Fracastoro - On Contagion

8/13/2019 Fracastoro - On Contagion

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F R O M P H O T O G R P H O F T H E B R O N Z EM E O L L I O N B Y C V I N O IN T H E M U S E OC I V I C O , P A O U A .

HISTORY OF MEDICINE SERIESISSUED UNDER THE AUSPICES OF THE

LIBRARY OF THE NEW YORK ACADEMY OF MEDICINENo. II

HIERONYMIR C STO RI I

DE CONTAGIONE ET CONTAGIOSIS MORBISET EORUM CURATIONE, LIBRI III

TRANSLATION AND NOTESBY

WILMER CAVE WRIGHT PHD.PROFESSOR OF GREEK IN BRYN MAWR COLLEGE

NEW YORK LONDONG P PUTNAM S SONS

OJ h e ~ u i : d t : e ~ : d , n nSJI1930


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CAPUT XIDE SypmLIDE MORBO, SEU GALLICO

Nunc ad eas contagiones pertranseamus, quae extrinsecamagis tentant, incipientes a Syphilide morbo: quippe novumet diu nostro orbe incognitum morbum inter alia admirandanostra tempestas vidit, qui Europam fere omnem, Asiae vero,atque Africae partem non parvam occupavit: in Itallam verofere iis temporibus erupit, quibus Galli sub rege Carolo regnumNeapolitanum occupavere, annos circiter decem ante 1500 aquibus nomen morbo inditum fuit, Gallicus appellatus: ~ l l ivero nominis injuriam in nos retorquentes morbum Italumvocant, Hispani Patursam, Germani nunc Mevium nunc GaIli-cum dicunt, nonnulli novo imposito nomine Pudendagram appel-lavere, quod a pudendis inciperet, sicuti et Mentagram, quoda mento inciperet, novum morbum apud antiquos appellatumfuisse Plinius est autor : nos Syphilidem in nostris lusibus appella-vimus.Hunc autem morbum nostro orbi adeo novum, familiarissi-

~ u tamen certis regionibus ferunt, qui per Hispanas naviga-tlOnes novum mundum comperere; ubi vel plurimum abundetea contagio, non secus illic domestica, ac apud nos scabies. Prin-cipio igitur, quum is apud nos apparuisset, hae fere notae con-spiciebantur in eo morbo: oriebatur in quibusdam sine ulla abalio concepta contagione, in quibusdam quae maxima parserat) e contage excipiebatur, verum non ex omni contactu,neque prompte, sed tum solum, quum duo corpora contactumutuo plurimum incaluissent, quod praecipue in coUu even-iebat, quo maxima mortalium pars infecta fuit; visi tamen

I Meunier, wrongly Partusam134

I

I.

CHAPTER XISYPHILIS OR THE FRENCH SICKNESS37

Now I will pass on to those contagions which attack ratherthe exterior of the body, and I begin with the disease calledsyphilis. This is a new disease, long unknown on our continent,but it has appeared in our time among other marvellous phe-nomena, and has invaded almost all Europe and no small partof Asia and Africa. In Italy it broke out about the time whenthe French under King Charles took possession of the king-dom of Naples about ten years before 1500 and from them itwas called the French Sickness. The French retort the scandalof the name againstus by calling it the Italian Sickness, whilethe Spanish call it Patursa, and the Germans sometimes call itthe Sickness of Maevius,38 sometime French Sickness. Somehave invented a new word for it and call it Pudendagra, be-cause it begins with the pudenda, on the analogy of Mentagra,39which begins at the chin and was so called as a new diseaseamong the ancients, according to Pliny. In my poem I havecalled this disease Syphilis.4This malady, though quite new to our part of the world, issaid to be very familiar in certain countries, according to theaccounts of those who have become acquainted with the NewWorld through the voyages of the Spaniards. For there, theysay, this contagion is widepsread and very common in fact itis as much at home there as scabies is with us. When it firstappeared in our country, the following signs were observed inthis disease. In certain individuals it would arise without anycontagion having been contracted from another person; in othercases, and these were the majority, it was contracted by con-tagion, but not from every kind of contact, nor readily, butonly when two bodies in close contact with one another becameextremely heated. Now this happened in sexual intercourseespecially, and it was by this means that the great majority ofpersons were infected. However, some cases were observed of

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136 DE CONTAGIOSIS MORBISinfantes nonnulli fuere, qui e suctu lactis a matre, aut nutriceinfecta consimiliter affecti sint. Fomitem autem non relinquebatea contagio, aut non nisi maxima quadam occasione, neque addistans etiam sese propagabat: sed neque statim manifestabatur,verum certo tempore delitescebat, interdum quidem per mensem, interdum per duos, saepe et per quatuor menses. Interea tamen signa nonnulla aderant conceptae labis, animum tris-. titi a quaedam detinebat, corpus lassitudo, pallor faciem; tandem,quod in majori parte inerat, ulcuscula quaedam circa pudendaoriebantur, iis non dissimilia, quae solent ex fatigatione contingere, quam cariem vocant, sed natura longe impar nam haec etemori contumax erat, et victa una parte alia regerminabatimmortali propagine: post haec, crustosae quaedam pustulae percutem erumpebant, in quibusdam quidem a calvaria incipientes(quod ut plurimum erat) in quibusdam in aliis locis : parvae primum eae apparebant, mox augebantur paulatim ad magnitudinem cooperculi glandis, et similitudinem etiam, iis non absimiles, quae in pueris Achores vocantur: differentiae earummultae visebantur, quibusdam parvae, et sicciores, quibusdammajores, et pinguiores, nonnullis lividae, allis e::talbidae leviterpallentes, allis duriores, et subrubentes: omnes autem paucispost diebus aperiebantur, ac mucore quodam mucilaginea foe-tido manabant, nec dici potest, quantus ille mucor perpetuoeffiueret, quanta sordities: exulceratae deinde exedebant moreeorum ulcerum, quae phagedenica appellantur, atque interdumnon solas carnes, sed et ossa etiam ipsa inficiebant. Quibusautem circa superiora vigebat malum, iis distillationes pravaecontingebant, quae modo palatum, modo gargareonem, modofauces et tonsillas erodebant: labia quibusdam consumptasunt, quibusdam nasus, quibusdam oculi, allis pudenda tota.Ad haec autem magna ex parte gummositates quaedam permembra concrescebant magna deformitate, nam saepe ovi,saepe panis magnitudinem aequabant, quibus apertis mucor suberat albus, mucilagineus: tenax is callus maxime in brachiis

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ook SYPHILIS 137infants who, by sucking milk from a mother or nurse who wasinfected, were themselves infected in a precisely similar way.This contagion did not leave fomes behind, or only when someespecially favorable opportunity occurred, nor did it propagateitself to a distant object. t did not manifest itself at once,but remained latent for a certain time, sometimes for a month,sometimes for two months, and often even for four months.But meanwhile there were some indications that the disorderhad been contracted. The patient s mind was dominated bya sort of sadness, his body by lassitude, and his face becamepale. At last, in the majority of cases, small ulcers began toappear on the sexual organs, not unlike those which arise fromover-fatigue and are called caries ,41 but in their nature theyare very different; for the kind that appears in syphilis was intractable and would not depart, but when subdued in one partof the body, it would germinate in another place and propagateitself so that it never died out. Next, the skin broke out withincrusted pustules, in some cases beginning with the scalp,which was what usually happened, though in other cases theybegan elsewhere. When they first appeared, the pustules weresmall, but they soon grew little by little till they were the sizeof the cup of an acorn; which in fact they resembled; they werenot unlike those eruptions which in children are called achores .Many very different varieties of these were observed. Onsome patients they were small and rather dry, on others largerand fatter; again, on some they were livid, on others whitish,turning pale, or in other cases harder and reddish. ut all,after a few days, opened of themselves and discharged a sortof sticky, offensive mucus, and it would be hard to say how muchmucus or how foul was continually discharged. Next, theseulcerated pustules ate away the skin, as do those ulcers whichare called phagedenic; and they sometimes infected not onlythe fleshy parts but even the very bones as well. In caseswhere the malady was firmly established in the upper parts ofthe body the patients suffered from pernicious c.atarrh whicheroded the palate or the uvula, or the pharynx and tonsils. Insome cases the lips or nose or eyes were eaten away, or in othersthe whole of the sexual organs. Moreover, many patientssuffered from the great deformity of gummata which developedon the members; these were often as large as an egg or a roll ofbread, and when opened contained a white, sticky mucus.


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138 DE CONTAGIOSIS MORBISet cruribus accidebat, qui interdum ulcerabatur, interdum inte-ger usque ad mortem perseverabat.Praeter praedicta omnia quasi parva ilIa forent, ingentes lacer-torum dolores accedebant, saepe cum ipsis pustulis, interdumante, nonnunquam post, et ipsi quidem diuturni, quibus nihilcrudelius aderat, affligebant praecipue noctu, dolor autem nonproprie in juncturis inerat, sed circa lacertos ipsos et nervos.Verum quibusdam nihilominus sine dolore ullo oriebantur pus-tulae, quibusdam sine pustulis dolores, major pars utrisqueaffligebatur. Interea languebant membra omnia, macies corpusdetinebat, nullum aderat desiderium cibi, nullus somnus, sedmoeror, et iracundia assidua, et amor decubitus, facies et cruraturgebant: quando que et febricula quaedam concomitabatur,sed raro; dolebat quibusdam caput, dolor is erat diuturnus, etnullis medicaminibus parens: sanguis, si hauriebatur, insincerus,mucosusque spectabatur: urina crassior, pinguis, divulsa, etsubrubens, quo ~ o o signo, quum non adesset febris, muItospraenovimus eo teneri morbo; egestiones aegre reddebantur,et ilIae mucosae, siccae: his ergo notis tenebantur, qui tum eomorbo laborabant.Loquimur autem de his quasi de praeteritis, quoniam, tametsinunc quoque ea contagio viget, post tamen ilIa prima temporaimmutata videtur: abinde enim annis fere viginti coeperuntpauciores videri pustulae, gummositates vero plures, quum econtrario primis annis fuisset, factae item fuere pustulae (siquae apparebant) siccibres, ac dolores (si qui accedebant) cuivis Isunt acerbiores. Porro et annis labentibus, annis jam fere sexin quibus nunc sumus, magna rursus mutatio facta est ejus morbi:quippe quum in valde paucis pustulae jam visantur, et doloresfere nulli, aut multo leviores, gummositates vero multae etquod mirum omnibus visum est, capilIorum, et reliquorum pilo-rum casus homines fere ridiculos facit, aliis sine barba, allis sine

xFirst ed. cuis (sic), ed. of 1555 cuivis 1550, 1554 cuius Meu-nier, eujus (sic).

Book SYPHILIS 139This obstinate callosity appeared especially on the arms andlegs; sometimes it became ulcerated, sometimes persisted with-out change until the patient s death.Besides all the above symptoms, as though they were not badenough, violent pains attacked the muscles, often at the sametime as the pustules, sometimes before them, and occasionallyfollowing them. These pains were persistent, tormented thesufferer chiefly at night, and were the most cruel of all thesymptoms. The pain was not precisely in the joints but inthe muscles themselves and the sinewsY ut some felt nopain at all on the appearance of the pustules, others had thepains without the pustules, though the majority suffered fromboth symptoms. Meanwhile there was lassitude of all theorgans; the body became emaciated, and there was no desirefor food, no sleep, but great depression, constant irritability;the patient longed to lie on his back; the face and legs becameswollen. Sometimes these symptoms were accompanied byslight, fever, but rarely; some had headache, and then the painwas persistent and would yield to no remedies. When bloodwas let, it was seen to be impure and to contain mucus; theurine was rather thick, oily, troubled (sedimentary) and reddish,and from these indications of the urine alone, even when therewas no fever, we knew beforehand, in inany cases that patientshad contracted this disease. The voidings were painful anddifficult, mucous and dry. 43 These, then, were the symptoms inthose who were at that time afflicted by this malady.I use the past tense in describing these symptoms, because,though the contagion is still flourishing today, it seems to havechanged its character since those earliest periods of its appear-ance. I mean that, within the last twenty years or so fewerpustules began to appear, but more gummata, whereas thecontrary had been the case in the earlier years. Moreover,whenever the pustules did appear, they were drier, and the ac-companying pains if any) were, in every case more acute.Moreover, in the course of time, within about the last six yearsof the present generation, another great change in this diseasehas taken place. I mean that pustules are now observed invery few cases, and hardly any pains, or much less severe, butmany gummata. Also to the general amazement, the hairfalls out from the head and the other hairy parts to such an ex-tent that it makes men look ridiculous; for some go about in


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14 DE CONTAGlOSlS MORBlSsuperciliis, aliis glabro capite in conspectum venientibus, quodinfortunium prius putabatur ex medicaminibus evenire, praeser-tim ex argento vivo, mox certiores facti omnes sciunt ex ipsomorbo immutato procedere, quinimo et (quod pejus est) jamnunc multis videntur labefactari dentes, quibusdam etiam cadere.

ook SYPHILIS 141public without a beard, some without eyebrows, others withheads totally bald. This mishap was at first supposed to bedue to medicines, especially to quicksilver. ut later, withgreater knowledge, all are now aware that it is the result of achange in the form of the disease; moreover, and this is stillmore serious, it is observed that the teeth in many cases nowbecome loose, or in some cases even fall out.


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CAPUT XIIDE C USIS

Igitur, quum primum tam novus apparuisset morbus, magnastatim inter medicos oborta controversia fuit, allis contendentibus nullam ab antiquis factam de eo mentionem fuisse, aliiscontra fuisse factam, his quidem Elephantiam existimantibus,illis vocatum ab Arabibus Safati, aliis Lichenas. Primus Nicolaus Leonicenus, v r doctissimus et gravis eam difficultatemsustulit, aperte monstrans nullum horum esse sed prorsus apudantiquos innominatum fuisse morbum: quanquam posterioresquidam obstinate quidem magis, quam rationabiliter, tanto vironon plane assensere, Elephantiasim omnino asserentes esse: dequo mox pauca quaedam et nos dicemus. Caeterum quicunquehactenus de eo morbo scripsere, alii quidem, quid non esset,magis dixisse videntur, quam quid esset: alii eam rationemquaesivisse magis, quae circa formam versatur, quod essetaegritudo partim in compositione, partim in complexione, etunitate, et id genus; materiam vero, et principia, quae magisfuerant perquirenda, reliquere: alii materiam quidem attigere,principia vero, et rationem eam, quae e contagione dependet,non, ut par erat, sunt prosecuti. Nos vero in iis lusibus, quosad Petrum Bembum nunc Cardinalem scripsimus, quo fortetempore a pestilentia rus pulsi multum otii nacti essemus, dehis omnibus quaedam certe attigimus, verum quantum Poeticaconcedere potuit: quae quum non admittat omnia, multa quidem praetermitti a nobis necesse fuit pro toto negotio, quae sinunc prosequamur, operae pretium facturos esse nos existimamus.

Quod igitur ad primam morbi originem attinet, arbitratisunt aliqui contagionem hanc e novo illo mundo delatam ad

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CH PTER XTHE CAUSES OF SYPHILIS

Now, on the first appearance of so novel a disease, a violentcontroversy at once arose among doctors; some contending thatno mention of it had been made by the ancients, others that ithad been mentioned, and some said that it had been calledelephantia, others that it was what the Arabians called Safati 44;while others said it had been called lichen . Niccolo Leoniceno 45 a man of the greatest learning and authority, was thefirst to clear up this difficulty by demonstrating with certaintythat syphilis was not anyone of the above diseases, but was adisease never named by the ancients. Nevertheless, certainlater authorities, more from obstinacy than correct reasoning,entirely disagreed with that great man, and continued to assert thaF it was actually elephantiasis; on this subject I shallhave something to say later on.For the rest, those who haye written on this malady, hitherto,have in some cases preferred to say what it was not, rather thanwhat it was; while others have sought to explain it theoretically,dealing with its form, and saying what sort of malady it was asit occurs in composition, in combination or alone, and questionsof that sort. But they left out of account its substance andprinciples, though these should rather have been thoroughly n-vestigated. Other writers did discuss its substance, but didnot, as they should have done, investigate its principles, or howwhy and when it depends on contagion. As for myself, in thepoem which I dedicated to Pietro Bembo, now Cardinal,46at a time when I was driven by the plague47 into the countryand had abundant leisure, I did, indeed, touch on all these questions, but only so far as the poetic form allowed. But sinceverse does not admit of exhaustive treatment of a subject, Iwas obliged to pass over many points in regard to the wholesubject, and i I now proceed to deal with these, I think it willprove worth while.In regard to the original source of the disease, some have be-

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144 DE CONTAGIOSIS MORBISnos fuisse, quem Hispanae navigationes adinvenere, ubi ealabes plurimum viget, cujus sigilum id afferunt, quod tum etmorbus hic apud nos primum apparuit, quum et navigatioilia facta fuit, et commercia habita illius gentis propter quodet primum apud Hispanos visus fuit: quare totam labem hancoonsistere putant in contagione unius ad alium. Sed profecto,tametsi maxima mortalium pars e contagione morbum hunccontraxit, observatum est tamen innumeros alios sine ulla con-tagione per se infectionem eam perpessos fuisse: impossibilepraeterea fuisset tam parvo tempore contagionem, quae perse segnis est, nec concipitur facile, tantum terrarum peragrasseab una c1asse ad Hispanos primum delatam, quando constataut eodem tempore, aut fere eodem et in Hispania, et Gallia,et Italia, et Germania, et tota fere Scythia visam fuisse. Addequod praedixisse iliam astronomos certis ante annis non parvumindicium est aliud subesse ll principium, quam simplicemcontagionem. Primum igitur iliud mirum videri non debetnovos atque insolitos morbos certis temporibus apparere, nonquidem delatos ab una regione ad aliam, sed suis causis exor-tos: anno 1482 pleuretidis genus quoddam erupit, quod totamfere Italiam affecit: nostris vero temporibus iliae prius nonvisae in Italia febres apparuere,quas lenticulas vocant, de qui-bus supra egimus: vidimus et annis superioribus lippitudinemcontagiosam quasdam civitates invasisse: vidimus et pestemiliam solis bobus communem, de qua supra meminimus: quamob rem nec mirum esse debet, si et Gallicus morbus non priuscognitus in nostro orbe per multa secula, nunc pr imum eruperit:venient et aegritudines aliae novae inusitataeque, quum tempusferet, sicuti et Mentagra apud antiquos, quae postea ampliusnunquam visa est: hic idem morbus interibit, et extinguetur,mox etiam et nepotibus nostris rursus videndus renascetur,

ook SYPHILIS 45lieved that this contagion was carried to us from the New Worldwhich was discovered by the Spanish voyages, for there thismalady is extremely prevalent. In proof of this, they pointto the fact that this disease first appeared among us in Italyat the very time when that voyage had been made and tradinghad been carried on with the people of that country. For thisreason too, they say, it was first observed among the Spaniards.Accordingly, they think that in all cases this malady dependson a contagion transmitted by one person to another. But,as a matter of fact, although the majority of those who havecontracted this disease have done so through contagion, never-theless it has been observed that countless others have beeninfected without any contagion per se. Moreover, it wouldhave been impossible that this contagion, which per se is slowto act and is not easily received, should have traversed so muchof the world after having been first conveyed to the Spanishby a single fleet of ships. For it is well known that at the sametime, or nearly the same, it was observed in Spain, France,Italy, Germany, and almost all Scythia. 8 Consider also thefact that astronomers predicted its coming some years beforeit arrived, which goes far to prove that it has some other under-lying principle than simple and direct contagion. Now inthe first place, we ought not to be surprised that novel and un-usual diseases appear at certain times, diseases not conveyedfrom one country to another, but arising from their own peculiarcauses. For instance, in the year 1482 there broke out a cer-tain kind of pleurisy which affected almost the whole of Italy.And in our own times there have appeared in Italy those fevers.never before observed there, which are called lenticulae ,and have been described above. Also in bygone years, wehave observed a contagious ophthalmia that attacked certaincountries; again, we have seen that pest which is prevalentamong cattle only and is recorded above. 9 Hence it oughtnot to surprise us that the French Sickness also, though notpreviously known to our continent for many centuries, hasnow broken out for the first time. There will come yet othernew and unusual ailments, as time brings them in its course;just as mentagra appeared among the ancients and has neversince appeared again.5 And this disease of which I speak,this syphilis too will pass away and die out, but later it will beborn again and be seen again by our grandchildren, just as in


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146 DE CONTAGIOSIS MORBISquemadmodum et praeteritis aetatibus visum a majoribus nostris fuisse credendum est, de quo non pauca indicia etiamnumsunt.

Tonsor quidam amicus noster libellum habebat experimentorum quorundam antiquum satis, inter quae unum inter aliascriptum erat, cui titulus erat, ad scabiem crassam, quae cumdoloribus juncturarum accidit: is ergo, quum primum recentissimus esset morbus. memor medicaminis consuluit medicosquosdam, num uti eo medicamento deberet in nova illa contagione, quam per scabiem crassam significari existimabat: mediciautem inspecto medicamine acriter prohibuere, quod ex argentovivo constaret et sulphure: felix nisi medicos illos consuluisset,incredibili quaestu dives futurus: paruit autem, nec ausus estexperiri medicamen: quod demum expertus atque optimumagnoscens valde indoluit, quod sero usus eo fuisset, quaestujam per alios sibi abrepto; ex quo videre profecto possumusaliis etiam aetatibus visum eum morbum fuisse. Sunt, quiputent, et Avicennam illum significasse capite de olibano,quum dixit Thus valere dolori composito illitum ex acetoet oleo. Et est dolor, inquit, cum quo proveniunt in corporesicut verrucae cum deambulatione sicut formicae: sed certe hocnihil est, quoniam Avicenna illic transfert, quod Dioscoridesscribit de Thure, quum dicit: Formicantes verrucas inter initia,impetiginesque ex aceto et pice illitum tollit, per quae Myrmecia intelligit.

Ut ergo ad propositum revertamur, inter novos morbos, eteos, qui raro in lucem veniunt, collocandus est morbus Gallicus:quare, et causas illius ac principia oportet ex iis esse, quae raroet ipsa contingant: esse autem talia, ut communia sint non solummultis mortalium, sed et regionibus multis: quod certe in null amaliam causam referri potest, quam in aeris constitutionem:qualis autem ea fuerit, et ex quibus principiis exorta, nunc estinquirendum.

ook SYPHILIS 147bygone ages we must believe it was observed by our ancestors.There are in fact many proofs of this still extant.A certain barber, a friend of mine, had in his possession asmall and very old book in which were certain prescriptions.Now among others there was one prescription entitled 'For usein the thick form of. Scabies that is accompanied by Pains inthe Joints'. Accordingly, when this disease first appearedand was still entirely novel, he remembered that remedy andconsulted certain doctors as to whether he ought to use it inthat new contagion, which he thought was identical with 'thickscabies'. But the doctors, after inspecting the remedy, emphatically forbade him to use it, because it was compoundedof quicksilver and sulphur. He would have been a lucky mani he had not consulted those doctors, for he would have madeprofits beyond belief and become a rich man. However heobeyed them, and did not dare to use the remedy. But finallyhe did try it, recognised that it was the best possible, and wasdeeply chagrined that he had not employed it until so late, forhis profits had by that time been snatched from him by others.We can surely see from this that this disease had appearedin former times as well as in our own. In fact some authoritiesbelieve that Avicenna X also was referring to syphilis when,under the heading '01ibanum',52 he said that incense mixedwith vinegar and oil and used as an ointment is good for a certain pain. I mean , said he, the pain that is accompaniedby warts of a sort, which break out on the body and seem torun about like ants . However, that remark is not to thepoint, for Avicenna is there merely translating what Dioscurideswrites5 'On Incense', where he says: In the early stage,compounded as an ointment with vinegar and pitch, it removesant-like warts and impetigo . Dioscurides here means thedisease called 'Myrmecia'.54To return to my subject, we must classify French Sicknessas a new disease, and as one of a class that seldom manifestthemselves. It follows that its causes and principles (primaryagents) must be such as seldom arise. Moreover these causesand principles must be such that they are common not only tomany human beings, but also to many parts of the world. Suchconditions can be referred to no other cause than the constitution of the air. We must now enquire what was the nature ofthis constitution, and from what principles it arose.


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150 DE CONTAGIOSIS MORBISet, quum accidit, magna semper apportare consuevit, tum quodea sidera potentissima sunt, tum quod unio ilia diu perduratpropter motus tarditatem, preaesertim Saturni, et Jovis: quamconjunctionem videntes Astrologi novas magnasque aegritudines portendi praedixere: si quid igitur probabiliter dici potestde principio tantae contagionis, ita certe existimandum est.Ergo facto eo siderum conventu ingentem vaporum tractionemfuisse factam credendum est, qui commisti aeri, diversimodequeagitati tandem sordidam putrefactionem intulerint, a quaseminaria ilia in nos importata fuere. quae ad sordidos et mucososhumores, quale est phlegma crassum et mucosum, haberentanalogiam: unde tandem contagio ilia enata est, quae mox totmortalium, tot regiones male affecit, partim quidem aere ipsoprincipia et seminaria immittente, partim de uno in alium contagione pertranseunte: ac de origine morbi et principiis ejusita traditum sit.

Quod vero et materia ejus, ad quam ea principia habueruntanalogiam, sit phlegma sordidum et crassum, ut diximus, manifestissimum esse potest: si enim pustulas inspiciamus, iliaeomnes pingues, mucore incredibili manantes fuere: si verogummositates, et iliae concreto phlegmate constabant: quodsi et ad dolores ipsos lacertorum, et illi quidem idem ostendent,erant enim diuturni, extensivi, noctu afHigentes: factis itemdissectionibus lentor quidam per nervos et lacertos coextentuscernebatur: quare nemini dubium esse debet materiam ejuscontagionis esse mucosum phlegma et sordidum. Videnturautem pustulae ex minus crassa materia originem habuisse,gummositates ex crassissima, dolores vero ex media quadam:quippe serpente contage per massam sanguinis, et pabulum sibifaciente in phlegmate, pars quidem, quae minus crassa, minusque segnis erat, extra pellebatur ad cutim, atque iliic sensimconcrescebat in pustulas, quae vero crassior aliquanto fuerat,et minus apta usque ad cutim expelli, residebat circa nervoset lacertos, ubi coextenta dolores acerbissimQs excitabat, cras-

ook SYPHILIS 151Jupiter and Mars. This is a conjunction that seldom occurs,and when it does it always brings in its train great events;partly because those stars are the most powerful of all, partlybecause that conjunction lasts a long while because of theirslow movements, especially that of Saturn and Jupiter. Whenastrologers observed that conjunction, t ~ y predicted noveland severe maladies. Accordingly, i it be possible to makea probable hypothesis as to the principle of this serious contagion, we must suppose that this is what happens. We maybelieve that, when that conjunction of the heavenly bodiesoccurred, it drew forth an immense amount of vapors; thesemingled with the air and were agitated in diverse ways anddirections, until finally they induced a foul putrefaction, andthe germs from it were carried to us. These germs were analogous with the foul and mucous humors, I mean thick and mucousphlegm; and in this phlegm, finally, that contagion came tobirth which presently infected so many human beings and somany countries; in part because the air itself carried thitherthe principles and germs, in part because the contagion wastransmitted by one person to another. This then is what Ihad to record concerning the orig in and principles of thisdisease.Now with regard to its substance, with which those principleswere analogous. That this is as I said, foul, thick phlegm, maybe seen unmistakably i we consider the pustules; for they werell plump and discharged an incredible quantity or mucus.The gummata, also, consisted of a mass of phlegm; and eventhe pains in the muscles will furnish the same evidence, forthey lasted long, were extensive, tormented the patient at night,and when dissections were made, viscous matter was revealedcoextensive with the nerves and muscles. Accordingly it mustbe clear to ll that the substance of this contagion is foul andmucous phlegm. The pustules seem to have had their originin a somewhat thinner substance, the gummata in very thick,and the pains in moderately thick substance. For, as the contagion crept through the mass of blood and found nourishmentfor itself in the phlegm, the thinner and less sluggish part wasdriven out to the skin, and there by degrees formed into pustules.ut the somewhat thicker part, which was less readily drivenout to the skin, settled about the nerves and muscles and, ex-tending along them, caused the most acute pains. ut the


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152 DE CONTAGIOSIS MORBISSlSSlma vero circa partes quasdam coagulabatur, et in gum-mositates concrescebat.

Non erat autem prompta contages, ut exciperetur, propterlentorem, in quo sepulta erant seminaria, sed indigebat con-calefactione quadam corporum, sic enim quodammodo actufiebant seminaria, et alteri agglutinari poterant, et se ex analogosibi pabulo propagare, quod non calef acta facere quidem nonpoterant, quasi coagulata.

Propter eandem causam et diu latebat contages intra corpusantequam sese manifeste ostenderet, quoniam segniter serperetpropter frigiditatem et crassitiem materiae, mox tamen exede-bat, et solida etiam carpebat propter acuitatem seminariorumin densa materia, quum actu fiebant, et putrefactio procede-bat Apparebant autem primum ulcuscula circa pudenda,quoniam inde prima origo contagionis initium capiebat inmajori parte ex coitu: erant autem et male morigerata ea ulcera,tum quod locus ilie per se satis putidus est, tum, quia seniinariishinc inde dispersis jam fiebat ut parte una sanescente propterremedia, alia regerminaret. At pustulae ut plurimum a cal-varia occipiebant, partim quidem, quia pars ilia propter sordi-tiem et crassitiem humoris, ex quo nutritur, quodammodoanaloga est ad contagem, partim quod eius evaporatio sursumfertur, in omni autem putrefactione evaporatio plurima fit.Quibus autem pustulae aderant multae, minus dolorum accede-bat, quod materia multa excerneretur, ac simul signum id essetmateriam esse subtiliorem: contra vero, quibus crassior erat,dolores quidem multi insurgebant, ac pustulae pauciores: materiavero, quae dolores dabat, non erat in juncturis ipsis infixa,quod crassior esset, quam ut penetrare in juncturas posset,quare super nervis et lacertis maxime residebat: afHigebat autemnoctu magis, et sole condente se, quoniam interdiu calor natura-lis solet exteriora petere, ad ea quae moveri solent membrademandatus a natura ad vigiliae opera exercenda, nec non a i

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ook SYPHILIS 153thickest part of the contagion coagulated in certain localitiesand formed gummata.This contagion was not very readily taken in by the body,because of the viscosity in which its germs. had been buried;hence there was needed a sort of reciprocal heat in two bodies;thus somehow the germs became active, and were able to ad-here to something else and to propagate themselves on nour-ishment analogous with themselves, but this, being as it werecoagulated, they could not have done unless they had beenheated.This is also the reason why the contagion remained latentfor so long in the body before it manifested itself unmistakably.On account of the coldness and density of its substance, it wouldcreep on sluggishly, but presently would eat its way out andattack the solid parts of the body also, because of the sharpnessvirulence) of the germs when they became active in that thicksubstance, and putrefaction began its work. First small ulcersappeared on the sexual organs, because it was in that localityand mainly from sexual intercourse that the contagion had itsorigin and beginning. These ulcers were not easy to deal with,partly because tl).at locality is per se rather unclean, partlybecause, since the germs were dispersed hither and thither,when one part yielded to remedies and healed, in another partan ulcer would sprout forth. A reason why the pustules veryoften invaded the hairy scalp first is that that part of the bodyis somehow analogous with the contagion on account of thefoulness and density of the humor by which it is nourished;another reason is that what evaporates from it rises upwards,and in every putrefaction much evaporation occurs. In caseswhere there were many pustules the pains were less severe, be-cause a great quantity of substance was being expelled, and atthe same time this was a sign that the substance was moresubtile. On the other hand, when the substance was moredensely compacted, there were many violent attacks of painand the pustules were fewer. The substance that caused thepains was not established in the actual joints, because it was toodense to be able to penetrate to the joints and therefore settledfor the most part above the nerves and muscles. The painwas felt more at night and at sunset because in the daytime thenatural heat makes for the outer surfaces and the membersthat are usually in motion; for nature demands this heat in


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154 DE CONTAGIOSIS MORBISlumine solis excitus, quamobrem fovebat quodammodo eamembra, et ventositates exsolvebat, quae lacertos et nervosextendebant, et vellicabant, ac simul et materiam concoquebat noctu vero introrsum recurrere calor solet, et membraea deserere, ad quae per diem demandatur a natura: qua decausa dolores tum excitabantur, et distentiones majores accrescebant destituta materia a calore fovente, et dissolvente ventositates.

Annis vero labentibus mutatio quaedam ejus morbi factaest, quoniam dispositio prima, quae in aere fuerat, jam cessa

v e r ~ t .nec morbus aliam sui propagationem habebat, quam econtaglOne unius ad alterum, propter quod perseverabat: omnisautem ~ o n : a g i o quanto magis abest a principio et prima origine,tanto Sl lOr fit et terrestrior propter adustionem, quae continenter conjungitur: qua de causa primi temporis contagionesquasi ortui et principio propinquae, sordidiores pinguioresquevisebantur, et pustularum plurium, minorum vero dolorum:quae vero annis post sequentibus contigere, utpote adustae etcrassae magis, pauciores quidem pustulas majores autem doloresdedere, nam et a principio, ubi plus erat pustularum, illic minuserat dolorum, ubi minus pustularum, plus dolorum cernebatur . Porro et annis hisce ultimis, quasi in senio existente contage, et materia facta crassissima, major adhuc mutatio factaest, nam gummositates multae apparent, pustulae autem pauciss ~ a e et illae sicciores, dolores autem fere nulli, aut longemmores, quod materia propter crassitiem facillime concrescatin gummdsitates, extra autem non facile propellatur ad cutim,vel resideat circa lacertos: quod siquid tamen ad cutim pervenitid tenue quoddam phlegma est, quod salsedinem quandarr:acquisivit ex adustione, quare ad radices pilorum latum pabulumeorum absumit, unde et ipsi mox cadunt, sicuti in porrigine,Alopecia, et Achoribus siccis accidit. Fortasse autem et idemfit in hoc morbo nunc, quod et in Alphis accidit, in quibus

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ook SYPHILIS 155order to carryon the work of the waking hours, and it is alsocalled forth by the rays of the sun. This natural heat to someextent comforted those members and dissipated the windyelements which were stretching and tormenting the muscles andnerves; moreover it concocted (digested) the substance. Atnight, however, the heat retreats within the body and abandonsthe members for whose benefit nature demands it during theday. For this reason the pains were more active at night andthere were greater distensions, because the substance was deprived of the heat which fomented it and dissipated the windyelements.In the course of years, however, there has come about a cer-tain alteration in this disease. Since the original disposingcause which had been in the air had now ceased to exist, thedisease had no other means of propagating itself than by contagion from one person to another, and hence it was by thismeans that it persisted. For every contagion, in proportionto its distance from its principle and original source, becomesdrier and more earthy on account of the adustion that is alwayscombined with it. For this reason the contagions of the earliestperiod, inasmuch as they were close to their place of origin andprinciple, were observed to be more foul and of fatter substance,and caused more pustules but fewer pains. But the contagionsof the following years, being more inflamed and denser, causedfewer pustules but more pains. For as, in the beginning, wherethere were more pustules there was observed to be less pain,so later, where there were fewer pustules there was more pain.Furthermore, in recent years, as i the contagion were now inits old age and its substance had become very densely compacted, a still greater change has come about, for many gummata appear, but very few pustules, and those drier, whilethere are hardly any pains, or far less severe; because the substance, on account of its density, very readily forms into gummata, but is not readily driven out to the skin, nor does it readilysettle about the muscles. But whenever anything does comeout to the skin, it is a kind of thin phlegm which has acquired asaline quality from adustion; hence, when conveyed to the rootsof the hairs on the body, it consumes their proper nourishment,and the hairs soon fall out, as happens in porrigo,s alopecia,and dry achores. Moreover it may be that now in this diseasethe same thing happens as in cases of alphuss7 for then, when


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156 DE CONTAGIOSIS MORBISdecidunt pili materia quadam alba mucilaginosa coextenta adradices eorum, nam vidimus quosdam, quibus barba deciderat,consimilem quendam sub cute coextentum humorem habuisse:quod facillime potest nunc evenire in evaporatione, et secretione, quae fit ab ea materia jam pene vitrea coagulatis vaporibus, ubi ad pilotum radices pervenere: quocunque igitur modoid fiat, existimandum est senium jam hujus morbi incoepisse,nee longe post futurum, ut ne per contagem quidem se propaget,quoniam materia in dies frigidior fit, et terrestrior, in qua etseminaria tum pauciora, tum et debiliora in dies gignuntur;propter quod nec tam facile concipitur nunc ea contagio, utiprius solebat: quare et tandem fiet, ut nec sese possit propagare,sed desinat, reversura mox quum eadem principia, et eaedemcausae revertentur. Est autem certis regionibus familiariscontages, ut in Hispana vocata insula, et vicinis aliis, quoniamut diximus) ea dispositio, quam ad nos temporis longitudoattulit, illic connaturalis viget huic morbo gignendo, quemadmodum Elephantiae Aegyptus Judaeaque familiaritatemquandam habent. Quae igitur principia et causae fuerintnovae hujus contagionis, et quo consistat, et quam habeatanalogiam, et quae sint ejus accidentia, et notae, per haechactenus determinatum sit.

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ook SYPHILIS 157the hair falls out, there is a white sticky sort of substance coex-tensive with the roots of the hair. In fact I have seen casesof persons, whose beards had fallen out, who had under theskin a sort of humor precisely of that kind and coextensive withthe beard. This may very easily happen in the present casefrom the evaporation and secretion proceeding from that substance, which is now almost transparent like glass, and made ofcoagulated vapors), when they have reached the roots of thehair. Whatever may be the cause, we must conclude that thisdisease has now entered on its old age and that the time isnot far off when it will cease to propagate itself, even by con-tagion. For the substance becomes colder from day to dayand more earthy, and in that sort of substance fewer and weaker germs are generated from day to day. For this reason, thatcontagion is not so easily contracted today as it was formerly,and it will come to pass, at length, that it will be unable topropagate itself and will cease to be. ut later it will return,when the same principles and causes return. In certain partsof the world, however, it is domesticated, as in the so-calledSpanish Island Hayti)58 and in the other adjacent islands; because, as I have said, in those places there prevail by natureconditions which are favorable for the generation of this disease,conditions which have been conveyed to us in the lapse of time.In the same way elephantia is domesticated in Egypt andJudaea. In what has been said, I have so far defined the principles and causes of this new contagion, the substance of whichit consists, with what it s analogous, its accidents and its symptoms.

Fracastoro - On Contagion

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