Sarah Dunant

Thoughts on disease and madness, past and present.

Cesare BorgiaWith the furore over a new pope having died down, my mind is once again full of thoughts about syphilis as I continue to collect interviews for a BBC Radio 3 documentary about this disease. I realise, looking back on it now, that syphilis has been in my life for quite a while. It started thirteen years with the Birth of Venus, when I found a reference to the “French Boils” in the diary of one Lucca Landucci, an apothecary in Florence who writes an extraordinary diary almost every day for thirty years. The date was 1496 and as I investigated further, along with giving a great idea for the life of a character in the novel, I learned the history of the disease’s arrival in Italy when a French invasion takes the city of Naples. (It is now pretty well established that it came with infected mercenaries soldiers who had travelled with Columbus in his 1491/92 journey to the new world.)

With In the Company of the Courtesan it passed across my radar again. By the 1530’s courtesan culture was flowering in many big Italian cities and women like Fiammetta, while they were higher status than regular prostitutes, were also vulnerable to contracting and then passing on the disease, with many of them dying in poverty with their looks and careers devastated,

But it was Cesare Borgia that finally brought the power of the disease home to me. This astonishing historical figure, much easier to malign than try to understand, was one of the great challenges of my new book Blood and Beauty. His coldness, his drive, his speed and his intelligence, added to the power he is given when at the age of eighteen his father becomes Pope, makes for a riveting journey in anyone’s eyes. Three years later he moves from the church, where he is already a cardinal, to becoming a solder and general. And it is on that cusp of that move, while he is papal legate in Naples sleeping with a number of different women (nothing new in that, I must say), that he contracts what was called the French disease.

First he suffers a outbreak of weeping pustules all over his body, swiftly followed by wracking pains. After a few months he recovers and seems perfectly well. Until, a year later, the attack repeats itself. Once. Twice… We know all this because we have the reports of his doctor who is one of the first to try a treatment of mercury through steam baths. Eventually the disease, no long infectious, goes underground, starting to eat up the nervous system and the gut and, in some, to travel as far as the brain.
Cesare doesn’t live that long, so I don’t know how far his would have been an eventual syphilitic death. But I do know that by the time we leave him at the end of Blood and Beauty, he is showing signs of erratic behaviour and a tendency to grandiosity and fits of manic energy that I suspect are as much the impact of syphilis as of the disease of power.

By the 18th and 19th century syphilis is deeply ingrained in Europe and seems to have mutated so that by default it ends up attacking the brain. Many of the hundreds and thousands of people who suffer from it are in asylums with a form of insane paralysis , not always diagnosed both because we didn’t know enough about the disease and because for many the shame was so great that even if the families knew they had it, they tried to hide it.

Stories of mania, depression, delusion and aggressive behaviour abound. While it is hard to imagine the horror of the sufferers it is equally upsetting to think about the impact it would have had on their loved ones around them. How lucky we are to no longer in such times, yes?
Except …except…. All this work with syphilis has made me start thinking about the seemingly unstoppable march of Alzheimer’s and dementia. Of course it is different in many ways. There is not the stigma of sex attached and it is not contagious. But oh, it has other horrors attached to it. The fact that it is incurable. The fact that it is growing so fast in an ageing population,(one to four people over sixty five will suffer from it is the latest statistic). And then of course there is the deep irony that it is partly the success of medicine that has brought us here: that now our bodies stay healthier for longer it is our minds which fracture and fall apart.

Among a number of posts celebrating International Women’s Day to which I contributed recently, I read a moving, anonymous account of a woman caring for her demented husband. And there was something in it – both the sadness and despair as well as the hint of shame – that reminded me of the past.

Of course you will say: No – no, but we are much luckier, now. No insane asylums when the horror hits. And that is true. Except in some ways I am not sure we are not doing that much better. The National Health Service, already reeling from the impact of impact of obesity. now has wards filled with demented elderly patents. Medicine, so good at curing, is less suited to long-term compassion. And when families can no longer bear the burden, the likelihood is that sufferers will end up in a home, where regular exposures build up a picture of carers becoming cruel almost because it seems too difficult to be endlessly kind. And so I have found myself thinking of all those syphilitic patients in public and private asylums all over Europe in the 19th century and how, when the mind and personality shatter, how fragile human dignity becomes.

Progress. Working in history I am continually struck by its cyclical nature. Yes we have come so far and yet often we seem to arrive at a place which, in many ways, looks so familiar.

RADIO 3 The Great Pox  Sunday 19th March 6.30 pm. 

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