Syphilis Outbreak in Europe



An epidemic of syphilis, a sexually transmitted disease which causes a rash, sores, and later systemic damage, erupted from the Italian port of Naples in 1495. The army of Charles VIII of France, in a retreat from the conquered city, brought the disease back to their own country. From there syphilis spread all over Europe and into Asia. This is the first well-documented outbreak of syphilis in Europe, and the strong role of Charles' army in its initial spread earned it the euphemistic moniker of "the French disease."


Medieval Syphilis


Often called "the great pox" to distinguish it from smallpox, syphilis was faster and more severe in the late fifteenth century than it is today. The first symptoms, ulcers covering the body, appeared 2-6 weeks after the initial infection; the modern strain can take up to three months to manifest ulcers, and then primarily on the genitals. If open, these foul-smelling sores provide an additional means of transmission for the anaerobic spiral-shaped bacteria that causes syphilis, Treponema pallidum. After a period of remission, in which the infected believed themselves cured, the sores would return, accompanied by fever and joint pain. As the disease progressed further, the sores would eat away at the bone; the pattern of degeneration and regrowth would cause great deformities. The infection could then spread to the nervous and cardiovascular systems, causing complications leading to death a few months after the first symptoms manifested. Modern syphilis, by contrast, does not reach its most serious symptoms until after a remission of 10-20 years.

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Charles' spent little time in Naples--his allies-turned enemies forced him to leave a skeleton guard over the city and make a hasty retreat.

Setting

Though a thriving seaport and the capital of Southern Italy, Naples was not a healthy city in the mid-1490s. There had been a run of natural disasters, such as floods, earthquakes, famine and disease. As the year 1500 drew nearer, religious figures began to make millenarian prophecies, suggesting that these disasters were punishment for sin.

The suggestion had a ring of truth: at the time, Neapolitans were very sexually active, and prostitution was a widespread institution throughout the Italian Peninsula. There were 6800 prostitutes in Rome alone; in Venice, prostitutes were openly marked with yellow handkerchiefs worn around the arm.

Charles VIII, urged to take Naples by several allies, assembled a mercenary army of 50,000 soldiers to take the city and marched on the city in 1494 to 1495. Armies at the time were composed of mercenaries, frequently assembled, disassembled and reassembled as the need arose; conditions in camps were filthy and unrestrained, making them breeding grounds for infectious disease.

Charles took Naples without resistance in February of 1495, frightening the surrounding rulers, including some of his allies, with the ease of his conquest. Banding together against him in the League of Venice, their powers drove Charles back to France, but not before his troops had fallen to an invisible enemy: syphilis.



syphilitic_man.jpg
This print of a syphilitic man comes from a woodcut by the German artist Albrecht Dürer. The piece was published in 1496; "1484" refers to the timing of an ill-boding astrological conjunction that caused the epidemic.


Outbreak


About 800 prostitutes accompanied Charles' army, and it is possible some of the sailors who sailed with Christopher Columbus were among his mercenaries. According to the Columbian theory of the origin of syphilis, these men would have given syphilis to the camp's prostitutes, who would then spread it to the rest of the soldiers. Then, when Naples fell, the soldiers celebrated with pillaging and debauchery, increasing the number of infected in the city populace and among themselves. The infected soldiers and prostitutes dispersed Europe when Charles disbanded his army, increasing the area of syphilis. The disease affected both nobles and peasants: the first person identified as a victim of this syphilis outbreak was Bernard Stuart, who was designated governor of Naples by Charles VIII. It would later infect Pope Alexander VI's son, Cesare Borgia, and Pope Julius II; ironically, Charles VIII is suspected of being a victim of the disease he spread.

The epidemic swept through France, Switzerland and Germany in 1496, and England and Scotland were infected by 1497. By 1500, all of Europe was contaminated; five years later, syphilis had crossed through Asia as far as China.



Social Impacts


Suspected Causes

In August, 1495 the Holy Roman Emperor, Maximilian I, declared the pestilence a punishment from God for blasphemy and especially lust. That the disease was venereal was largely agreed upon; the specific cause, however, was not. Adherents to astrology believed that a conjunction of the planets was to blame for the illness, while proponents of Galen's Humoral Theory of Disease identified the root of the problem as an excess of phlegm.

Treatment

Those who thought that the "great pox" was a divine punishment prayed for forgiveness. Believers in astrology, who thought that the disease was in the air, tried to take themselves out of the air, staying indoors and breathing as little as possible. Mercury, inherited from the Arabs as a cure for skin ailments, was used by followers of the Humoral Theory. Despite its severe side effects, they knew that mercury promoted spitting, which would 'remove the excess phlegm.' It was even used in a preventative measuredeveloped in the mid-1500s--a mercury-soaked linen bag, predecessor of the condom. Other syphilitics tried to sweat out the phlegm in "dry stoves," in which a person and a small oven would be enclosed to promote sweating. Some doctors called for the use of guaiacum, a "New World" wood, which was powdered and then consumed, turned into a salve for the sores, or poured into a bath. Bleeding and the cauterization of pustules were also tried.

In a practical vein, hospitals specifically for patients with syphilis, known as incurabili, sprang up in all the major cities of Italy, such as Naples, Venice and Rome. The two women who originated the effort worked in Naples to raise public awareness about the disease. Thanks to them, the city was spared some of the force of the chronic disease. Control of prostitution was also urged, as early as 1500, but was not heeded by the authorities. When the Church did eject all prostitutes from Rome and the Papal State in the mid-1500s, the public's revolt against the idea forced them to reconsider. Worse, the ejected prostitutes spread syphilis in a greater area.


Bibliography


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Cefrey, Holly. Syphilis and Other Sexually Transmitted Diseases. New York: The Rosen Publishing Group, Inc., 2002

Diamond, Jared. Guns, Germs, and Steel: The Fates of Human Societies. New York: W. W. Norton & Company, Inc., 1997.

Di Cicco, Camillo. “History of Dermatology and Venereology.” January 9, 2009. Online video clip. Youtube. Accessed January 10, 2010. http://www.youtube.com/watch?v=G2d9oHSR0EM.


Eisler, Colin. “Who is Dürer’s “Syphilitic Man”?” In Perspectives in Biology and Medicine, Vol. 52, Number 1, Winter 2009. Online through Project MUSE. Accessed January 18, 2010. http://muse.jhu.edu/journals/perspectives_in_biology_and_medicine/v052/52.1.eisler.html.

Hayden, Deborah. Pox: Genius, Madness, and the Mysteries of Syphilis. New York: Basic Books, 2003.

Hays, J.N. Epidemics and Pandemics: Their Impacts on Human History. www.abc-clio.com: ABC-CLIO, Inc., 2005.

Karlen, Arno. Man and Microbes: Disease and Plagues in History and Modern Times. New York: Simon & Schuster, Inc., 1995.

The President and Fellows of Harvard College. “Open Collections Program: Contagion, Syphilis, 1494-1923.” Harvard University Library. 2008. Accessed Jan. 7, 2010. http://ocp.hul.harvard.edu/contagion/syphilis.html.

“STD Facts—Syphilis.” Centers for Disease Control and Prevention. January 4, 2008. Accessed January 14, 2010. http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm.

Wills, Christopher. Yellow Fever, Black Goddess: The Coevolution of People and Plagues. New York: Addison-Wesley Publishing Company, Inc., 1996.

Zuk, Marlene. “A Great Pox’s Greatest Feat: Staying Alive.” New York Times. April 29, 2008. Accessed January 9, 2010. http://www.nytimes.com/2008/04/29/health/29essa.html?_r=2.