Introduction
The rich history of the Mediterranean region is mainly due to the great and important events that occurred in the area. Such is the importance of the region because of its strategic location in which they cater to the major maritime traffic in the world. This is the main reason why several empires have tried to conquer the region dating back to the Roman Empire to the Ottoman Empire during 1300-1650. It is also because of this, that the areas that surround the Mediterranean Sea have become active in trades and barters with each other. During the 15th century, it was the city-states that played an active role in the economic, political, and cultural activities in the region. Ports and cities such as those in Rome, Florence, Venice, Genoa, Seville, and Lisbon are actively engaged in trading with each other and with other traders in areas like Alexandria, Constantinople, and Tunis. The area is also full of pilgrims and crusaders during the Middle Ages on their way to the Holy Land (The Mediterranean). The region is also a witness of the Renaissance as the major players in the period includes France, Italy, and Spain which surrounds the sea. It marked the development of modern approaches to science and technology.
The “Mediterraneans” or the people that inhabit the region in the Modern Era are united in a common world view. They view their area and themselves as the center of the Earth. The region was witness to the rise and fall of civilizations. The decline of feudal society saw the rise of city-states that are economically independent and are prosperous in the sense that trading and other economic activity are booming. Merchants travel from city to city to sell their wares and products while the residents get the feel of the product from other city-states. This also encouraged the citizens into traveling. The revitalized interests in cultures have promoted studies that focus on art and science. With the advent of printing, ideas were easily distributed. As the Mediterranean prepares for the expanding Ottoman Empire and the possible Muslim, traders and mariners looked for safer routes to the riches of the East.
The development that was felt in the area was also accompanied by consequences. War and conflict arise periodically because of differences in religion and culture. The region, being a transit point, is also vulnerable to diseases that are brought upon by travelers from other parts of the world. The spread of disease that is sexually transmitted also poses a problem because of the emergence of brothels and the proliferation of prostitution in the area. Even though prostitution declined in the 16th century in Europe, mainly as a result of strict condemnation of both the Protestants and the Catholics. Aside from considering it immoral, it was also suspected that there is a relationship between prostitution and the outbreak of syphilis, a venereal disease (James, 2006).
Syphilis
The origin of syphilis has two main theories; the New World or Columbian theory and the Old World or pre-Columbian theory. According to the New World theory, Columbus was the one who brought the disease to Europe during the 1400s. It was believed that he acquired it in Haiti where it was thought to be prevalent. On the other hand, the pre-Columbian theory suggests that syphilis originally came from Central Africa and was brought to Europe before the arrival of Columbus. But another theory, the Unitarian theory, suggests that syphilis and the non-venereal treponematoses were all symptoms of the same infection, the differences are mainly due to several factors such as environment and temperature. There is also an indication that syphilis was already in Europe before the Middle Ages, but it was first observed and considered to be an epidemic in 1495. But it is also said that it was acquired by the French invaders from mercenaries who also acquired it from Columbus. The spread of the disease in Europe marked a time in which the disease fell on virgin soil. This is the reason why it was considered a plague in that period. The widespread epidemic of syphilis spread throughout Europe in 1495 and was observed in India in 1498 and China in 1505. The disease was also referred to as the Great Pox, Venereal Disease, and French Disease but syphilis was commonly used. The term syphilis was believed to be first used by Hieronymus Fracastorius in his poem Syphilis Sive Morbus Gallicus in 1530 which means “Syphilis or the French Disease” (Singh & Romanowski, 1999).
The Columbian theory was challenged by giving out instances and evidences that show that it was not Columbus that brought the disease to the country but rather it was already endemic in the region. The following shows the points given by Rosemary (1992).
It was though that Syphilis appeared already in an epidemic proportion. Considering the words of Fracastor, a poet at that time, “a far more virulent, acute, and fatal condition than it is now.” The idea of the epidemic is used first by Ruy Dias da Isla, a doctor who probably saw a lot of syphilis around Columbus’ time. But the description he had given about the disease turned out to be typhus typhoid syndrome.
Syphilis was documented to first appear in 1495. But the date has questions and issues it must clear. It was in 1495, where the disease was associated with Charles VII of France when his army is still in Italy when they left France in 1494, where Emperor Maximilian issued the following summer when Emperor Maximilian issued a decree about the disease. The decree called the new disease with evil pocks. In the first quarter of 1493, it was when Columbus was returning home from his first voyage where a decree against the disease was issued in Paris. It was also considered that the disease began in Naples around this time and it was then linked to the arrival of Jewish refugees from Spain. The Jews are leaving Spain after a law of expulsion was promulgated in the early parts of 1942. All of this shows that the disease which they considered “first appeared in 1495” was not really syphilis.
It was also said that the French army got the disease from the mercenaries who in turn got the disease from Columbus’ sailors. It was considered that the mercenaries got the disease after Columbus’ second voyage rather than the first. But it there would be no possibility for his crew to infect the army or the mercenaries because the date of the return voyage was June 11, 1496. The infection would be in the first voyage, but the accounts of the travel showed no illness among the crew who sailed from Lisbon in 1493. It was said that the crew was healthy but exhausted. It was also considered that if they have the lesion, which is the primary symptom of the disease, they would be quarantined in observance of the strict vigilance on diseases after the devastation of the Black Death a century earlier (Rosebury, 1992).
The virulence of the so-called “Great Pox” was also challenged. This also insinuates the notion that the disease is somewhat different from what we know today or being entirely different from what they have faced before. This opened the doors of the inaccuracy of the diagnosis and the earlier beliefs toward the disease. Considering the New World Theory is correct, it is possible that the host population has developed a certain degree of adaptation to the virus. The decline in the virulence of the virus was observed after six years after the onset of the epidemic. This is considered a very short time for the human population to develop body defenses against the disease. Virulence is considered an adaptive entity that is influenced by the selection that gives the agent appropriate changes for its survival (Knell, 2003). Syphilis appeared in Europe at the end of the 15th century and caused some irreversible effects on society. The discrimination felt by the patients and also the severe symptoms they experienced. But in a matter of years, the severity of the symptoms somewhat declined. The way it happened is too short for any natural body changes that can reduce the effects of the disease. This shows that it is not the host population that changed but the disease. The symptoms that appear at the onset of the epidemic can be credited to the notion that the host population has never encountered such a disease and that their body’s natural defenses are not yet adaptive to counter the effects done by the disease. Also the “survival of the fittest” is also applicable to the viruses in which those less virulent are the ones that have higher survival rates because of their higher transmission rates compared to those with higher virulence (Knell, 2003).
It was at the end of the sixteenth century where the spread of syphilis has blown into epidemic proportions. Hospitals were not able to accommodate patients that require treatment. The widespread occurrences of the disease made some people think of an imminent apocalypse. This is according to Clowes 1 (Milburn, 2004) “It is wonderful to consider the huge multitudes of such as be infected with it, and that daily increase, to the great danger of the commonwealth, & the stain of the whole nation.” The syphilis epidemic, which “increaseth yet daily, spreading itself throughout all Englander, and overflowed (as I think) the whole world,” The rapid spread of the disease in Europe was also attributed to the many conflicts that happened in the regions. Raids that result in slavery and prostitution are one, the army personnel that always travel around the region are also considered among the factors that help spread the disease. The difficulty of determining that a person is afflicted with the disease without the body characteristics is also another factor. In the past, the difficulty in diagnosing the disease is because of the limitation of the medical personnel on the knowledge of the disease and the lack of equipment that helps in early determination. Waiting for the obvious symptoms to appear which is three to six weeks from actual infection is a major factor in which the infected person is not aware that he or she is a carrier and can help prevent the spread of the disease. The stigma that accompanies the disease is also a factor in the sense that the affected person will not come out and seek help. They would rather hide the disease from society until it will become very obvious. The lack of control over the sexual activity and the absence of information on the disease can also be attributed to the spread of the disease. The lack of knowledge on virulence and the methods in which it can be transferred are among the factors considered for its spread.
The movement of armies and the general excitement that is manifested by the Renaissance also causes the spread of syphilis. But the disease may have been confused with other diseases that appear to have the same symptoms. But even the poet Fracastor speaks of the transmission of the disease in an abstract manner. Also plays by Shakespeare do not show where the disease started or how it was acquired (Rosebury, 1992).
The primary stage of the disease is characterized by a small gash, which is called a chancre that appears at the site of infection three to six weeks after exposure, the fluid from the chancre extremely infectious. It is a single or sometimes sore-like outgrowth that is painless. After six weeks, the second stage begins wherein a generalized rash appears, painless ulcers develop in the mouth and wart-like gashes appear in the genital area which is also highly infectious. It is accompanied by headache, fever, loss of appetite, and enlarged lymph glands. This is where the disease can cause liver or kidney problems. The symptoms usually disappear in 3 to 12. Late Syphilis is considered the least infectious but the most destructive. It attacks any tissue or organ of the body that includes the brain, heart, internal organs, and eyes. The internal damage is not immediately noticed because symptoms show up only after years of infection. The symptoms include loss of muscle control, poor vision, numbness, and dementia. The damage could be serious enough to cause death.
This is the actual account of Ulrich von Hutten (Knell, 2003) himself also a sufferer. “…truly when it first began, it was so horrible to behold that one would scarce think the Disease that now reigneth to be of the same kind. They had Boils that stood out like Acorns, from whence issued such filthy stinking Matter, that whosoever came within the Scent, believed himself infected. The Colour of these was of a dark Green and the very Aspect as shocking as the pain itself, which yet was as if the Sick had laid upon a fire. (Von Hutten (1519), translation from Major (1945), p. 31. taken from Knell, 2003).
The sufferers of this disease face public humiliation because of the visible symptoms it shows. The lesions that are easily seen in the body of an infected person can deter other people from mingling with them. Even health workers those days despise persons with such diseases. For instance, in 1972, Flora Price asked for assistance from local church workers that act as charitable support for patients. She said that she has “pox” which was the term used at that time for both gonorrhea and syphilis. Instead of being admitted to a hospital, she was rather sent to an institution that caters to bum. She received mercury treatment for her “pox” which was the primary medicine for these kinds of diseases at that time. She had seen that her male companions are in a much more comfortable situation since they have a bed for themselves aside from being treated with mercury. It was the female patients that have these diseases that are suffering from maltreatment and discrimination from church workers. But still, only the rich and wealthy patients have access to clandestine treatment with minimal or no instances where they are publicly humiliated (McGough, 2005).
This shows the stigma suffered by those affected by such diseases. Both syphilis and gonorrhea are considered curable during the late 16th century. But still, the stigma of the patients exists and humiliation was still practiced in many ways. Just like the case of Flora Price shows that the health care and social welfare services can also add to the stigma of discrimination between wealthy and poor patients. This can be seen in the different standards of treatment, comfort, and security that are offered to patients. It is because wealthy patients have the resources to successfully shield their disease from the scrutinizing public and on the other hand, the poor are dependent on public resources which they have to share with everyone and on charitable institutions like the church that also possess the accusing eyes that add up to the stigma. This then supports the notion that disease is closely associated with being poor. This cycle continues since poverty is believed to make people the easy target of diseases. The stigma is rooted in this social cycle of power, wealth, inequality, and poverty (McGough, 2005).
The stigma is also continued in the treatment stage wherein the health workers and physicians consider morality as the reason why such treatment is not successful wherein the real reason is that during that time, the therapy was not that effective or the real cause of the disease is not fully known. This shows that the stigma is also one reason why advancement in the area of medicine is slow. Such acts will render the patient guilty and sulk into isolation because of shame and feeling of rejection from society. They consider themselves “outcasts” living in a different world because of such limited notions on the disease. Since they consider the patients liable for their treatment failure, the public and the physicians themselves consider that they have already done what has to be done.
But in the 17th and 18th centuries, significant changes were experienced. This was the time when the cure for “pox” was discovered. Businesses for pharmacists and traders that sell cures for the “pox” opened and flourished. But still, discrimination exists; it was the notion that such cures were not effective for prostitutes. Stigma also persists in this time and is expanding to the broader section of society because it is connected to a group vulnerability. The disease is also used as a metaphor by those in the arts, just as Fracastorious used in his poem.
Another instance, in 15th and 16th century Venice, the epidemic was coined as the “French disease” which is named after the French army that invaded the area. The reaction to the name-calling was just the same as what Flora Rice felt, loss of morale among soldiers then consequently loss of power. It then became the weakness of the military and subsequently firming up the stigma that is known for it. The physicians themselves are helpless in changing the stigma that associates diseases with a particular discriminated group or race.
Physicians, as human beings can help slow the stigma but on the contrary, they are the ones leading the violation of such. They are the ones who start pressuring the patients into believing that there is no hope for them and that it is their fault why treatment therapies did not work. They must also be aware that stigma will still increase every time they associate the disease with social, cultural, and moral disorders. This further increases the stigma. Aside from the physicians, the health care system itself is also to blame when there is a significant difference in the way one health worker treats a wealthy and rich patient to the way he also does services to the poor and common folk. The stigma is not easily removed by the introduction of new therapies (McGough, 2005).
Another problem that was faced by the patients is misdiagnosis. Sometimes leprosy, gonorrhea, and other diseases with the same symptoms are considered syphilis. The lack of appropriate diagnostic methods during those times also leads to considerable error in the statistical data during those times. Misinterpretation of the symptoms is also common among inexperienced physicians and medical workers.
Before the sixteenth century ended syphilis became an epidemic and the medical practitioners tried many ways of curing or may be preventing it from spreading to the individuals and the community as well. The treatment was tried in so many methods. One method of curing it, which the populace believed will stop the spread of syphilis, is by bloodletting, lancing, and cauterizing. This may sound weird but during the sixteenth century, this is one way of doing it. The part infected is cut, opened, and let the blood flow so that infection will be removed. After the infected area was opened it is then cauterized using fire to kill the disease. This has created astonishment to the community and to the patient as well because of the immense quantity of blood discharged from the patient’s body. They argued that it is like killing the person itself. But the venereal warrior, these are the medical practitioners during the sixteenth century until the 18th century, concluded that this is the only way to kill the monster infection. These violent and painful ways of treatment also deter patients from seeking a cure. They would rather hide the disease rather than seek treatment and suffer the pain and humiliation from being tagged as carriers of the “pox”.
But as the years passed this was not the only cure the medical practitioners have. They tried the second treatment where it was called resolution and desiccation. One way of doing it during the sixteenth century was wrapping the patient with sackcloth and letting them bake in the dry oven for quite a while to let the pores come out and attain heavy sweating. The patients were covered with clothes and let the heat stand for quite some time, turning the patient’s body from time to time to his side until it is spread all over the body of the patient. After doing so, frequent salt baths and dehydration through regulation of diet were done to stop the disease from spreading throughout the body. Although this can a cure to a patient this can also be tormenting in some ways. This is argued again by medical practitioners because they said there should be pain felt in curing such painful disease. Writers during that time were pleased with how the disease was treated. Through this, there will be a decrease in the number of whores and sinful acts in the community and the thought of spreading it throughout the community.
The argument went on until they introduced another way of preventing and curing it. Mercury was seen as an effective remedy for curing the disease. It was described as a “miraculous substance” that can cure and stop its spread. A mercury-based ointment is applied to the skin infected. This ointment will make the infected area absorb the ointment and thus helping to kill the infected area. The ointment let stand onto the body for several days until there are sweating occurrences. During the sweating, the pores will open up and will absorb the mercury and this will kill the infections. On the contrary, there were also downsides to using this kind of ointment. Several patients have tried it and they have the same observations after using the ointment all over the infected area of their body. Effects such as gum bleeding, falling of teeth, and occurrence of ulcers and eventually eat up their bodies before the ointment or medicine takes effect to the disease itself. It became a debate over the patients, the patient’s family, and the medical practitioners whether to continue the use of the mercury-based ointment. The argument of the medical practitioners “if we want to kill the disease itself we should use the strongest and powerful medicine even if killing the infected.” The mercury then was the strongest weapon of the medical practitioners until they tried to research and find out how it should be treated in an easy and convenient way to benefit the patients not only the disease itself. (Milburn, 2006). In those times, they are not aware of the toxicity of mercury. Continuous application of mercury to a patient will induce chronic heavy metal toxicity. This lack of knowledge on mercury also paved way for negative notions on the efficacy of the treatment. The medical workers then will conclude that if a patient dies, it is because of the disease rather than investigating whether it is because of the heavy metal that was used as an antidote. These methods are sought upon by the patients with the disease but the medical personnel and the physician themselves are also doubtful of the efficiency of these methods. If the person they treat is not giving positive signs, they would conclude that this patient is not keen on healing and thus needs spiritual intervention. They consider those not well after treatment as those with low moral values and are sinful enough that medicines are not capable of cleaning them. This notion adds to the stigma already connected to the disease itself.
One convenient way of doing it was the discovery of the miracle tree which they called the Guaiacum wood. The extracts prepared were mixed with the patient’s drink and they assured that this will not bring harmful effects such as Mercury. This has wonderful effects on the patient.
The disease syphilis has come a long way. Though its exact origin is still debatable, the fact that it has been part of history has helped the human population in a way. The stigma that accompanies the diseases has created an important sense of equality among patients. It also changed the way physicians treat patients with diseases of the same nature, which is without the discrimination that the patients in the past have felt. The uneasiness and the shame that the people felt when affected have changed today because of the advances in science and medicine that were initiated by the onset of epidemics such as syphilis.
Several hospitals that were managed by the Orders in Malta were also helpful in delivering medical services to those affected with the “pox”. These hospitals that were operated and managed by Orders have Jewish doctors and surgeons that help with the medical services to the Maltese. Even though the hospital can only accommodate a couple of patients, this shows that not all medical facilities at that time discriminate against those persons afflicted with the “pox” but still considerations have to be made since religious leaders think that those with the disease are with little faith.
The rise of venereal disease at that time is also due to the rampant abuses and rape that occur to women in the region. But according to researchers, it is also the women that are charged with offenses like concubinage, sexual immorality, and the likes. These behaviors are considered punishable offenses in which these poor women take the damage in addition to the notion that they are the major carriers of the pox.
It was considered a plague in those times was because of the rapid spread of the disease throughout Europe. It was the pattern by which it happened that just like the real plague, it developed fear and discrimination in the society at that time. It was not until the late 17th century until the early 18th century that the fear subsided because of the cures that were invention and formulated.
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Taken from Knell, 2003 “William Clowes, A Brief and Necessary Treatise, Touching the Cure of the Disease Called Morbus Gallicus, or Lues Venerea, by Vntions and Other Approoued Wales of Curing (London, 1585), fol. lv. Clowes had made the same claim six years earlier in the first edition, A Short and Profitable Treatise Touching the Cure of the Disease Called Morbus Gallicus by Unctions (London, 1579). All further references to Clowes are to the corrected and revised text of 1585.”
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