandt Harmensz. van Rijn 095.jpg|thumb|Portrait of [[Gerard de Lairesse]] by [[Rembrandt van Rijn]], circa 1665–67, oil on canvas. De Lairesse, himself a painter and art theorist, had congenital syphilis that deformed his face and eventually blinded him<ref>''[[Metropolitan Museum of Art|The Metropolitan Museum of Art Bulletin]]'', Summer 2007, pp. 55–56.</ref>]]

[[Paleopathology|Paleopathologists]] have known for decades that syphilis was present in the Americas before European contact.<ref>{{Cite journal |last=Rothschild |first=B. M. |date=15 May 2005 |title=History of Syphilis |url=https://academic.oup.com/cid/article-lookup/doi/10.1086/429626 |journal=Clinical Infectious Diseases |language=en |volume=40 |issue=10 |pages=1454–1463 |doi=10.1086/429626 |pmid=15844068 |issn=1058-4838}}</ref><ref>Baker, B. J. and Armelagos, G. J., (1988) "The origin and antiquity of syphilis: Paleopathological diagnosis and interpretation". ''Current Anthropology'', 29, 703–738. https://doi.org/10.1086/203691. Powell, M. L. & Cook, D. C. (2005) ''The Myth of Syphilis:'' The natural history of treponematosis in North America. Gainesville, FL: University Press of Florida. Williams, H. (1932) "The origin and antiquity of syphilis: The evidence from diseased bones, a review, with some new material from America". ''Archives of Pathology'', 13: 779–814, 931–983.1932).</ref> The situation in [[Afro-Eurasia]] has been murkier and caused considerable debate.<ref>Dutour, O., et al. (Eds.). (1994). L'origine de la syphilis in Europe: avant ou après 1493? Paris, France: Éditions Errance. Baker, B. J. et al. (2020) "Advancing the Understanding of Treponemal Disease in the Past and Present". ''Yearbook of Physical Anthropology'' 171: 5–41. [[doi: 10.1002/ajpa.23988]]. Harper, K. N., Zuckerman, M. K., Harper, M. L., Kingston, J. D., Armelagos, G. J. (2011) "The origin and antiquity of syphilis revisited: An appraisal of Old World Pre-Columbian evidence of treponemal infections". ''Yearbook of Physical Anthropology'', 54: 99–133. https://doi.org/10.1002/ajpa.21613.</ref> According to the Columbian theory, syphilis was brought to Spain by the men who sailed with [[Christopher Columbus]] in 1492 and spread from there, with a serious epidemic in [[Naples]] beginning as early as 1495. Contemporaries believed the disease sprang from American roots, and in the 16th century physicians wrote extensively about the new disease inflicted on them by the returning explorers.<ref>For an introduction to this literature see Quétel, C. (1990). ''History of Syphilis''. Baltimore, MD: The Johns Hopkins University Press.</ref>

Most evidence supports the Columbian origin hypothesis.<ref>{{Cite web |last=Hemarjata |first=Peera |date=17 June 2019 |title=Revisiting the Great Imitator: The Origin and History of Syphilis |url=https://asm.org/Articles/2019/June/Revisiting-the-Great-Imitator,-Part-I-The-Origin-a |access-date=27 November 2023 |website=[[American Society for Microbiology]] |language=en}}</ref> However, beginning in the 1960s, examples of probable [[treponematosis]]—the parent disease of syphilis, [[Nonvenereal endemic syphilis|bejel]], and [[yaws]]—in skeletal remains shifted the opinion of some towards a "pre-Columbian" origin.<ref>Early work includes Henneberg, M., & Henneberg, R. J. (1994), "Treponematosis in an ancient Greek colony of Metaponto, southern Italy, 580-250 BCE" and Roberts, C. A. (1994), "Treponematosis in Gloucester, England: A theoretical and practical approach to the Pre-Columbian theory". Both in O. Dutour, et al. (Eds.), ''L'origine de la syphilis in Europe: avant ou après 1493?'' (pp. 92-98; 101–108). Paris, France: Éditions Errance.</ref><ref>{{Cite web |last=Salmon |first=Marylynn |date=13 July 2022 |title=Manuscripts and art support archaeological evidence that syphilis was in Europe long before explorers could have brought it home from the Americas |url=http://theconversation.com/manuscripts-and-art-support-archaeological-evidence-that-syphilis-was-in-europe-long-before-explorers-could-have-brought-it-home-from-the-americas-182114 |access-date=27 November 2023 |website=The Conversation |language=en-US}}</ref> A 2024 study published in ''[[Nature (journal)|Nature]]'' supported an emergence postdating human occupation in the Americas.<ref>{{Cite journal |last1=Barquera |first1=Rodrigo |last2=Sitter |first2=T. Lesley |last3=Kirkpatrick |first3=Casey L. |last4=Ramirez |first4=Darío A. |last5=Kocher |first5=Arthur |last6=Spyrou |first6=Maria A. |last7=Couoh |first7=Lourdes R. |last8=Talavera-González |first8=Jorge A. |last9=Castro |first9=Mario |last10=von Hunnius |first10=Tanya |last11=Guevara |first11=Evelyn K. |last12=Hamilton |first12=W. Derek |last13=Roberts |first13=Patrick |last14=Scott |first14=Erin |last15=Fabra |first15=Mariana |date=2024-12-18 |title=Ancient genomes reveal a deep history of treponemal disease in the Americas |journal=Nature |volume=640 |issue=8057 |language=en |pages=186–193 |doi=10.1038/s41586-024-08515-5 |pmid=39694065 |issn=1476-4687|doi-access=free |pmc=11964931 }}</ref>

When living conditions changed with urbanization, elite social groups began to practice basic hygiene and started to separate themselves from other social tiers. Consequently, treponematosis was driven out of the age group in which it had become endemic. It then began to appear in adults as syphilis. Because they had never been exposed as children, they were not able to fend off serious illness. Spreading the disease via sexual contact also led to victims being infected with a massive bacterial load from open sores on the genitalia. Adults in higher socioeconomic groups then became very sick with painful and debilitating symptoms lasting for decades. Often, they died of the disease, as did their children who were infected with congenital syphilis. The difference between rural and urban populations was first noted by Ellis Herndon Hudson, a clinician who published extensively about the prevalence of treponematosis, including syphilis, in times past.<ref>Hudson, E. H. (1946). "A unitarian view of treponematosis". ''American Journal of Tropical Medicine and Hygiene'', 26 (1946), 135–139. https://doi.org/10.4269/ajtmh.1946.s1-26.135; "The treponematoses—or treponematosis?" ''The British Journal of Venereal Diseases'', 34 (1958), 22–23; "Historical approach to the terminology of syphilis". ''Archives of Dermatology'', 84 (1961), 545–562; "Treponematosis and man's social evolution". ''American Anthropologist'', 67(4), 885–901. [[doi:10.1001/archderm.1961.01580160009002]]. On status see also Marylynn Salmon, ''Medieval Syphilis and Treponemal Disease'' (Leeds: Arc Humanities Press), 8, 30-33.</ref> The importance of bacterial load was first noted by the physician Ernest Grin in 1952 in his study of syphilis in Bosnia.<ref>Grin, E. I. (1952) "Endemic Treponematosis in Bosnia: Clinical and epidemiological observations on a successful mass-treatment campaign". ''Bulletin of the World Health Organization'', 7: 11-25.</ref>

The most compelling evidence for the validity of the pre-Columbian hypothesis is the presence of syphilitic-like damage to bones and teeth in medieval skeletal remains. While the absolute number of cases is not large, new ones are continually discovered, most recently in 2015.<ref>Walker, D., Powers, N., Connell, B., & Redfern, R. (2015). "Evidence of skeletal treponematosis from the Medieval burial ground of St. Mary Spital, London, and implications for the origins of the disease in Europe". ''American Journal of Physical Anthropology'', 156, 90–101. https://doi.org/10.1002/ajpa.22630 and Gaul, J.S., Grossschmidt, K., Budenbauer, C., & Kanz, Fabian (2015). "A probable case of congenital syphilis from pre-Columbian Austria". ''Anthropologischer Anzeiger'', 72, 451–472. [[DOI: 10.1127/anthranz/2015/0504]].</ref> At least fifteen cases of acquired treponematosis based on evidence from bones, and six examples of congenital treponematosis based on evidence from teeth, are now widely accepted. In several of the twenty-one cases the evidence may also indicate syphilis.<ref>They include Henneberg, M., & Henneberg, R. J. (1994). "Treponematosis in an ancient Greek colony of Metaponto, southern Italy, 580-250 BCE". In O. Dutour, et al. (Eds.), ''L'origine de la syphilis in Europe: Avant ou après 1493?'' (pp. 92–98). Paris, France: Éditions Errance. Stirland, Ann. "Evidence for Pre-Columbian Treponematosis in Europe". In Dutour, O., Pálfi, G., Bérato, J., & Brun, J. -P. (Eds.). (1994). ''L'origine de la syphilis in Europe: avant ou après 1493?'' Paris, France: Éditions Errance, and ''Criminals and Paupers: The Graveyard of St. Margaret Fyebriggate in combusto, Norwich''. With Contributions from Brian Ayers and Jayne Brown. East Anglian Archaeology 129. Dereham: Historic Environment, Norfolk Museums and Archaeology Service, 2009. Erdal, Y. S. (2006). "A pre-Columbian case of congenital syphilis from Anatolia (Nicaea, 13th century AD)". ''International Journal of Osteoarchaeology'', 16, 16–33. https://doi.org/10.1002/oa.802. Cole G. and T. Waldron, "Apple Down 152: a putative case of syphilis from sixth century AD Anglo-Saxon England". ''American Journal of Physical Anthropology'' 2011 Jan;144(1):72-9. [[doi: 10.1002/ajpa.21371]]. Epub 2010 Aug 18. PMID 20721939. Roberts, C. A. (1994). "Treponematosis in Gloucester, England: A theoretical and practical approach to the Pre-Columbian theory". In O. Dutour, et al. (Eds.), ''L'origine de la syphilis in Europe: avant ou après 1493?'' (pp. 101–108). Paris, France: Éditions Errance.</ref>

[[File:Medieval illumination of Christ being tortured.jpg|thumb|A healthy man and a diseased man torture [[Jesus|Christ]] before [[Crucifixion of Jesus|his crucifixion]]. From a French [[book of hours]], {{circa|1375–1435}}]]

In 2020, a group of leading paleopathologists concluded that enough evidence had been collected to prove that treponemal disease, almost certainly including syphilis, had existed in Europe prior to the voyages of Columbus.<ref>Baker, B.J. et al. (2020) "Advancing the Understanding of Treponemal Disease in the Past and Present". ''Yearbook of Physical Anthropology'' 171: 5–41. [[doi: 10.1002/ajpa.23988]].</ref> There is an outstanding issue, however. Damaged teeth and bones may seem to hold proof of pre-Columbian syphilis, but there is a possibility that they point to an endemic form of treponemal disease instead. As syphilis, bejel, and yaws vary considerably in mortality rates and the level of human disease they elicit, it is important to know which one is under discussion in any given case, but it remains difficult for paleopathologists to distinguish among them. (The fourth of the treponemal diseases is [[Pinta (disease)|pinta]], a skin disease and therefore unrecoverable through paleopathology.) Ancient [[DNA]] (aDNA) holds the answer, because just as only aDNA suffices to distinguish between syphilis and other diseases that produce similar symptoms in the body, it alone can differentiate [[Spirochaete|spirochetes]] that are 99.8 percent identical with absolute accuracy.<ref>Fraser, C. M., Norris, S. J., Weinstock, G. M., White, O., Sutton, G. G., Dodson, R., ... Venter, J. C. (1998). "Complete genome sequence of ''Treponema pallidum'', the syphilis spirochete". ''Science'', 281(5375), 375–388. https://doi.org/10.1371/journal.pntd.0001832. Čejková, D., Zobaníková, M., Chen, L., Pospíšilová, P., Strouhal, M., Qin, X., ... Šmajs, D. (2012). "Whole genome sequences of three ''Treponema pallidum'' ssp. ''pertenue'' strains: yaws and syphilis treponemes differ in less than 0.2% of the genome sequence". ''PLoS Neglected Tropical Diseases'', 6(1), e1471. [[doi: 10.1371/journal.pone.0015713]]. Mikalová, L., Strouhal, M., Čejková, D., ''Zobaníková'', M., Pospíšilová, P., Norris, S. J., ... Šmajs, D. (2010). "Genome analysis of ''Treponema pallidum'' subsp. ''pallidum'' and subsp. ''pertenue'' strains: Most of the genetic differences are localized in six regions". ''PLoS ONE'', 5, e15713. doi.org/10.1371/journal.pone.0015713. Štaudová, B., Strouhal, M., Zobaníková, M., Čejková, D., Fulton, L. L., Chen, L., ... Šmajs, D. (2014). "Whole genome sequence of the ''Treponema pallidum'' subsp. ''endemicum'' strain Bosnia A: The genome is related to yaws treponemes but contains few loci similar to syphilis treponemes". ''PLoS Neglected Tropical Diseases'', 8(11), e3261. https://doi.org/10.1371/journal.pntd.0003261.</ref> Progress on uncovering the historical extent of syndromes through aDNA remains slow, however, because the bacterium responsible for treponematosis is rare in skeletal remains and fragile, making it notoriously difficult to recover and analyse. Precise dating to the medieval period is not yet possible but work by Kettu Majander et al. uncovering the presence of several different kinds of treponematosis at the beginning of the early modern period argues against its recent introduction from elsewhere. Therefore, they argue, treponematosis—possibly including syphilis—almost certainly existed in medieval Europe.<ref>Majander, K., Pfrengle S., Kocher, A., ..., Kühnert, J. K., Schuenemann, V. J. (2020), "Ancient Bacterial Genomes Reveal a High Diversity of ''Treponema pallidum'' Strains in Early Modern Europe". ''Current Biology'' 30, 3788–3803. Elsevier Inc. [[doi: 10.1016/j.cub.2020.07.058]].</ref>

Despite significant progress in tracing the presence of syphilis in past historic periods, definitive findings from paleopathology and aDNA studies are still lacking for the medieval period. Evidence from art is therefore helpful in settling the issue. Research by Marylynn Salmon has demonstrated that deformities in medieval subjects can be identified by comparing them to those of modern victims of syphilis in medical drawings and photographs.<ref>''See her Medieval Syphilis and Treponemal Disease'' (Leeds: Arc Humanities Press, 2022), 61-79.</ref> One of the most typical deformities, for example, is a collapsed nasal bridge called [[saddle nose]]. Salmon discovered that it appeared often in [[Illuminated manuscript|medieval illuminations]], especially among the men tormenting Christ in scenes of the crucifixion. The association of saddle nose with evil is an indication that the artists were thinking of syphilis, which is typically transmitted through sexual intercourse with promiscuous partners, a mortal sin in medieval times.

It remains mysterious why the authors of medieval medical treatises so uniformly refrained from describing syphilis or commenting on its existence in the population. Many may have confused it with other diseases such as leprosy ([[Leprosy|Hansen's disease]]) or [[elephantiasis]]. The great variety of symptoms of treponematosis, the different ages at which the various diseases appear, and its widely divergent outcomes depending on climate and culture, would have added greatly to the confusion of medical practitioners, as indeed they did right down to the middle of the 20th century. In addition, evidence indicates that some writers on disease feared the political implications of discussing a condition more fatal to elites than to commoners. Historian Jon Arrizabalaga has investigated this question for [[Castile (historical region)|Castile]] with startling results revealing an effort to hide its association with elites.<ref>Arrizabalaga, Jon. "The Changing Identity of the French Pox in Early Renaissance Castile". In ''Between Text and Patient: The Medical Enterprise in Medieval and Early Modern Europe'', edited by Florence Eliza Glaze and Brian K. Nance, 397–417. Florence: SISMEL, 2011.</ref>

The first written records of an outbreak of syphilis in Europe occurred in 1495 in [[Naples|Naples, Italy]], during a French invasion ([[Italian War of 1494–98]]).<ref name="Music08" /><ref name="Orgin10" /> Since it was claimed to have been spread by French troops, it was initially called the "French disease" by the people of Naples.<ref>{{cite book|last1=Winters|first1=Adam|title=Syphilis|date=2006|publisher=Rosen Pub. Group|location=New York|isbn=9781404209060|page=17|url=https://books.google.com/books?id=1A0yMoQaMC0C&pg=PT16|access-date=15 September 2017|archive-date=18 August 2020|archive-url=https://web.archive.org/web/20200818163738/https://books.google.com/books?id=1A0yMoQaMC0C&pg=PT16|url-status=live}}</ref> The disease reached [[London]] in 1497 and was recorded at St Bartholomew's Hospital as infecting 10 out of the 20 patients.<ref>Hidden Killers of the Tudor Home: The Horrors of Tudor Dentistry etc</ref> In 1530, the pastoral name "syphilis" (the name of a character) was first used by the Italian physician and poet [[Girolamo Fracastoro]] as the title of his [[Latin]] poem in [[dactylic hexameter]] ''[[Syphilis sive morbus gallicus]]'' (''Syphilis or The French Disease'') describing the ravages of the disease in Italy.<ref>{{cite book|last1=Dormandy|first1=Thomas|title=The worst of evils: man's fight against pain: a history|date=2006|publisher=Yale University Press|location=New Haven|isbn=978-0300113228|page=[https://archive.org/details/worstofevilsmans00dorm/page/99 99]|edition=Uncorrected page proof.|url-access=registration|url=https://archive.org/details/worstofevilsmans00dorm/page/99}}</ref><ref>{{cite book|author1=Anthony Grafton|title=New Worlds, Ancient Texts The Power of Tradition and the Shock of Discovery|date=March 1995|publisher=Harvard University Press|isbn=9780674618763|pages=159–194|chapter=Drugs and Diseases: New World Biology and Old World Learning}}</ref> In Great Britain it was also called the "Great Pox".<ref name="Old05">{{cite journal |last=Dayan|first=L|author2=Ooi, C |title=Syphilis treatment: old and new|journal=Expert Opinion on Pharmacotherapy|date=October 2005|volume=6|issue=13|pages=2271–80|pmid=16218887|doi=10.1517/14656566.6.13.2271|s2cid=6868863}}</ref><ref name="Euro04">{{cite journal|last=Knell|first=RJ|title=Syphilis in renaissance Europe: rapid evolution of an introduced sexually transmitted disease?|journal=Proceedings: Biological Sciences|date=7 May 2004|volume=271|pages=S174–6|pmid=15252975|doi=10.1098/rsbl.2003.0131|pmc=1810019|issue=Suppl 4}}</ref>

In the 16th through 19th centuries, syphilis was one of the largest public health burdens in [[prevalence]], symptoms, and disability,<ref name="de_Kruif_1932">{{cite book |author=de Kruif, Paul |author-link=Paul de Kruif |chapter=Ch. 7: Schaudinn: The Pale Horror |title=Men Against Death |publisher=Harcourt, Brace |location=New York |year=1932 |oclc=11210642 |chapter-url=https://books.google.com/books?id=IokwAAAAIAAJ&q=editions:IokwAAAAIAAJ |access-date=30 September 2020 |archive-date=28 August 2021 |archive-url=https://web.archive.org/web/20210828011939/https://books.google.com/books?id=IokwAAAAIAAJ&q=editions%3AIokwAAAAIAAJ |url-status=live }}</ref>{{rp|208–209}}<ref name="pmid_">{{cite journal |last1=Rayment |first1=Michael |last2=Sullivan |first2=Ann K |date=April 2011 |title="He who knows syphilis knows medicine"—the return of an old friend |journal=British Journal of Cardiology |volume=18 |pages=56–58 |url=https://bjcardio.co.uk/2011/04/he-who-knows-syphilis-knows-medicine-the-return-of-an-old-friend/ |department=Editorials |quote="He who knows syphilis knows medicine" said Father of Modern Medicine, Sir William Osler, at the turn of the 20th Century. So common was syphilis in days gone by, all physicians were attuned to its myriad clinical presentations. Indeed, the 19th century saw the development of an entire medical subspecialty – syphilology – devoted to the study of the great imitator, ''[[Treponema pallidum]]''. |access-date=7 April 2018 |archive-date=7 August 2020 |archive-url=https://web.archive.org/web/20200807164844/https://bjcardio.co.uk/2011/04/he-who-knows-syphilis-knows-medicine-the-return-of-an-old-friend/ |url-status=live }}</ref> although records of its true prevalence were generally not kept because of the fearsome and sordid status of [[sexually transmitted infections]] in those centuries.<ref name="de_Kruif_1932"/>{{rp|208–209}} According to a 2020 study, more than 20% of individuals in the age range 15–34 years in late 18th-century London were treated for syphilis.<ref>{{cite journal |last1=Szreter |first1=Simon |last2=Siena |first2=Kevin |title=The pox in Boswell's London: an estimate of the extent of syphilis infection in the metropolis in the 1770s† |journal=The Economic History Review |year=2020|volume=74|issue=2|pages=372–399 |doi=10.1111/ehr.13000|issn=1468-0289|doi-access=free}}</ref> At the time the [[causative agent]] was unknown but it was well known that it was spread sexually and also often from mother to child. Its association with sex, especially [[sexual promiscuity]] and [[prostitution]], made it an object of fear and revulsion and a taboo. The magnitude of its morbidity and mortality in those centuries reflected that, unlike today, there was no adequate understanding of its [[pathogenesis]] and no truly effective treatments. Its damage was caused not so much by great sickness or death early in the course of the disease but rather by its gruesome effects decades after infection as it progressed to [[neurosyphilis]] with [[tabes dorsalis]]. [[Mercury (element)|Mercury]] compounds and isolation were commonly used, with treatments often worse than the disease.<ref name="Old05"/>

The causative organism, ''Treponema pallidum'', was first identified by [[Fritz Schaudinn]] and [[Erich Hoffmann]], in 1905.<ref name=Schaudinn1905>{{cite journal| last1 = Schaudinn| first1 = Fritz Richard| author-link1 = Fritz Richard Schaudinn| last2 = Hoffmann| first2 = Erich| author-link2 = Erich Hoffmann| year = 1905| title = Vorläufiger Bericht über das Vorkommen von Spirochaeten in syphilitischen Krankheitsprodukten und bei Papillomen| trans-title = Preliminary report on the occurrence of Spirochaetes in syphilitic chancres and papillomas| journal = [[Arbeiten aus dem Kaiserlichen Gesundheitsamte]]| volume = 22| pages = 527–534| url = https://archive.org/stream/bub_gb_TPkAAAAAYAAJ#page/n535/mode/2up}}</ref> The first effective treatment for syphilis was [[arsphenamine]], discovered by [[Sahachiro Hata]] in 1909, during a survey of hundreds of newly synthesized organic [[arsenic]]al compounds led by [[Paul Ehrlich]]. It was manufactured and marketed from 1910 under the trade name [[Salvarsan]] by [[Hoechst AG]].<ref>{{cite magazine |url=http://pubs.acs.org/cen/coverstory/83/8325/8325salvarsan.html |title=Salvarsan |access-date=1 February 2010 |magazine=[[Chemical & Engineering News]] |archive-date=10 October 2018 |archive-url=https://web.archive.org/web/20181010053811/http://pubs.acs.org/cen/coverstory/83/8325/8325salvarsan.html |url-status=live }}</ref> This [[Organoarsenic chemistry|organoarsenic compound]] was the first modern [[Antimicrobial chemotherapy|chemotherapeutic agent]].

During the 20th century, as both [[microbiology]] and [[pharmacology]] advanced greatly, syphilis, like many other infectious diseases, became more of a manageable burden than a scary and disfiguring mystery, at least in [[developed countries]] among those people who could afford to pay for timely diagnosis and treatment. Penicillin was discovered in 1928, and effectiveness of treatment with [[penicillin]] was confirmed in trials in 1943,<ref name="Old05"/> at which time it became the main treatment.<ref name=pmid24653750>{{cite journal |last1=Tampa |first1=M |last2=Sarbu |first2=I |last3=Matei |first3=C |last4=Benea |first4=V |last5=Georgescu |first5=SR |title=Brief History of Syphilis |journal=Journal of Medicine and Life |date=15 March 2014 |volume=7 |issue=1 |pages=4–10 |pmid=24653750 |pmc=3956094 }}</ref>

Many famous historical figures, including [[Franz Schubert]], [[Arthur Schopenhauer]], [[Édouard Manet]],<ref name=Music08/> [[Charles Baudelaire]],<ref>{{cite book|last1=Hayden|first1=Deborah|title=Pox: Genius, Madness, and the Mysteries of Syphilis|date=2008|publisher=Basic Books|isbn=978-0786724130|page=113|url=https://books.google.com/books?id=p8wM1Y4opdQC&pg=PA113|access-date=15 September 2017|archive-date=19 August 2020|archive-url=https://web.archive.org/web/20200819172057/https://books.google.com/books?id=p8wM1Y4opdQC&pg=PA113|url-status=live}}</ref> and [[Guy de Maupassant]] are believed to have had the disease.<ref>{{cite web|last1=Halioua|first1=Bruno|title=Comment la syphilis emporta Maupassant {{!}} La Revue du Praticien|url=http://www.larevuedupraticien.fr/histoire-de-la-medecine/comment-la-syphilis-emporta-maupassant|website=www.larevuedupraticien.fr|access-date=29 November 2016|date=30 June 2003|url-status=live|archive-url=https://web.archive.org/web/20160602081305/http://www.larevuedupraticien.fr/histoire-de-la-medecine/comment-la-syphilis-emporta-maupassant|archive-date=2 June 2016}}</ref> [[Friedrich Nietzsche]] was long believed to have gone mad as a result of [[tertiary syphilis]], but that diagnosis has recently come into question.<ref>{{cite encyclopedia |last=Bernd |first=Magnus |title=Nietzsche, Friedrich |url=http://www.britannica.com/EBchecked/topic/414670/Friedrich-Nietzsche |encyclopedia=Encyclopædia Britannica |access-date=19 May 2012|url-status=live |archive-url=https://web.archive.org/web/20120723024352/http://www.britannica.com/EBchecked/topic/414670/Friedrich-Nietzsche|archive-date=23 July 2012}}</ref>
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This is a **brief** list of "historical figures", not modern people. Please don't add names of people from the 20th or 21st centuries. Further examples may be appropriate for [[History of syphilis]]. Thanks.
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