Notorious Gangster Al Capone Was In Incredibly Poor Health At End Of Life — What Was Wrong?

A leading expert in neurology told Oxygen.com that a late stage form of syphilis could cause many of the maladies on display in "Capone."

Capone 1

A new film about Al Capone, one of the most famous mob figures of all time, doesn't focus on his criminal exploits or his downfall and imprisonment. Instead, it squares its sights on a rarely told aspect of his life: his final years when he was suffering from debilitating illness brought on by a sexually transmitted disease. 

"Capone" depicts in graphic detail the slow degeneration of Capone (Tom Hardy) at the mob boss' home in Palm Island, Florida following his release from prison. The legendary, once-terrifying mobster is seen losing control of his bladder and defecating in his bed seemingly uncontrollably while he suffers from hallucinations and visions of his violent past. 

Warning: mild film spoilers below.

As the film notes in the opening credits, Capone suffered from neurosyphilis — a complication of syphilis that can bring about dementia and a myriad of other health problems. But what else would this disease do to a person?

Dr. Christina Marra, a professor of neurology at the University of Washington, spoke with Oxygen.com about the portrayal of Capone's health issues in the film. Capone died at age 48 from apparent heart failure, PBS NewsHour previously reported. Marra theorized that neurosyphilis could have been a driving factor in his death given his surprisingly young age.

The Centers for Disease Control and Prevention likewise told Oxygen.com that it is possible for Capone to have suffered heart failure brought on by tertiary syphilis, as the late stage of the disease can damage multiple organ systems, including the nervous system and a person's heart and blood vessels — even though it is very rare. 

"While we don’t know what stage of syphilis that Al Capone had, we do know that most people with untreated syphilis do not develop tertiary syphilis. However, when it does happen it can affect many different organ systems," the CDC explained.

Marra also noted that Capone had a number of co-morbidities that could have exacerbated his health issues, including his famed lifelong love of cigars. The mobster even drank whiskey and smoked while in prison, according to The Chicago Tribune.

Marra explained that syphilis generally progresses through three stages as a bacterial infection, the first stage being defined by a sore at or near the point of infection. 

The secondary stage is defined by a rash on one or more areas of the body, according to a fact sheet on syphilis from the CDC. The rash is defined by "rough, red, or reddish brown spots on the palms of your hands and/or the bottoms of your feet. The rash usually won’t itch and it is sometimes so faint that you won’t notice it," the fact sheet reads. 

The rash will go away with or without treatment, but the CDC noted without treatment the disease will continue to be in your body in a latent form. Syphilis can also spread to a patient's brain or eyes at any stage during the disease's development — resulting in the development of ocular syphilis or neurosyphilis, the CDC said.

The disease can go dormant for decades if it progresses past the secondary stage without treatment — but can re-emerge in a third stage around 20 years later, Marra explained.

From there, a number of symptoms and ailments displayed by Capone in the film would generally be what a neurosyphilis patient could be expected to suffer from, although some artistic liberties were taken for the film. 

This matches with what is known of when Capone first contracted the disease, as he reportedly became infected with syphilis in his 20s while working as a bouncer at a Chicago bordello, PBS NewsHour previously reported. 

In real life, Capone first began showing symptoms of apparent neurosyphilis following his conviction for tax evasion and while he was serving his sentence at federal prisons in Atlanta and on Alcatraz Island, according to the FBI.

Patients with neurosyphilis could expect a form of the disease that attacks the spinal cord and a form that causes dementia by attacking the brain, Marra explained — also noting that an unfortunate patient like Capone could suffer from both forms, as he appears to in the film. 

As such, Capone's frequent loss of control of his bladder and emptying his bowels without notice could actually be seen in patients suffering from spinal cord complications, known as tabes dorsalis, according to the National Institute of Neurological Disorders and Stroke.

As seen of the filmic Capone when he is walking around, tabes dorsalis often results in a jerky, uncoordinated gait resulting from the degeneration of the spinal cord, Marra said. The degeneration can also result in damage to the eyes' ability to respond to light and potential blindness, according to the NINDS.

Capone was diagnosed with paresis stemming from syphilis and he mentally deteriorated during imprisonment, according to the FBI. Paresis, or paralytic dementia, is a mental disorder brought on by brain atrophy caused by syphilis infection, according to the U.S. National Library of Medicine. It generally results in vivid delusions and in further stages can result in a speech disorder called dysarthria.

The disorder also results in reduced mental capacity. Both Capone's personal physician and a Baltimore psychiatrist concluded Capone then had the mentality of a 12-year-old child after examinations in 1946, the FBI said.

In the film, Capone is also shown to have an explosive temper and frequently lashes out at people — which could be explained by general paresis.

Despite the apparent degeneration of his brain, the visual hallucinations and flashbacks Capone experiences throughout the film are virtually unheard of as an actual symptom of neurosyphilis, with Marra saying this would likely be embellishment for the film. However, his paranoia and distrust of the people around him would be expected of someone suffering from dementia, Marra said.

Likewise, the CDC said that dementia is a common symptom of neurosyphilis, alongside "severe headache, difficulty coordinating muscle movements, paralysis, numbness."

"It was the most common cause of admission to mental hospitals," Marra said of syphilis before it became treatable with the advent of antibiotics. 

But even if Capone had sought earlier treatment for his syphilis, successful treatments of syphilis prior to the adoption of the anti-bacterial medication penicillin were not widely reported, Marra said.

Penicillin is still considered an effective course to treat syphilis and the bacteria that causes syphilis has not adapted to become resistant, Marra explained. Penicillin was first discovered in 1928 by Scottish scientist Alexander Fleming, although clinical trials only first began in the United States in 1942, according to a paper from the Yale Journal of Biology and Medicine.

Being treated with penicillin would have stopped the progression of the disease that would have ultimately resulted in Capone becoming a "vegetable," Marra explained. However, by the time penicillin was used to treat Capone in the United States in 1945, his body had already been ravaged by the disease and he would die two years later in 1947, according to the FBI.

Vertical Entertainment's "Capone" is available to watch VOD now. 

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