by Sean Martin
It was on the genitals, or the mouth, where chancres – the first signs of the disease – appeared. This is the first sign of syphilis’s three stages, the primary, which usually appears two to four weeks after the initial infection. The chancre will usually disappear after a couple of weeks, perhaps leading the sufferer into a false sense of security that the disease has left them. During primary syphilis, buboes can also appear, which no doubt would have led the afflicted into believing that they had contracted the plague. As a result of this, syphilis came to be dubbed ‘the great imitator’ by the eminent Canadian doctor William Osler (1849–1919), as it produced symptoms that appeared to be those of other diseases (plague, meningitis and heart disease in particular). Syphilis is at its most infectious during the primary stage.
Secondary syphilis sees painless skin rashes appear all over the body. The sufferer will get headaches, fever, a feeling of exhaustion. They might lose some hair, ‘resulting in an almost moth-eaten appearance to the scalp’.205 And they will feel an ache in their bones. This is the sign that the spirochete is spreading throughout the body, burrowing its way into the unfortunate person’s bones. Alessandro Benedetti once performed an autopsy on a woman who had suffered from syphilis and noted that her bones ‘were tumorous and suppurated to the very marrow’.206 After a few weeks, the secondary symptoms disappear. Again, the person with syphilis would be forgiven for thinking that they were clear of the disease.
But then comes the tertiary phase. This will only develop in around one third of untreated cases, but when it does develop, the results can be horrific. Taking between one and twenty years to develop, the symptoms of tertiary syphilis can include further tumours and suppurating abscesses, ‘from which issued a villainous and infected mud which almost made the heart stop beating.’207 Inside the body, the bones are further destroyed, ‘producing especially horrific mutilations when the nasal and palate bones have been destroyed.’208 The cardiovascular system is attacked, causing aneurysms, while in the central nervous system, meningeal syphilis can develop, which will eventually shut the body down altogether. During this time, the syphilitic will develop the stumbling gait of a leper, and is quite likely to become blind, insane and violent.
After the campaigns of 1495, Charles’s army disbanded; the soldiers, mercenaries and camp followers dispersed through Europe, taking syphilis with them. By 1496, it was in France, Switzerland, Germany and Holland; by 1497, England and Scotland; by 1499 it had reached Hungary, Poland and Russia. When Vasco da Gama set out for India in July 1498, a number of his crew were syphilitic, and would live to introduce the disease to the subcontinent.209
As the disease spread, so did the horror stories. Diarist Bernardino Zambotti, writing in late 1496 of syphilis’s effects in Ferrara, noted that the disease was incurable, ‘following excruciating pains in the bones and nerves, accompanied by massive pustules all over the body.’210 The stricken ‘screamed day and night without respite, envying the very dead.’211 One merchant in Perugia was ‘so consumed by the disease between the thigh and the torso that it was possible to see everything that he had inside his body.’212
Doctors were powerless to stop the disease. They tried bloodletting. Ruy Diaz de Isla prescribed sexual abstinence, good hygiene, and eating well. The prescription in Fracastoro’s poem was quicksilver. None of it did any good, although quicksilver – mercury – became a popular method for treating syphilitics in the sixteenth century. Quite why is a mystery: it frequently did more harm than good. Doctors, it seemed, wanted to be seen to be doing something to justify their fees.
A link with sexual activity was soon established, and syphilis, like leprosy before it, became the disease of the sinner. The radical Florentine preacher Savonarola saw it as divine punishment for the excesses of the age; the French invasion of Italy and the advent of the pox were seen as signs of the imminent end of the world.213 Humanist scholar Joseph Grünpeck saw signs of a different kind: he attributed the advent of the pox to the ‘Great Conjunction’ of Jupiter and Saturn that occurred on 25 November 1484.214
This date appears on one of the earliest known depictions of the disease, a woodcut of a syphilitic man by Albrecht Dürer. The man stands beneath an astrological emblem representing the conjunction, displaying ulcers on his legs, arms and face. That he is dressed in the garb of a landsknecht, or mercenary, suggests Dürer was well aware that the disease was being spread by returning soldiers. (It is one of the artist’s earliest woodcuts, dating from 1496.) The image illustrates a poem about epidemics by the humanist scholar Theodericus Ulsenius, and carries the title Der Syphilitische oder Die Franzosenkrankheit ‘The Syphilitic, or the French Disease’), although this was probably added later, after the publication of Fracastoro’s poem in 1530.215 Swiss artist Niklaus Manuel Deutsch created a more chilling image around 1517. Death as a Soldier Embraces a Young Woman shows death in the tattered rags of a transi soldier, embracing a girl, one hand thrust between her legs. The anonymous St Anthony and the Syphilitics of 1520, (now in Lübeck) is a gentler depiction. A man and a woman, their faces bearing the signs of advanced stages of the disease, are brought before the saint in a woodland scene. They are introduced to Anthony by none other than Mary Magdalene, herself long associated with repentance for sins of the flesh;216 here those sins are embodied by a small group of naked girls just inside the treeline behind the saint.
Everyone blamed everyone else for the pox. The Italians referred to it as ‘the Spanish disease’ or ‘the French disease’. (The Germans and the English preferred the latter.) The French, for their part, dubbed it the ‘Pox of Naples’. The Japanese, who had suffered their first outbreak in 1569, called it the ‘Portuguese Sickness’ after the sailors who had introduced it. The Portuguese called it the ‘Castilian Disease’. For the Chinese, it was the ‘Ulcer of Canton’, a reference to the city where the first outbreaks had been recorded (introduced by the Portuguese, again). Tahitians, in the eighteenth century, called it the ‘British Disease’. (Captain Cook thought it was the fault of the French.) The Persians called it the ‘Disease of the Turks’, while the Turks called it the ‘Christian disease’.217 As one historian of epidemics remarked, ‘In this way syphilis announced the birth of nationalism.’218 The Spanish writer Oviedo, who spent ten years as an administrator on Hispaniola, was in no doubt as to where the disease came from. Writing to the King of Spain in 1526, he advised, ‘Your majesty may take it as certain that this malady comes from the Indies, where it is very common amongst the Indians, but not so dangerous in those lands as it is in our own.’219
By the time Fracastoro published his poem, syphilis had spread very rapidly across the Old World. No one was exempt (except the celibate, of course). In particular, the rich and powerful could be as susceptible as the poor. Ivan the Terrible (1530–1584), Tsar of Russia, suffered from it, leading to madness and cruelty. In one insane rage, he attacked his pregnant daughter-in-law, causing her to have a miscarriage; and in 1581, he notoriously murdered his own son. Another son, Feodor, was thought to suffer from congenital syphilis and in a moment of madness – one of many, it seems – proposed marriage to Elizabeth I. Robert Desowitz notes that the Cardinal Bishop of Segovia and Pope Alexander VI (Alexander Borgia) were also thought to be syphilitics.220 Another Borgia, Cesare (1475–1507), was syphilitic and had to wear a mask over his face to cover the disease’s ravages. So too was another Pope, Julius II (1503–13), who is remembered for commissioning Michelangelo to paint the Sistine Chapel’s ceiling. Julius is thought to have contracted the ‘French disease’ from Rome’s male prostitutes. On Good Friday 1508, he was unable to bare his foot to be kissed by worshippers as it was completely covered with syphilitic sores.
Less certain is the case of Henry VIII of England. Like Ivan, he became a tyrant, and was prone to fits of violence. He also suffered from a possibly telltale ulcer on his leg. He is said to have undergone a personality change in the late 1520s, around the time he was starting to push for divorce from his first wife, Cather
ine of Aragon. From then on, Henry became ever more the tyrant, breaking with Rome, proclaiming himself head of the Church of England and, in a massive larceny operation, stole vast amounts of land and wealth when he dissolved the monasteries. After changing the landscape of faith in England forever, he then began to backtrack in the early 1540s, allegedly showing signs of remorse for his actions. Could the English Reformation have been driven by a syphilitic tyrant and his henchmen?
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There is ongoing debate about the origins of syphilis. One argument holds that it started in the Americas, as de Isla and Oviedo believed, mutating in the 1490s when it came into contact with Europeans. Objections to an American origin were raised even while the disease was causing terror and shame across sixteenth century Europe. Scholars pointed to the Bible, and the illnesses Job suffers: ‘the days of affliction have taken hold upon me. My bones are pierced in me in the night season: and my sinews take no rest.’ (Job 30.16–17) The references to pains in the bones were seen as proof that syphilis had been part of God’s plan since time immemorial. Not content with the word of God, humanist doctors scoured the works of Hippocrates, Celsus and Galen.
Later participants in the debate ‘claimed to have identified the pox in the Babylonian poem of Gilgamesh, in the Ebers Papyrus, and in the ulceration of the genitals described by Paul of Aegina, Pliny the Younger, and so many others. What is the “country sickness” Horace refers to? What is the ficus which, according to Juvenal and Martial, makes doctors smile and results from debauchery, particularly pederasty? And don’t the Arab doctors also describe a plethora of lesions on the genitals and anus – ulcers, chancres, warts, verrucae and rhagades?’221
Modern objections to the American or Columbian theory of origin revolve around the disease’s links to other ailments of the same genus – pinta, bejel and yaws. This theory holds that a form of syphilis was long endemic in Africa and in Europe but went unrecognised until the ‘French’ or ‘Neapolitan’ disease appeared after the Battle of Fornovo. This theory maintains that what had often been taken for leprosy in the Middle Ages could well have been syphilis.
Another theory – that of the ‘dual origin’ – is a variation on these themes, maintaining that there were two forms of the disease, one from Africa spread by social contact, and the other strain that developed in the Americas, that was also spread by social contact until it became a sexually transmitted disease once it encountered Europeans.222 The African strain eventually spread north into Europe, where it was taken for leprosy (‘pre-Columbian’ syphilis), while the American strain came back with Columbus.
Of the theories, the Columbian is best backed up by paleopathological evidence,223 although the cause of the pre-Columbian camp has been bolstered by a number of archaeological discoveries in Britain. Bodies from Hull Priory, Blackfriars in Gloucester and Whithorn in Galloway – all of people who had died before Columbus’s return to Europe in 1493 – showed evidence of the bone damage characteristic of syphilis.224 How syphilis – if that is indeed what it is – reached late mediaeval Britain remains unknown. Similarly, in 2010, the body of a young man from an Anglo-Saxon cemetery at Apple Down in Sussex was also found to show evidence of syphilis.225 He had died in the sixth century AD. This discovery would appear to support a ‘dual origin’ theory for the beginnings of syphilis, although it remains controversial.
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Europe’s aggressive drive outwards in the sixteenth century was marked by disease. As the Cambridge World History of Human Disease notes, ‘In the sixteenth and seventeenth centuries, dozens of “new” diseases seemed to demand or defy medical explanation.’ Many of these diseases were the result of Europe’s ‘outward urge’ (to borrow a phrase from John Wyndham). This onslaught of new diseases, combined with the invention of the printing press and Renaissance humanism’s desire to debate and explain the world in new terms, produced some of the earliest medical descriptions we have of diseases like typhus, scarlet fever, rickets, ‘the “English sweate” (whatever that was), and even anorexia nervosa.’226
The ‘English Sweate’ is the odd one out in this group, as it remains one of the great unknowns of Renaissance epidemiology. It first appeared in London in September 1485, shortly after the new Tudor king, Henry VII, had been victorious at Bosworth Field. As the humanist scholar – and sometime courtier – Polydore Vergil commented, it ‘was taken by many as a bad omen’.227
The sickness struck quickly, its victims succumbing to acute feverish sweating, becoming comatose and dying within 48 hours. It seemed to strike men more than women, and, unlike so many diseases we’ve looked at, affected the rich more than the poor. It also seemed to home in on Englishmen – the Scots, Welsh and Irish being largely immune. There were recurrences in 1508, 1517, 1528, and 1551, each time affecting a comparatively small number of people. The Chronicle of Edward Hall (1497–1547) reports that the 1517 outbreak ‘was so cruel that it killed some within three houres, some within two houres, some merry at dinner and dedde [dead] at supper. Many died in the Kynges court, the lord Clinton, the lorde Gray of Wilton, and many Knightes, gentlemen and officers.’228
Justus Hecker (1795–1850), the German physician and writer who arguably did more than anyone else to start the study of the history of disease,
blamed the English climate and the habits of the English nobility. [T]he English sweating sickness was a spirit of the mist, which hovered amid the dark clouds. Even in ordinary years the atmosphere of England is loaded with these clouds during considerable periods, and in damp seasons they would prove the more injurious, as the English of these times were not accustomed to cleanliness, moderation in their diet, or even comfortable refinements. Gluttony was common among the nobility as well as among the lower classes; all were immoderately addicted to drinking.229
Modern theories have tended to steer clear of the weather and drink as causes: it was quite possibly a virus (or a new arbovirus) brought to England by Henry VII’s Flemish mercenaries, who were immune to the ‘sweate’ themselves. But it disappeared in 1551, and has not reappeared since.
Hecker was also fascinated by another mystery disease that was contemporaneous with the English Sweate: the dancing mania. The most celebrated case occurred in Strasbourg in the summer of 1518, when a woman started to dance in the street. Bystanders began to join in. Soon hundreds were dancing, and wouldn’t – or couldn’t – stop. At the peak of the phenomenon, about 400 people were dancing. The authorities decided to let them carry on, in the hope that they would exhaust themselves. They didn’t. Some danced themselves to death. Eventually, the remaining dancers were bundled into wagons and taken to the shrine of St Vitus at Saverne, thirty or so miles away, which seems to have had the desired effect.
The Strasbourg outbreak had not been the first. The earliest recorded spate of mass dancing occurred in Flanders in the seventh century.230 In the thirteenth century in Germany, a group of children danced from Erfurt to Arnstadt, which may have inspired the legend of the Pied Piper of Hamelin. In 1278, around 200 people were stricken with the mania on a bridge across the Meuse. The bridge collapsed. In 1374, there was a major outbreak in Aachen, which spread to a number of cities in western Germany and the Low Countries.
There were further outbreaks after 1518, too. In 1564, on St John’s Day, there was an outbreak in Flanders, said to have been witnessed by Pieter Bruegel, who made an engraving of the dancers. (The image remains in a copy by Hendrik Hondius.)
What could have caused this bizarre behaviour? Hecker believed the dancing was an attempt to ward off disease, plague in particular, stoked by religious fervour.231 More recent scholarship argues that, in each case, the communities affected were recovering from trauma and hardship, such as floods, famine, plague.232 An additional factor may have been the cult of St Vitus, who was thought to be able to curse people by making them dance. Weakened by famine and its resultant illness, the people of Strasbourg may have begun to dance to appease the saint, and then entered a trance state. The more people who
joined in, the harder it was to stop. It’s significant that the epidemic seems to have stopped after the dancers were taken to the shrine of St Vitus to pray.
Modern medicine explains St Vitus Dance in terms of Sydenham’s chorea, a streptococcal infection that causes involuntary jerking movements. (Another chorea, Huntington’s, causes similar movements, but is the result of a genetic abnormality.) The condition takes its name from Thomas Sydenham (1624–89), the doctor and medical reformer who was dubbed ‘the English Hippocrates’. Sydenham’s work helped move the study of disease and the practice of medicine away from the classical model of the humours, and into the modern era. Humoural theory wasn’t quite dead in Sydenham’s time, but was starting to look unwell.
Concepts of disease – and the medicine required to treat them – had been changing for a century or more by Sydenham’s time. The iconoclastic Swiss doctor Philippus Aureolus Theophrastus Bombastus von Hohenheim (c.1493–1541) adopted the alias Paracelsus – ‘greater than Celsus’, a reference to the first century Roman doctor – and publicly burned the works of Galen and Avicenna at Basel in 1526. Paracelsus questioned unthinking acceptance of tradition and authority, and stressed the importance of observation and experiment.
Such observation and experiment saw Renaissance scholars looking both outwards to the world around them, and inwards, into the workings of the human body. In the same year that Nicolaus Copernicus published De revolutionibus orbium coelestium (On the Revolutions of the Celestial Spheres, 1543), which overturned the geocentric model of the heavens, Andreas Vesalius’s De humani corporis fabrica (On the Fabric of the Human Body) represented a huge advance in the fledgling science of human anatomy.