Art. 7.-SYPHILIS.

1. Conférence Internationale pour la prophylaxie de la syphilis et des maladies vénériennes, 1899. And IIème Conférence Internationale, etc., 1902. Rapports publiés par le Docteur Dubois-Havenith. Five vols. Brussels: Lamertin, 1899-1900 and 1902-1903.

2. Transactions XVIIth International Congress of Medicine. London: Frowde, 1913. Section xiii: 'Dermatology and Syphilography.' London: Frowde & Hodder & Stoughton, 1914.

3. Le mal français à l'Epoque de l'Expédition de Charles VIII en Italie, d'après les documents originaux. By Hesnaut. Paris: Marpon et Flammarion, 1886.

4. Der Ursprung der Syphilis: eine medicinische und kulturgeschichtliche Untersuchung von Dr. med. Iwan Bloch. Two vols. Jena: Fischer, 1901-11.

5. Report on Venereal Diseases. By Dr R. W. Johnstone, with Introduction by the Medical Officer of the Local Government Board. London: Wyman, 1913.

And other works.

THE grave danger to the national health arising from the prevalence of the disease known as syphilis has of late forced itself insistently on the attention of the public. Much discussion upon the subject has taken place in the press; and a Royal Commission has recently been appointed to enquire into it. The stage has produced-privately, it is true-'Les Avariés' of Brieux in English dress under the title of Damaged Goods,' a play which has been well known on the Continent for some years. Ibsen dealt with the same matter in Ghosts,' which was published in England a long time ago, though it was not given on a public stage. 'The Great Scourge and how to end it' has been issued from the woman's suffrage point of view. Moreover, at the International Congress of Medicine last year, the subject of syphilis was prominently discussed and fully reported. In the face of all this, it is important to view the subject in its proper perspective and try to handle it in as calm a way as possible. A matter of such general importance to the community cannot be left entirely to the medical journals, nor to the sociologists and the eugenists alone; it is for the nation at large to inform itself and to judge

what, if any, measures can be taken to control so great a plague. If any success in this direction is to be achieved, it can only be by a reasoned and a national effort; and the first and indispensable condition of this is full and accurate information. This we may hope eventually to obtain from the report of the Royal Commission, but meanwhile it is desirable that the public mind should be prepared and should fully realise the importance of the matter. It is on this account that, from a sense of public duty, we venture to handle the subject, repulsive as it is, in the pages of this Review.

There is no doubt that, although syphilis had been apparently observed in Spain and France for a year or two before the entry of Charles VIII into Naples in February, 1495, the sudden and terrifying explosion of the disease on every hand was the result of this expedition. In May, 1495, after sacking the city, Charles VIII and his army of mercenaries made their way back from Naples to France. The disbanded troops scattered in various directions and spread the disease wherever they went, along the road and in their native towns and villages. When one realises the promiscuity of the sexes, the overcrowding and wretchedness of the dwellings, the convivialities and merry-makings of those days of the quatro- and cinquecentos, it is not surprising that such a disease as syphilis should have become epidemic-nay, apparently pandemic. In this connexion it must not be forgotten that infection results not only from cohabitation, but also accidentally, as for example by kissing or in passing the loving cup. The disease may find its way into the system through various parts of the body.* At the present time, in some of the more primitive areas of Europe, in Russia for instance, house-epidemics of syphilis are not uncommon. On this point a Russian expert states that' By spreading mainly-in over 70 per cent. of the cases-by extragenital infection, syphilis in the rural districts often remains untreated for ten or more years, by reason of purely local conditions.' These accidental infections have been named by some medical writers, syphilis of the innocent

* Pernet, A Lecture on Extra-genital Chancres' ('Clinical Journal,' No. 908. Mar. 23, 1910).

or syphilis insontium-unfortunately, for such a label would imply that the disease in other instances was a syphilis of the guilty, a distinction which is quite outside the purview of medicine.

But to return to the disbanded mercenaries. An examination of city records and the printed works of the early part of the 16th century shows the coincidence of the appearance of the disease with the return of the soldiers from the Italian war. In an old chronicle, 'Sejours de Charles VIII et Loys XII à Lyon sur le Rosne,' the following occurs:

'En ce mesme temps vindrent en France plusieurs des gens du roy, lesquels avoient une manière de maladie que aucuns appelloient la grant gorre, les autres la grosse vérolle, et aucuns la maladie de Naples, à cause que les Français venant de Naples en estoient malades, dont on fut bien esbahy en France, et disoit on que les Lombards avoient este inventeurs de ceste maladie pour se venger des François.'

It should be noted here that there were many prostitutes in Lyons,† and Lyonnaise' was a term frequently used to designate a courtesan. A number of these women followed the army to Italy on the passage of Charles VIII through that city; and no doubt survivors returned to their native haunts, not only in Lyons but in other places, thus disseminating the disease broadcast. In Germany the Emperor Maximilian, whose troops had fought side by side with the Milanese and Venetian army, issued an edict dated from Worms, August 7, 1495, in which the new disease is referred to as novus ille et gravissimus hominum morbus nostris diebus exortus, quem vulgo malum Francicum vocant, post hominum memoriam inauditus.' As to Switzerland, all the chronicles point to the disease as having been introduced by the mercenaries from the Italian war of Charles VIII. In England, Andrew Boorde, in his 'Breviarie of Helthe' (1567), says that in English Morbus Gallicus is named the French pocks; when that I was young they were named the Spanish pocks.' Boorde was born about 1480. It would appear, therefore, that syphilis may have been

* Potton, De la Prostitution, etc., dans la ville de Lyon, 1842,' cited in Bloch's Ursprung der Syphilis,' i, 262 n.

* See Erasmus in his dialogue on Inns (Early 16th Century Account).

brought direct to England by Spaniards a year or two before the siege of Naples. Grünpeck, an early writer on the subject, states that English mercenaries fought in the Italian campaign.

Suffice it to say it appears clear on the evidence that the disease was brought to Europe from the Caribbean Seas by the companions of Christopher Columbus. After the siege of Naples, syphilis not only spread through Europe but also invaded the African boundaries of the Mediterranean, and thence extended to other contiguous portions of that Continent by means of petty wars and slave raids. Asia was apparently infected by foreign navigators-Spaniards, Portuguese, Dutch, English and French, and not the other way about, as has been, and is still maintained by some writers. It has been held that syphilis is as old as the Asiatic civilisations and came from the East, and that the disease was known to the ancient Greeks and Romans. This opinion is losing ground, notwithstanding the efforts of those who have examined the Latin poets, for instance, from that point of view. On trouve ce que l'on cherche,' but the proofs put forward are not convincing. Recent anatomical work on mummies in Egypt has not confirmed the antiquity of syphilis in that region; * nor has the examination of the Ebers Papyrus.† At one time China was looked upon as the cradle of the infection, but here again recent investigation by a Japanese gives no support to that opinion. Indeed the result of this research has been to show that the disease was brought to China and Japan by European, i.e. Portuguese, navigators. More recent navigators, the Spaniards, who sailed their galleons on the Pacific, and Bougainville and Cook among others, infected many of the islands of the South Sea. An English writer of the early 19th century, J. Bacot, went very thoroughly into the question of the antiquity of syphilis, and expressed himself in the following terms: 'Surely I may be allowed to say that, if there is any single

*Armand Ruffer and others: cf. Ruffer, 'On arterial lesions found in Egyptian Mummies (1580 B.C.-526 a.d.).'

Joachim, H., 'Papyros Ebers. Das älteste Buch über Heilkunde,' 1890. Tatsuhiko Okamura, Zur Geschichte der Syphilis in China und Japan.' Monatshefte für prakt. Dermatologie.' Band xxviii, p. 295, 1899.

historical fact that can be said to be proved, it is that of the origin of syphilis being referrible to the latter years of the fifteenth century; for I cannot understand otherwise why, at that precise period, we all at once hear of [the well-known symptoms], followed speedily by excruciating nocturnal pains, by corroding ulcers over the whole body, by affections of the throat and nose, and very frequently by death; when not one word, that can be construed into any similar affection, is to be met with distinctly stated by any writer before that period.' (Medical Gazette,' Vol. II, 1828.)

All one can say is that syphilis appears to have originated in the West Indies, so far as Europe is concerned. There are writers, however, who still maintain a pre-Columbian origin and assert that syphilis prevailed from time immemorial in the East and during the civilisations of Greece and Rome.

At all events, one great fact stands out, viz. that the dreadful disease, which attacked European countries immediately after the Italian war of Charles VIII, was something new. Writers of that period are unanimous on that point. The medical men of the time were taken by surprise by the fell and destructive complaint, which played havoc round them all the more because it was attacking fresh soil. But for other good reasons too, when war and famine were abroad, and typhus, malaria and other maladies were prevalent, the picture of disease must have been very complex. Another factor, in my opinion, was the verminous condition of the people. Vermin and the itch, the latter especially, complicated many cases of syphilis, and must have led to an objective state of things of which medical men of the present day can have but little conception. So dreadful was the sight of some of the victims that here and there the doctors refused to touch the patients. From what one can gather, reading contemporary accounts, the people and authorities were panic-stricken. Few apparently were spared, from kings, princes, dignitaries of the Church, and nobles downwards. Francis I of France and our own Henry VIII apparently did not escape.

A notable contribution to the literature of syphilis is that of Fracastorius of Verona, born in 1483, who wrote a long poem in the usual heroico-epic style of those days. He it is who is responsible for the present name of the