From the archives: the personal health records of Kostas Nouros

Part I – Introduction

For over forty years, a document has sat in the rebetika song archives of folklorist Elias Petropoulos (1928-2003), unstudied and unacknowledged.[1] It is no exaggeration that it is a unique document[2] which sheds light on the personal life of one of Greece’s greatest singers of traditional and popular song.

In late-2019 I trawled through the boxes comprising Section VI of Petropoulos’s personal papers currently held at the Gennadius Library in Athens, Greece. This section is dedicated to the formidable archive Petropoulos amassed on rebetika songs, and includes original music manuscripts, lyric sheets, personal documents, letters, flyers, drawings, musical instruments and articles.

Along with the photographs of rebetika musicians and subcultures held in Section IX of his personal papers, these materials comprise the largest (and most important) publicly accessible archive of rebetika that is held in any research institution, despite the fact that it contains no sound recordings. Access to the materials is straightforward and free of charge to all interested researchers and members of the public.

The photographs preserved in the archive, along with a selection of documents, were reproduced in the second edition of Petropoulos’s “Rebetika Songs” anthology, published by Kedros in 1979.

It was in box no. 5 of the rebetika archive (Section VI), that I came across a document belonging to the great singer of rebetika, smyrneika and amanédes, Kostas Masselos Nouros (1892-1972). This was held amongst a fascinating trove of personal documents from rebetika artists, including the marriage certificate of Roza Eskenazi, a drawing by “rebétis” and lyricist Nikos Mathesis, and two photographs of musician Yiorgos Batis.

This document was the “Personal Health Record” [Ατομικόν Βιβλιάριόν Ασθένειας] of Kostas Nouros, which was issued on the 24^th of May 1948 by ΙKA (Ίδρυμα Κοινωνικών Ασφαλίσεων) [Social Insurance Institute] when he was 56 years old. What became clear when I transcribed and researched the legible stamps and medication names in the booklet, was that Nouros suffered from an eye infection that was the result of some kind of sexually transmitted infection (STI). As I possessed no medical knowledge, I couldn’t reliably conclude what kind of STI Nouros suffered from.

Through the kind assistance of archivist Nick Henderson, I was put in touch with Dr. David Bradford, a retired sexual health physician based in Melbourne, Australia, who worked at the height of the HIV/AIDS epidemic. Through our correspondence, we came to the following conclusion, based on Dr. Bradford’s medical knowledge as well as biographical and anecdotal information on Nouros.

In summary, Nouros “almost certainly” suffered from an eye infection that was chronic (extending over a long period), and which was a complication of syphilis, probably secondary syphilis, that was possibly contracted through sex with men.

It is currently a mystery exactly how Petropoulos acquired such a sensitive medical document, along with other personal photographs of Nouros in the archive. I argue that these materials were possibly collected in the years following the publication of the first edition of Petropoulos’s “Rebetika Songs” anthology in 1968, considering that none were reproduced in that edition.

Although Petropoulos must have known Nouros fairly well, and even reportedly remained by his bedside when he was dying and in a coma[3], the writer never elaborated on his encounters with Nouros in his published writings.

The possibilities of how Petropoulos acquired this material include “borrowing” them while Nouros was still alive and with his consent (during the years 1968-1972) or simply by stealing them in some way or other with or without Nouros’s knowledge.

It is not out of the question that Petropoulos could have broken into Nouros’s home on 33 Grevenon Street in Piraeus and salvaged all that he could find, shortly before or after his death. On a brown envelope preserved in the rebetika archives is a pasted reproduction of a photograph of Nouros from 1930 that circulated widely in advertising flyers for performances. Petropoulos writes on this envelope: «αντίγραφα απ’ το κλισέ που βρήκα στο σπίτι του» [copies from the “printer’s plate” that I found in his home]. I wonder if this annotation is a clue which indicates that Petropoulos “salvaged” these documents from Nouros’s home without the singer’s expressed consent. 

Regardless of how Petropoulos acquired this medical booklet, the very fact that it survives means that we can now open up an entirely new discourse in the life of Nouros: that of illness, and a particularly stigmatising one at that.

This post will therefore not only interest rebetologists, but those researching queer lives and sexual diseases before the HIV/AIDS epidemic.

Below I have included extracts from my correspondence with Dr. Bradford, and in the third part photographs of the complete pages in Nouros’s personal health record, along with the initial notes I made at the Gennadius Library.

Special thanks to the Gennadius Library staff, especially the reference archivist Dr. Eleftheria Daleziou for her continuing support and help with access to the Elias Petropoulos papers.

-Michael Alexandratos, Sydney,

September 6, 2020.

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[1] The first two inside pages of Nouros’s health booklet (stamped with the no. 1459) were published in the second edition (1979) of Petropoulos’s anthology on pg 639. Otherwise, the booklet has not been commented on or analysed.

[2] Two other health record booklets issued by ΙΚΑ [Social Insurance Institute] are preserved in the Petropoulos archives, one belonging to Apostolos Hadzichristos (no. 1524), reproduced on pg 516 of Petropoulos’s 1979 rebetika anthology, and that of the Payioumtzis family (no. 1457), pg 458 of (Petropoulos, 1979).

[3] According to Kostas Ferris and Thesia Panayotou in their unpublished book “Rebetiko: Songs of the Hellenes.” Quoted in an article by Kostas Ladopoulos on his website elkibra-nouros.blogspot.com in a post on March 8, 2008. I would appreciate if someone provides me with a more direct source for this claim.

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Part II – Correspondence with Dr. David Bradford

May 22, 2020, 2:23pm

Dear David,

[…]

I am currently researching a Greek singer by the name of Kostas Nouros (1892-1972). In Athens I found his medical insurance booklet in an archive there and have been trying to transcribe and interpret the entries.

I would like your professional medical advice in interpreting the data, as from what I understand, Nouros suffered from eye infections that were a result of an STI [Sexually Transmitted Infection], but of course I am hardly trained in medical matters!

I’ll try to present the data and images here and will try to be as brief as possible.

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Note the column in RED, which is the medication he was prescribed, in GREEN the name of the treating doctor, and in YELLOW the diagnosis column.

31-7-1951 = underlined in GREEN is the name of the ophthalmologist in Greek. In the RED column are the medications, most of which I can’t recognise. One that I can make out is Ascorbine (which apparently helps the body absorb iron?)

Dr. Bradford’s comments:

The first entry in the treatment column I am pretty sure is Bismuth – perhaps what’s written is neo. Bismuth, but I am not sure). Bismuth used to be used in combination with an arsenical drug for the treatment of syphilis before the discovery of penicillin. Even after penicillin was introduced in the forties as the treatment of choice for syphilis, some older venereologists used to give an injection of a bismuth compound before starting a course of penicillin.

I think you are right about Ascorbine, or it might just be Ascorbic acid which is Vitamin C.

The last entry I am absolutely sure is Penicillin injection, although the dose I am uncertain of – perhaps 5x??200 IU ie international units. On the next page in the treatment column there are another six injections of Penicillin listed with varying doses (10x; 10x; 15x; 10x; 10x; 5x??200IU). This would be entirely consistent with a course of penicillin injections, although I find the dates a bit odd, seems to start on 18/8, then next is 19/9 and then, 21/9, 24/9, 26/9, 28/9 and 29/9 – could there be a page missing – I note page 4 doesn’t seem to be there? I ask this because eye complications of syphilis are serious – can be sight threatening, and a longer course of penicillin than usual would usually be prescribed – two or even three weeks). It would not be good practice to start treatment for syphilis with a penicillin injection and then have a long gap before the next one. I presume in the 1950s (early days in the use of penicillin) it would be short acting soluble penicillin used; a few years later longer acting preparations were developed reducing the need for daily injections. Even today though, syphilis involving the eye would be treated with three long acting penicillin injections at weekly intervals so the patient got a good solid three weeks treatment.

Now in the diagnosis column the first entry is (sp)? I wonder if this could be syphilis. The entry on the next line I can’t decipher at all – the first word could possibly be something like ‘solar’ and I wonder if the second word starts with ‘cornea…’ There are a number of eye conditions which can be caused by syphilis – in secondary syphilis (a relatively early stage of the infection ie in the first year or so) the commonest is a uveitis; in tertiary or late syphilis – some years after infection – the cornea can be affected – this is known as keratoderma. Nowadays the treatment of ocular syphilis is strictly the province of a specialist ophthalmologist, so I know little about it, other than to say that the basic treatment is always to give a course of penicillin injections to treat the underlying syphilis, with local eye drops and ointments etc as prescribed by an eye specialist to treat the eye complications.

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11-10-1951 = Nouros is prescribed by his ophthalmologist 1 tube of (illegible) and Pan. Aureomycine (trade name: AUREOMYCINE or Chlortetracycline, antiobiotic discovered in 1945, used in veterinary medicine to treat conjunctivitis, or in humans to treat allergic eczema.)

Dr. Bradford’s comments:

Yes, I agree that is definitely aureomycin probably administered as an ointment or drops – could be used if there was uveitis or keratoderma, as the tetracyclines have some anti-syphilitic action. Perhaps the other – the tube- is albucid, a sulphonamide antibiotic. Sulphonamides don’t have any activity against syphilis.

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On 2/11/1951 he is prescribed Sulfagram (underlined in RED).

Dr. Bradford’s comments

 I presume this is a sulphonamide drug.

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Underlined in RED, the stamp in Greek of a “Venereologist – Dermatologist”.

On the dates 8-5-1952 and 16-5-1952 I can’t make out the prescribed drug. There are more medication names on this page but they are not legible to me?

Dr. Bradford’s comments

Nor me, I’m sorry.

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Note underlined in RED: 28-1-1953 he is prescribed “pepto-iodine”???

30-1-1953 – (I can make out the medication “piperazine” which is apparently used to fight parasitic infections and worms?).

Also note that around the date 12-2-1953 there is another stamp for the same “venereologist and dermatologist.”

Dr. Bradford’s comments

In preantibiotic times, iodine compounds were also used in the treatment of syphilis, but again older venerologists used to hang onto its use even after they had switched over to penicillin as the mainstay of treatment.

[Re: the drug piperazine] Yes, especially round worms and pinworms. I can’t link that with the eye though.

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Underlined in RED (7/6/1954) he is prescribed “Alousol” which I assume is Alosol (for the treatment of ocular infections or infected wounds???)

There is another stamp for the venereologist and dermatologist on this page (underlined in RED).

Dr. Bradford’s comments

Yes, I think you are right – it contains neomycin I think, another topical antibiotic which can be used in eye infections.

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24-9-1954 = another entry for the prescribed drugs Alosol.

21-5-1955 there is an entry by a “Surgeon”, a certain Ioannou Kossifakis, although this is all written in Greek and is almost completely unreadable.

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Hospital admissions (circled in RED). Transcription of the first circled entry:

Athens – Public Hospital of Athens Ε.Ε.Σ – admitted 11/7/1957, discharged 23/7/1957

Discharge diagnosis: Τρυχίαβις?? (Trichiasis?? Ingrown eyelashes)

The same discharge diagnosis “Trichiasis” (in the far-right column) is written for the second circled entries, although for some reason the date looks like 1951 instead of 1957?

On Page 25 stamped around the dates 22/10/1957 and 31/10/1957 [only a few months after his operation recorded on Page 14] is a stamp for a ΚΗΛΕΠΙΔΕΣΜΙΚΟΣ ΟΙΚΟΣ, which is a place where they manufacture trusses (hernia truss, hernia belt etc)

Dr. Bradford’s comments

Sorry, I can’t shed much light on any of this.

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Let me know if you can help interpret the information I have presented here!

Kind regards,

Michael.

May 22, 2020, 5:05pm

Dear Michael,

Thanks for your interesting email. Yes I am a retired venereologist (or as we call ourselves now – sexual health physician). I’ll make what contributions I can below in the body of your text – my comments will be enclosed in brackets so I hope they will be clear for you.

However, in summary my conclusions are:

1. Your patient had an eye condition, almost certainly an infection, which seems to have been quite chronic (extending over a good while).
2. I think it likely it was a complication of syphilis, a well-known venereal disease (ie sexually transmitted infection) because:
3. (sp)? is listed in the diagnosis column followed by something illegible which is presumably the diagnosis of the particular eye complication of syphilis.
4. bismuth, a course of penicillin injections, and an iodine preparation are all listed as treatments, together with several other broad-spectrum antibiotic preparations.
5. a dermato-venereologist carried out most of the treatments – in Europe the specialties of dermatology and venereology have traditionally been combined. If only a simple eye infection or condition was the problem it would be unlikely to come to the attention of a dermato-venereologist.
6. most other sexually transmitted infections involving the eye tend to cause more acute, less chronic conditions. Syphilis seems the obvious culprit here.

I am a bit puzzled that the diagnosis is written with a query (sp)? The diagnosis of syphilis is easily confirmed by a blood test which by the fifties was quite reliable and specific, and any patient with a chronic eye condition where syphilis was a suspicion would have had the blood test. Maybe on the first day (first page of his recorded history) the result of the blood test wasn’t available as yet so the diagnosis was based on clinical suspicion alone, and when it was confirmed they embarked on the full penicillin injection course. 

I do hope all this is helpful,

Best regards

David.

May 22, 2020, 5:22pm

[In this message I provided another page from Nouros’s health record booklet for Dr. Bradford’s opinion]:

Page 4 (they all look like penicillin injection doses) but please confirm your interpretation…

Regards,

Michael.

May 22, 2020, 5:27pm

Also, another thing I forgot…

[…]

I know it probably doesn’t mean much with a syphilis diagnosis, but how would one contract such an illness from male homosex? Would he have contracted the disease from his eyes?

Again, speculating how he contracted the disease based on the data is going out on a limb…but I’d like to hear your expert opinion.

Regards,

Michael.

May 22, 2020, 6:02pm

Hi again Michael,

Yes, they are all penicillin doses of varying strengths – in total I think seventeen days treatment – a long course which is what I would expect with syphilis with eye involvement.

Syphilis is very infectious if you happen to have unprotected sex with a person who is within a year (sometimes as long as two years) of having acquired it. It can be acquired through vaginal sex, anal sex, oral sex, and even through deep prolonged kissing. It has always been at least as common and generally considerably more common amongst men who have sex with men – MSMs (yes, I understand all that about the complicated societal nature of male to male sex in most Mediterranean countries as well as in Greece – unlike in classical times!) than amongst heterosexuals. Right now in most of the Western World there is quite a resurgence of syphilis in gay men (or MSMs). And I know that in the fifties, venereologists in London for example, were already becoming aware how common syphilis had become in men who had “homosexual relations”. So your poor singer wasn’t alone.

A syphilis infection in the eyes is not acquired directly – unlike gonorrhoea where if someone with a urethral discharge (a drippy dick) rubs his eyes after touching his contaminated penis he can get a nasty acute conjunctivitis caused by gonorrhoea.

Syphilis in the eye tends to be a later manifestation of the infection. Syphilis starts out as a local sore – usually on the genitals, or around the anus, or inside the vagina – which may be quite unremarkable and then disappears on its own – this is the primary stage. Then the infection becomes generalised and weeks to months later, the secondary stage starts, with fever, swollen glands, rash and sometimes more nasty complications like neurological or eye manifestations – uveitis, retinitis, although these things are relatively uncommon. The secondary stage settles down then and syphilis becomes latent (although detectable by a blood test). Eventually about a third of people with untreated syphilis will get tertiary syphilis many years later – 5, 10, 20 years even which can affect virtually any organ of the body – heart, aorta, brain, spinal cord, skin, mouth, and the eye (keratoderma where the cornea can be seriously damaged).

So your singer was unlucky I think. He would have been what? around sixty in the early 1950s? So unless he was still sexually active around that age with other guys, in which case his eye condition would have most likely been a manifestation of secondary syphilis, he might even have acquired his primary infection ten or more years before and have developed a tertiary manifestation of syphilis. It’s hard to know for sure at this stage. If treated early with penicillin, the secondary stage responds well and reasonably quickly, but in the tertiary stage (syphilis of many years standing) the response is less certain and much slower…

…did he in fact develop very poor eyesight? 

All good wishes – don’t hesitate to ask any more questions. Good luck with it all.

David.

May 22, 2020, 7:28pm

Hi David,

Interesting too that syphilis was common in MSMs.

The fascinating thing with Nouros is that I have found no other source which mentions that he had poor eyesight, although the fact that in some photographs from the 1940s-50s he wears sunglasses could hint at this condition! He lived until 1972, and I haven’t the slightest idea if his syphilis was a contributing factor to his death, although he was 80 years old when he died.

So if he lived that long after his syphilis/eye troubles, does that mean that it is unlikely he had a tertiary manifestation of syphilis?

….[based on anecodtes I have collected] Nouros seems to have been quite “promiscuous” in that very decade (1950s) when he was suffering from those ailments, although it is unknown if he actually had sex with men at that time (which would have meant passing on the infection!).

Kind regards,

Michael.

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22 May, 2020, 10:08pm

Dear Michael,

[…]

Yes, I think it’s likely that Kostas didn’t have tertiary syphilis if indeed he was having a number of sexual partners in the late forties and early fifties. He probably had secondary syphilis, in which case his treatment was given early enough to have completely cured him and he probably died of something else, and his eyesight probably wasn’t permanently affected, even though he might have had an uncomfortable and worrying few weeks or months of treatment and follow-up.

[…]

Anyway I am always happy to help and syphilis was always one of my enduring interests – such a very fascinating, and still unbeaten disease despite the fact that we have had an excellent and reliable diagnostic blood test for over one hundred years and an excellent and reliable treatment with penicillin since about 1945 with the only drawback that it has to be given by injection. But the major problem has been that syphilis above all other diseases, with the possible exception of HIV/AIDS, has been so stigmatised for so long. And yet so many major artists and other eminent people died of it – Schubert, Delius, Henry VIII, and the list goes on and on.

All good wishes…

David.

22 May, 2020, 10:52pm

Dear David,

[…]

Yes…I think it’s reasonable to assume that Nouros was cured by the 1960s, he probably just died of old age. In fact there is a passport photo of Nouros c. Early 1960s and his eyes look perfectly healthy (at least to my non-specialist eyes).

[…]

I can only imagine the stigma around syphilis in 1950s Athens/Piraeus, but I assume it must have been a common disease (sailors coming in and out, lots of brothels, lack of education etc etc).

[…]

All the best for now.

Regards,

Michael.

23 May, 2020, 12:29pm

Dear Michael,

[…]I got the feeling Piraeus especially was a pretty raunchy place – I arrived there by ship in Feb 1969, when the Colonels were in power. (I had been a ship’s doctor on a cargo ship to get a free passage to London, but the old ship was very slow and so as not to be late I had to get off in Athens and fly to London to start a post-graduate course in surgery – but I managed about three days in Athens – I remember you could walk about quite freely and openly all over the Parthenon site then with hardly any crowds).

You can’t help feeling sorry for Kostas Nouros, can you? It must have been very difficult being same-sex attracted in his times – well, it was bad enough in 1969 when I came out first in London. But also you’ve got to admire him for all he went through –  being a refugee, losing two wives and a daughter, serving in the army as an entertainer (no wonder he looked a bit lined and unsmiling!) – and his lust for living, his love of singing, and getting what he could despite the difficult climate he lived in.

[…]

You are correct of course – syphilis was very common in both men and women after the second world war, and health department’s in countries like the UK and Australia ramped up their VD clinics to deal with it. But I bet it was rampant in Piraeus and Athens and other big Greek cities especially with the sailors and the military and all the social disruption associated with the civil war as well as the aftermath of WW2, and not much easily accessible medical help probably.

[…]

Stay in touch,

Best wishes

David.

Part III – Complete pages of booklet

The following document is held in the Elias Petropoulos papers at the Gennadius Library, Athens, in Section VI – Rebetika Songs, Box 5 – documents of rebétes and rebetiko musicians.  

ΕΝΟΤΗΤΑ VI: ΡΕΜΠΕΤΙΚΟ ΤΡΑΓΟΥΔΙ, Φακ. 5: Τεκμήρια Ρεμπετών.

It is stamped with Petropoulos’s own cataloguing system for the rebetiko archives, under the number 1459.

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