A Historical Approach to Syphilis Infection in Korea

Original scientific article Acta Med Hist Adriat 2018; 16(2);185-202 Izvorni znanstveni ~lanak https://doi.org/10.31952/amha.16.2.1 A HISTORICAL APPROACH TO SYPHILIS INFECTION IN KOREA POVIJESNI OSVRT NA INFEKCIJU SIFILISA U KOREJI Dong Hoon Shin*, Hye Jin Lee*,**, Jong Ha Hong*, Eun Jin Woo***, Eunkyoung Shin****, Yi-Suk Kim*****, Ho Chul Ki******, Eunju Lee******* Summary From the end of the 15th century, syphilis spread worldwide, posing a serious threat to public health. Venereal syphilis has been a major research topic, not only in clinical medicine but also in paleopathology, especially because it is a disease of questionable origin and of high prevalence until the discovery of antibiotics. Syphilis in history has been studied extensively in Europe and the Americas, though less so in Asia. In this review, based on extant historical documents and available paleopathological data, we pinpoint the introduction and trace the spread of venereal syphilis in Korea to the end of the 19th century. This review provides * Lab of Bioanthropology, Paleopathology and History of Diseases, Department of Anatomy/Institute of Forensic Science, Seoul National University College of Medicine, Seoul, South Korea. ** Ministry of National Defense Agency KIA Recovery & Identification, Seoul, South Korea. *** Department of History, Sejong University, Seoul, South Korea. **** Department of Social Welfare, Dankook University, Cheonan, South Korea. ***** Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea. ****** Ancient Institute of Heritage, Jukhyun-ro 514, Hwasun-gun, South Korea. ******* Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Correspondence Address: Dong Hoon Shin, Department of Anatomy/Institute of Forensic Science, Seoul National University College of Medicine, Daehak-ro 103, Chongno-gu, Seoul 110-799, South Korea. E-mail: [email protected]. 185 fundamental information that will be of great help to future research on pre-20th century syphilis in Korea. Keywords: Syphilis, Joseon Dynasty, Korea, origin, history, paleopathology Introduction Treponemal diseases are caused by the genus Treponema, a spirochete bacterium. Various treponemal diseases, including pinta caused by T. car- ateum, yaws by T. pallidum subsp. pertenue, and bejel or endemic syphilis by T. pallidum subsp. Endemicum, are known to infect human beings [1]. Apart from these treponemal diseases of non-venereal contact, T. pallidum subsp. pallidum, the most destructive subtype causing serious harm to health and sometimes leading to death, is transmitted by sexual contact (venereal syphilis) [2, 3]. In addition to the general symptoms of sexually transmitted disease (STD) and the characteristic whole-body rash, venereal syphilis sometimes invades various internal organs, causing damage especially in the nervous (tabes dorsalis) and cardiovascular (syphilitic aortic aneurysm) systems. It sometimes involves the skeleton, leading to serious degenerative conditions such as caries sicca in the skull, saddle nose, or saber shin in the tibia. As venereal syphilis’ clinical features are so variable, it is called ‘the great imitator’ [2, 4]. Until relatively recently an optimistic view had prevailed, in that venereal syphilis was seen to be readily eradicable by antimicrobial therapy, popu- lation screening, and improvements in social health care systems [5]. In fact, during the worldwide campaign against syphilis in the 1960s, its infection prevalence dropped dramatically, and endemic treponematoses (bejel, pinta and yaws) were almost eradicated [2, 6]. However, in the 1980s, syphilis re- emerged in close association with AIDS infection worldwide and economic booms in developing countries [2, 7, 8]. In 2002, 157,000 people died of syphilis, and 270,000 suffered from congenital syphilis in Africa [10]. In this light, more attention to the prevention and treatment of syphilis is needed in clinical medicine around the world. Historical syphilis infection also has been of great interest to paleopathologists over the past several decades. Venereal syphilis was a devastating disease, one of the most feared in human history [11]. In fact, it was so severe and rapidly transmitted, that it made a very strong impression on the people at the time of its initial emergence. In particular, as the appearance of syphilis occurred nearly at the same time as Columbus and his men returned from 186 the New World, the idea that these two historical events were closely related to each other has long been popularly accepted [12]. However, new arguments against this allegation having been made [13, 14], the origin of syphilis came to be hotly disputed, which debate is still ongoing among paleopathologists and historians of medicine. Interest in venereal syphilis in East Asia is similar to that in other countries. Since the disease shows serious signs and symptoms that were rarely identified in the region, it has attracted the attention of contemporary doc- tors and the general public from the time of its first appearance. Since the early 20th century, the history of syphilis has been well studied in East Asian countries such as Japan. However, the volume of research on syphilis in East Asia is far smaller than that on other continents [15]. Especially in Korea, its history has been only scantily studied to date. This review summarizes the findings and achievements of medical history and paleopathological research reported to date, which information will prove valuable to future related research in South Korea and elsewhere. The Dispute on the Origin of Syphilis Syphilis first appeared in the 15th century [16, 17]. This new STD was called by different names such as French disease (pox), Neapolitan disease, Spanish disease, the great pox, and so on [17]. The new term ‘Morbus venerus’ (venereal disease) was coined in 1527 by Jacques de Bethencourt, and, finally, ‘syphilis’ in 1530 by Girolamo Fracastoro [17]. When syphilis first appeared in Europe, the signs and symptoms were very different from the syphilis of today. It was a disease of severe virulence that inflicted very high mortality rates [3, 17]. As time passed, however, its virulence weakened, its lethality re- markably lessened, and finally, it came to exhibit symptoms almost identical to those seen today [17]. Regarding the origin of syphilis, there has been a very old claim that it was closely related to Columbus’ discovery of the New World. In this ‘Columbian hypothesis,’ the seamen joining in Columbus’ expedition to the New World brought the syphilis pathogen back to Europe, which then spread more widely, eventually covering the entire world. From the first time this claim was made, it has continued to be supported by many scholars as the most reliable hypothesis [12, 18]. Briefly, Rodrigo Ruiz Diaz de Isla and Gonzalo Fernandez de Oviedo chronicled the first outbreak of a syphilis epi- demic in 1493, specifically in Barcelona after Columbus and his men’s return 187 from Haiti. In his book (published in 1539), Ruiz Diaz de Isla, a Barcelona physician who had treated Columbus’ men, also stated about the illness that it was unknown disease, so far not seen and never described [12, 18-20]. Significantly, this newly emerging disease reappeared during the war (1494-1498) conducted by the French King Charles VIII against the Kingdom of Naples. An outbreak occurred in the French army that was besieging Naples in 1495 [21, 22]. When Charles VIII’s army retreated back home, many soldiers were already infected by and seriously suffering from this disease [17]. Moreover, as the war had been prosecuted mainly by the employment of mercenaries from various countries, the disease spread rapidly all over Europe soon after those soldiers returned to their home countries [17, 23, 24]. Thereby, the disease spread to France, Switzerland and Germany in 1495, Britain and Scotland in 1497, and the Scandinavian countries, Hungary, Greece, Poland and Russia in 1500. By 1520, it also had spread to Africa, the Near East, East Asia, and Oceania [17]. According to supporters of this theory, this disease, which manifested as a dramatic onset followed by rapid spread, originated from the New World [12, 20]. However, this theory has been seriously challenged by other researchers. A JAMA editorial for the 1935 issue [25] stated that the syphilis originally present in the Old World was not recognized as a separate, independent disease, but for many years was confused with other illnesses such as leprosy. In 1934, Richmond Cranston Holcomb [13, 14] likewise proposed that syphilis might have existed in the Old World even before 1493 (the Pre-Columbian hypothesis). In 1974, two researchers [26] made similar claims. According to this hypothesis, Columbus’ expedition to and return from the New World was coincidental with a sudden spike in syphilis virulence, which disease was mistakenly identified as a new, New World-origin disease [17]. This ar- gument is appealing in that it can explain why syphilis-like signs have been occasionally found in bones unearthed at Old World sites dated pre-1493 [12, 20, 27]. According to this theory, the syphilis was actually present in the Old World even before the 1490s [28, 29]. However, objections to this hypothesis have been made as well. After re- viewing the previous paleopathological reports, Harper et al. argued that, with respect to the diagnostic criteria, the certainty of diagnosis and the ac-

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