Disease Detective

Schaberg says that Nietzsche believed a writer's personality imbues his work -- that systems of philosophy do not exist independently of the philosopher's emotional life. Schaberg has not thought about how his own work reflects his personality, but, he says, people often end up where they are in life by "following threads." Hayden, he says, is a dedicated thread follower.

One thread led her to the late Dr. Eugene Farber, former chairman of the dermatology department at Stanford University School of Medicine.

"When I called him and told him what I was working on, he said he would be glad to meet with me if I could answer a test question: Who first viewed the syphilis spirochete [the bacterium that causes the disease]? My mind went blank. Just as I sensed that he was about to hang up, I blurted out: 'Fritz Schaudinn, parasitologist of ducks and owls.'"

Farber was impressed. He later spent many hours guiding Hayden through the symptomatology of syphilis, which largely disappeared after the invention of penicillin, leaving most modern doctors unknowledgeable about its chronic effects. Farber told Hayden to read 19th-century medical texts to find out more about the disease's dreadful consequences. He even lent her, she says, "his treasure: a beautiful art book of colored pictures of syphilitic lesions."

Using her favorite research tool -- Google -- Hayden located several dozen old textbooks, including the 1,400-page Modern Clinical Syphilology, the last edition of which was published in 1945. The classic text's author, John H. Stokes, M.D., called upon syphilologists to cultivate "suspiciousness of mind."

"This does not mean a vague awareness of [syphilis'] existence," wrote Stokes. "It means ... an alert sense of nearness such as experienced by the hunter stalking big and dangerous game. A zest in the ferreting out of the obscure, a positively detective zeal in the running to earth of this most subtle master of the dissembling art .... [T]hink of syphilis as a disease of signs rather than symptoms."

As she searched for signs of syphilis in biographies, personal correspondence, and medical records of her famous subjects, Hayden kept in mind that their doctors may have been unaware of the real reasons why their patients were chronically ill. Conversely, a prescription of mercury was a good sign that a doctor had diagnosed syphilis, since ingestion of the toxic metal in the form of salves, fumes, and pills was thought to be curative.

By correlating medical and biographical histories, Hayden makes strong evidential cases that her characters had the disease. She is extremely careful, however, to assert only that her evidence amounts to a high probability of infection, since no one has performed definitive clinical tests on her dead. She knows, too, that "people will come out of the woodwork" to dispute that their particular heroes, such as Lincoln, were infected.

"We do not have tissue diagnosis [for Hayden's subjects], so we will never have absolute proof," says Dr. Norbert Hirschhorn, a medical historian who lectures at Yale Medical School. "She is careful not to be sensational, but she pulled together many different strains of biography. It's quite a tour de force."

Brandeis University history professor Rudolph Binion, who has written biographies of both Salomé and Hitler, says he didn't believe Hayden's thesis that Nietzsche's sexual inhibitions with Salomé were attributable to his syphilis. Now, says Binion, he does.

"I did not believe her about Hitler, either," he says. "I gave her his medical records. Her case for Hitler [as a syphilitic] is extremely strong and cast light on his conduct at the end."

Even some who disagree with Hayden's conclusions admire her. One such person is Lise Deschamps Ostwald, a UCSF psychiatry professor's widow who annually sponsors a lecture-recital at UCSF, followed by a complementary musical recital at the San Francisco Conservatory of Music. In 1999, she invited Hayden to lecture to 400 psychiatrists about her theory that Schumann had syphilis. After the talk, Ostwald, a concert pianist, performed a Schumann composition.

"Deborah is very flexible," says Ostwald, who disagrees with her that Schumann was syphilitic. "She is not dogmatic. It is hard to prove who had syphilis 100 years later."

Ostwald also helped kick-start Hayden's new career, referring her to literary agent Rosalie Siegel in Pennington, N.J. Siegel was intrigued enough to read an article that Hayden wrote about Nietzsche's syphilis that appeared in a 1999 publication, Nietzsche and Depth Psychology. She was impressed. She helped Hayden develop a book proposal and then sold it to Basic Books. The print run is moderate for a first effort -- 10,000 copies -- but Siegel hopes Pox will "outrage" enough people to warrant additional printings. She's excited about the New York Times review, which, she says, positions Pox "as a serious book, a must-read."

Contract in hand, Hayden focused on writing for two years. She read and reread her medical texts plus hundreds of biographies and other secondary sources. She put in 18 hours a day organizing her material, corresponding with experts, writing hundreds of thousands of words, and getting friends to help edit the ever-growing draft.