The Early
History
of Syphilis:
A Reappraisal
4
The New World gave much in return for what it received from the Old World. In the writings of Desiderius Erasmus, one can find mention of nearly every significant figure, event, crusade, fad, folly, and misery of the decades around 1500. Of all the miseries visited upon Europe in his lifetime, Erasmus judged few more horrible than the French disease, or syphilis. He reckoned no malady more contagious, more terrible for its victims, or more difficult to cure … or more fashionable! “It's a most presumptuous pox,” exclaims one of the characters in the Colloquies. “In a showdown, it wouldn't yield to leprosy, elephantiasis, ringworm, gout, or sycosis.”1
The men and women of Erasmus's generation were the first Europeans to know syphilis, or so they said, at least. The pox, as the English called it, had struck like a thunderbolt in the very last years of the fifteenth century. But unlike most diseases that appear with such abruptness, it did not fill up the graveyards and then go away, to come again some other day or perhaps never. Syphilis settled down and became a permanent factor in human existence.
Syphilis has a special fascination for the historian because, of all mankind's most important maladies, it is the most uniquely “historical.” The beginnings of most diseases lie beyond man's earliest rememberings. Syphilis, on the other hand, has a beginning. Many men, since the last decade of the fifteenth century, have insisted that they knew almost exactly when syphilis appeared on the world stage, and even where it came from. “In the yere of Chryst 1493 or there aboute,” wrote Ulrich von Hutten, one of Erasmus's correspondents, “this most foule and most grevous dysease beganne to sprede amonge the people.” Another contemporary, Ruy Diaz de Isla, agreed that 1493 was the year and went on to say that “the disease had its origin and birth from always in the island which is now named Española.” Columbus had brought it back, along with samples of maize and other American curiosities.2
The most popular theory of the origin of syphilis since the third decade of the sixteenth century has been the Columbian theory, but popularity has not saved it from disputation. In fact, the matter of the origin of syphilis is doubtlessly the most controversial subject in all medical historiography. It would take months of labor merely to assemble a full bibliography of the subject.
Until the most recent decades there were only two widely accepted views of the provenance of syphilis: the Columbian theory and its antithesis, which stated that syphilis was present in the Old World long before 1493. Now the Unitarian theory has appeared, which postulates that venereal syphilis is but one syndrome of a multi-faceted world-wide disease, treponematosis. But before we examine this newest challenge to the veracity of Ulrich von Hutten and Diaz de Isla and the other Columbians, let us deal with the older argument: was venereal syphilis present on both sides of the Atlantic in 1492 or only on the American?
The documentary evidence for the Old World seems clear. No unequivocal description of syphilis in any pre-Columbian literature of the Old World has ever been discovered. Description of diseases which might be the pox have been uncovered, but they might also be descriptions of leprosy, scabies, or something else. It is especially noteworthy that, in spite of Chinese worship of the ancients and the tradition of quoting from the classics whenever possible, no Chinese writer has ever described syphilis as being mentioned in ancient literature. Galen and Avicenna and other medical writers of ancient and medieval times knew nothing of germ theory or antibiotics, but they were accomplished clinicians and could describe the surface symptoms of a disease as well as any modern physician. If a disease is not mentioned in their writings, we may assume that it had a different character in their time or that they never saw it.3 This assumption is particularly safe when we are searching for mention of a disease which spreads as widely as syphilis does in nearly every society exposed to it.
The physicians, surgeons, and laymen of the Old World who wrote about venereal syphilis in the sixteenth century recorded, with few exceptions, that it was a new malady; and we have no reason to believe they were all mistaken. From Díaz de Isla to Wan Ki—Spaniards, Germans, Italians, Egyptians, Persians, Indians, Chinese, and Japanese—agreed that they had never seen the pox before.4 It is very unlikely that they were all mistaken on the same subject at the same time.
Even if no direct statements on the newness of syphilis to the inhabitants of the Old World existed, there is enough linguistic evidence to support that contention. The variety of names given it and the fact that they almost always indicate that it was thought of as a foreign import are strong evidence for its newness. Italians called it the French disease, which proved to be the most popular title; the French called it the disease of Naples; the English called it the French disease, the Bordeaux disease, or the Spanish disease; Poles called it the German disease; Russians called it the Polish disease; and so on. Middle Easterners called it the European pustules; Indians called it the disease of the Franks (western Europeans). Chinese called it the ulcer of Canton, that port being their chief point of contact with the west. The Japanese called it Tang sore, Tang referring to China; or, more to the point, the disease of the Portuguese. A full list of the early names for syphilis covers several pages, and it was not until the nineteenth century that Girolamo Fracastoro's word, “syphilis,” minted in the 1520s, became standard throughout the world.5
Another indication of the abrupt appearance of the pox is the malignancy of the disease in the years immediately after its initial recognition in Europe. The classic course of a new disease is rapid spread and extreme virulence, followed by a lessening of the malady's deadliness. The most susceptible members of the human population are eliminated by death, as are the most virulent strains of the germ, in that they kill off their hosts before transmission to other hosts occurs. The records of the late fifteenth and early sixteenth centuries are full of lamentations on the rapid spread of syphilis and the horrible effects of the malady, which often occurred within a short time after the initial infection: widespread rashes and ulcers, often extending into the mouth and throat; severe fevers and bone pains; and often early death. The latter is a very rare phenomenon in the initial stages of the disease today, and most who do die of syphilis have resisted the disease successfully for many years. Ulrich von Hutten's description of syphilis in the first years after its appearance indicates a marked contrast between its nature then and its “mildness” today:
There were byles, sharpe, and standing out, hauying the similitude and quantite of acornes, from which came so foule humours, and so great stenche, that who so ever ones smelled it, thought hym selfe to be enfect. The colour of these pusshes [pustules] was derke grene, and the slight therof was more grevous unto the pacient then the peyne it selfe: and yet their peynes were as thoughe they hadde lyen in fire.
This extreme manifestation of the disease, he tells us, “tarryed not long above the vii yere. But the infyrmytie that came after, which remayneth yet is nothynge so fylthy.”6
The most convincing of all evidence for the abrupt arrival of the French disease in the Old World in approximately 1500 is the physical remains, the bones of the long dead. No one has ever unearthed pre-Columbian bones in the Old World which display unequivocal signs of syphilitic damage. Elliott Smith, the famous paleopathologist, tells us that “after examining something like 30,000 bodies of ancient Egyptians and Nubians representing every period of the history of the last sixty centuries and from every part of the country, it can be stated quite confidently that no trace whatever, even suggesting syphilitic injuries to bones or teeth, was revealed in Egypt before modern times.” It is nearly certain that if syphilis were present in pre-Columbian Europe, and likely that if it were present in any of the high civilizations of the Old World engaged in long-distance commerce before 1493, one of the bodies examined by Smith would have shown syphilitic lesions.7
Several anti-Columbian theorists have brushed aside all the above arguments by hypothesizing that syphilis had existed in the Old World prior to the 1490s, but in a mild form. Then, in the 1490s the causative organism mutated into the deadly Treponema pallidum, and syphilis began to affect the deep body structures and became a killer. This hypothesis cannot be disproved and it comfortably fits all the facts, but it cannot be proved, either. Microorganisms simply do not keep diaries, so the only way we can “prove” the validity of the mutation theory is by the process of elimination. We must disprove all the other hypotheses, which brings us to a direct consideration of the Columbian theory.
Where did syphilis come from? If it came from America, then we may be nearly certain that it came in 1493 or shortly after. Let us consider the physical evidence first. Is there a contrast here between the Old and New Worlds? The answer becomes more and more unequivocally affirmative as the archeologists and paleopathologists disinter from American soil an increasing number of pre-Columbian human bones displaying what is almost surely syphilitic damage. According to one researcher, the deformation of the forehead bones in some of these skeletons is as unambiguously syphilitic in origin as a positive Wassermann reaction.8
Documentary evidence supporting the Columbian theory is quite impressive: some of the most trustworthy physicians and historians of the sixteenth century insisted that Columbus must bear the blame for bringing the pox to Europe. But the certainty with which they spoke must be weighed against the fact that none of them insisted on the American origin of syphilis until a generation after the first Columbian voyages. One would think that if a relationship existed between the sensational discovery of the New World and the sensational new disease, that relationship would have been emphasized over and over again in the 1490s and early 1500s. No mention of the connection between the two, however, appears until guaiacum, a decoction of a West Indian wood, became widely popular as a sure cure for the French disease. According to the logic of the time, God always arranges for a disease and its remedy to originate in the same locality. “Our Lorde GOD would from whence this euill of the Poxe came, from thence would come the remedy for them.” To reverse the logic, if American guaiacum cured syphilis, then syphilis must be American. What could be more sensible? Many historians have judged, therefore, that the source of the Columbian theory is guaiacum, and not the actual origin of syphilis in the West Indies.9
Even more discomforting for the Columbians is the fact that neither syphilis nor anything resembling it is mentioned at all in the documentation of the Columbian voyages written prior to the first epidemic of the pox in Europe. It certainly would have been advantageous to Columbus to omit any such mention from his reports, but it is strange that one of the other eyewitnesses did not do so. Nor do we find any contemporary reports of syphilis in Spain or Portugal in the months and years between the return of the ships of the 1492 and 1493 voyages to America and the first recorded epidemic of syphilis in Europe, which began in Italy in 1494 or 1495. Such reports do exist, but they were written years after the alleged events.
But we cannot be sure that syphilis was not prevalent simply because it is not mentioned in contemporary documents. The documentation is too sparse. For example, we know little or nothing about what happened aboard the Pinta on the first voyage, for she spent much of the time in the West Indies and the last half of the return trip far beyond the sight and knowledge of Columbus, the only chronicler of that voyage. Nor do we know much about the condition of the Indians—who may well have been latently syphilitic—brought back to Europe in 1493 and 1494. Furthermore, it was to the interest of many involved in Columbus's schemes, some in high places, to suppress negative reports about the New World. There may be an even simpler explanation for the absence of the mention of the pox from the early documentation. Many of the documents of this period have been lost forever. Others undoubtedly still lie buried in European archives, unread for four hundred years.10
Let us examine the written evidence supporting the Columbian hypothesis. The first mention of Europeans with syphilis in the New World is found in the biography of Columbus by his son, Ferdinand. It is a work of immense value, but unfortunately we have only an Italian translation of it. The original Spanish version is lost, and we cannot be sure that the Italian translation is absolutely accurate. Be that as it may, Ferdinand tells us that when his father arrived in Española on his 1498 voyage he found that “Part of the people who had left were dead, and of the survivors more than one hundred and sixty were sick with the French sickness.” This unfortunately proves nothing beyond the fact that the colonists were a very active lot, because syphilis was already widespread in Europe by 1498.
Also contained in this book is the “Relation of Fray Ramon Concerning the Antiquities of the Indians, Which He, knowing Their Language, Carefully Compiled by Order of the Admiral,” written, according to Ferdinand, in the mid-14908. This relation tells practically all we know of the cosmogony of the Arawak people of Española. Their great folk hero, according to the good friar, “had great pleasure” with a woman, “but soon had to look for many bathhouses in which to wash himself because he was full of those sores that we call the French sickness.” Humans are very slow to change their folklore, and so it seems unlikely that the Arawaks would have altered their legends so as to give a new disease to their Achilles, their Beowulf, so soon after the arrival of the Europeans.11
The two most important historians of the early Spanish empire, Bartolomé de Las Casas and Gonzalo Fernández de Oviedo y Valdés, both state that Columbus brought syphilis back from America to Europe. Their accounts differ somewhat in detail, and taken together, are not clear as to which of the first fleets returning from America first brought syphilis to Europe. The difference in detail does not necessarily indicate a lack of veracity: such an importation would be very difficult to pinpoint chronologically. Both Las Casas and Oviedo were certainly qualified by personal experience and access to those who sailed with Columbus to make their statements on the origin of the pox. Las Casas was in Seville in 1493 when Columbus came to that city with his report on his discoveries and with his Indian captives. Las Casas's father and uncle sailed with Columbus in 1493, and he must have known many other participants in the early voyages, as well. Las Casas himself came to the New World in 1502, and spent most of the rest of his life working for and with the Indians.
Oviedo was attached to the Spanish court in the 1490s, and met Columbus even before his 1492 epochal voyage. Oviedo was quite friendly with the great explorer's sons and with members of the Pinzón family, which figured so importantly in the first voyáges to America. A number of his friends, whom he asked to bring back detailed reports, sailed with Columbus in 1493. Oviedo was even on hand in Italy for the initial European syphilis epidemic, about which he wrote, “Many times in Italy I laughed, hearing the Italians speak of the French disease, and the French call it the disease of Naples; and in truth both would have had the name better, if they called it the disease of the Indies.” In 1513 he sailed to the Indies, where he spent most of the rest of his life. No one can claim that Las Casas and Oviedo did not have full opportunity to know all there was to know about the alleged American origin of the pox.
Las Casas personally asked the Indians if they had known the disease before the coming of the Europeans, and was told, that they had indeed suffered from it beyond all memory. Both the historians report the medically significant fact that the disease was much less dangerous for the infected Indians than for the Spaniards, a contrast one would expect if the former race had had long contact with the malady and the latter none at all.12
The third charter member of the Columbian theory school was a physician, Ruy Díaz de Isla, who claimed in a book first published in 1539 that he had treated some of Columbus' men who had contracted syphilis in 1492 in America, and that he had observed its rapid spread through Barcelona. He did not know what the disease was at the time, but later realized that he had been witness to the arrival of syphilis. He called it Morbo Serpentino, for, as the snake “is hideous, dangerous and terrible, so the malady is hideous, dangerous and terrible.”
One must either accept Díaz's account and become a Columbian, or one must reject it completely. It is certain that he was no quack. He was one of the most accomplished clinicians of his time, and even his most vehement twentieth-century detractor, R. C. Holcomb, admitted that “he was the greatest syphilographer of his time. His historical errors do not affect my opinion of him as a surgeon in the slightest.” Indeed, it took scientists immeasurably better equipped than Díaz four hundred years to properly appreciate his shrewd guess that a high fever, such as that caused by malaria, tends to arrest syphilis.13
At the present stage of research we have no documents specifically confirming what Díaz tells us. Perhaps one day we will. It is lucky that we even have his book, which apparently caused little stir when it first appeared. Then, in contrast, for instance, to the writings of Paracelsus, it almost completely disappeared from scholarly concern until Jean Astruc consulted it in the eighteenth century. Again it dropped out of sight, for all practical scholarly purposes, until rediscovered by Montejo y Robledo in the 1850s. It is a very rare book today, and but for microfilm, few researchers would ever have a chance to read it. All in all, the saga of Díaz's book is a very good object lesson for any who would place a great deal of confidence in negative evidence when dealing with the documentation of the sixteenth century.14
The only evidence we have which even tends to directly corroborate Diaz's statements was taken down a generation after the initial voyage to the West Indies, and pertains to the obscure death of the commander of the Pinta, Martin Alonso Pinzón. In his original manuscript, but not in the published book, Díaz says that one of the seamen who returned from America in 1493 suffering from syphilis was “a pilot of Palos called Pinzón.” At least two members of the Pinzón family of Palos sailed with Columbus in 1492, and all authorities agree that Martín Alonso died very shortly after his return to Spain. Díaz tells us that the ailing sailors attributed their new illness to “the tolls of sea, or other causes according as they appeared to each one.” In testimony taken a generation later, witnesses of the return of the Pinta to Palos agree that Martín Alonso was sick upon arrival and that he died shortly after of an illness brought on by the exhaustion and hunger he had undergone during the voyage. This testimony corroborates in part what Díaz says. Even though he may have misinterpreted the facts, he did have them.15
The documentary evidence for the Columbian provenance of venereal syphilis is obviously shaky. We cannot say, moreover, that the evidence provided by the paleopathologists is utterly decisive, but when the two are combined—when archivists and gravediggers join hands to claim that America is the homeland of Treponema pallidum—it becomes very difficult to reject the Columbian theory. Or, at least, it would be very difficult to do so if the argument on the history of syphilis was still being fought over the same ground as it was a generation ago. But the scene of battle has changed. All the arguments, pro and con, touched on in this paper thus far may not be wrong so much as merely irrelevant!
Is venereal syphilis a separate and distinct disease, once endemic to only one part of the world, or is it merely a syndrome of a disease which has always been worldwide, but happens to have different symptoms and names in different areas? Those who accept the Unitarian theory, as it is called, claim that that which is called syphilis, when transmitted venereally, is really the same malady as the nonvenereal illnesses called yaws in the tropics, bejel in the Middle East, pinta in Central America, irkinja in Australia, and so on. The manner in which this ubiquitous disease, named “treponematosis” by the Unitarians, manifests itself in man is somewhat different in different areas, because of climatic and cultural differences, but it is all one disease. If this is true, then all the squabble about deformation of forehead bones here and not there, ulcers on the sex organs now and not then, and on and on, is completely irrelevant. As E. H. Hudson, the foremost champion of the Unitarian theory, puts it, “Since treponematosis was globally distributed in prehistoric times, it … is idle to speak of Columbus' sailors bringing syphilis to a syphilis-free Europe in 1493.”16
Perhaps the best way to present the Unitarian theory is to summarize Hudson's version of that theory. His arguments are not accepted universally even by the Unitarians, but they will serve to introduce the reader to the basic ideas of the proponents of this hypothesis. The organism which causes treponematosis is an extremely delicate one. It needs the moisture and the warmth of the body of a host to survive for more than a few minutes, and normally it is carried by man alone among the animals.17 Thus it is very sensitive to differences in climate and human habits, and, in its Darwinian adaptations to these differences, appears as “different” diseases. Hudson theorizes that man first acquired the treponema causing these maladies in moist, hot sub-Saharan Africa, where the climate allowed it to live on the surface of the body, many thousands of years ago. The disease was originally manifested as yaws, an infection which, initially, at least, affects only the surface layers of the body. Then, as man migrated into drier areas, the organism retreated into the bodies of its hosts, and became a kind of nonvenereal syphilis, a disease of childhood, transmitted by close contact under very unhygienic conditions. This manifestation is called bejel in the Middle East. As cities developed and the general level of civilization rose, more careful personal hygiene, cleaning of eating utensils, separation of sleeping individuals, and so on, robbed the treponemas of most of their avenues of transmission from human to human and threatened their existence everywhere on the surface of the bodies of their hosts. Therefore, they retreated even deeper into the human body, into the bones and arteries and nervous system, and utilized the only avenue of transmission left open to them by modern man: the one extremely intimate contact with another human which modern man has not given up and in which he indulges many times over, sexual intercourse. Venereal syphilis appeared.18
A great deal of scientific evidence has accumulated to support the Unitarian theory. The syndromes of the several “different” diseases of the trepanematosis group are not sharply contrasted one from the other. Rather, there seems to be a continuum of at least partial similarity from the surface lesions of pinta, on one extreme, to the deep body structure damage caused by venereal syphilis, on the other extreme. The recognition of these similarities is not new. Sixteenth-century Europeans in America were certainly acquainted with venereal syphilis, and may also have seen yaws among the Indians. The latter had a disease they called “pians,” characterized by pustules and often, but not always, transmitted venereally. Some Europeans called it the French disease and some did not, even when Europeans contracted it through intercourse with Indian women. Thomas Syndeham, the great British physician of the seventeenth century, believed venereal syphilis to be a variation of yaws, brought to both Europe and America on the slave ships. In the book Every Man His Own Doctor or Poor Planter's Physician, popular in Britain's American colonies around 1730, the suggested cure for yaws is also recommended for syphilis, “because the Symptoms are much the same, [and] it is very probable, the one was the Graft of the other.”19
The organisms which cause the various treponematoses have different names—Treponema pallidum, Treponema pertenue, Treponema carateum—but they cannot be differentiated under a microscope. The antibodies created within the body of the host by one treponema serve to immobilize the others, too, so acquired immunity to one of the treponematoses seems, in many, many cases, to confer immunity to all of them. All, or at least very many, of the victims react positively when given the Wassermann test, which was specifically created as a test for venereal syphilis alone. At present, the only way to differentiate between the several allegedly different treponemas is by infecting laboratory animals with them, and then checking the symptoms. The symptoms thus created are different, but by no means is the contrast a sharp one. And the symptomatic differences observed in one animal (e.g., rabbits) are not always identical to those found in another (e.g., hamsters).20
All this is very disconcerting for the Columbians, but not necessarily disastrous for their hypothesis. The scientific evidence certainly indicates a very close relationship between the various treponemas, but it has not been proved that they are all the same. The great majority of experts either withhold final decision on the matter or continue to consider them as separate kinds of organisms. Perhaps our current means of differing between these organisms are too crude, and one day soon a more discriminating test will be invented. After all, smallpox and cowpox are closely related maladies symptomatically, immunity to one is immunity to both, and the organisms that cause these diseases appear to be nearly identical under the electron microscope. But no one would claim that the two illnesses are the same.21
If we accept the Unitarian theory we have two possible explanations for the appearance of venereal syphilis in Europe during the lifetime of Columbus. One, the practice of improved hygiene in the cities had risen to such a level as to bring about, by the process of elimination of the less adaptable treponemas, a venereal strain of treponematosis. This seems unlikely because it would have been a gradual process, and the contemporaries agreed upon the abrupt appearance of venereal syphilis. Two, in the 1490s the treponemas living in the bodies of Europeans suddenly mutated, producing a new and deadly version of an old disease. This explanation fits nearly all the facts we have, but, as said before, it is not susceptible to proof or disproof.
In fact, such is the paucity of evidence from the fifteenth and sixteenth centuries that the Unitarian theory is no more satisfactory than the Columbian. We simply do not know much, and may never know much about the world distribution of the treponemas in the 1490s. The field is nearly as wide open for theorizers today as in that terrible decade when many Europeans blamed the pox on the conjunction of Saturn and Mars and on “the unholsom blastes of the ayre.”22
There are only two things of which we can be sure. One, the only pre-Columbian bones clearly displaying the lesions of treponematosis or one of that family of diseases are American. The infections which affect only the surface or viscera would, of course, leave no trace on bones, no matter how deadly the disease, but that does not necessarily prove that pinta did exist in the Old World in 1492. It only means that we do not know and perhaps never will. Two, several contemporaries did record the return of venereal syphilis with Columbus. Their testimony cannot be shrugged off. They may have been confused, but they were not fools or liars.
The Columbian theory is still viable. Even if it is unequivocally proved that all the treponematoses are one, the Columbians can simply claim that treponematosis was exclusively American in 1492. There is no unquestionable evidence that any of the treponematoses existed in the Old World in 1492. For instance, sub-Saharan Africa is usually thought of as the homeland of yaws, but we really do not know this as a fact. We know practically nothing about the medical situation in Africa in Renaissance times.23
It is not impossible that the organisms causing treponematosis arrived from America in the 1490s in mild or deadly form, and, breeding in the entirely new and very salubrious environment of European, Asian, and African bodies, evolved into both venereal and nonvenereal syphilis and yaws. If this is true, then Columbus ranks as a villain with the serpent of the Garden of Eden.
A less presumptuous theory is that the treponematoses were one single disease many thousands of years ago. Then, as man changed his environment and habits, and especially when he crossed the Bering Straits into the isolation of the Americas, the differing ecological conditions produced different types of treponematosis and, in time, closely related but different diseases.24
To illustrate how difficult it is to definitively solve the riddle of the origin of venereal syphilis, let us examine briefly the history of another disease carried from one hemisphere to the other. This disease affected plants, not people, and traveled from the Old to the New World, rather than vice versa. The chestnut trees of the United States are closely related to those of Asia. The American and Asian chestnuts are both often hosts to Endothia fungi native to their areas, and suffer no damage from those fungi. But in the 1890s the Asian variety, Endothia parasitica, arrived in the United States, and by the mid-1930s the American chestnut, which had been one of the dominant trees of the eastern deciduous forests—the tree beneath which Longfellow's smithy labored—was gone. Only a few examples of it remain in the United States.25
Imagine how difficult it would be to recreate the history of this epidemic if it had taken place four hundred years ago. Who could say with certainty that a given piece of disinterred wood was four hundred and fifty, four hundred, or only three hundred and fifty years old? Who could say with certainty that the tree which had produced this piece of wood had been exactly what kind of chestnut tree, which had died of exactly what kind of fungus? The ambiguities and possibilities for error are so many that even science can offer only tentative answers. We might find ourselves turning with at least equal confidence to the record of history. The men who lived four hundred years ago knew more about their world than we do.
The field is still wide open for those who wish to theorize about the origin of syphilis. It seems logical to believe that if deadly diseases crossed the Atlantic from east to west, then there must have also been a similar countercurrent. The most likely candidate for the role of America's answer to the Old World's smallpox is venereal syphilis. The theory of the origin of the treponematoses offered in this chapter squares with all Darwin tells us about evolution, and allows the American Indians and Columbus the dubious honor of incubating and transporting venereal syphilis. It is this hypothesis which, in the current state of medical and historical research, seems to hold the most promise as a vehicle for future inquiry and speculation.
Having finished with the polemics of syphilis, let us turn to the first century of its recorded history. By the fifteenth century, treponematosis had evolved into several related maladies in the desert-isolated jungles, isolated plateaus, different islands, and continents of the world. Then came one of the greatest technological advances: European innovations in shipbuilding, seamanship and navigation spawned the generation of Columbus, Da Gama, and Magellan. All the races of mankind found themselves in direct contact for the first time since the days of Adam. A great mixing of peoples, cultural influences, and diseases began.
The various treponematoses spread out from their hearth-lands, mixing and changing under new ecological conditions in a way that will probably always confound medical historians. The evidence that comes down to us from that time is sparse and confused. The Europeans bemoaned the arrival of venereal syphilis. The Ceylonese became the reluctant hosts of the organism causing yaws, which, according to tradition, was introduced following the arrival of the Europeans.26 (If this expanded version of the Columbian hypothesis is kept in mind, perhaps other evidences of the wanderings of the treponematoses may be discovered.)
Europeans drew the world together by means of ocean voyages. Their great travelers were sailors. The epidemiology of syphilis has a special characteristic: it is usually transmitted by sexual contact and spreads when a society's or a group's allegiance to marital fidelity fails. Sailors, by the nature of their profession, are men without women, and therefore, men of many women.27 If we may assume that the nature of sailors in the sixteenth century was not radically different than in the twentieth, then we can imagine no group of the former century more perfectly suited for guaranteeing that venereal syphilis would have worldwide distribution. Whether Columbus's sailors or his Indians brought it across the Atlantic makes little difference. European sailors carried it to every continent but Antartica and Australia before Columbus was in his grave.
Venereal syphilis arrived in Barcelona in 1493, according to Díaz de Isla, but we have no other news of it in Spain for several years. Why? First, because of the paucity of documentation. Second, because syphilis spreads by venereal contact, and not by touch, breath, or insect vectors, as do the traditional epidemic diseases of smallpox, typhus, plague, and so on. In a stable society its spread will be steady but not extremely fast. Let us play an artificial little game to illustrate this point. Imagine 1,000 people, one of whom is syphilitic. He infects two others, who infect two others each, in turn. The number of the diseased goes up steadily: 1, 2, 4, 8, 16, 32, and so on. In the early stages the disease's advance is rapid, but the victims are few and below the threshold of society's attention. The disease's spread does not accelerate, it is passed on from one to another no more rapidly than before, but 32 becomes 64, 64 leads to 128, 128 is suddenly 256—and society abruptly decides that its existence is threatened by epidemic, long after the initial arrival of syphilis.
Venereal syphilis will only spread with the rapidity of plague or typhus when a society is in such chaos that sexual morality breaks down. Such a sad state of affairs is usually the product of war. Women are without protection or food, and have only their bodies to sell. The men of the armies have a monopoly of force, most of the wealth and food—and no women.
The first recorded epidemic of syphilis took place in Italy in the mid-1490s. In 1494 Charles VIII of France, in pursuit of his claims to the throne of Naples, crossed the Alps into Italy with an army of about 50,000 soldiers of French, Italian, Swiss, German, and other origins. The campaign was not one marked by full-scale battles, but the army, trailing its column of the usual camp followers, engaged in the usual practices of rape and sack anyway. The Neapolitans, retreating toward their city, laid the countryside to waste. Charles, once ensonced in Naples, discovered that the Italians, appalled by his success, were putting aside their personal conflicts and forming a coalition against him. Ferdinand and Isabella, anxious to prevent the establishment of French hegemony in Italy, were sending Spanish troops. Charles packed his bags and marched back to France, and the whole process of battle, rape, and sack was repeated in reverse.28
Syphilis, hitherto spreading slowly and quietly across Europe, flared into epidemic in Italy during this invasion, just as the epidemiology of the malady would lead one to expect. It is probable that there was also a rapid spread of typhus, another traditional camp follower. It was in Italy that the truth of Voltaire's epigram was first demonstrated: “Depend upon it, when 30,000 men engage in pitched battle against an equal number of the enemy, about 20,000 on each side have the pox.”29
Charles arrived back at Lyon in November 1495, where he disbanded his army; and its members, with billions of treponemas in their blood streams, scattered back to their homes in a dozen lands or off to new wars. With the dispersal of that army, the lightning advance of syphilis across Europe and the rest of the Old World became inevitable.30
Syphilis had already appeared in Germany by the summer of 1495, for in August Emperor Maximilian of the Holy Roman Empire issued a mandate at Worms calling it the “evil pocks” and blaming it on the sin of blasphemy. In the same year Swiss and Frenchmen recorded its arrival with horror. The pox reached Holland and England no later than 1496. Greece knew it in the same year, and Hungary and Russia in 1499.31
By the turn of the century, from London to Moscow great numbers of Europeans “be vexed with the frensshe pockes, poore, and nedy, leyenge by the hye wayes stynkynge and almoost roten above the ground … [suffering] intollerably withe puscules & dolorus burnings o the armis shulders nek & leggs or the shynnes as the bones shuld part from the flesh.” Europe was in the terrible grip of an epidemic of venereal disease.32
The epidemic rolled on into Africa, where “If any Barbarie be infected with the disease commonly called the Frenche pox, they die thereof for the most part, and are seldom cured”; and appeared in the Middle East as early as 1498, with a similar result. The Portuguese, among the earliest to receive the infection, probably carried it farthest, around the Cape of Good Hope. It appeared in India in 1498 and sped on ahead of the Portuguese to Canton by 1505. In a decade it advanced from the Caribbean to the China Sea, at once a tribute to man's nautical genius and social idiocy.33
We are lucky in our attempt to trace the early history of syphilis in that shame was not attached to the disease at the beginning. One of the common symptoms of early syphilitics was biographical in nature. As if to illustrate the frankness of the age, Ulrich von Hutten, the great humanist, wrote a gruesomely detailed tract on his own sufferings, gratuitously mentioning that his father had the same disease, and dedicated the whole to a cardinal!34 Our knowledge of early syphilis is limited only by the diagnostic abilities of the sixteenth century.
The plentiful documentation enables the venerologist of an antiquarian bent to trace not only the history of the epidemic but the history of its remedies and of the character of the disease itself. The best analysis of the latter is by Jean Astruc. Although he died just over two hundred years ago, he is still probably the greatest venerologist who ever lived, and his writings on the early history of the French disease are the best secondary study on the subject to date. He breaks down the early history into five stages.
1) 1494–1516. In this period the first sign of the disease in a patient was small genital ulcers, followed by a widespread rash of various character. (This rash is vividly illustrated in all the early depictions of the disease, including one by Albrecht Dürer, dated 1496).35 As the disease spread through the victim's body, palate, uvula, jaw, and tonsils were often destroyed. Large gummy tumors were common, and the victim suffered agonizing pains in muscles and nerves, especially at night. General physical deterioration followed and often culminated in early death.
2) During the period 1516 to 1526 two new symptoms were added to the syphilis syndrome: bone inflammation, characterized by severe pain and eventual corruption of the bone and marrow; and the appearance in some suf ferers of hard genital pustules, resembling warts or corns.
3) A general abatement of the malignancy of the disease marked the period 1526 to 1540. The number of pustules per sufferer decreased, and we hear more of gummy tumors. Inflammed swelling of the lymph gland in the groin became common. Loss of hair and teeth became common, but this may have been caused by mercury poisoning, mercury having been used as a remedy.
4) From 1540 to 1560 the diminution of the more spectac ular symptoms of the malady continued. Gonorrhea, which by this time and for centuries afterward was con fused with syphilis, became “the most common, if not perpetual symptom” in the early stages of syphilis.
5) Between 1560 and 1610 the deadliness of the malady continued to decline, and only one new symptom was added: noise in the ears.
By the seventeenth century syphilis was as we know it today: a very dangerous infection, but not one that could be called explosive in the nature of its attack on the victim. Astruc was so encouraged by the record of the declining virulence of the malady that he looked forward with hope, if not with complete confidence, to its final disappearance.36
If one wished to create a disease to encourage the proliferation of quacks and quack remedies, one could do no better than syphilis; and this was particularly true in the sixteenth century. The disease was new and no traditional remedies for it existed. Its symptoms were hideous, persuading sufferers to try any and all cures. Syphilis is a malady characterized by periods of remission and latency: “it seemeth to edyfye and fortyfye a castell, there to reste a longe season” and so if the quack does not kill with his cure, he can often claim success—for a time, at least. The quacks cured by searing the pustules with hot irons, and prescribed an unbelievable assortment of medicines to swallow and to apply, the latter including even boiled ants' nest, along with the ants. Ulrich von Hutten, whom one healer warned not to eat peas, for “there growe certayne worms in them with wynges,” knew of another so skilled “that in one day he killed iii husbandmen. …”37
The two most popular remedies for syphilis in the sixteenth century were mercury and guaiacum. The first came into use very soon after the appearance of the pox, both in Europe and Asia. It was already on hand as the most important ingredient in the Arabic ointment, Ugentum Saracenium, which had been used successfully in treatment of scabies. Syphilis also produced skin sores, and so the ointment was quickly enlisted against it. It was effective, and in fact it proved to be the only generally effective means of arresting syphilis for the next four hundred years. Before the middle of the sixteenth century, mercury was being rubbed on, applied to the body in plasters and swallowed in pills.38
Unfortunately, mercury was overused, and in many cases the cure was successful but the patient died of it. The humoral theory of disease, which dominated European thinking at the time, taught that illness came as the result of an imbalance among the four humors. Syphilis could be cured if the body could be obliged to bleed, defecate, sweat out, and spit out the excess of the offending humor: phlegm, in this case. The most obvious symptom of mercury poisoning is the constant dribbling of saliva, even to the amount of several pints a day. What, though the sixteenth-century physician, could be more desirable? The body is purging itself of that which is making it sick. Out came the offending excess, often along with gums, teeth, and assorted interior fragments of the body. William Clowes, a Tudor surgeon of some wisdom, vividly describes the plight of one poor mercury victim as follows: “A great and an inordinate flux of vicious and corrupt humours passed out of his mouth, with much acrimony, burning heat and sharpness, by reason of the putrefaction of his gums, with a horrible stinking savour and a fever accompanying the same.” “Many had lever dye,” said Ulrich von Hutten, “than so to be eased.”
Although mercury remained the only effective means of treating the pox for several hundred years, patients from London to Canton were inclined to agree with the Scot whose unintentional slip of the pen rendered its name “quack-silver.”39 Many other remedies were tried in its place—China root, sassafras, sarsaparilla, and so on—but only one displaced mercury as the cure, if only for a time. This was guaiacum, a decoction of the wood of a tree of the West Indies, which became the most popular panacea of the 1520s. The wood had much to recommend it. It came from America, as did the disease; and this is, of course, the way a thoughtful God would arrange things. It was a very impressive wood, extremely hard and so heavy that “the leaste pece of its caste into water, synketh streyght to the bottom,” which indicated that it must have additional miraculous properties. A decoction of it caused the patient to perspire freely, a very desirable effect, according to humoral theory. Among its proponents were Girolamo Fracastoro and Ulrich von Hutten, two of the greatest writers of the day—a high recommendation for the wood in that age of humanism. And it at least did not injure the patient. Benvenuto Cellini, in spite of the advice of physicians, used it to treat himself for a self-diagnosed case of the pox; and if it did not cure him of what he probably did not have, at least it did not kill him, either.40
The prevalence of syphilis and the wood's effectiveness not only against it but also against “goute in the feete, the stone, palsey, lepre, dropsy, rallying evyll, and other diseases,” drove its price to dizzy heights. Like a poor man's soup bone, the sawdust of guaiacum was boiled up again and again for those not lucky enough or wealthy enough to buy the first decoction. Counterfeit guaiacum flooded the market and pieces of the wood were hung in churches to be prayed to by the most impecunious syphilitics. And all, all were cured.
Or were they? Murmurs, soon rising to shouts, of the wood's ineffectiveness began to be voiced in the 1530s. Philippus Paracelsus, for one, proclaimed the wood worthless, and mercury the real hope of the syphilitic. The fad of the Holy Wood from the New World returned a few generations later, and the use of it never quite died out—it was not removed from the British Pharmacopoeia until 1932—but its reputation as the cure had evaporated. Europe returned to China root, sassafras, prayer, and, especially, mercury.41
The effects of the guaiacum fad were what one would expect: desperate optimism and finally the death of men and women who might otherwise have received at least partly successful treatment. There are few lines in all literature more pitiful than those of Ulrich von Hutten on his “cure.” With little left of his few remaining years but a return of pain, he wrote:
And lo through the helpe of Guaiacum, I am bolde nowe to lyve, and to drawe breath agayne. Whiche mynd god gyve to all good menne, that they never ceasse to hope and trust. As for me, I repent my selfe in nothynge, and yf by any meanes long lyfe myght be graunted unto me, I have great hope that I shulde lyve hole, sounde, and lusty.42
In an age in which the Pope had to rescind an order expelling all prostitutes from Rome because of the loss of public revenue that resulted, the new venereal disease inevitably spread to every cranny of Europe and became, like smallpox or consumption, one of the permanently resident killers. The English doctor, William Clowes, stated in the 1580s that one out of every two he had treated in the House of St. Bartholomew had been syphilitic, and that “except the people of this land do speedily repent their most ungodly life and leave this odious sin, it cannot be but the whole land will shortly be poisoned with this most noisome sickness.”43
However, Treponema pallidum brought some good in its train, though those who benefited from it were few. Physicians, surgeons and quacks found a source of wealth in the pox. The story goes that the physician Thierry de Héry once knelt before a statute of Charles VIII, explaining that “Charles VIII is good enough saint for me. He put 30,000 francs in my pocket when he brought the pox to France.”
The Fuggers of Augsburg, the greatest banking family of the day, also turned the spread of the French disease into money. They became the chief importers of guaiacum in Europe and were among the most enthusiastic promoters of the Columbian theory of the origin of the pox. At least one doctor, mentioned by Ulrich von Hutten, took a not unwise view of guaiacum and its successes, calling it “a vayne thing, and nothing worthe; but that the marchauntes fayned it to doo these things.”44
For many for whom the pox was not a matter of profit, it became a subject for humor. When man is both helpless and foolish in the presence of horror, as is often the case in matters pertaining to venereal disease, he finds solace in jokes. There was a great deal of joking about the French disease in the sixteenth century. Cervantes mentions it in a satirical treatment of one scholar's criticism of another's work: My rival, says the pedant, “forgot to tell us who was the first man in the world to have a cold in his head, or the first to take unctions of mercury for the French disease, all of which I bring out most accurately, citing the authority of more than twenty-five books.”45 Rabelais, as one would expect, touches on the subject of syphilis many times, once even using it as a means of self-praise:
What shall I say of those wretched devils plagued by pox and gout? How often they have appeared before us saturated with quicksilver ointment, salves and grease. Their faces shone like a larder keyhole … their teeth danced in their heads like a keyboard of an organ or spinet under the fingers of a maestro … they foamed at the gullet like a boar at bay in the toils of a pack of bloodhounds. … What did they do in this crisis? Their sole consolation was to have somebody read them a few pages of this book.”46
Erasmus mentions syphilis a number of times. In one of his Colloquies he announces to the world that “unless you're a good dicer, an infamous whoremonger, a heavy drinker, a reakless spendthrift, a wastrel and heavily in debt, decorated with the French pox, hardly anyone will believe you're a knight.”47 It almost seems that this description inspired Shakespeare to create his bacchanalian knight, Sir John Falstaff. Sir John feared himself to be afflicted with the dreadful French disease and, like so many since, sent off a urine specimen to be tested. He was informed that the doctor said that “the water itself was a good healthy water; but, for the party that owed it, he might have more diseases than he knew for.” Sir John decided to turn his illnesses to good use: “A pox of this gout! or a gout of this pox! for the one or the other plays the rogue with my big toe. 'Tis no matter if I do halt; I have the wars for my colour, and my pension shall seem more reasonable. A good wit will make use of anything: I will turn my diseases to commodity.” On his deathbed, in which he laid himself not long thereafter, he spoke mournfully of women and said “they were devils incarnate.”48
To most, however, the pox was no subject for laughter, but an unmitigated disaster. It was no respecter of rank, and thus had a direct and dismal effect on political and church history. Díaz de Isla claimed to know “of kings, dukes, and grand señores, who had died of the disease,” and no one familiar with the history of the sixteenth century would contradict him. Two dynasties whose members were not noted for monogamous behavior died out in that age, the House of Valois and the House of Tudor. As usual, little can be proved, but the inability of queens to give birth to living children makes one suspect that syphilis played a role in the demise of these families, and thus in the political turmoil of their realms. There is little doubt that Francis I, famous for having “lost all save life and honor” in the battle of Pavia, lost both in the end to the pox. And there is little doubt that one and possibly two of the husbands of Mary Queen of Scots, and, therefore, possibly the woman herself, had the disease. In 1500 Cesare Borgia, refused to give an audience because he was suffering from an “ulcer” and “a sore in the groin”; and three years later his “face was disfigured with red blotches and pimples.” Do these bits of information refer to the primary and then the secondary symptoms of syphilis, and, if he had it, how did his illness affect his policies? Is it true that Pope Julius II would not allow his foot to be kissed because it was disfigured with syphilitic sores? The truth does not matter: the Protestants believed all such reports.49
The pox's full impact, however, can never be measured if we restrict ourselves to economics, literature, politics, and religion. Treponema pallidum was chiefly a social villain, one of the most evil of the whole age of Erasmus, Shakespeare, and Francis I. The fear of infection tended to erode the bonds of respect and trust that bound men and women together. The prostitute's chance of Christian forgiveness faded. “If I were judge,” roared Luther, “I would have such venemous syphilitic whores broken on the wheel and flayed because one cannot estimate the harm such filthy whores do to young men.”50 And those less obviously offensive suffered, also, from the terror engendered by the new plague. The sick and the stranger found closed doors where once they had found hospitality. Friendships were altered by a new coolness, as men began in some degree to limit their contacts with any who might conceivably have been touched by the pox.
We find little bits of information indicating the change. Public baths went out of style, for it was widely realized that many as innocent of promiscuity as newborn babes had contracted the French disease in such places. The use of the common drinking cup fell out of style.51 The kiss, a customary gesture of affection between friends as well as lovers, came under suspicion. In Henry V, Shakespeare tells us why. Nell, taking leave of the men off to the wars in France, kisses Bardolph goodbye. Nym, although her former lover, refuses the invitation to follow him to her lips. He deprives himself, perhaps for the good reason that Bardolph's face “is all bubukles, and welks, and knobs, and flames o' fire.” “Bubukles” is a combination of the words carbunkles and bubos, the name the Spaniards gave to syphilis and the English gave to syphilitic swellings. When next we hear of Nell, it is that she is “dead i' the [ho]spital Of the malady of France.”52
What was the effect of syphilis on general human contact? Consider that one of the crimes—false or no—of which Cardinal Woolsey was accused in his arraignment before Parliament in 1529 was that he, “knowing himself to have the foul and contagious disease of the great pox … came daily to your grace [Henry VIII], rowning in your ear, and blowing upon your most noble grace with his perilous and infectious breath, to the marvellous danger of your highness.”53
Erasmus summed up the whole diffuse but powerful influence of the pox on the manners of the time in a perky dialogue between one Petronious and his friend, Gabriel:
Pet: At least so deadly a disease as this should have been treated with the same care as leprosy. But if this is too much to ask, no one should let his beard be cut, or else everybody should act as his own barber.
Gab: What if everyone kept his mouth shut?
Pet: They'd spread the disease through the nose.
Gab: There's a remedy for that trouble, too.
Pet: What is it?
Gab: Let them imitate the alchemists: wear a mask that admits light through glass windows and allows breath through mouth and nose by means of a tube extending from the mask over your shoulders and down your back.54
It is obvious that in no area did syphilis wreak more havoc than in relations between men and women. No civilization has ever satisfactorily solved the problem of sex. Even if there were no such thing as venereal disease, the sex relationship would still produce distrust, fear, and pain, as well as confidence, love, and comfort. Add to the normal emotional difficulties of the sex relationship not just the possibility of the pains of gonorrhea but the danger of a horrible and often fatal disease, syphilis. Where there must be trust, there must now also be suspicion. Where there must be a surrender of self, there must now also be a shrewd consideration of future health. Generosity of spirit and body may lead one to the ludicrous fate of the syphilitic Englishman of the late sixteenth century whose lover insisted that “but for only him and her husband she was as good a maid as she was born of her mother.”55
Gabriello Falloppio, in his book of syphilis, De Morbo Gallico (1564), suggested that after sexual intercourse a man should carefully wash and dry his genitals. The age of the canny lover had arrived.56
NOTES
1. Desiderius Erasmus, The Colloquies of Erasmus, trans. Craig R. Thompson, 401, 405.
2. Ulrich von Hutton, Of the Wood Called Guaiacum, trans. Thomas Paynel, 1; Ruy Díaz de Isla, Tractado llamado fructo de todos los sanctos: contra el mal Serpentino, iii. The passages in the Díaz book which pertain to the American origin of syphilis are reproduced in Ivan Bloch, Der Ursprung des Syphilis, 306–307. Bloch's book is the most famous secondary source on the American origin of Syphilis. The equivalent for Old World origin is Karl Sudhoff's “The Origin of Syphilis,” in his Essays in the History of Medicine.
3. K. Chimin Wong and Lien-teh Wu, History of Chinese Medicine, 218; William A. Pusey, The History and Epidemiology of Syphilis, 12.
4. P. Huard, “La Syphilis Vue par les Médecins Arabo-Persans, Indiens et Sino-Japonais du XVe et XVIe Siècles,” 9–13.
5. Ibid., passim; Wong and Wu, Chinese Medicine, 217; Cyril Elgood, A Medical History of Persia and the Eastern Caliphate, 378; Pusey, Syphilis, 7–8; Bloch, Ursprung des Syphilis, 297–305; G. L. Hendrickson, “The ‘Syphilis’ of Girolamo Fracastoro with Some Observations on the Origin and History of the Word ‘Syph ilis,’” 544; Díaz de Isla, Tractado, iii.
6. Girolamo Fracastoro, Fracastor, Syphilis or the French Dis ease, A Poem in Latin Hexameters, trans. Heneage Wynne-Finch, 8; F. S. Morton, Venereal Diseases, 27, 87; Pusey, Syphilis, 11; von Hutten, Guaiacum, 2–2r.
7. Bruce Barrack, “Syphilis and Yaws,” 510; Folke Henschen, The History and Geography of Diseases, trans. Joan Tate, 124–126.
8. Henschen, History and Geography of Diseases, 124; Saul Jarcho, “Some Observations on Diseases in Prehistoric America,” 14–15; James E. Anderson, “Human Skeletons of Tehuacan,” 497; Henry E. Sigerist, A History of Medicine, vol. 1: Primitive and Archaic Medicine, 55–56; C. W. Goff, “Syphilis,” 279–294.
9. Nicolás Monardes, Ioyfull Newes Out of the Newe Founde Worlde, trans. John Frampton, 10r; Robert S. Munger, “Guaiacum, the Holy Wood from the New World,” 196, 197, 226; Samuel Eliot Morison, Admiral of the Ocean Sea, A Life of Christopher Colum bus, 2: 199–200; Charles C. Dennie, A History of Syphilis, 30.
10. For a masterly consideration of this evidence, consult Morison, Admiral of the Ocean Sea, 2: 193–218.
11. Ferdinand Columbus, The Life of Admiral Christopher Columbus by His Son Ferdinand, trans. Benjamin Keen, 155, 191.
12. Bartolomé de Las Casas, Historia de las Indias, 5: 349; Gonzalo Fernández Oviedo y Valdés, Historia General y Natural de las Indias, 1st ed., 1: 55; Gonzalo Fernández Oviedo y Valdés, Natural History of the West Indies, trans. Sterling A. Stoudemire, xi, xii, 88–90. Carl O. Sauer, The Early Spanish Main, 38–39.
13. Díaz de Isla, Tractado, iii; Richmond C. Holcomb, Letter to the Editor, 515; Dennie, History of Syphilis, 16.
14. Richmond C. Holcomb, “Ruiz Díaz de Isla and the Haitian Myth of European Syphilis,” 277–280.
15. Morison, Admiral of the Ocean Sea, 2: 204, 248; Bloch, Ursprung des Syphilis, 307; Emiliano Jos, “Centenario de Fernando Colón (Enfermedad de Martín Alonso),” 99–100.
16. E: H. Hudson, “Treponematosis in Perspective,” 738.
17. Morton, Venereal Diseases, 69; C. J. Hackett, “On the Origin of Human Treponematoses,” 21.
18. Hudson, “Treponematosis in Perspective,” 735–748; E. H. Hudson, “Treponematosis and Man's Social Evolution,” 885–901; E. H. Hudson, “Treponematosis and African Slavery,” 43–52.
19. Ed. Jeanselme, Traité de la Syphilis, 227–228; Max Isenberg, “Syphilis in the Eighteenth and Early Nineteenth Centuries,” 456; John E. Lane, “A Few Early Notes on Syphilis in the English Colonies of North America, 217–218; Dennie, Syphilis, 66, 68; Jean de Léry, Journal de Bord de Jean de Léry, ed. M. R. Mayeux, 376–378; André Thevet, The New Found Worlde, or Antarctike, trans. Thomas Hacket, 70–71.
20. Hackett, “Human Treponematoses,” 8, 18–19; Abner I. Weisman, “Syphilis: Was It Endemic in Pre-Columbian America of Was It Brought Here from Europe?” 297; Thorstein Guthe, “The Trepone matoses as a World Problem,” 68; Philip H. Manson-Bahr, Manson's Tropical Diseases, 512; Morton, Venereal Diseases, 42–43, 69.
21. A. J. Rhodes and C. E. van Rooyen, Textbook of Virology for Students and Practitioners of Medicine (1962), 156, 167, 173–174.
22. von Hutten, Guaiacum, 2r-3.
23. Barrack, “Syphilis and Yaws,” 515.
24. This pattern of divergent evolution has affected more than one of man's parasites. For example, body lice, certainly ancient companions of man, have become adapted to the differences among the races. Oriental, Caucasian, African, and American Indian lice are all different. See Thomas A. Cockburn, “The Origin of the Treponematoses,” 221–228.
25. W. D. Billings, Plants and Ecosystems, 35.
26. Hackett, “Human Treponematoses,” 16.
27. A United States Public Health Service publication of 1948 states that eighty seafarers, selected at random, admitted to sexual intercourse with 615 persons in 112 ports in forty-five different countries. See Eduard H. Hermans, “Interrelationship of Syphilis Incidence and Maritime Activity,” 132.
28. The Cambridge Modern History, vol. 1, The Renaissance, 108–117; The New Cambridge Modern History, vol. 1, The Renaissance, 350–354.
29. Voltaire, Candide and Other Stories, trans. Joan Spencer, 125; Morison, Admiral of the Ocean Sea, 2: 197–198.
30. Fracastoro, Fracastor, 4.
31. Ibid., 4–5, 9; Pusey, Syphilis, 5.
32. John Fisher, The English Works of John Fisher, ed. John E. B. Mayor, 240; E. L. Zimmermann, “An Early English Manuscript on Syphilis,” 468.
33. Holcomb, “Ruiz Díaz de Isla,” 355; Huard, “La Syphilis Vue Par Les Médecins,” 10; Fracastoro, Fracastor, 5.
34. Fracastoro, Fracastor, 208; von Hutten, Guaiacum, passim.
35. Pusey, Syphilis, 6, 7, 10.
36. R. S. Morton, “Some Aspects of the Early History of Syphilis in Scotland,” 176–177; Jean Astruc, A Treatise of Venereal Diseases, part 1: 95–99, 104.
37. von Hutten, Guaiacum, 3r, 4, 6r; E. L. Zimmermann, “Extragenital Syphilis as Described in the Early Literature (1497–1624) with Special Reference to Focal Epidemics,” 771–772.
38. Fracastoro, Fracastor, 22–25.
39. William Clowes, Selected Writings of William Clowes, ed. F. N. L. Poynter, 65; von Hutten, Guaiacum, 6; Morton, “Syphilis in Scotland,” 177; Wong and Wu, Chinese Medicine, 219.
40. von Hutten, Guaiacum, 9; Benevenuto Cellini, The Memoirs of Benvenuto Cellini, trans, Anne MacDonell, 122–123.
41. Munger, “Guaiacum,” 212, 213–218; Fracastoro, Fracastor, 27.
42. von Hutten, Guaiacum, 51.
43. Preserved Smith, The Age of the Reformation, 507; Clowes, Selected Writings, 74.
44. R. S. Morton, “St. Denis, Patron Saint of Syphilitics,” 285; von Hutten, Guaiacum, 19r; Munger, “Guaiacum,” 209–210, 227; Henry E. Sigerist, Civilization and Disease, 76–77.
45. 45. Miguel de Cervantes Saavedra, Don Quixote, trans. Samuel Putnam, 652.
46. 46. François Rabelais, The Five Books of Gargantua and Pantagruel, trans. Jacques Le Clerq, 162.
47. Erasmus, Colloquies, 428–429.
48. William Shakespeare, King Henry IV, Part II, act 1, sc. 2; William Shakespeare, King Henry V, act 2, sc. 3.
49. Holcomb, “Ruiz Díaz de Isla,” 359. Henschen, History and Geography of Diseases, 127; Morton, “Syphilis in Scotland,” 179; James Kemble, Idols and Invalids, 86; Will Durant, The Renaissance, A History of Civilization in Italy from 1304–1476 a.d., 441. It seems unlikely that that most famous of rakes, Henry VIII, had syphilis. See J. F. D. Shrewsbury, “Henry VIII: A Medical Study,” 141–185.
50. Martin Luther, Luther's Letters of Spiritual Counsel, ed. and trans. Theodore Tappery, 293.
51. Zimmermann, “Extragenital Syphilis,” 757–780; Erasmus, Colloquies, 150, 402.
52. Shakespeare, King Henry V, act 2, sc. 3, act 3, sc. 6, act 5, sc. 1.
53. Shrewsbury, “Henry VIII,” 175.
54. Erasmus, Colloquies, 411.
55. Clowes, Selected Writings, 91–92.
56. B. E. Finch and Hugh Green, Contraception through the Ages, 4.