Philippe Ricord (1800–1889)

Philippe Ricord was a nineteenth-century physician and surgeon in France who studied syphilis and demonstrated that it is different from gonorrhea. As of 2024, researchers recognize that syphilis and gonorrhea are both sexually transmitted infections, or STIs. However, the bacterium Treponema pallidum causes syphilis, leading to symptoms such as sores and fever, whereas the bacterium Neisseria gonorrhoeae causes gonorrhea and leads to different symptoms such as discharge from the urethra. Before Ricord, researchers thought syphilis and gonorrhea were the same disease. Ricord, through observation and experimentation, distinguished syphilis from gonorrhea and arranged the stages of syphilis into primary, secondary, and tertiary, each associated with different symptoms and levels of severity. By distinguishing syphilis from other STDs and accurately categorizing its stages, Ricord helped researchers better understand how to treat syphilis, a disease that can be transmitted from mother to child, causing life-threatening illness in infants.

1. Early Life and Education
2. Professional Career
3. Honors and Accolades
4. Legacy and Impact

Early Life and Education

Ricord was born on 20 December 1800 in Baltimore, Maryland, to parents who emigrated from France to the US to escape the unrest and violence of the period known as the Reign of Terror. During the French Revolution from 1789 to 1799, the Reign of Terror was a yearlong period where revolutionary extremists accused many French citizens of crimes such as treason and then publicly executed them. Ricord’s father died when he was young, so Ricord’s older brother, Jean Baptiste, raised Ricord and his other brother, Alexander. Ricord attended the Economical School in New York City, New York, which was a school for refugee children from France. According to John David Oriel, a physician and researcher who studied STIs and the history of STIs, Ricord had to leave the school due to financial challenges. After his time at school, Ricord worked odd jobs, but also assisted his older brother Jean Baptiste, who studied natural history. During one trip, when Ricord was helping his brother, he met Charles Alexandre Lesueur, a researcher from France who also studied natural history. Lesueur was in the US collecting specimens for the Paris Museum when he met Ricord. At the age of twenty, Ricord and his brothers accompanied Lesueur back to France to work for him as a curator of plant and animal specimens.

In the 1820s, Ricord began to pursue a career in medicine, and studied at various hospitals under multiple different mentors in France until 1826 when he received his medical degree. In 1821, Ricord began working at Val-De-Grâce Hospital in Paris, France, as an extern, which according to Oriel, was an unpaid medical student who did ward rounds daily. Shortly after that, Ricord began working under Guillaume Dupuytren, who was a surgeon who worked at the Hôtel Dieu hospital in Paris, France. In 1822, Ricord passed the medical exam required to become an intern, which according to Oriel, was a paid medical student who is also capable of teaching. After becoming an intern, he continued to study at Hôtel Dieu under Dupuytren. However, according to Oriel, Ricord and Dupuytren had a dispute that led to Ricord’s dismissal from Hôtel Dieu. Dupuytren claimed that he invented a surgical procedure to create an artificial anus, but Ricord disagreed, stating that a surgeon in the US had done the surgery years prior. The disagreement led Ricord to begin studying at l‘Hôpital de la Pitié and worked with various new mentors. In 1826, Ricord presented his thesis, Dissertation Sur Diverses Propositions de Chirurgie (Dissertation on Various Surgical Propositions) and earned his medical degree. He then spent a few years practicing general medicine in rural regions of France and also supported himself by teaching anatomy at l’Hôpital de la Pitié. 

Professional Career

In 1831, Ricord earned a position at l’Hôpital du Midi, where he began studying syphilis in an attempt to prove that it was different from other venereal diseases such as gonorrhea. L’Hôpital du Midi was a hospital that treated venereal diseases. Venereal disease is an older term that refers to STIs. At that time, physicians did not know exactly what caused syphilis and according to Oriel, by the sixteenth century, physicians subscribed to the theory that the same infectious substance caused both syphilis and gonorrhea, but resulted in different symptoms. Specifically, they thought that syphilis led to chancres, which is a sore that typically appears on the genitals and is caused by STIs, whereas gonorrhea resulted in pus-like discharge from the urethra.

Though many physicians subscribed to the idea that syphilis and gonorrhea were the same disease, one surgeon, John Hunter, offered evidence in favor of the theory with his 1786 text, “Treatise on the Venereal Disease.” There he uses the term venereal poison and states that it is responsible for causing venereal disease. In his book, Hunter states that the poison is present in pus, as well as other secretions from the body and causes venereal diseases when humans encounter those substances. He claims that if the poison meets a mucus membrane, it causes gonorrhea, if it gets into the bloodstream, it causes syphilis, and if it comes into contact with skin, it causes a chancre. According to Oriel, Hunter was not qualified to make such a statement, as he had not been formally trained as a physician but rather trained as a surgeon.

Other physicians and researchers at the time also attempted to prove that the same causal agent led to gonorrhea and syphilis, but according to Oriel’s biography, Ricord found their diagnostic techniques to be inadequate. Hunter practiced one of the diagnostic techniques Ricord disproved of in 1767, which entailed inoculating a healthy person. According to Hunter, when he did so with gonorrheal pus, the individual began to show symptoms of syphilis, so he diagnosed them with syphilis, declaring that he had proved that the same infectious material causes both syphilis and gonorrhea. As of 2024, researchers believe that the individual in that experiment likely had a double infection of syphilis and gonorrhea. However, Ricord sought to investigate the relationship between syphilis and gonorrhea for himself and began by creating a diagnostic technique to use on those already infected with one or both conditions.

During the 1830s, while working at Hôpital du Midi, Ricord developed a technique of his own to diagnose individuals with venereal diseases, in which he inoculated people with genital discharge, discharge from their own lesions, or from an inflamed lymph node to distinguish syphilis from other venereal diseases. Lymph nodes are organs that are a part of the immune system. He also wanted to use his method as a way of diagnosis. With that diagnostic method, Ricord collected fluid from genital discharge, lymph node, or a chancre of an infected individual. Then, he injected it into their thigh, covered the injection site with a piece of specialized glass, and observed it every day to determine if a lesion would form. Ricord found that the result of his test differed depending on the stage of syphilis that a patient had. He organized syphilis into primary, secondary, and tertiary stage syphilis based on the symptoms. As of 2024, researchers recognize an additional stage of syphilis, called latent syphilis, which occurs in between the secondary and tertiary stages. During latent syphilis, many years can pass without a person experiencing any symptoms of the disease.

During his research, Ricord observed how the inoculations he performed produced different results depending on the stage of syphilis and noted that gonorrheal discharge did not result in chancres. Ricord found that after inoculating a person in the primary stage of syphilis with discharge from a chancre, it would always produce a new chancre. He also concluded that discharge from an ulcer of a person in the secondary stage of syphilis cannot produce a new chancre. However, researchers after Ricord learned that a person in the late primary stage or second stage of syphilis has already generated an immune response to the bacteria, therefore they are less likely to form a chancre when inoculated with syphilitic material. Ricord proposed that inoculation to be the only accurate means of diagnosis, as it allowed him to distinguish syphilis as a separate condition from other venereal diseases. Gonorrheal discharge did not cause chancres when used for the inoculation, while discharge from a person in the primary stage of syphilis did induce chancres. That difference in combination with careful consideration of other physical symptoms present in a patient allowed Ricord to distinguish syphilis from gonorrhea. From 1831 to 1837, Ricord performed the procedure more than 2,500 times.

In 1838, Ricord published Traité pratique des maladies vénériennes (A Practical Treatise on Venereal Diseases), in which he sought to achieve multiple goals, including proving that some specific agent caused syphilis, distinguishing syphilis from other similar venereal diseases or symptoms, organizing syphilis into stages, and considering different treatment methods for the disease. In that text, Ricord details the results of his inoculation experiments, how he distinguished syphilis from gonorrhea, and how he organized the stages of syphilis, into primary, secondary, and tertiary syphilis based of his observations. Ricord also includes numerous case reports of individuals with syphilis whom he treated. Those case reports included descriptions of the patients’ symptoms, the treatments Ricord gave to patients, and the results of the inoculations. Before describing the case reports, Ricord expresses that he does not believe it is permissible to inoculate a healthy person with any disease, as the consequences are unpredictable. Ricord also explains that despite performing syphilis inoculations on dogs, cats, guinea pigs, rabbits, and pigeons at his clinic, he was not able to induce syphilis in any of those animals. He used the same inoculation technique on the animals as he did in humans to produce a positive result, but the animals never presented symptoms of syphilis as people did. That led Ricord to declare that syphilis is unique to humans and cannot be transmitted to animals. According to Oriel, Traité pratique des maladies vénériennes was highly acclaimed and Ricord later won a gold medal from the French Academy of Sciences for the publication.

Additionally, in his 1838 publication, Ricord wrote about the vaginal speculum that he used to better examine the vagina and the cervix for venereal diseases. At that time, physicians typically did not perform thorough vaginal examinations on women experiencing symptoms of venereal disease. Rather, they diagnosed women by simply looking at the vulva and palpating the vagina to determine if they were infected. According to Oriel, Ricord did not believe that method of examination was sufficient. Thus, Ricord used a speculum, which is a device that physicians insert into the vagina to hold the vaginal walls apart to visualize chancres and discharge within the vagina and on the cervix. He explains the results of his examination in his 1838 publication, clarifying that genital discharge and chancres were not mutually exclusive in women.

In 1840, Ricord published an updated version of “A Treatise on Venereal Disease,” the text that John Hunter had originally published in 1776 to provide up-to-date information on venereal disease. In the newly published version, Ricord added many annotations throughout and thereby provided readers with an updated understanding of venereal disease according to what he had found during his research in the 1830s. For example, in the text where Hunter states that the same venereal poison is responsible for both syphilis and gonorrhea, Ricord responds that Hunter’s conclusions are the result of an erroneous interpretation of his experiment. Ricord goes on to describe his method of inoculation to clarify the difference between gonorrhea and chancres that may form from syphilis.

Starting in the 1840s, Ricord criticized the work of Joseph-Alexandre Auzias-Turenne, a physician and researcher, about syphilis transmission in animals. Despite Ricord’s 1838 publication reporting that animals cannot contract syphilis, Auzias-Turenne performed experiments inoculating animal with the pus from chancres. During the 1840s, Auzias-Turenne conducted experiments on monkeys and was able to induce a lesion that Auzias-Turenne concluded was a chancre. When Auzias-Turenne presented his findings to other experts, he was met with doubt and skepticism. Ricord criticized Auzias-Turenne’s experiment and conclusions, stating that Auzias-Turenne should inoculate himself with pus from the monkey’s chancre to see if he himself would develop syphilis.

During Auzias-Turenne’s research, he studied the practice of syphilization, which is the process of desensitizing an animal or person to syphilis by repeatedly inoculating them with syphilitic material until they do not produce new chancres anymore so that they are immune to the disease. Auzias-Turenne eventually performed the experiment on sex workers and even inoculated himself with syphilis hoping to prove that syphilization could be used to protect against syphilis. According to Oriel, in 1844, when Auzias-Turenne presented his research to several medical societies in Paris, Ricord prevented him from conducting further research on sex workers. Then, in 1867, during a medical conference, Auzias-Turenne proposed syphilization as a prophylactic, or preventative, measure for syphilis, which according to Oriel, led to Ricord unleashing a long, personal tirade against Auzias-Turenne. That resulted in an argument between those against and for syphilization.

Honors and Accolades

Ricord’s accolades for his research and work as a physician grew during the 1850s with new positions and more publications on his work with syphilis. Ricord became a member of the Académie de Médecine in 1850. Also in 1850, Ricord began publishing Lettres sur la Syphilis (Letters on Syphilis) in the journal l’Union Médicale. Ricord wrote and addressed the letters to the editor of the journal Amédée Latour. In the letters, Ricord explains his career with syphilis, the research he conducted, and the evolution of the academic understanding of syphilis as a disease throughout history. For example, in his first letter, Ricord writes about his career in venereology and his intimate studies of syphilis. In that letter, Ricord details how he began working at l’Hôpital du Midi and became involved in researching syphilis. He then explains how he set out to learn the cause of syphilis through experimentation and observation.

In 1860, Ricord retired from his position at the Hôpital du Midi and began working at his private practice in France and took on new leadership positions during the Siege of Paris in 1870. In 1868, Ricord became president of the Académie de Médecine, and in the following year, 1869, he became the consulting surgeon to the Emperor of France, Napoleon III. During the siege of Paris in 1870, during which Prussian forces invaded and captured Paris, Ricord worked as an ambulance surgeon, treating wounded people, and directing the physicians and medical students of the ambulance service.

Legacy and Impact

Ricord’s contributions to the discipline of venereology at the Hôpital du Midi and through his text had widespread impacts and allowed for researchers to better understand and categorize symptoms of STIs. His 1838 publication, Traité pratique des maladies vénériennes challenged and disproved common erroneous theories about the cause of syphilis and clarified the relationship between gonorrhea and syphilis. Additionally, Ricord’s students Jean Alfred Fournier, Charles-Paul Diday, and Léon Bassereau, continued his work and made contributions to the field of venereology, such as finding ways to prevent the spread of STIs. Additionally, Bassereau distinguished between soft-chancres and hard, or syphilitic chancres, something Ricord had not identified during his own career. Ricord also reintroduced the speculum, which improved the treatment of females experiencing STIs. However, Ricord was not entirely correct in all of his theories. For example, as of 2024, researchers recognize that certain species can contract syphilis, although the causative agent may differ, and syphilis is still infectious in the secondary stage, contrary to what Ricord stated.

Ricord died in 1889 of pneumonia.