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Casanova's memoirs there are anecdotes about syphilis that the author plainly regards as excruciatingly funny. Making sport of it may have been the only way in which the offspring of the Enlightenment could come to grips with a pestilence that seemed as immutably fixed in history as war or famine. In a secular age, gags were appropriate for an inexplicable calamity that in olden times had been regarded as divine retribution. Previous centuries had seen people calling on God for help, and God had not answered.
    The disease first swept like a hurricane over Europe during the period of Columbus's voyages (whether Columbus and his crew were responsible for importing syphilis from the West Indies is disputed by scholars, but it seems a strong possibility), and it took an exceptionally virulent form, often killing its victims in the secondary, or rash-and-fever, stage, which most people in later epochs (including me) weathered without harm. In its congenital mode, it was particularly disfiguring and malevolent, which increased the terror. No wonder that the Diet of Worms, the same assembly that condemned Martin Luther for heresy, issued a mandate declaring that the “evil pocks” was a scourge visited upon mankind for the sin of blasphemy.
    But it was the doctrine of original sin, falling upon both Catholics and backslid Presbyterians like me, that made the sufferers of syphilis pay a special price in moral blame unknown to those who acquired other diseases. This was particularly true in the early Victorian era, when a return to faith, after a long time of frivolous impiety, was coupled with a return to the Pauline precept that the act of sex is an act of badness—absolute badness more often than not, exceeding all other abominations. This connection with sexuality gave syphilis, in a puritanical culture, its peculiar aura of degradation. As Susan Sontag has shown in
Illness as Metaphor
, her study of the mythology of disease, all the major illnesses have prompted a moralistic and punitive response, and have given rise to entire theoretical systems based on phony psychologizing. The bubonic plague implied widespread moral pollution; tuberculosis was the product of thwarted passion and blighted hopes, or sprang from “defective vitality, or vitality misspent”; out of emotional frustration or repression of feeling has come the curse of cancer, whose victims are also often demonically possessed. As I have discovered firsthand, mental disorders may be the worst, inviting suspicion of inborn feebleness.In such views, the disease itself expresses the character of the victim. Syphilis, however, has suffered a different stigma, one that has been of a singularly repellent sort. It has reflected neither feebleness nor misspent vitality nor repression of feeling—only moral squalor. In recent years, AIDS has been similarly stigmatized, despite extensive enlightenment. But in square, churchgoing America at the time of my diagnosis, a syphilitic was regarded not as a sexual hobbyist whose pastime had got out of hand—in other words, with the ribald tolerance Voltaire would have brought to the circumstance—but as a degenerate, and a dangerously infectious one at that. Doctors are, of course, supposed to be free of such proscriptive attitudes, but there are always some who are as easily bent as anyone else by religion or ideology. Klotz was one of these, and while I'm sure that he was only doing his duty in tracking my history, his temper was chillingly adversarial. Also, he was, in my case, guilty of an act of omission that unalterably stamped him as a doctor who hated not the disease but its victims.
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    As the wintry days and nights in the hospital wore on, and the Kahn tests continued to show my blood serum swarming with spirochetes, and I worried myself into a deeper and deeper feeling of hopelessness, I brooded over my past sex life, which seemed to me a paltry one, at least numerically speaking. By what improbable mischance had