Syphilis — A Terrible,
Widespread Disease

Among the diseases that ravaged Transylvania until the mid-twentieth century, syphilis stands out for both its prevalence and its social consequences. A venereal disease caused by the bacterium Treponema pallidum, it was transmitted primarily through sexual contact and, during pregnancy, from mother to child. It recognised no social boundaries — affecting every stratum of society — and even when not fatal, it frequently produced severe disfigurement and lasting incapacity. Most tragically, it imperilled the lives of infants born to syphilitic mothers.

Three Stages of a Relentless Progression

Syphilis is characterised by three distinct clinical stages, each with its own profile of symptoms and degree of contagiousness. The disease's propensity to mimic other conditions — and to enter prolonged asymptomatic phases — made it extraordinarily difficult to identify and contain.

The disease is most contagious during the primary and secondary stages and the early part of tertiary syphilis; infectiousness diminishes markedly during the latent phase, though the infection persists.

Visualising the Unspeakable: Nineteenth-Century Medical Illustration

Before photography became a clinical tool, medical illustrators produced detailed chromolithographic plates and watercolour drawings to document the progression of syphilis. These images served a didactic purpose — training physicians to recognise the disease's many manifestations — but they also bear witness to the profound suffering of individual patients.

The Challenge of Counting the Dead

Reliable quantitative data on the morbidity and mortality attributable to syphilis in Transylvania is conspicuously scarce — a lacuna that itself speaks volumes about the disease's social character. Newspaper accounts and personal memoirs, however, leave no doubt as to how pervasive the infection was. Several structural factors impeded accurate recording.

The disease was routinely misdiagnosed, owing to its symptomatic overlap with other illnesses and the variable competence of those certifying causes of death. Social stigma — syphilis being closely associated in public perception with immorality and prostitution — discouraged patients from seeking care openly, particularly among members of the educated elite who had most to lose by disclosure. Many cases were managed discreetly, outside formal medical channels, and never entered the statistical record.

The causes of the disease's persistence were multiple and interconnected: widespread lack of education among patients; restricted access to medical care, especially in rural communities; the protracted and costly nature of treatment; the reluctance of many sufferers to acknowledge their diagnosis; and, particularly in urban centres, the role of commercial sex workers in sustaining transmission networks.

From Mercury to Penicillin: A Century of Therapeutic Struggle

For much of syphilis's recorded history, the mainstay of treatment was mercury — administered by inunction, fumigation, or ingestion. The remedy, however, was treacherous: the margin between therapeutic and toxic doses was narrow, and mercury poisoning produced destruction scarcely less severe than the disease itself. Patients endured salivation, tooth loss, and neurological damage in the hope of a cure that was never guaranteed.

The therapeutic landscape was transformed in 1909, when the German physician and immunologist Paul Ehrlich — working with his colleague Sahachiro Hata — discovered Salvarsan (arsphenamine), the first truly effective targeted drug against syphilis. An arsenic-based compound, Salvarsan was later refined into Neosalvarsan, which combined comparable efficacy with a somewhat improved safety profile. Until the widespread adoption of penicillin following the Second World War, Salvarsan and its derivatives remained the standard of care worldwide. Romanian medical journals and pharmaceutical advertisements of the interwar period reflect the enthusiasm with which the new treatment was received.

Alongside arsenical preparations, bismuth-based compounds and mercury salicylarsenate — marketed as Enesol — were employed, particularly in the treatment of pregnant women with syphilis, in whom preventing vertical transmission to the foetus was paramount.

Given the devastating toll of the disease on society — and above all on children born to infected mothers — sustained public health campaigns were mounted during the interwar decades. These initiatives aimed to screen and treat patients, with particular attention to disadvantaged populations, in order to curb the epidemic's spread before an effective, universally accessible cure became available.