THE EARLIER METHODS EMPLOYED IN THE TREATMENT OE SYPHILIS By FRANCIS R. PACKARD,* M.D.

PHILADELPHIA, PA. LTHOUGH Ivan Bloch1 consid­ The name syphilis was first used in con­ ered that the American origin of nection with the disease by Fracastorius syphilis was proven beyond con­ in his poem entitled “Syphilis sivc morbus tradiction, the tendency on the gallicus,” 1530.4 The source from whence he part of more recent writers is to regardderived his the name is unknown. In the poem Areasoning as fallacious. Bloch argued that he uses it as the cognomen of one of the because certain documents which had been characters, a shepherd, who is stricken with relied upon to prove that syphilis existed it because of an act of sacrilege. Before earlier than the return of Columbus were Fracastorius applied the term, syphilis found to be spurious, therefore the whole was known as morbus vcncrcus, or more case fell down. But in recent years more popularly was designated by the name of undoubtedly authentic evidences have been some nation, the Spanish and Italians discovered, and it is now generally believed speaking of it as morbus gallicus or the by medical historians that syphilis existed French disease; the French terming it the in Europe long before the year 1495, in Spanish disease, or the Neapolitan disease. which it suddenly sprang into such terrible Europeans tired of attributing it to one prominence. The works of Buret2 and another called it the new disease and blamed Sudhoff3 contain overwhelming proof that its introduction on the sailors of Columbus. in different forms and under many names, Until John Hunter, in the latter part of especially leprosy, syphilis was disseminated the eighteenth century, differentiated throughout all the countries of the Old chancre from chancroid, all venereal sores World. The phenomenon of its sudden or manifestations, including gonorrhea, were prominence corresponds with the develop­ regarded as syphilitic and treated by the ment of a brilliant epoch in medicine, same remedial measures. Ricord5 first estab­ illuminated by the labors and researches lished gonorrhea as a distinct disease entity. of men who were to raise medicine out The unfortunate predominance of quack­ of its medieval thraldom. To their more ery in the treatment of venereal diseases exact methods and knowledge we may has been a notable fact from the earliest attribute a differentiation of syphilis from times to the present. To a great extent this its leprosy and the supposed new diffusion state of affairs is attributable to the feeling to the kind of loose statements made by the of shame which the disease inspires in those ignorant when they speak as though the who are its victims and the desire for recognition of the disease, appendicitis, was concealment on their part. Other reasons that of a new disease instead of merely the prevailed in the fifteenth century. Buret6 result of new knowledge and power of gives three statements quoted from Torella differentiation. Certain it is that before (1500), Wendelin Hock (1502) and Ulrich the year 1500 there were some 19,000 leper von Hutten (1519), which accord in saying hospitals scattered over Europe and Great that the regular physicians all recognized Britain which vanished completely as syph­ the failure of the measures which they ilis came to the fore. adopted to combat the disease and conse­ quently the quacks came to the fore vaunt- * Read at the meeting of the College of Physi­ cians of Philadelphia, February 7, 1923. 4 Fracastoro, G. Syphilis, from the original Latin, 1 Bloch, I. Ursprung der syphilis, 1901. St. Louis, 1911; Syphilis, a poetical history of the 2 Buret, F. Syphilis in the middle ages and in French disease, written in Latin by Fracastorius, now modern times, translated by A. H. Ohmann-Dumes- attempted in English by N. Tate, London, 1686. nil, Philadelphia, 1895. 5 Ricord, P. Traite pratique des maladies vene- 3 Sudhoff, K. Studien z. geschichte der medizin, riennes, Paris, 1838. Leips., 1912, and many other separate publications. 6 Buret, F. Op. cit. ing a great many supposed cures by all cepts begin with the advice to seek a kinds of bizarre treatments, advertising sunny, dry climate, avoiding marshy, wet themselves and their wares just as they do places, and to take strenuous exercise in the now, and numbering their victims by open air, such as hunting; or agricultural thousands. A very curious fact is that the occupations, ploughing or hoeing and wood­ most successful quack remedies of the six­ chopping. He also advises dancing and teenth century contained mercury, which playing shuttle-cock and palestra. He gives had been the favorite medicine against lep­ minute advice as to the diet; the patient rosy, given by fumigation or inunction. should eat no fish taken from either salt or For many generations the Arabians used fresh water, except in case of necessity, mercurial salves in the treatment of leprosy and then only those which are fished near and skin diseases. Roger, the great medieval waterfalls in swift-moving water. He should surgeon of the twelfth century, and Theo- eat no aquatic birds, nor the flesh of hogs, doric, in the thirteenth century, advocated nor cucumbers, truffles, artichokes, onions, their use, and the latter described the vinegar or milk, and should drink only very salivation which followed their absorption. light wines. If the disease occurs in the A poem on syphilis which, though now spring or autumn, he should be bled less widely known than that of Fracas- copiously from the basilic or median vein torius, had in its time great fame “On the and thoroughly purged. The patient should Contagious and Accursed Buboes” was drink freely of decoctions containing mix­ appended to “El Sumario de la Medi- tures of aromatics and bitters of which cina,” by Francisco Lopez de Villalobos, Fracastorius gives a long list. Lemon juice first published in 1498, thirty-two years is particularly salutary. Ulcers in the mouth before Fracastoro wrote his poem. Villa­ or throat are to be destroyed with verdigris, lobos was the physician to Ferdinand of which is also useful to destroy the pustules Spain in 1514. He was a learned and very on the skin. Osteocopic pains are to be witty man. An English translation of the relieved by the use of topical remedies of a poem with extensive notes was published soothing nature, such as goosegrease, mas­ by George Gaskoin.7 Villalobos mentions tic, linseed, daffodils, elder and honey. the treatment in vogue of salivation with Fracastorius says that possibly after mercury administered by fumigations or having exhausted this series of remedies inunctions, only to condemn it with the the patient loses patience because he has greatest vigor. He used mercury in an oint­ failed of obtaining relief by such mild but ment solely as an application to the buboes, safe measures. Then, relying upon his not for its constitutional effect. Villalobos, strength, he resolves: after giving instructions as to diet, hygiene To turn to more energetic agents to end the and the use of mild purgation, recommended matter with the hated enemy as soon as possible. bleeding from the basilic vein, and the Be it so! I will show you these violent and administration of theriaca. expeditious methods which can triumph in Fracastorius, in his famous poem, written a short time, over a disease that is usually long in 1530, ascribed the disease to astrological in duration, stubborn, subject to relapses and agencies, and stated his opinion that it had rebellious to mild medication. But also learn existed in various forms before its appear­ the price you will have to pay for your hasty ance as a virulent epidemic in Europe. deliverance. The principles on which he based his After this rather unpromising induction treatment were the chief mainstays of Fracastorius describes first the treatment the therapeutics of syphilis for some hun­ by means of fumigations composed of dreds of years after he wrote. His pre- styrax, cinnabar, antimony and incense. 7 Villalobos, F. L. Medical works. Translated, with He says that these fumigations should commentary and biography by George Gaskoin, never be used on the entire body as they London, 1870. are very violent and irritating and may cause respiratory difficulties and suffoca­ in the treatment of syphilis with mercurial tion. Therefore, their action should be con­ inunctions. Cellini says, however, that Ber­ fined to those parts which are the seats of engarius left Rome in great haste and very eruptions or ulcers. If it is decided to use wisely because his patients all relapsed, fumigations he prefers mercury as a basis “so that he would have been murdered if instead of the other substances. he had stayed.” The action of mercury on the scourge is The mercurial inunctions of the fifteenth marvellous, either because its natural affinity century were certainly carried out in such for heat and cold renders it proper to absorb a manner as to ensure salivation. The the devouring fire of the disease, or because its patient was smeared from head to foot with surprising density permits it to divide and to a thick semifluid mixture containing the dissolve the humors for a reason that is analo­ mercury, which was applied with a brush, gous to that which gives to incandescent iron a generally by a barber surgeon or an apoth­ caustic action more marked than that of a light ecary, called by Rabelais “graissiers de la flame; or that its mobile and penetrating verole.” After the ointment had been molecules, apt to infiltrate themselves in the applied the patient was put in a great tub warp of the tissues, have the power of con­ or cask and sweated. Many died of mer­ suming even to the bottom of organs the impure curial poisoning and some from exhaustion. yeasts of the disease; or finally, that its magie virtues are derived from some occult force Pare’s treatise on syphilis was based, as he whose mystery escapes us. states in a foreword, almost entirely on the less known book of his friend and fellow­ Fracastorius says he administered mer­ worker, Thierry de Hery,8 which had been cury in an ointment mixed with black published at Paris in 1552. He gives four hellebore, orris* root, galbanum, asafetida, methods of cure: 1. With guaiac given in oil of mastic and oil of native sulphur: decoctions; 2. by friction or rubbing with So, without hesitation, spread this mixture ointments, most of which contained sulphur on your body and cover with it your entire skin, or mercury; 3. by the application of plasters with the exception of the head and the pre­ containing mercury; 4. fumigation with cordial region. Then, carefully wrap yourself in cinnabar. wool and tow; then get into bed, load yourself It should be noticed that every one of with bed-covering and thus await until a sweat these methods was based on the production bathes your limbs with an impure dew. Ten of profuse sweating; the patient in order days in succession renew this treatment, for to facilitate this being swathed in blankets ten entire days you are to undergo this cruel in a bedroom, or in the process of fumigation trial whose beneficial effects will not cause you in a huge sort of cask. Pare does not make to wait. As a matter of fact, very soon an infal­ lible presage will announce to you the hour of any mention of the internal administration your freedom. Very soon you will feel the fer­ of mercury. ments of the disease dissolve themselves in Shakespeare alludes to the method of your mouth in a disgusting flow of saliva, curing syphilis by fumigation with mercury and you will see the virus, even the virus, and to the existence of hospitals or Iazar evacuate itself at your feet in a copious flow houses where such treatment was given. of saliva. Pistol: No; to the spital go, and, from the Thus the salivation of the patient was powdering tub of infamy, fetch forth the the aim of the physician, for the system Iazar-kite of Cressid’s kind, Doll Tear Sheet, thus rid itself of the poison of the disease, she by name.9 and this was the fundamental principle of To Paracelsus (1493—1541) is generally mercurial therapy for many generations. given credit for the popularization of the Giacomo Berengario or Berengarius of Carpi, who died in 1550, has had his name 8 de Hery, Thierry. La methode curatoire de la immortalized in the pages of Benvenuto maladie venerienne, Paris, 1552. Cellini for the great success he achieved 9 Shakespeare. Henry v, 11, i, 78-81. internal use of mercury in syphilis. Baas10 syphilis when but twenty years old. In quotes his vigorous statement, “This poi­ 1519 he published his “De guiaci medicina son, as you call it, has a far different and a et morbo gallico,” in which he narrated his better effect than the wagon-grease with experiences. For nine years he was treated which in the treatment of the French disease with mercury, during which time he thinks you are so fond of smearing your patients, the treatment only served to aggravate the worse than a cobbler greases his leather.” disease. He finally achieved his cure by He rejected all other treatments, such as drinking decoctions of guaiac. decoctions of guaiac, inunctions, fumiga­ Fracastorius in his poem, written in tions, stating “If sweating will expel the 1546, speaks highly of the virtues of French disease, a warm oven, or even a decoctions of guaiac, but relegates it below warm skin and the dog-days, would do it.” mercury. The root of Chinese smilax was Mattioli (1501-1577) mentions, accord­ another remedy which was highly extolled ing to Wootton11 that he had known women in the fifteenth century. Vesalius in 1546 take a pound of quicksilver to produce wrote a treatise on it entitled “ Epistolae de abortion without producing any bad effect, radice Chinae.” It owed its fame largely to and he quotes Falloppio (1523-1562) the fact that the Emperor Charles v used as remarking that in his time shepherds it for his gout, but it seems to have proven gave quicksilver to sheep to kill worms, and as useless in the cure of syphilis as it was Brassavola (1500-1555) as stating that in the case of the Emperor’s gout. Vesalius he had given it to children in doses of thought it inferior in value to guaiac. two to twenty grains for the same purpose. Another root soon supplanted smilax and Sprengel also says that Mattioli gave to a certain extent has maintained some mercury internally in syphilis. reputation as an antisyphilitic, especially According to Wootton the first known among the laity, even to the present day. formula for mercury in pill form was one This was sarsaparilla. Physicians still use which Barbarossa 11, a pirate king of it as a vehicle for the administration of Algiers and an admiral of the Turkish Fleet potassium iodide. under Solyman, Sultan of Turkey, sent to According to Wootton13 a certain Antonio Francis 1 of France, in the second quarter Lecoq, a physician in Paris, acquired a of the sixteenth century. It may be recalled great reputation, about 1540, for the cure that Francis is supposed to have contracted of syphilis with gold. “Fallopius, Hoff­ syphilis from La Belle Ferroniere. This mann and Pitcairn, of Edinburgh, more or formula, very slightly modified, was that of less fully adopted his treatment, but the the famous Befloste’s pills, which came theory gradually dropped out of medical into vogue about 1700 and are still retained practice.” Early in the nineteenth century in the French Codex. Dr. Chrestien of Montpellier, revived it and Next to mercury, the first syphilographers it was tried out in some French hospital with placed their faith in guaiac as a remedy. very disappointing results. It was called “the sacred wood.” Guaiac was The credit for introducing the use of very largely popularized by a treatise potassium iodide in syphilis is ascribed written by a layman, Ulrich von Hutten, a to William Wallace of Dublin, who in his German knight,12 *who was afflicted with “Treatise on the Venereal Disease and its Varieties,” published in 1833, recommended 10 Baas, J. H. History of Medicine, translated by it in advanced cases of the disease. Handerson, New York, 1889. 11 Wootton, A. C. Chronicles of Pharmacy, 1, Wood called Guaiacium that healeth the French 409, London, 1910. pockes, and also helpeth the goute in the feete, the 12 The College of Physicians of Philadelphia stoone, the palsey, Iepree, dropsy, fallynge evyll possesses three interesting copies of the most impor­ and other dyseases,” another edition appeared in tant English translation of von Hutten’s treatise. 1540. In 1730, Daniel Turner, of London, revised Thomas Paynell, a chaplain to Henry vm, pub­ and republished Paynell’s translation. lished in 1536 his translation entitled: “Of the 13 Wootton, A. C. Op. cit.