The infectious disease that sprung Al Capone from Alcatraz

January 25 marks the 70th anniversary of Al Capone’s death. Better known as “Scarface Al” (a nickname Capone hated) or, as the FBI once referred to him, “Public Enemy No. 1,” Capone is considered by many to be the most famous gangster in American history.

Yet after he was finally imprisoned for his life of crime, it was neither case law nor strong-armed tactics that set him free. It was, in fact, a tiny microbe called Treponema pallidum.

Capone’s storied career included running gambling rings and bordellos, loansharking operations, protection services, murderous rampages, and a slew of other nefarious activities, all of which have served as the source for hundreds of motion pictures and television shows.

He was born in Brooklyn on January 17, 1899, and his parents, Gabriel Capone (a barber) and Teresa Raiola, were immigrants from Naples. True to form, Al was kicked out of public school at age 14 for hitting his teacher in the face. Shortly thereafter, he took to the streets as a low-ranking thug and gangster.

Sometime around 1920 (historians argue over the precise date), Capone stepped on the fast track to becoming a “made guy” when he was recruited by Johnny Torrio (whom Capone considered his mentor) to join “Big Jim” Colosimo’s crew in Chicago. The two later colluded to murder Big Jim so that Torrio could take over the Colosimo’s business.

It was Al Capone’s first job in Chicago, as a bouncer in one of Colosimo’s bordellos, where our medical story begins. Eager to partake in the business’s offerings, Capone sampled many of the prostitutes working there and, soon enough, contracted syphilis. Capone was too ashamed to seek out medical attention for his “venereal disease.” As a result, his disease was allowed to fester and progress in an unchecked manner. Yet at this point in medical history, even if he had consulted a physician, there was no guarantee of cure. Salvarsan, or arsphenamine, the medication for which Paul Ehrlich won the 1908 Nobel Prize, was a fairly good treatment for what was once known as “the Great Pox” but it was hardly perfect. Indeed, syphilis remained a major cause of death in the United States until after World War II when the real magic bullet, penicillin, became widely available.

Al Capone smiles as he smokes a cigar on his way to Atlanta Federal Penitentiary after conviction for Federal Income Tax Evasion on May 4, 1932, in Chicago. Photo by Popperfoto and Getty Images

Syphilis has three major stages. The primary stage is heralded by a painless sore, or chancre. Because the infection is typically transmitted sexually, that sore is most commonly found on the genitals and appears anywhere from three to 90 days after exposure. After the chancre heals, the infected person then experiences a rash over all or much of the body. This secondary stage occurs four to 10 weeks after exposure. And then the infection goes quiet — without any symptoms or problems for years. But syphilis is merely fooling the infected individual that all is well. Over the next several years, the syphilis microbes are pathologically boring their way into various organs of the body, especially the liver, the heart and the brain. When the symptoms of this damage do appear (the third stage of syphilis), a decade or more after infection, it is typically too late to change the disease’s march toward killing the infected person.

Al Capone, of course, graduated to terrorizing Chicago and beyond. It took dozens of years of criminal mayhem before the U.S. federal government finally nailed him in 1931 for, of all things, tax evasion. He was sentenced to 11 years, first at a federal penitentiary in Atlanta and, soon after it opened in 1934, Alcatraz Island, the famed prison in the middle of San Francisco Bay.

“The Rock,” as Alcatraz was nicknamed, was widely heralded to be inescapable. Not so for Al Capone whose unchecked syphilis destroyed his brain while he was an inmate there, confined to Cell No. 181.

Neurosyphilis has many manifestations along the central and peripheral nervous system but Capone’s case was notable for making him certifiably insane. He often failed to follow the guards’ orders even at the penalty of severe punishment, less out of defiance than out of an inability to intellectually process them. Occasionally, he wore a “strange grin” on his face and even dressed up in his winter coat, hat and gloves while sitting quietly in his heated cell. At other times, he was somewhat lucid.

His wife, Mae, seized on Al’s increasingly odd behavior and petitioned the warden to release him from Alcatraz. The “fact” that cinched the deal was a formal diagnosis of syphilis of the brain made in February of 1938. Capone was released on Nov. 16, 1939 on the grounds of “good behavior” and, more cogently, his medical condition.

Capone’s life back “on the outside” was hardly a picnic. His physical and mental health continued to deteriorate and his syphilis worsened with each passing year until his death in Florida, of heart failure, on Jan. 25, 1947. He was only 48.

Yet how ironic, despite all the “tommy guns” Capone shot at others, it was “a shot of syphilis” — as the vernacular of the day referred to such infections — that served as his “get out of jail free” card.