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Symptoms of Syphilis

Image of a syphilitic head from Marco Aurelio Severino’s
De recondita abscessuum natura, libri VIII (Frankfurt, 1643), p. 253.

This illustration, taken from Worth’s copy of Marco Aurelio Severino’s De recondita abscessuum natura, libri VIII (Frankfurt, 1643), shows a syphilitic head, where the nose has been eaten away in the tertiary stage of syphilis. What frightened early modern victims of syphilis was not only the unpredictable nature of the disease, which was most infectious when it seemed most innocent, but the horrendous symptoms that accompanied both the disease, and, indeed, its treatment.

For the early modern physician it posed a number of significant challenges. In order to successfully treat the disease they had to determine its cause and how this new scourge fitted into the established hippocratic and galenic medical lore. The symptoms of ‘this skulking poison’, as François Calmette, author of another work collected by Worth calls it, were many and confusing. In the words of Calmette:

‘This Distemper is thought difficult to be known, when but few of the said Symptoms appear; but far more difficult, when it imitates the Symptoms of other Distempers; as when there are Ophthalmies, Blindness, Deafness, Ringing in the Ears, a Vertigo; then some expert Physician ought to be consulted, that may discover the Distemper, examine the Patient about past Diseases, whether he had had a Gonorrhaea, Bubo, &c. and what Remedies he has used: Thus a skilful Physician shall find out where the cunning Enemy lurks, and not throw uncertain Darts. From what has been said it is manifest, that the Pox is not one Distemper, but several Evils together, that leave no part of the Body untouch’d and no Action undisturb’d.’

Calmette, Riverius reformatus (London, 1706), p 468.

Brown (2006) explains that syphilis has three stages:

Primary syphilis has no visible symptoms – a useful characteristic for the aspiring bacterium as it ensured that prospective sexual partners would not be alerted to the sexual health of each other until it was too late. Such symptoms as were present, such as chancres on the genitals, might wear off without treatment, leaving the sufferer much relieved that these small painless ulcers had disappeared. In some case, particularly in women, the chancres might form internally and so be undetected by the woman herself. Disturbing though these symptoms were they were mild and thus gave the sufferer no indication that their presence was a sign that the disease was at its most infectious.
Secondary syphilis witnessed the development of a rash all over the body, often accompanied by fever, headaches and pain, particularly in the bones. Sometimes the patient might suffer from hair loss but again after a few weeks all would seem well: the symptoms would disappear though not the infectious state.
Tertiary syphilis saw the bacterium finally reveal its true strength. It might only develop in one third of the sufferers and it might take years to develop, but once it did it was horrendous: Gumma, small tumours would form on bones, producing effects like the illustrated syphilitic head. The nervous system would be attacked, affecting coordination and the brain would be attacked, leading to insanity.

It is clear from the reports in Worth’s copies of Luigini’s famous compilatory work that the symptoms of the initial syphilitic outbreak in Europe were particularly acute and the movement from primary to tertiary much faster. Knell (2004) quotes Ulrich Von Hutten’s personal account of his own sufferings (an account summarised in Worth’s copy of Luigini):

‘…truly when it first began, it was so horrible to behold that one would scarce think the Disease that now reigneth to be of the same kind. They had Boils that stood out like Acorns, from whence issued such filthy stinking Matter, that whosoever came within the Scent, believed himself infected. The Colour of these was of a dark Green and the very Aspect as shocking as the pain itself, which yet was as if the Sick had laid upon a fire.’

As Quétel (1990) argues, the initial catastrophic stage lasted a mere 5-7 years. Exactly why the infection became less virulent so quickly is unknown but certainly by the time Luigini was publishing his collection of treatises on syphilis it was clear that the ferocity of the early symptoms had changed and ameliorated over time.

Selected Reading
Brown, Kevin (2006), The Pox. The Life and Death of a very Social Disease (Stroud).
Calmette, François (1706), Riverius reformatus (London).
Knell, R. J. (2004), ‘Syphilis in Renaissance Europe: rapid evolution of an introduced sexually transmitted disease?’, Proceedings of the Royal Society, London B. (Suppl.) 271, pp 174-176.
Luigini, Luigi, De morbo Gallico omnia quae extant apud omnes medicos cuiuscenque nationis … in unum … corpus redacta. … (Venice, 1566-67). 2o. Worth also had the later edition, edited by Hermann Boerhaave: Aphrodisiacus, sive De lue venerea; in duos tomos bipartitus, continens omnia quaecumque hactenus de hac re sunt ab omnibus medicis conscripta. … Ab … Aloysio Luisino … novissimé collectum (Leiden, 1728).
Quétel, Claude (1990), The History of Syphilis (Baltimore).
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