In her pathography, Deborah Hayden, an independent American scholar, proposes an intriguing thesis, that syphilis, a disease known as the “Great Imitator” of diseases and thus frequently misdiagnosed, is a secret, unacknowledged subtext in history. Employing retrospective diagnosis, Hayden suggests that many prominent nineteenth- and twentieth-century historical figures suffered from syphilis. She then suggests that this disease might have accentuated existing abilities, talents or predilections, and so might help to explain the productions or actions of a number of composers, writers, artists, philosophers, politicians and dictators. Beginning with an overview of the impact of the disease on Western Europe from the period of Columbus' adventures in the New World, the discussion centres on biographical analyses of fifteen possible syphilitics: famous, or infamous, nineteenth- and twentieth-century figures. According to Hayden, among the possible contenders are Ludwig van Beethoven, Robert Schumann, Charles Baudelaire, Abraham Lincoln and his wife Mary Todd (one of only two women discussed in the book), Gustave Flaubert, Friedrich Nietzsche, Vincent van Gogh, Oscar Wilde, James Joyce and Adolf Hitler. Hayden draws the parallel between the effects on the brain of the later stages of syphilis and the condition of manic-depression, which has been linked in some quarters with artistic creativity. In doing so, Hayden displays an engaging writing style and a flair for rendering complex symptoms intelligible to the lay (non-medical) reader. She explains that as late-stage neurosyphilis develops, periods of depression and pain can be replaced with episodes of creative euphoria and heightened perception, which, she insists, must surely have had some influence on people's work or actions. The reader is left to infer from Hayden's description that the syphilis bacterium, affecting the central nervous system and inducing the illusion of great light, is an important factor to be considered in the circumstances surrounding Beethoven's composition of ‘Ode to joy’, or van Gogh's paintings such as ‘Crows over the wheatfield’. In her final case study, Hayden provides an interesting analysis of the possible role syphilis might have played in Hitler's life. Hayden proposes that Hitler's anti-semitism was possibly heightened by his personal experience of syphilis, being a disease that, as she points out, Hitler closely identified with the Jews in Mein Kampf. Yet for the medical historian the book throws into sharp relief the problem of evidence, and raises questions over the validity of retrospective diagnosis in historical inquiry. Her description of how stigmatizing the disease has been during the five hundred years it has been prevalent in Europe, and the difficulties surrounding its accurate diagnosis, ultimately serve to undermine her thesis. As she admits, “The reader looking for proof in the contentious cases will find none.” In some cases, for instance in her chapter on Beethoven, Hayden is forced to acknowledge that “As much as we might like proof for a diagnosis of syphilis, there is none”. Yet, as subsequent chapters show, Hayden does not allow a lack of evidence to spoil a good story. Concluding her fifty-page chapter on Hitler, Hayden states, “There is no definitive proof that Adolf Hitler had syphilis, any more than there is undeniable evidence that he did not.” The thesis is an interesting one, but the foundations of proof that Hayden provides are shaky. The argument is built on a structure of circumstantial evidence and conjecture that historians will find flimsy. In order to be a helpful addition to medical history such a discussion requires much more evidence than Hayden is able to provide. Without this evidence we are in danger of proving Cecil Graham's charge, in Wilde's Lady Windermere's Fan, that “history is merely gossip”.