Endoscopic and histologic appearance of rectal syphilis - 23/08/11
Doi : 10.1016/j.gie.2007.07.020
| Commentary Syphilis is one of the great masqueraders, along with tuberculosis, lupus, and cytomegalovirus. Here we have a case of rectal syphilis, looking not unlike other colitides. But what is in a name, specifically, the name Syphilis? Syphilis is, indeed, a name, that of a fictional shepherd, first mentioned in the 3-part Latin hexameter poem, Syphilis sive morbus Gallicus (Syphilis, or the French disease), published in 1530 by Girolamo Fracastoro (1478-1553). In Part 1 of this poem, Fracastoro discourses upon the complexities of nature and upholds the traditional Galenic theory of humors, viewing all disease, including syphilis, as an imbalance among essential components that must be corrected by measures such as bleeding, sweating, and purging. In Part 2 he extols the virtues of mercury as a cure for syphilis, but interpreting its benefits only in terms of humoral rebalancing and the purging of poisons. In Part 2, Fracastoro tells his tale of human hubris, repentance, and the discovery of mercury. A hunter named Ilceus kills one of Diana’s sacred deer. Diana’s twin brother, Apollo, becomes infuriated and inflicts the pox of syphilis upon Ilceus. The contrite hunter prays sincerely for relief, and the goddess Callirhoe, feeling pity, carries him underground, out of reach of the sun god’s continuing wrath, where Ilceus discovers the curative power of mercury. Fracastoro later added a third part to describe the curative power of mercury, but this time with a shepherd named Syphilis (in place of Ilceus) who incurred the wrath of Apollo by killing his sacred parrots. Apollo promises horrible retribution in the form of a foul disease, ever since which the natives perform an annual rite of sacrifice to memorialize the hubris of Syphilus and the salvation of the people by repentance. The natives still suffer from syphilis, but their annual rites of sacrifice please Juno, who, in return, allows a wondrous cure, the guaiacum tree, to grow on their isle alone. The Spanish sailors, now also infected with the disease, learn about the new cure and bring guaiacum back to Europe. In due time it was shown that Guaiacum, also known as lignum vitae or lignum sanctum (“wood of life” or “holy wood”), had use as an expectorant and test for occult blood in the stool, but not for treating syphilis. In the later work of 1546 that secured his enduring fame (De Contagione et Contagiosis Morbis et Curatione [On Contagion and Contagious Diseases and Their Cure]), Fracastoro recognized the venereal nature of syphilis, and that infected mothers can pass the disease to their children. He admitted and excused the follies of his previous poem, written “quum iuniores essetamus” (when we were younger), and accurately described both the modes of transmission and the 3 temporal stages of symptoms. Fracastoro discussed particles of contagion called semina (seeds), but argued that the infecting semina of syphilis may arise from poisonous emanations sparked by planetary conjunctions. We need only recall Erasmus’s sardonic quip that in exchange for a night with Venus, one must spend a month with Mercury. As for treatment of rectal syphilus in the 21st century, penicillin has replaced mercury and guiaicum, but I would urge caution before spending that one night with Venus, regardless of planetary alignments. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 67 - N° 1
P. 161-162 - janvier 2008 Retour au numéro
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