The Appearance of Syphilis in the 1490s

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The Appearance of Syphilis in the 1490s

Overview

The earliest references to the disease now known as syphilis come from the 1490s, when it broke out among French troops besieging the city of Naples. Initially known as morbus gallicus (the French Disease), it soon became epidemic throughout Europe. The disease left visible and disfiguring signs of infection, which led to social stigmatization. Most damaging in its late stages, it often produced severe disabilities and even death. Believed to be a new disease imported from the Americas, syphilis helped challenge traditional ideas of disease causation and spread. While most early modern medical authorities believed syphilis was a new disease, scholars today continue to debate its origins and antiquity.

Background

In 1494, the Italian city-state of Milan appealed to King Charles VIII of France for military assistance. Seizing the opportunity, Charles VIII invaded with mercenary troops. Opposed by Italian forces from Florence, Venice, and the Papal States, as well as by those from Spain, Charles initiated what became known as the Italian Wars. The French succeeded in capturing Naples in 1495 after a long siege. Disease broke out among the troops in the midst of their subsequent celebrations, and when they were sent home many returned to their native lands bringing this new disease with them. By the end of 1495, all of Europe seemed to be infected with the French Disease, which caused painful aches and fevers, disfiguring sores, and often death. Sometimes called the Great Pox, to distinguish it from smallpox, the disease was also variously called the Spanish, Neapolitan, Polish, Russian, British or Portuguese disease, depending on the nationality of the speaker. Its common name today, syphilis, comes from a poem published in 1530 by the Italian physician and humanist, Girolamo Fracastoro (c. 1478-1553). Entitled Syphilis sive morbus Gallicus (Syphilis or the French Disease), the poem tells the story of a young shepherd named Syphilis who was infected with a "pestilence unknown" after offending Apollo. It goes on to describe the course and symptoms of the disease, vividly describing events such as when "unsightly scabs break forth and foully defile the face and breast" and " a pustule resembling the top of an acorn, and rotting with thick phlegm, opens and soon splits apart flowing copiously with corrupted blood and matter." Although Fracastoro's term did not catch on immediately, by the nineteenth century morbus gallicus was known as syphilis.

Modern science has shown that syphilis is caused by a corkscrew-shaped bacterium, or spirochete, known as Treponema pallidum. It is one of four treponemes that infect humans, though the only one that is currently found worldwide. The other three cause the diseases pinta (T. carateum), a skin disease endemic today in Central and South America; yaws (T. pertenue), which affects both skin and bones and is found today in warm, humid climates including Africa, Southeast Asia, the Caribbean and South America; and endemic syphilis (T. pallidum endemicum), which is similar to yaws, but is found only in warm, arid climates such as Saharan Africa. Interestingly, despite causing four clinically distinct diseases, these treponemes are indistinguishable in the laboratory. All four are transmissible, though only venereal syphilis is passed through sexual contact (or through in utero infection of an unborn child by a syphilitic mother).

The first stage of venereal syphilis produces a painless lesion in the genitals, which will heal of its own accord within weeks. After a six-to-eight-week latent period, the second stage is generally marked by a rash, fever, and swollen lymph nodes. These symptoms also disappear spontaneously after a few weeks. The third stage of syphilis does not occur in all cases, and then only after a lengthy latent period, often as much as 20 years. During this latency, the disease continues to be transmissible. Tertiary syphilis is the most damaging stage of the disease. Most typically, it produces gumma, small rubbery lesions that can occur in all parts of the body, including on internal organs. The disease can affect the cardiovascular system, the nervous system, the spinal cord, and even the brain, producing a form of insanity known as dementia paralytica. Today, syphilis is treatable with antibiotics, and tertiary syphilis has largely disappeared.

Impact

The withdrawal of the French troops and dispersal of their multinational mercenaries is credited with aiding the quick spread of the disease throughout Europe. After this initial outbreak, syphilis remained epidemic throughout the sixteenth century. It produced violent symptoms and often resulted in death. By the seventeenth century, the disease seems to have become less virulent, settling down into the chronic disease still suffered in many areas today. While the emergence of syphilis as an epidemic disease did not have long lasting economic or demographic effects, it did have important social and medical repercussions.

Socially, syphilis led to increased stigmatization and fear. Joseph Grunpeck, a sufferer in this early epidemic, described it in his autobiography as "a disease which is so cruel, so distressing, so appalling that until now nothing so horrifying, nothing more terrible or disgusting, has ever been known on this earth." Quickly recognized as a venereal disease, so called because of its association with Venus, goddess of love, syphilis became a disease of vice, marking its sufferers as corrupt and licentious. This corruption was reflected in the very faces of the infected, including noses destroyed by both the disease and the mercury used to treat it. One result, then, was an increased demand for an early form of plastic surgery. Gasparo Tagliacozzi, a Bolognese surgeon in the late sixteenth century, acquired an international reputation for his technique of grafting skin from the upper arm onto the nose. His 1597 work, De curtorum chirurgia per insitionem (On the Surgery of the Mutilated by Grafting), provided a precise guide to the technique. A second repercussion of syphilis was that these visible signs reconfirmed the ancient association of sexual activity with sin, which in turn led to increased state regulation and restriction on licentious entertainment, such as brothels and steam baths.

Treatments for syphilis included bleeding, mercury treatments, and guaiac tree bark. Bleeding and mercury treatments had the same goal—to remove bad humors from the body. Mercury had long been used by Europeans in salves for skin diseases, and was soon applied for syphilis as well. Later used in baths or taken orally, mercury treatments prompted heavy salivation, which was believed to be a sign of the effectiveness of mercury in pulling poisons out of the body. In reality, it was a sign of mercury poisoning, along with other side effects such as loss of hair, bleeding gums and loose teeth. The third common treatment, guaiac wood, was from the New World. This tree (Guaiacum officinalis) grew only in the Americas and decoctions made from its bark or wood were used by natives to treat a variety of skin problems. Bolstering this trade was a belief, common at the time, that for every disease God had created a cure nearby. Many believed that the disease had been brought to Europe from the Americas, and therefore that the cure was sure to come from there also. Experience showed this treatment less effective than mercury, however, and by the late sixteenth century it had fallen out of favor.

The belief that syphilis was a new disease was common from the fifteenth century on, though there were some disagreements in the medical community over its origins. The earliest reference to a New World origin for syphilis comes from Gonzalo Fernández de Oviedo, who wrote of it in his 1526 work, Summary of the Natural History of the Indies. Another important support for this belief came from Ruy Díaz de Isla, who argued in his Tractado contra el mal serpentino (Treatise on the Serpentine Malady), published in 1539 but written as early as 1505, that the disease was brought back by Columbus and his men, and that he had treated one of them in 1493. As some of these men were known to be fighting at the siege of Naples, the spread of syphilis was blamed on them. Many other well-known and respected Spanish authors, such as Nicolás Monardes, Bartolomé de Las Casas, and Bernardino de Sahagún, all agreed that the disease had long been known in the Americas, and only recently brought to Europe. Arguments to the contrary, however, came as early as 1497, when Niccolò Leoniceno (1428-1524) argued in his De epidemia quan vulgo morbum gallicum vocant (On the Epidemic Vulgarly Called the French Disease) that ancient authors had indeed discussed this malady, but poor translations hindered modern understanding.

The idea that syphilis was a new disease also played a part in challenging some traditional medical theories. The sixteenth century saw the beginnings of the scientific revolution, which may be summarized as a change from relying entirely on ancient authorities to relying on observation and experiment. The advent of recent new diseases, such as bubonic plague in the fourteenth century and syphilis in the fifteenth, prompted a reevaluation of traditional Galenic approaches to health and disease. Ancient authorities were found to be useless, as they had neither descriptions of these diseases nor treatments for them. Doctors were thus forced to adapt old theories or rely on their own experiences and observations. By the mid-sixteenth century, these diseases prompted a new theory of disease transmission, that of contagion, which was developed by the same Girolamo Fracastoro who had named syphilis. He argued for tiny causative agents, or "seeds", rather than internal humoral imbalance to explain disease. The process of changing or discarding ancient knowledge was a very slow one, and Fracastoro's contagion theory was not immediately embraced. Nonetheless, in hindsight we can see the emergence of syphilis, and reactions to it, as having a role in these larger ongoing changes.

Questions on the origins and antiquity of syphilis were revived during the Enlightenment, and the debate continues among many scholars today. Modern scholars have produced both skeletal and linguistic evidence to support the contention that syphilis existed in the Americas prior to contact with Europeans. What remains unclear is whether syphilis existed in Europe before Columbus's voyages. Archeologists have found what they believe to be skeletal evidence for syphilis in Europe prior to the age of discovery, but this evidence is not conclusive and remains subject to interpretation.

Literary evidence is also used by both sides. Modern proponents of the view that it was a new disease point to the large numbers of treatises written in the early sixteenth century. References to and descriptions of syphilis seem to suddenly explode from the 1490s onward, while earlier writings do not directly address a disease recognizable as syphilis. Certainly, morbus gallicus acted like a new disease—it spread quickly, caused extremely debilitating symptoms, and took a high toll in lives. All early chroniclers of the disease asserted it was new, and witnesses repeatedly declared it to be unlike anything they had previously seen.

Opponents of the American theory argue that syphilis existed in earlier centuries, but was simply not differentiated from other diseases. Most likely, it was encompassed by leprosy, another disfiguring disease often associated with corruption and uncleanliness. Leprosy was a common diagnosis in medieval Europe, one that has been shown to embrace more than just the medical condition implied by the term today. Most significantly, there are numerous references in medieval literature to "venereal leprosy", which was believed to occur from sexual contact with one already infected. True leprosy, however, is not sexually transmitted, and is transmissible only with years of close contact. In addition, leprosy was often treated with a mercury-based salve known as Saracen ointment. While mercury does little for true leprosy, it became the primary treatment for syphilis after the fifteenth century. Finally, at the same time that syphilis became epidemic, leprosy was on the wane and leper houses were being closed down, sending any remaining residents out into society. All this evidence is taken to show that leprosy simply masked the existence of syphilis in the Old World.

A third approach to the question, which focuses on the biology of syphilis, has been put forth in the last half century. Known as the unitarian theory, it takes into account the enormous similarities of the four human treponematoses, to argue that all four originated from a common ancestral spirochete and simply adapted to differing climates and societies, producing different diseases. Thus, these treponemes existed in both the Old and New Worlds, and simply evolved over time alongside humans. The oldest of the four diseases, pinta and yaws, are both transmissible through direct skin to skin contact, and flourish in warm humid climates where such contact is common. Endemic syphilis emerged later as a response to dryer regions, where the treponeme could not survive on the surface of the skin and was forced to use the body's mucosal tissues to remain moist. Venereal syphilis, according to this theory, was simply another adaptation to colder climates and heavier clothing, in which the spirochete found warmth and moisture by retreating further into the interior of the body, relying on sexual contact for transmission. The epidemic of venereal syphilis at the end of the fifteenth century is thus accounted for not by the introduction of a new causative agent, but by social changes, including population expansion, migration, and changing morality codes that increased sexual activity and enabled the treponeme to adapt and flourish. This theory has been well received by many modern scholars, and shows a great deal of promise for solving the riddle of syphilis's origins.

KRISTY WILSON BOWERS

Books

Arrizabalaga, John, John Henderson and Roger French. The Great Pox: The French Disease in Renaissance Europe. New Haven: Yale University Press, 1997.

Crosby, Alfred W. The Columbian Exchange: Biological and Cultural Consequences of 1492. Westport, CT: Greenwood Publishing Company, 1972.

Oriel, J.D. The Scars of Venus: A History of Venereology. London: Springer-Verlag, 1994.

Watts, Sheldon. Epidemics and History: Disease, Power and lmperialism. New Haven, CT: Yale University Press, 1997.