The Pox: The Life and Near Death of a Very Social Disease

by Kevin Brown

Overview

From almost the time when man first discovered the pleasures of sin, he has also experienced the torments of the Pox. Drawing on references from art and literature, stories of famous sufferers and medical documents, this book presents the history of syphilis and gonorrhoea, and their treatment, from the Renaissance to the antibiotic age.

Product Details

ISBN-13:	9780752495705
Publisher:	The History Press
Publication date:	09/21/2006
Sold by:	INDEPENDENT PUB GROUP - EPUB - EBKS
Format:	eBook
Pages:	288
File size:	470 KB
Age Range:	18 Years

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The Pox

The Life and Near Death of a Very Social Disease

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By Kevin Brown

The History Press

Copyright © 2013 Kevin Brown
All rights reserved.
ISBN: 978-0-7524-9570-5

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CHAPTER 1

The Wrath of Apollo

It was an age in turmoil, a time when the excitement of the new was such that it seemed to those living through it to be a time of fundamental change for mankind. In Renaissance Italy there was a brilliant burst of achievement in scholarship, literature, architecture, sculpture and painting that accompanied a rediscovery of the splendours of classical antiquity and the appreciation of the capabilities of the individual. In the quest for the fabled wealth of the Indies, a New World had been discovered and an era of exploration initiated that was to expand the horizons of the Old World, albeit at the expense of older, if previously unknown cultures. Knowledge was opened up and resources and diseases exchanged. Yet, even as a golden age seemingly dawned, there were troubles ahead. Italy, cradle of the rebirth of the arts, became a battleground for foreign powers seeking supremacy, and from the smoke of battle came a fearful new disease destined to wreak havoc, cause great personal suffering and upturn long-established ideas in medicine and society.

The invasion of Italy by Charles VIII of France in 1494 in pursuit of his claims to the throne of Naples initiated thirty-six fruitless years of campaigning for supremacy in the Italian peninsula that changed very little politically except for the acquisition by Spain of the Duchy of Milan and the Kingdom of Naples and Sicily. For Italy, these were indeed years of woe, heralded by a succession of natural disasters such as floods, severe snowstorms, famine and outbreaks of pestilent disease. Foremost among these disasters was a new and frightening disease that was to be the scourge not only of Italy for an age but of the entire world for centuries to come. The earliest written reports of it followed the battle of Fornovo on 6 July 1495. Marcello Cumano, a military doctor serving with the Venetian troops, wrote:

Several men-at-arms or foot soldiers, owing to the ferment of the humours, had pustules on their faces and all over their bodies. These looked rather like grains of millet and usually appeared on the outer surface of the foreskin or on the glans, accompanied by a mild pruritis. Sometimes the first sign would be a single pustule looking like a painless cyst, but the scratching provoked by the pruritis subsequently produced a gnawing ulceration. Some days later, the sufferers were driven to distraction by the pains they experienced in their arms, legs and feet, and by an eruption of enormous pustules which lasted ... for a year and more if left untreated.

This new disease among the soldiers fighting at Fornovo was also observed by another doctor from the Veneto serving as chief surgeon to the Italian armies massed against Charles VIII. Alessandro Benedetti, 45-year-old Professor of Medicine at the University of Padua, was a humanist physician and epidemiologist convinced of the importance of naturalistic observation as the basis of all medical progress. He was quick not only to record the repulsive symptoms but also to establish how this new disease was transmitted from person to person:

Through sexual contact, an ailment which is new, or at least unknown to previous doctors, the French sickness, has worked its way in from the West to this spot as I write. The entire body is so repulsive to look at and the suffering so great, especially at night, that this sickness is even more horrifying than incurable leprosy or elephantiasis, and it can be fatal.

It is remarkable that the sexual nature of the disease should have been apparent so early after it first caught the attention of the medical profession. However, it was not only in soldiers that Benedetti had investigated the effects of the disease. He had also performed an autopsy on a woman suffering from it and observed that her bones were tumorous and suppurated to the very marrow, even though the membrane covering her bone was still intact. Moreover, licentiousness and marauding soldiers went hand in hand; the disease had first been observed the previous year among French troops at the siege of Naples, where they had come into intimate contact not only with their own camp-followers but also with the Neapolitan prostitutes who had plied their trade with mercenaries from all over Europe recruited for defence against the invaders. Former Florentine ambassador to Spain and adviser to three popes, Francesco Guicciardini wrote in 1537 in his magisterial history of Italy in his own lifetime that at 'those very times when it seemed destined that the woes of Italy should have begun with the passage of the French ... was the same period when there first appeared that malady which the French called the Neapolitan disease and the Italians commonly called either the boils or the French disease'.

This new disease was what we now know as venereal syphilis. It is caused by the corkscrew-shaped spirochaete Treponema pallidum, a bacterium not discovered until 1905. It is passed on primarily by sexual intercourse, but can also be transferred by infected mothers to foetuses during pregnancy. As a disease, it has three very distinct stages: primary, secondary and tertiary syphilis, separated by latent periods with no visible symptoms. Primary syphilis usually appears between a fortnight and a month after infection. It is characterised by the development of a chancre, a small, firm, hard-edged but painless ulcer, on the genitals where it has entered the body. If it is left untreated this primary lesion will usually heal spontaneously within a few weeks. Buboes, swellings of the lymph glands, can also appear. In women, this primary stage may go undetected if the chancre has formed inside the body, and the disease is revealed only in the secondary stage. However, syphilis is at its most infectious during the primary stage.

If early syphilis has been left untreated, most sufferers will go on to the secondary stage after the spirochaete has spread through the body. Extensive but painless skin rashes develop all over the body, often accompanied by fever, headaches, a general exhaustion and aching bones. There may also be patchy hair loss or alopecia, resulting in an almost moth-eaten appearance to the scalp. Then, after a few weeks these secondary lesions and symptoms disappear in their turn. Sometimes these symptoms will recur after a latent period. Both the latent and secondary periods remain infectious.

Tertiary syphilis develops only in roughly one-third of untreated cases after a further latent period of anywhere between 12 months and 20 years. It progressively destroys the skin, mucous membranes, bones and internal organs, inflicting the greatest horrors on its victims. Gumma, a small rubbery, benign tumour, can develop anywhere in the body. The attack on the bones can cause small depressions where the tumours have been or eat away the bone entirely, producing especially horrific mutilations when the nasal and palate bones have been destroyed. Meanwhile, late syphilis can also attack the cardiovascular and central nervous system. Cardiovascular syphilis may weaken the walls of the aorta, causing aneurysms (balloon-like swellings of the artery wall), which may sooner or later burst, with fatal results. Neurosyphilis can take a number of forms. With tabes dorsalis (a form of neurosyphilis that progressively destroys the sensory nerves), the destruction of the nerve cells in the spinal cord produces a stumbling gait and very poor coordination in its victims. Paresis or general paralysis of the insane is caused by a general softening of the brain resulting in a form of insanity often linked with a form of creative genius but actually more destructive in its effects. Such an array of symptoms led the physician and medical humanist William Osler to dub it 'the great imitator' in the early twentieth century and explains why deaths from tertiary syphilis might be ascribed variously to heart disease, insanity or meningitis. Since the introduction of antibiotics, tertiary syphilis has virtually disappeared, but it was once a great killer. Yet, even if they correctly diagnosed the cause of death, doctors often put on the death certificate the more socially acceptable disease that the symptoms resembled, prompting Osler to comment wryly that 'men do not die of the diseases that afflict them'.

One manifestation of syphilis that has all but disappeared in the Western world since the 1960s is congenital syphilis, although it can still be found in underdeveloped countries. This is transmitted to the foetus during pregnancy by an infected mother. Children unfortunate enough to be born with the affliction bore the stigmata of shame. Often they would be small in stature because their skeletons were underdeveloped. Generally they could be recognised by their 'family appearance' of flat faces with saddle-noses. Sometimes the septum (partition) of their noses and their palates would be eaten away by gumma. Linear scars radiated from their noses and mouths, and the wrinkling of their skin gave an 'old-man look', whatever age they may actually have been. Patchy hair loss and a skin discoloration that gave them a 'café-au-lait' tinge were further signs of the disease. Most characteristic of all were notched and peg-shaped Hutchinson's teeth. Such were the manifestations of syphilis that now struck Europe with terrible effect.

The pox may have first erupted into public consciousness in Naples, but it had its origins elsewhere. It had been noticed that some of the Spanish soldiers defending Naples against the French had accompanied Columbus on his second voyage. The Spanish mercenaries had withdrawn before the arrival of the French, but not before they had had the opportunity to sleep with local prostitutes. That this was the origin of the pox was proposed by Fernandez de Oviedo in 1525, and the theory was supported in 1539 by Ruy Diaz de Isla, who had attended Columbus's crew in March 1493 when he reported his discoveries in the New World to Ferdinand and Isabella, the Catholic Kings, at Barcelona. These pox-stricken sailors had originally thought that their disease was merely the effect of the hardships of their voyage, but had then spread it among the inhabitants of Barcelona, who responded with prayers and fasting in an attempt to avert the malady. The mercenaries had subsequently taken it to Naples. Diaz de Isla identified it with the Serpent in the Eden of the newly discovered demi-paradise of Hispaniola, now better known as Haiti, and named it the serpentine disease because, 'as the serpent is abominable, terrifying and horrible, so is this disease'. Although other sixteenth-century physicians denied that the disease was new to Europe and tried to link it with elephantiasis and leprosy in the classical writings of Hippocrates and Galen, the idea that the disease had been imported from the Americas became dominant, especially as it could be depicted as evidence of a decay or weakness in the New World that might justify its conquest and colonisation by the European powers. The theory depended on the coincidence of the date of Columbus's return from his second voyage with the first great European epidemic of syphilis. Spanish sailors had undoubtedly raped Indian women, and there were frequent allusions to sickness and exhaustion of his sailors in Columbus's own accounts of his voyages, but no conclusive evidence as to the nature of that illness. In the twentieth century, this explanation of the origin of syphilis was given new prominence with the idea of the Columban Exchange: syphilis was the only serious disease to be transmitted from the New to the Old World, whereas the Europeans had brought with them to the Americas many pathogens to which the indigenous population had no immunity. By contrast, the Amerindians experienced much milder cases of syphilis than the Europeans, since they had immunity to that disease.

Indeed, the medical lore of the indigenous cultures of Central and South America was well aware of syphilis-like diseases. Mayan medical texts had terms for gonorrhoea (kazay), syphilitic sores (yaah) and buboes (zali). Meanwhile the Aztecs had several gods concerned with venereal diseases. Titlacahuan, Tezcatlipoca, Macullxochital (god of pleasure) and Xochiquetzal (goddess of love) all punished any breach of vows or unchaste behaviour with an infliction of nasty diseases affecting the genitals of their victims. This would suggest that the disease was already familiar in these parts of the New World when the conquistadores arrived.

There was a certain symmetry and indeed justice to the idea of the Columban Exchange, but the notion has not gone unchallenged. Some European skeletons from before 1493 have been excavated that showed such signs of syphilitic infection as star-shaped scars on the skull and traces of inflammation in the bones. If syphilis was already present in Europe, its apparently sudden appearance in the 1490s could be accounted for only by a great increase in the virulence of the infection by a mutation of the bacterium, Treponema pallidum, causing it. This theory was based on the idea that a non-venereal syphilitic infection known as yaws may have originated in Central Africa. It had spread east and north from the earliest times, its dispersal encouraged by slave trading, reaching first Egypt and then Mesopotamia, where it was called bejel. It had then spread into Europe by the eighth century, when the Crusades had encouraged travel and made the slave trade from Africa more popular. The discovery in the nineteenth century of a number of yaws-like diseases in poor, remote, backward rural areas on the fringes of Europe, such as spirocolon in Greece and Bosnia, button scurvy in Ireland, radesgye in Norway and sibbens in Scotland, showed that yaws-like infections were indeed present in Europe, transmitted by social contact and commonest in children. If such relatively benign treponemal diseases were already present in Europe, their survival was threatened from the fourteenth century onwards by greater attention to personal hygiene and the use of soap. The theory is that, in order to survive, the bacteria mutated into a more infectious and lethal organism spread by sexual contact rather than by touch. Another plausible explanation was that treponemal infections native to Europe had combined with others imported from overseas, such as non-venereal yaws, which the Portuguese may have brought from Africa as a result of their voyages of discovery in the half-century before Columbus set out on his voyages, and that this combination proved more potent and devastating than the two infections had ever been singly. Thomas Sydenham, a seventeenth-century physician, actually blamed the slave trade, 'that barbarous custom of changing men for ware', for the introduction into Europe of what he called 'the contagion of the Blacks bought in Africa'. However, the evidence still remains strongest for an American origin for syphilis. The indications of the presence of the disease in medieval Europe remain inconclusive, because signs of syphilis in skeletons are difficult to distinguish from damage caused by other diseases such as leprosy. Moreover, relatively few European skeletons show signs of syphilis before 1492 compared with later, although many more indications are found in skeletons in the Americas from the pre-Columban era.

Although the pox in the form it took in the late fifteenth century was new in Europe, sexually transmitted diseases were nothing unusual. Gonorrhoea, which was believed by many people before the nineteenth century to be the first stage of syphilis, had been a problem since antiquity. Like the bacterium that causes syphilis, the gonococcus is primarily spread through sexual contact. In men, its most common symptom is white or yellowish milky pus discharging from the penis, accompanied by pain when urinating. However, some men may be infected and show no symptoms, although asymptomatic infection is more common in women, who otherwise suffer from vaginal discharges and infection of the uterine cervix. In the past, because fewer women than men displayed any symptoms, it was commonly believed to be a less serious disease for women. In fact, it can destroy the female reproductive organs. William Osler described it as 'not a great destroyer of life' but 'the greatest known preventer of life'.

In Egypt the Ebers papyrus of c. 1550 bc mentioned herbal extracts as treatment to soothe painful urination, the result of what may possibly have been gonorrhoeal infections. Another medical text from ancient Egypt, the Kahun papyrus, describes what may be a gonococcal infection that had caused a woman to suffer a discharge from her vagina and given her problems with her eyes. The biblical book of Leviticus advised the children of Israel to avoid contact with any man or woman who 'hath a running issue' and to cleanse themselves by bathing and washing their clothes if they came in to contact with anyone 'unclean'. Hippocrates and Galen, the prime authorities of classical medicine, recognised the venereal nature of the disease. In medieval England, gonorrhoea was referred to as 'the brennynge' or 'the burning', a name reflecting the symptom of painful and sometimes bloody urination that afflicted sufferers. The French term for the disease, chaude pisse ('hot piss'), was just as descriptive. Polite society in England preferred to call the disease by its French name until the sixteenth century, when all classes began to call it 'the clap'. John Aderne, physician to Richard II, recommended syringing a lead lotion into the urethra to relieve the burning sensation. Although actually a very different disease, syphilis when it first made its appearance was sometimes described in the same way as gonorrhoea as 'the burning'.

Stricken with the seemingly novel illness of the pox, whatever its origins, Charles VIII of France and his army of mercenaries were forced to retreat from Naples and withdraw from Italy. In the wake of their passage across northern Italy, they left a terrible trail of victims afflicted by this frightening new epidemic. An outbreak was recorded in Cremona in 1495. The notary Bernadino Zambotti reported its first appearance in Ferrara in December 1496 with the observation that it seemed to be incurable and for most of the sufferers proved fatal, following excruciating pains in the bones and nerves, accompanied by massive pustules all over the body. These pains in the joints could be so intense, according to Sigismondo dei Conti da Foligno, secretary to Pope Julius II, that sufferers from them 'screamed day and night without respite, envying the very dead'. The pustules and ulcers 'gnawed away as far as the marrow'. In Perugia, a merchant 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'. In Bologna, the pox 'ate away the nose and half the face' of another of its victims.

(Continues...)

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Table of Contents

Contents

Preface and Acknowledgements,
One The Wrath of Apollo,
Two 'Gentleman's Sniffles',
Three Containing the Contagion,
Four The 'Magic Bullet',
Five Fit to Fight,
Six Tuskegee: 'Shadow on the Land',
Seven The 'Best Military Advantage',
Eight 'No Medicine for Regret': Complacency and Resurgence,
Notes,
Bibliography,