The increased prevalence of leprosy in Europe in the Middle Ages is often attributed to the Crusades.[12] Leprosy was very widespread in Germany, France, Italy, and other countries of Europe before the Crusades; according to Hirsch it appeared in the Roman Empire in the first century before the birth of Christ, but did not become very prevalent until later. Legal regulations governing the marrying of lepers date back as far as the seventh century, while the earliest reports regarding leper-houses come down from the eighth and ninth centuries. Most leper-houses, however, were built between the eleventh and thirteenth centuries, and although the reverse opinion has been expressed, it is nevertheless improbable that the building of these houses was not due to the increased prevalence of the disease. Inasmuch as leprosy was very widespread in the Orient, where numerous crusaders contracted it, as indicated by the fact that institutions were founded there for its victims, many crusaders doubtless returned with the disease in their systems. But regarding this matter we shall never have absolutely reliable information; for it is assumed that many people suffering from other chronic skin diseases were placed in the leper-houses. A careful study of the available data, however, leads us to believe that wrong diagnoses were not so frequent as to account for the large number of cases of leprosy in the eleventh, twelfth, and thirteenth centuries. Admittance to leper-houses was regulated by many precautionary measures, and the diagnosis of the disease was made by churchmen, even bishops, who without doubt necessarily acquired a good eye for the disease in the course of time. Not until later, when we may be certain that leprosy was no longer brought from the Orient, was the disease probably now and then confused with syphilis.
The notable pandemic outbreak of syphilis at the end of the fifteenth century was also largely attributable to warlike events. The rapid spread of the disease throughout Central Europe was due, according to contemporary notices, to the Landsknechte (common foot-soldiers). The rough coincidence of this epidemic with the discovery of America has given rise to the view that the disease did not exist in Europe at earlier periods, but was borne thither from America. But we can point to numerous instances in the course of the last century, of how infectious diseases, hitherto unknown, or existing only sporadically, all of a sudden became pandemic (cholera, plague, diphtheria, influenza), although no satisfactory and comprehensive explanation of the phenomenon has been offered. It is generally known that infectious diseases break out in a mild form and last for years, and then suddenly change their character and cause virulent epidemics; this is positively confirmed by the epidemic of small-pox in 1870–2, which will be discussed later. At all events we cannot draw the conclusion from the sudden outbreak of an epidemic of syphilis, that the disease was not present in Europe before.
A serious epidemic of syphilis broke out in the army of Charles VIII of France during his expedition to Naples. Inasmuch as his advance was nowhere opposed, he was able to enter Naples on February 12, 1495. There the French army gave itself over to the most unbridled licentiousness, and the result was that the disease spread rapidly in both the French and Italian armies. Italians and Frenchmen accused each other of having brought the disease, so that the former called syphilis ‘French disease’ and the later ‘Neapolitan disease’. The disbanding of Charles’s army caused the disease to spread far and wide in Europe. ‘Those who had most to do with the further dissemination of the disease,’ says Häser,[13] ‘were the Albanian and Roumanian estradiots serving in the Venetian army, brutal and rapacious adventurers, and also the German and Swiss Landsknechte returning from Italy, who spread the disease over a large part of Europe.’
A large number of writers of the beginning of the sixteenth century bear witness to the fact that the pestilence was borne into Germany by Landsknechte; e.g. Pastor N. Berler (Ruffachische Chronik of 1510), Heinrich Brennwald (1519), Johann Haselbergk (1533), Valentin Müntzer (1550), Nuremberg Chronicle of 1580.[14] In the year 1495 the pestilence broke out in many places in France and Germany; in Strassburg, for example, the disease was planted by Landsknechte who had served in, and been discharged from, the army of Charles VIII; Hans Schott testifies to this fact in his Weltlich Leyenbuch (Strassburg, 1541). The city of Metz tried in vain to ward off the disease; according to the Metz Chronicle, many Burgundians (500 cavalrymen and 700 infantrymen) came to Metz in May 1495, and since the most of them were suffering from mal de Naples, they were not allowed to enter the city. But the soldiers infected the women in the vicinity, and the disease was later borne by them into the city, where it prevailed for four years, not beginning to abate until the year 1500.[15] We also have testimony to the fact that the outbreak of the disease in Nördlingen (1495) was caused by the arrival of Landsknechte.
In a supplementary way we may add here that later wars also caused frequent epidemics of syphilis within narrow confines; instances of this kind are cited by A. Hirsch[16] and H. Schwiening.[17]
In August of the year 1486 English sweating-sickness appeared in England for the first time; it broke out among the troops of Henry VII shortly before his victory at Bosworth on August 22, 1486. And when Henry landed at Milford the disease spread, carrying away many victims wherever it went. ‘Strong and well-nourished people were particularly susceptible to it—more so than old men, children, and poor people. From three to nine, sometimes all the inmates of a house caught it, and it gradually spread over half the inhabitants of the town. The first appearance of the disease is said to have caused more devastation in London (where it broke out on September 21), Bedford, and Cambridge, than the sword, which had been ruling for thirty years in a fearful civil war. According to Forest, an incredible number of people died from it, while Thomas Moore also speaks of the dangerous character of this epidemic. In many places a third of the inhabitants are said to have died from it, scarcely one in a hundred of its victims recovering.’[18] The subsequent appearance of the disease, especially the transplantation of it to the continent in the year 1529, was not attributable to warlike events. In the year 1551 it disappeared as suddenly as it had appeared in 1486.
The disease usually began with a chill, headache, palpitation of the heart, difficulty in breathing, and later a profuse, very malodorous emission of sweat from all parts of the body. The patient quickly lapsed into a state of lethargy. The progress of the disease was uncommonly rapid; ‘in one day either the disease or the patient came to an end,’ says Fracastorius. Any patient who did not succumb, recovered completely after one or two weeks.
From the sixteenth century on notices are more abundant; we now hear of epidemics of typhus fever throughout all Europe, although we do not know positively where the disease first appeared. ‘At all times,’ says Hirsch,[19] ‘as far back as historical investigation is able to follow the course of typhus fever at all, the disease has always been bound up with the most dismal calamities of the nations. The supposition is therefore justified that, in the numerous war-pestilences and famine-pestilences of antiquity and the Middle Ages, regarding which we have no medical reports and must rely only upon the chronicles, typhus fever has played a conspicuous rôle.’ By this, however, Hirsch does not mean to say that the specific disease in all the so-called war-pestilences was typhus fever; on the contrary, he adds: ‘In saying this I by no means wish to imply that I always identify “war-pestilences” and “famine-pestilences” with epidemics of typhus fever; those pestilences, appearing at epochs of general misery, for the most part represent a mixture of diseases, especially catarrh of the stomach, dysentery, scurvy, typhus fever, and frequently malaria and typhoid fever, which not only by chroniclers, but also by medical statisticians, have quite often been lumped together as one disease.’ It is to-day almost impossible to analyse these accounts, in which we can distinguish only individual characteristics of those various diseases. This appears most distinctly in the reports of the chroniclers and historians regarding the war pestilences and famine pestilences of antiquity, and it also explains the futile effort of the historians to reduce to one disease known to us the numerous and complicated symptoms which they have looked upon as the expression of a single disease-process—an effort which has led some of them to the somewhat extravagant conclusion, that they were diseases which are now extinct. The same backwardness, furthermore, characterizes—though to a lesser extent—the descriptions which the physicians of the seventeenth and eighteenth centuries wrote of the epidemics of ‘putrid fever’, ‘bilious fever’, and ‘mucous fever’ occurring at that time. Here, too, in many cases