Secale 164. The Formative Period of Syphilis
Whatever syphilis be entertained concerning the pathological character of that epidemic, it is an established fact that: (1) subsequent to this epidemic, a new form of the venereal malady, our chancre-syphilis, made its appearance, of which nothing was known prior to the raging of that same epidemic; and that, (2) the lepra, since then, has almost entirely disappeared from Europe. This does not, indeed, show that the epidemic in question had any thing to do with syphilis; a relationship of this kind might be accepted as a probable thing, if it were certain that our modern syphilis had not existed previous to the arrival of European soldier in America, and that, if it was brought over from America, its existence remained unnoticed during the prevalence of the epidemic, with which the syphilitic malady either coalesced, or by which the latter remained suspended for the time being. What most of out manuals teach of the original appearance of syphilis, as a cutaneous disease, and of the gasiform, pneumatic nature of the syphilitic miasm communicating the infection by the mere breath of the patients, must be considered as mere hypothesis, so far as our modern syphilis is concerned, until it is definitively settled that the epidemic in question was nothing else than an acute form of syphilis. For, even if we take it for granted that our syphilis was born of that epidemic, and that it was not a previously-existing disease, which only manifested itself after the disappearance of the epidemic, for the simple reason that it had remained suspended by the latter, and had existed in a masked form during its continuance, the peculiar conduct of that epidemic dose not yet account for the independent idiopathicity of the syphilitic disease itself, since the pathognomonic features of that epidemic might still be derived from the variolous typhus which gave birth to syphilis, perhaps, at the very moment when it lost its own pathological characteristics. In addition to all this nothing is more uncertain, according to every writer of that age, than the different degrees which the syphilitic disease passed through from the time of that epidemic until it reached the present development of its diversified, but yet fixed, and at all times and places, identical forms. Then only author who alludes to this point, Astruc, does not furnish any satisfactory clue to this problem. The seven periods in which he divides the course of syphilis as so many transition-stages to the present chronic form of this disease, can only be regarded as a substitutive explanation of the real facts. Even Fernelius, who was a contemporary witness of that epidemic, and who regards the subsequent chancre-syphilis as a gradual weakening and the precursor of a final and complete effacement of that epidemic, is unable to account for the connection of these two diseases, or for the passage of the one into the other, but contents himself with stating that the now prevalent (in the year 1540) “lues venerea” did no longer, like the former “morbus gallicus,” infect people by the air, but solely by sexual connection, or by nursing infants at diseased breasts, or that the disease might be communicated to midwives by the contact of infected sexual organs, or by the mouth of diseased nurslings, or by the spittle of infected persons when kissing, or, finally, by the insertion of the poison in parts denuded of their epidermis; and that, when the disease broke out, it manifested itself by ulcers on the infected parts, by buboes, and discharges, and afterwards, after the whole organism was pervaded by the poison, by pustules on the skin, pains, etc. This shows that, even a few years subsequent to the prevalence of that epidemic, our modern syphilis was born full-fledged, even as Minerva was born armed cap-a-pie out of Jupiter’s brain without it being possible to show the different stages through which this disease gradually marched onward to its present stage. Let us examine the opinions of other writers of this subject; first, however, let us cost a glance at the symptoms of that epidemic themselves.
Secale 165. Forms of the so-called Epidemic Syphilis.
The first and worst characteristic of this epidemic was its volatile contagium, which, according to the testimony of all contemporary writers, not only infected persons by simple contact, but likewise by the air and, consequently, more specially during the act of coition. Of the malady itself, Petrus Pintar reports to Pope Alexander VI.: “The prevailing epidemic is characterized by a variety of symptoms, more particularly by keen and excessively violent pains. Some do not have any pains, in the place of which they are attacked by pustules of various shapes and sizes, being very numerous on some individuals, and on others more scanty. Sometimes the pustules break out only in the face, or on the head, while the other parts of the body remain free; in other cases they are only seen on the abdomen; most frequently they break out on the thighs and legs, but may likewise spread over the whole body.” The same author, who regarded this disease as a species of small-pox (variola), continues in another place: The general symptoms of this disease are the same as those of any other case of small-pox; languor restless sleep, a general feeling of heaviness, accelerated pulse, rough and husky voice, dryness of the mouth and tongue, sore throat and pains in the chest. Particular symptoms are: At first a few small vesicles of the size of punctures with needles, more particularly on the chin, glans, in the hair of the pudendum (this symptom likewise occurs in small-pox-Jahr), sometimes also in the face, on the forehead or limbs; but rarely all at once in all these localities. Gradually these vesicles increase in size, even to that of split peas, until they finally grow as large as the palm of the hand. On most patients these pustules are very dry, sometimes, however, they discharge more or less of a purulent matter; sometimes they form scales; but in all cases they are accompanied by the most violent and agonizing pains, more specially in the upper and lower extremities. At the same time, most patients have an appetite that frequently increases to canine hunger. He states, moreover, that there is little danger if the pustules come out properly and mature rapidly, if pain and fever are wanting, and the patients preserve their courage and appetite. “On the contrary,” writes this author, “if the pustules are scanty, dry, prominent, like warts; if the skin shows deep rhagades, the throat is inflamed, the breath foul and the voice feeble, and as if extinct, death is unavoidable.” Beside direct infection by contact and living together, he indicates want of cleanliness and the influence of strong heat of the sun as exciting causes of this disease. Bartholomaeus Steber calls these pustules hideous; he says that they ulcerate, differ in shape, density, color, in venomous character, and in regard to the accompanying pains. Grunbeck, who regards the disease as mentagra, furnishes the following description of it: “Some patients were attacked on the head and chin with a horridly- disgusting, dirty and blackish crust, which, with the sole exception of the eyes, gradually spread over the whole face, neck, head, chest, and pubes, so that the poor sufferers, abandoned by their companions in the open field, where they were exposed to the burning rays of the sun, called for no other relief than a speedy death. Others driven to despair by the pain, tried to tear off this crust, which was harder than the bark of trees, with their nails; others, again, had their whole bodies covered with innumerable quantities of warts and pustules. On many patients there appeared in the face, on the ears, or in the nostrils, a sort of thick, rough pustules, that assumed the shape of elongated horns, secreted a fetid, purulent fluid, and had the appearance of protruding teeth. The pains accompanying this eruption are sometimes so violent, that the patients are deprived of their sleep for forty, sixty, and even a hundred nights together, after which the pains likewise assail the head. Others experienced in their shoulders an indescribable feeling of stinging and weight; others, again, experienced the same pain in the elbows, knees, even in all the limbs and joints at the same time, that they are unable either to walk or to stand, and have to abandon every kind of work.”Grunbeck, moreover, states, that the disease commenced with languor and debility of the limbs, after which the pustules break out with intense fever; he adds, that, whenever these pustules or tumors burst open, they some- times become converted into frightful phagedaenic sores.
Secale 166. The Forms of Syphilis subsequent to this Epidemic.
On reviewing this picture of the epidemic, it is indeed impossible not to recognize among its features some that resemble more or less our modern syphilidae. On the other hand, some of its features might cause us to liken it to small-pox (the pustules of which I have seen in my own practice spread even over the penis, prepuce and glands); others again to lepra; and, on account of the peculiar bone-pains of which Grunbeck speaks, we might even like it to the modern trichinae-disease. What is most remarkable is that, previous to Oviedo’s fable of the colonization of syphilis from America to Europe, nobody thought of seeing in this epidemic a venereal plague, and that Fernelius, probably with a view of refuting Oviedo’s explanation, made every effort, in the year, 1542, to warn against syphilis being confounded with the former epidemic, which he designated as morbus gallicus, and to distinguish the two diseases, which seem to have co-existed in his time, from each other by distinct diagnostic signs. If Schoenlein, who describes this epidemic, without any further proofs, as an acute epidemic, afterwards proceeds to divide to historical developments of our modern chancre-plague into two periods, the first of which extends to the year 1550, and is distinguished by the volatile nature of the contagium; his opinion is at once refuted in the most positive manner by the previously expressed statement of Fernelius. His other observation, that the second period commenced with the appearance of gonorrhoea, is likewise untenable. We have shown, in No. 156-158, that gonorrhoea, of which he says that it transformed the volatile into a fixed contagium, as well as venereal diseases generally, except the modern chancre, has existed at all times. It is true that soon after that epidemic, or even during its decline, a new and hitherto unknown form of gonorrhoea made its appearance, which Borgarucci termed gonorrhoea gallica, and of which he says that a diagnostic sign of this new disease was the property “of not being curable by local treatment alone.” That this gonorrhoea did not first make its appearance in the year 1550 may be learned from Paracelsus, who taught in Basle in the year 1527, and spoke of this gonorrhoea as gonorrhoea francigena. In the next chapter we shall revert to this gonorrhoea, which has given rise to so much dispute concerning the syphilitic and non-syphilitic nature of gonorrhoea; for the present it may suffice to state that this gonorrhoea, which might even yet he called blennorrhagia gallicus, was a new phenomenon.
