To the Editor:
The disease named “syphilis” by Girolamo Fracastoro in 1530 was characterized by more than 400 allusive names from its beginnings (1494) until the 19th century, and more than 30 allusive names were also given to those suffering from it. In both cases, the various allusive names are reminiscent of the discipline of dermatopathology (Fig. 1).1
It is likely that the clinical symptoms of syphilis were first recorded in the history of dermatopathology and venereology in the form of the woodcut “The Syphilitic” by Albrecht Dürer, published by Theodoricus Ulsenius in his Flugblatt (pamphlet) entitled Vaticinium in epidemicam scabies (Prediction on the pestilence) (1496) emphasizing the disease's severity.
Syphilitic patients were a major cause for mockery within 16th-century burlesque literature. In fact, the poet Giovanni Battista Lalli called them affranciosati (those suffering from the “French disease”: the most widely used allusive name for syphilis) in his poem La Franceide (1629). This includes the lines: “Look at them, Aesculapius, united with the Goddess' love,/All the inspected affranciosati./French people lose the war, and its name have transmitted/To that dangerous disease, which consumes any hearth […].” From this synonym are derived the allusive names describing subjects affected by the dermatological symptoms caused by both primary and secondary syphilis: infranciosato, malfrancesato, sfrancesato and which all relate to France and to French people. In the same way, the burlesque poet Antonio Cammelli writes of the poxes that cover his body like a dress in his 2 sonnets, saying to a gentlewoman: “Lady, I am dressed as a French man, […] seriously wounded over and under and front and aside/Within the whole flesh of my body/[…].”2 He considers that being affected by such a serious disease indicates that he is a genuine member of the nobility: Lady, I am elected among Francia Barons.2 Still referring to France, Niccolò Campana, affected by syphilis, identifies himself in a sonnet as Paladin or Count of France.3 His peer Giovanni Francesco Bini also uses the allusive name Paladin of France4 that Pietro Aretino changes to amorous disease knight,5 which strikingly indicates the sexually contagious nature of the disease, as a result of syphilitic primitive follicular ulceration on the gland. Moreover, and in a sarcastic example of burlesque literature, Anton Francesco Doni, in his Foglie della zucca del Doni (1552), and more specifically in the chapter Il pelatoio (the bald man), the author refers to a syphilitic patient as bald: a reference to the hair loss that represents an early symptom of the disease. The clinical and dermatopathological symptoms of syphilis also became allusive names for syphilitic patients. For example, Bernardino Zambotti, a chronicler, referred to Duke Alfonso Este as follows in his history of the city of Ferrara: “On 3 [December 1497], […] Lady Anna [Anna Maria Sforza] was buried […] and Sir Alphonse […] was not present to be […] because I am impiagato de brozole (ulcerated by the venereal poxes) […].6
Generally, while noble syphilitic patients were treated in their own homes, most poorer patients affected by poxes or plagues (piagosi or impestati, respectively) and unable to walk were transported by wheelbarrow to the “hospital for incurables,” and syphilitic patients were also incurable.
Moreover, some allusive names used by Spanish authors are also highly evocative: Francisco Lopez de Gomara, writing on the symptoms of syphilis, calls a syphilitic patient a buboso7: one affected by bubas (poxes). Al fino buboso is the name given by Francisco Lopez de Villalobos to Spanish aristocrats affected by the fine bubas (fine poxes).8
Moreover, the term variola [from the Latin noun varus (pox) or the adjective various (spotted)] was used by Mario (Bishop of Avenches, a chronicler and later a saint) to describe, for the first time, a smallpox epidemic in Europe9 in the 16th century, and has also often been used to describe syphilis. In fact, like a number of ancient dermatological diseases, syphilis was often misdiagnosed as smallpox and thus the syphilitic patient was called “spotted.” Another misdiagnosis of syphilis is that of elephantiasis. In the words of Giovanni Manardi, […] “elephantiasis […] is characterized by a humor extending on the whole external parts […] [rendering] all patients foul showing a dreadful look […], [this is similar to those] who are affected by that disease called Gallico; we called it elephantiasis [and elefantioso is the patient].10 In the first half of the 16th century, Jacques de Béthencourt coined the term “venereal disease,” meaning syphilis, that of “venereal” for the patient. Furthermore, the term lue from the Latin lues (disease, endemics, plague, infection) is a clear indication of the origin of the allusive name luetic11 used from the 19th century to the second half of the 20th century. Not all allusive names are so appropriate. However, luetic, like avarié (damaged)12 and vermoulu (worm-ridden)13 represent just some of the popular names used within society to allude to syphilis. In fact, the wealth of scientific and popular terms for syphilis is justified because of the widespread and major influence of the disease in history, society, and culture and within daily life. Within medicine, the allusive names reflect the powerlessness of physicians to heal syphilitic patients and the fact that the disease was considered more repugnant than leprosy and more dangerous than the plague. Moreover, such a broad spectrum of names for the disease, in the area of dermopathology but also in other medical disciplines, mean that it can be considered as an imitator of any disease. William Osler's words provide some assistance here: “I often tell my students that it is the only disease which they require to study thoroughly. Know syphilis in all its manifestations and relations, and all other things clinical will be added unto you.”14
In conclusion, it comes as no surprise to us that a great number of allusive names describe some aspect of the physical symptoms of both the disease and those suffering from it. Verbal language takes its origin from the things it denotes! (Nomina sunt consequentia rerum!) (The names are consequential to the things!).15
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2. Renier R. I sonetti del Pistoia. Giusta l'apografo trivulziano. Turin, Italy: Loescher; 1888.
3. Campana N. Lamento di quel tribulato di Strascino Campana Senese sopra il male incognito, il quale tratta della patientia et impatientia. Venice, Italy: Annibale d'Aristotile detto Zoppino; 1529.
4. Berni Casa, Varchi Mauro, Bino Molza, et al. Il primo libro delle opere burlesche. Usecht al Reno: Broedelet; 1771.
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7. Lopez De, Gomara F. La Historia general de Las Indias, con todo el descubrimiento y cosas notables que han acacido que se gonaron, ata el año de 1551. Saragozza, Spain: Çapila M; 1553.
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9. Causati Vanni AM. Il vaiolo nella storia. In: Tagarelli A, Piro A, Pasini W, eds. Il vaiolo e la vaccinazione in Italia. Vol 3. Villa Verucchio, Rimini, Italy: La Pieve Poligrafica Editore; 2004.
10. Manardi G. Epistolarum medicinalium. Lib. XX. Eiusdem in Joan. Mesue Simplicia et Composita annotations et censurae, amnibus practicae studiosis admodum necessariae …. Venice, Italy: P. Schoeffer; 1542.
11. Cipriani M. I nomi di persona nella terminologia dermo-e venereo-patica. Sintomi, sindromi e malattie. Dizionario. Ascoli Piceno: Società Tipo-Litigrafica; 1942.
12. Brieux E. Die Schiffbrüchigen [from the original: Les Avariés; 1901]. Berlin, Cologne: Lipsia: Ahn A; 1903.
13. Rho A. Gli spettri. Torino: Einaudi G; 1959.
14. Osler W. Aequanimitas With Other Addresses to Medical Students, Nurses and Practitioners of Medicine. Philadelphia: Blakiston's P. Son & Co; 1905.
15. Radding CA, Ciaralli A. The Corpus Iuris Civilis in the Middle Ages: Manuscripts and Transmission From the Sixth Century to the Iuristic Revival. Leiden, the Netherlands: Brill; 2007.