Disease Detective

- Painter Vincent van Gogh wrote 874 letters to his syphilitic brother, Theo. "A careful reading reveals numerous references that suggest that Vincent and his brother were well aware of each other's disease and wrote of it in safe, veiled language," writes Hayden. Her book sympathetically examines the life of van Gogh's common-law wife, Clasina Hoornik, who also was infected and whom the painter cast off to fend for herself as their mutual doom approached. Hoornik is the only "common" person treated by Hayden and is, without a doubt, the least despicable syphilitic of the lot.

- Whether or not Oscar Wilde died from syphilis has been the subject of learned articles in prestigious medical journals. Hayden summarizes this literature, noting that Wilde probably caught the disease from the "one and only campus prostitute" at Oxford University, and possibly passed it on to his wife, Constance, who died of spinal paralysis. Wilde's chances at syphilitic euphoria were canceled by his consumption of a liter of brandy every day.

- Karen Blixen, who wrote Out of Africa under the pen name Isak Dinesen, caught the pox from her husband, Baron Bror von Blixen-Finecke. In 1926, Blixen wrote to her brother, "If it didn't sound so beastly I might say that, the world being as it is, it was worthwhile having syphilis in order to become a Baroness."

Hayden treats each of her subjects in a detached fashion, methodically marshaling the evidence for syphilis while acknowledging the arguments of naysayers. But it is for Nietzsche and Hitler -- who among all her characters arguably had the greatest impact on history -- that she reserves her most thorough treatment.

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"Nietzsche is a personal philosopher," Hayden says. "His aphorisms may be read in many different ways. His influence on religion, politics, art, music, and psychology is remarkable." When she goes to scholarly conferences on Nietzsche, she says, she knows more about his life than do many of the academics, who are focused on his philosophy.

Nietzsche's works were known only to the few during his lifetime, but in death he influenced many Western intellectuals with his nihilistic (the desire for nothingness) approach to all systems of thought. His writings shaped the thinking of many early psychologists, including Freud, Carl Jung, and Salomé. He also influenced political reactionaries, including Hitler and his followers, with his notion of the "superman" whose duty is to exploit inferior human beings.

In 1889, shortly after experiencing a burst of creative activity, Nietzsche was admitted to the psychiatric clinic of Dr. Ludwig Wille of Basel, Switzerland, an expert on how general paralysis manifests itself in the insane. Wille recorded his new patient as "Syphilit Infect," noting that he had acquired the disease in 1866 at the age of 23. Finally diagnosed in middle age, Nietzsche took 11 long years to die, during which he had moments of lucidity even though he was as likely on any given day to be smearing his feces on the wall.

Nietzsche's writings at once enlighten and infuriate liberal scholars, such as Schaberg, the Nietzsche expert who consulted on Pox for Hayden. Schaberg complains that the philosopher was "a radical aristocrat, very anti-democratic." Hayden acknowledges that Nietzsche was an elitist, but argues that he nonetheless has broad appeal. She likes Nietzsche's letters the best of all his work. If his problems were indeed caused by syphilis, she says, "then his archive is the most profound and eloquent record of a syphilitic that exists."

She is drawn to Nietzsche's notion that truth is perceived differently by different people, that a person's reality is relative to his personal story. To Hayden, the "superman" is not about genetic superiority. Rather, she says, "it is about self overcoming adversity, such as illness."

Hayden's book spends little time analyzing the creativity of her syphilitics in the light of their disease. But she agrees with Nietzsche's observation that "every great philosophy so far has been: namely, a personal confession of its author and a kind of involuntary and unconscious memoir." In Nietzsche's case, it is easy to place his misanthropic, messianic, nihilistic exaltations in the context of his miserable life, which was marked by social isolation, sexual confusion, and horrible physical pains attributable to syphilis.

In the 1930s, Nietzsche's name and philosophy were publicly associated with Hitler by Nietzsche's racist sister, Elizabeth. Although the two men certainly shared a hatred of democracy, Nietzsche was neither an anti-Semite nor a nationalist and would have viewed Hitler as a filthy upstart.

Hayden's main achievement as a scholarly sleuth is her chapter on Hitler. She relied heavily on two secondary sources, The Medical Casebook of Adolf Hitler, by Leonard and Renate Heston, and The Secret Diaries of Hitler's Doctors, by David Irving. She also worked with a primary source: a postwar debriefing of Hitler's doctors by U.S. military intelligence agents. Irving transcribed and published records of Hitler's primary physician, Dr. Theo Morell, a renowned syphilologist. These documents do not directly record syphilis as one of Hitler's afflictions, even though by 1944 the farting, eczematous, jaundiced, jerking, inattentive, drooling Führer was exhibiting signs of tertiary syphilis.