Acta Dermatovenerol Croat 2010;18(4):234-242 HISTORY OF MEDICINE Syphilis and Scherlievo in Dalmatia Franjo Gruber1, Jasna Lipozenčić2 1Retired Professor of Dermatovenereology, Rijeka; 2University Hospital Center Zagreb, Department of Dermatology and Venereology, School of Medicine University of Zagreb, Zagreb, Croatia Corresponding author: SUMMARY The authors describe the emergence of syphilis in Dalmatia, th Professor Franjo Gruber, MD, PhD the coastal part of Croatia, at the very end of the 15 and the beginning of the 16th century, its presence up to the 20th century, making reference Buzetska 2, to the most important physicians that tried to cure the new disease. The HR-51000 Rijeka archives of Dalmatian towns, their statutes, some literary works, travel Croatia writers, physician books, and articles by historians of medicine contain data on syphilis in Dalmatia. Syphilis was first observed in Zadar (1500), [email protected] Trogir (1501) and Dubrovnik (1502). Among the first physicians who treated patients in Dubrovnik were Mariano Santo and Amatus Lusitanus. Received: May 26, 2010 The latter was the first to make prosthesis for the palate defect to cure Accepted: September, 2010 tertiary syphilis lesions. According to the statutes of Dalmatia towns, each had one or more paid physicians and pharmacists. The Ottoman travel writer Evlija Celebi gave an account of syphilis in Dalmatia in the 17th century. At the end of the 18th century and during the 19th century, endemic syphilis known as morbus de Scherlievo and morbus Brenensis appeared in Dalmatia. Because of the numerous cases observed in the region, new hospitals were opened in Dalmatian towns and the patients were hospitalized. Among the physicians who were engaged in the fight against syphilis in the 19th century, mention should be made of Giovanni Battista Cambieri, Nikola Selak and Božo Peričić. They all treated the affected patients and described syphilis and ‘Scherlievo disease’in Croatian as well as in other languages. Syphilis was present in Dalmatia towns during the 15th-20th century, remaining a challenge and arousing the interest of current dermatovenereologists as well as other specialists. KEY WORDS: syphilis, Scherlievo, Dalmatia INTRODUCTION Today’s Dalmatia, rich in natural beauties and of Ragusa (Dubrovnik), Jadera (Zadar), Aspala- history, is part of Croatia on the eastern Adriatic tos (Split), Tragantium (Trogir), and others. In the coast. Among the first inhabitants in antique Dal- Middle Ages, these towns were municipal institu- matia were the Illyrics, then the Greeks, mostly tions, had a communal administration and a well on the islands. The Roman invasion of Dalmatia documented culture, especially in Dubrovnik. After began in the first centuries BC. After a short pres- Charlemagne, the rule was divided between the ence of the Goths, the Slavs settled in Dalmatia Venetian Republic, Byzantium, the Croatian-Hun- in the 7th century AD. At first, they lived in the ru- garian government, and Turkey with permanent ral hinterland, then penetrated the coastal towns changes. During the 15th-18th centuries, the towns 234 Gruber and Lipozenčić Acta Dermatovenerol Croat Syphilis and Scherlievo in Dalmatia 2010;18(4):235-242 gained some autonomy, and Dubrovnik became Fornovo) mentioned that the new disease ‘fatto ha a maritime Republic; the nobility and the wealthy in Dalmacia e Grecia gran spavento’, i.e. caused class riches spoke Latin, Croatian and Italian. great panic in Dalmatia and Greece (9,10). The These circumstances remained unchanged until disease was first noticed in a soldier in Zadar the fall of Venice (1797), the occupation of Dal- (1500), as told by the Venetian chronicler Marino matia by the French and annexation to Austria- Sanuda in his voluminous Diaries from 1496 to Hungary Monarchy (Kingdom of Dalmatia) at the 1533 (11); then in Trogir (1501), Dubrovnik (1502) beginning of the 19th century (1,2). and other parts of Dalmatia (12). During their long and complex history, the people It should be noted that Dubrovnik (Ragusa) in in Dalmatia had been troubled by various diseases, the Middle Ages was already an important mari- especially malaria and bubonic plague (3). The time republic (from 1358 to 1797), with a flourishing subject of this paper is the history of syphilis in Dal- commerce, cultural and scientific influences from matia from the 15th to up to the 20th century, i.e. the the West and East, and with a skilled diplomacy authors attempt to outline the first cases observed (13). This port-city had a consistent fleet, and their along the coast, the course of the disease during vessels (argosy) are mentioned in Shakespeare’s these centuries, the political, economic and social works ‘The Merchant of Venice’and ‘Taming the circumstances during the period, and the achieve- Shrew’(14).The communal statute from 1272 (the ment of the physicians engaged in the cure. statute of Korčula is even older, from1265, and of Syphilis appeared in Europe at the end of the Split from 1240), written in Latin, did not mention 15th century, possibly imported from America by any physicians, but indicated some hygienic mea- the Columbus‘s sailors (there also were two Dal- sures such as to keep clean the streets and toi- matians among the crew), but some authors be- lets in houses (15), while pharmacists had to use lieve to be a myth (4). The disease soon expanded exact balances. Later statutes had additions and to many countries after the French army of Carl improvements. Official scripts from 1302 cite ‘me- VIII, consisting largely of mercenaries of differ- dicus physicus’Ricardus de Cesario, and in 1305 ent nations, had conquered Naples, followed by Peter Marangius, both from the Salernitan medical rape and pillages. The first observed cases were school, who were town physicians (16,17). There among soldiers after the battle of Fornovo (1495), were also surgeons, pharmacists and hospitals described by the Italian military physicians Marcel- (18). The physicians engaged by the town by one- lo Cumano and Alessandro Benedetti (5-7). Some or two-year contracts were well paid but had to physicians thought the disease had appeared per- cure the citizens free of charge. The first pharmacy haps earlier in Barcelona (8), while others consid- in Dubrovnik, and it still exists today, was opened ered it was a punishment sent by God for human in the Franciscan friary in 1317 (19,20), but there sins or due to astrological influences. The disease is a notice that in Trogir there was a pharmacy as seemed to be new and had a severe course, but early as in 1271 (21). This indicates that the sepa- after a few decades its severity waned. The sol- ration of pharmacy from medicine, according to diers, prostitutes, merchants, and seamen spread the Edict of Friedrich II, king of Naples and Sicily the malady called ‘French disease’, while the (1240), was quickly adopted in Dalmatian towns French called it ‘Neapolitan disease’, throughout and this role was included in their Statutes. The Europe, and cases of syphilis were soon reported first hospital of Dubrovnik was Hospitale Mag- in Dalmatia, especially along the coast, while it ap- num (H. Communale) or Domus Christi (House of peared later in other parts of Croatia. Christ) founded in 1347, near the St. Claire nun- nery, firstly for the disabled, the old and poor, and HISTORY OF SYPHILIS IN DALMATIA later it enlarged to become Civic Hospital in 1540; TH UNTIL THE 18 CENTURY here the communal physicians had to visit the pa- Data on the presence of syphilis in Dalmatia at tients twice a day. From 1540, it also had a phar- the very end of the 15th and during the 16th century macy (22,23). can be found in the archives of Dubrovnik, Zadar, In 1377, after the plague of 1348, the Great Split, but also in the works of some literary men, Council of Dubrovnik was the first town in the travel writers, and most of all in the works of the world that issued a decree to introduce a quaran- physicians that treated patients with this disease tine (Lazaret) in Cavtat and on the island of Mrkan in Dalmatian towns. against plague and other diseases, in shanties for In 1496, Giorgio Summaripa, a cultured Ve- people that came from suspected regions by ships ronese poet (known for his verses on the battle of or caravans. Later, the lazarettos were transferred ACTA DERMATOVENEROLOGICA CROATICA 235 Gruber and Lipozenčić Acta Dermatovenerol Croat Syphilis and Scherlievo in Dalmatia 2010;18(4):235-242 to Mljet, Danče, Lokrum, and the greatest in Ploče cured them with plants and mercury. In 1591, Niko- on the eastern border of Dubrovnik (24-26). The la Miloš opened a little hospital ‘Ospedale degli in- oligarchic government of the town was aware that curabili’, as was the use in some Italian towns. the health of the folk was of paramount importance As in other parts of Europe, promiscuity was for flourishing of their prosperity. So, there were not present in Dalmatia towns, as evidenced by the only processions and prayers to the patron saint founding of an orphanage for illegitimate and un- against contagious diseases, but also wise admin- wanted children with ruota (a turntable stone in the istrative and health measures and physicians. orphanage window, where unwed mothers could The presence of syphilis in Dubrovnik at the be- place the unwanted child, ring the bell, and dis- ginning of the 16th century is confirmed by the fact appear) in Dubrovnik in 1432. This institution was that in 1510, the surgeon Antonio Spagnolo (Anto- also called Ospedale della Misericordia (33,34). nius Hyspanicus), looking for work in this town, as Similar orphanages were also opened in Zadar a promotion of his ability said that he could treat (1409), later in Split and other towns, but sadly, the ‘male de Franza’, i.e.