Treatment

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Treatment of Syphilis in Early Modern Europe*

As Arrizabalaga et al (1997) suggest, understanding of cause necessarily affects treatment. Galenic physicians arguing for a humoral imbalance attempted to restore the balance by using tried and trusted methods of doing this. The emphasis in the treatment of syphilis was therefore to restore the body to health by encouraging it to rid itself of any morbid matter. Such conventional methods in restoring the equilibrium of the four humours, such as bleeding, purging, bathing and sweating were perhaps the least intrusive. Fracastoro’s theory of contagion spread by seminaria likewise suggested new methods of treatment. Two new remedies for this new disease emerged in the sixteenth century: guaiacum and mercury.

Guaiacum was a particularly popular cure for syphilis in the sixteenth century, if not a particularly effective one. The theory was that, just as the disease had originated in the Americas, so God had provided a cure in the same place. Guaiacum or holy wood, came from Hispaniola (Haiti, the scene of the initial contact) and not just from Hispaniola but from an island off it, given the encouraging title of ‘Isola Beata’. Proponents of the use of guaiacum may be found in Luigini’s compilation volumes, owned by Worth. Undoubtedly the most famous was Ulrich Von Hutten (1488-1523) who argued forcibly for its use.

Stein (2006) has shown that guaiacum was the first treatment given to sufferers of syphilis in the Blatterhaus in Augsburg after 1522. It was given as a hot drink and followed by a sweating cure. As the Blatterhaus records demonstrate, the use of guaiacum was undoubtedly popular but it was soon upstaged by the appearance of mercury, a seeming effective but generally foul method of treatment. The success rate of mercury treatment was offset by the stringent side effects, so stringent as to ensure that it was introduced in Augsburg only as a treatment of last resort.

Treatment using mercury is seen in this frontispiece illustration of a German hospital, one of the specialist Franzosenhäuser or Blatternhäuser set up by the civic minded citizens of the south-west Germany imperial cities of Nuremburg, Strasburg and Ulm in the 1490s.

Treatment in a German hospital: Courtesy of the National Library of Medicine.

Mercury could be used in three different ways. Calmette, in a text collected by Worth, outlines the principals methods of mercury treatment:

‘… The Patient being thus prepared by Bleeding, Purging and Bathing, proceed to the use of Mercury, whch is the only Remedy that can extirpate the Distemper: for Diaphoreticks, as Guajacum, and Salsa-paril, are able ‘tis true to lessen the Distemper, but not to cure it; with these the Cure may begin, but cannot be finish’d by them; for a little after the Venom, come to Life again, brings back the Symptoms that were lull’d asleep, and renews the same Tragedy; so that a perfect Cure is only contain’d in a due administration of Mercury.But the Mercury is made use of several ways: Some rub the Parts with a Mercurial Ointment; others apply a Plaister made with Mercury; some to provoke Salivation give Mercurius Praecipitatus, both red and white: Yet I am of the Opinion, that nothing exceeds Anointings, or helps more the penetrating Virtue, with which the Mercury is endued; they are made of Neapolitan Ointment, which is here prescribed.Take of Quick-silver squeez’d through Leather a pound; of Venice Turpentine three Drams; rub them together for some Hours in a Brass Mortar, till the Quick-silver if quite kill’d; mix by little at a time two Pound of Hogs-lard with it, and make an Ointment.

With this anoint the whole Body from the Soles of the Feet to the Hair of the Head; all but the Breast and Belly, in regard to the Parts contain’d within; which Unction, that it may be successful, must be done before a clear Fire, if the Patient’s Strength will bear it, otherwise in the Bed. Each Unction requires five or six Unces of the Ointment; for those, that are most tender, four Ounces may suffice; the Soles of the Feet, Knees, Thighs, Buttocks, and Arms being only anointed. The Unction must be repeated several times once a Day, either in the Morning fasting, or in the Evening two Hours before Supper.

If after the third Unction no sign of Salivation appear yet, the Patient is to be anointed twice a Day, if his Strength will bear it, or once augmenting the Dose of the Ointment.

Observe that you must leave off with the seventh or eighth Unction; as also, as soon as any Signs of Salivation appear; which are known by this; the Head akes, the Face looks red, the Throat grows rough, Ulcers break out in the Mouth, and the Patient Spits much and often; some Days after the whole Mouth is full of Ulcers, the Patient speaks thick, the Palate and Tongue burn, in which, if they are not often wash’d with warm Milk, they feel very acute Pains, and thus the Fluxing continues without Intermission with a nauseous Stink; if the Spittle flows in such a quantity, that you fear a Suffocation; to free the Patient from the imminent danger, let him be Blooded twise, or three times, and give him a Laxative Ptisane every other Day…

They that cure this Distemper with a Fumigation of Mercury, throw half an Ounce, or six Drams of Quick-silver in a red hot Crucible, standing upon Coals, over which the Patient sits in a Seat wthout a bottom; or else he is put into a Tabernacle, to receive the Steam; wrapping Linnen, or Cloth close about his Neck, that the Steam may not reach up to his Head: thus the Patient remains till all the Quick-silver is exhaled. Others make Tablets of Quick-silver, kill’d with Turpentine, distill’d Vinegar, Bole-Armoniack, and powder’d Charcoal; of this they make a Mass, which extended upon Paper they dry in the Shade, keeping this Proportion, that the Mercury is third part of the Tablets; of these they strew by little at a time an Ounce and a half, or two Ounces upon hot Coals, or they put it in a red hot Crucible, and let the Patient receive the Steam; this Fumigation is perform’d once or twice a Day, and continued till the Salivation begins.

The last Method of curing the Pox is with white, or red Precipitate; of which they give twelve, or fifteen Grains; which is continued for six, eight, or twelve Days, till they Flux copiously. If the Salivation proceeds slowly, to hasten it you may add six, or at most ten Grains of red Precipitate to the Dose. But let every prudent Physician abhor this Method: for this way the Venom cannot be extirpated: For this Remedy raises only very small Ulcers in the Mouth; that are only fit, to let out the thinnest Particles of the Venom; the thicker Part, and Faeces remain, and cannot be forced to the Throat from so small a quantity of Mercury….’

Calmette, Riverius reformatus (London, 1706), pp 471-4.

The aim of mercury treatment was to bring on salivation – and thereby hopefully expelling the disease. Patients were caught between a rock and a hard place: either put up with their unpleasant and increasingly obvious symptoms or put up with the treatment, which might lead to loosening of teeth and gum ulcers. As Brown (2006) has pointed out, syphilis treatment was big business and those involved in the guaiacum trade did their best to disparage mercury as a cure for the disease – with little effect. In most cases it was not a choice between these two remedies: Thomas Sydenham (1624-89), the noted late seventeenth-century English physician used both in his treatment of syphilitic patients.

Another treatment, though lesser known, was the use of Root of China – a treatment advocated by one of Worth’s authors on the subject: Antonio Musa Brasavola (1500-55) , who gives directions about its preparation:

‘twenty-two Ounces divided into twenty-four Parcels, one of which is to be boil’d in three Pints of Water, to a Pint, and drank hot every Morning, sweating thereupon, as in the Use of the Indian Wood [guaiacum]; being fresh prepar’d every Day. And this he extols as an efficacious Remedy in many Diseases of the Stomach, Liver, and Spleen, as well as in this; which seems indeed intended for the milder Species thereof, as a general Cleanser of the Blood, and Opener of Obstructions: For when the Disease is radicated, the Sick must have Recourse, as before, to the Fume, the Unction, or the Indian Drink; concerning which, he has the following pleasant Remark, i.e., that as new Diseases have been brought thence as from their native Place, into Italy, so likewise Remedies for the same Diseases….’†

*The treatments outlined in Worth’s collection all date from the sixteenth-eighteenth centuries and therefore should not be attempted. Today syphilis is treated via antibiotics. For more information on syphilis today see the World Health Organizations websites:

http://www.who.int/std_diagnostics/publications/Disease%20watch%20syphilis.pdf
http://www.who.int/std_diagnostics/publications/manuals/Syphilis_Eng_14May07.pdf

The HSE provides a useful booklet on the topic of syphilis in Ireland:
http://www.hpsc.ie/hpsc/A-Z/HepatitisHIVAIDSandSTIs/SexuallyTransmittedInfections/Syphilis/EpidemiologicalData/File,1424,en.pdf

† All translations from Luigini’s compilatory work of tracts on syphilis are taken from the English translation of Boerhaave’s 1728 edition, undertaken by Daniel Turner and printed at London in 1736. As Worth died in 1733 this English translation, the Aphrodisiacus is not in the Worth Library.

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