Friday, May 18, 2018

Infectious diseases, Part 23: Syphilis (Sp. sífilis) and related diseases

[This entry comes from a section of Chapter 34, "Words about infectious diseases", of Part II of the open-source textbook Spanish-English Cognates: An Unconventional Introduction to Spanish Linguistics.]

The word syphilis [ˈsɪ.fə.ləs] and its Spanish cognate sífilis [ˈ] are names for an infectious venereal disease (Sp. enfermedad venérea infecciosa). The name of the disease is derived from the name Syphilus of a character in a 16th century poem by Girolamo Fracastoro, a physician, astronomer, and poet from Verona (Republic of Venice). In the poem, written in 1530, Syphilus is a shepherd who was the first sufferer of the disease, a curse resulting from having offended the god Apollo. The poem, written in Latin, was titled Syphilis, sive morbus Gallicus, which means ‘Syphilis, or the French Disease’. Note that the title has Syphilis, not Syphilus, the shepherd’s name, for some unknown reason (more later on the French Disease part). Anyway, Girolamo Fracastoro gave the name syphilis to the disease in a famous treatise on contagious diseases that he wrote a few years later called De contagione et contagiosis morbis ‘On Contagion and Contagious Diseases’ (1546). Curiously, Fracastoro is also known as the first to propose a germ theory of disease, three centuries before it was formulated scientifically and proven empirically by French chemist Louis Pasteur and German physician Robert Koch.[1]

We do not know why Fracastoro chose the name Syphilus for the shepherd or syphilis for the disease. It is possible that the name was inspired by the name Sipylus of a character in one of Ovid’s works, the Metamorphoses (written in 8 CE), since that name is known to have been mis-spelled as Siphylus and Syphylus in some manuscripts of the work (note the spelling differences from Syphilus).

The name syphilis for the disease is not attested in English until 1718, two centuries later. In French, the word syphilis is not attested until 1808, though the adjective syphilitique ‘syphilitic’ is attested already in 1725. (English syphilitic is first attested almost 70 years after syphilis, in 1786.) In Spanish, sífilis first appears in Vicente Salvá’s Nuevo diccionario de la lengua castellana in 1846 and in the DRAE in 1884.[2] As in the case of the French language, the adjective sifilítico is attested in Spanish earlier in the 19th century, decades before the first attestation of the name sífilis for the disease.

It was estimated that in 2012, half of one percent of the world’s adults were infected, with several million new cases happening every year. When an infected woman is pregnant, this results in spontaneous abortions, stillbirths, or congenital syphilis in the newborn baby. In 2010, syphilis was responsible for some 113,000 deaths, down from 202,000 in 1990. In the US six times more men than women are affected and half of all cases are in African Americans.

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum of the genus Treponema, which scientists have not figured out how to cultivate yet and is difficult to study. The New Latin word Treponema was coined in the early 20th century from  Greek τρέπειν (trépein) ‘to turn’ and νῆμᾰ (nêma) ‘that which is spun (thread, yarn, etc.)’. It is a spiral-shaped bacterium of the Spirochaetaceae family.[3] This disease is caused by one of the three (or perhaps four) subspecies of this bacterium, namely Treponema pallidum pallidum. First we are going to talk about syphilis before turning to the diseases caused by the other subspecies.

There are up to three stages to the syphilis disease: primary, secondary, latent, and tertiary. The first stage (primary syphilis) starts usually after three weeks of exposure, but it can be anywhere from 10 days to 10 weeks. The first symptom is usually a single painless sore called a chancre [ˈʃæŋ.kəɹ], Sp. chancro [ˈʧaŋ.kɾo], ‘a painless ulcer, particularly one developing on the genitals in venereal disease’ (COED). These words come from French chancre, which comes from Lat. cancer. This chancre gets larger and often breaks, leaving an ulcer, but eventually it disappears after 3-6 weeks, leaving no scar.

The second stage (secondary syphilis) happens in about half of the people inflected. It starts typically 4-8 weeks after the appearance of the chancre and the most common symptom is a skin rash, especially on the palms of the hands and the bottoms of the feet. These symptoms also go away by themselves without treatment, though they may return. The second stage may last up to several months, until the symptoms disappear, again leaving no scars.

Then, the disease goes into latent period, which can last only a few months or forever. However about a quarter of those infected reach the last stage (tertiary syphilis), which for about half the symptoms are benign but for the other half is either incapacitating or fatal. At this stage, the bacteria attach different parts of the body, including heart, arteries, eyes, brain, nervous system, bones, liver, and joints. In the benign cases, the main symptom is ulcerated skin lesions that are not infectious and which are called gummas (Sp. goma), from Lat. gumma, ‘a tumor of gummy or rubbery consistency that is characteristic of the tertiary stage of syphilis’ (MWC).

The infection gets passed on through direct contact with a first-stage syphilis sore on the external genitals, vagina, anus, or lips during vaginal, anal, and oral sex. For centuries, various treatments were used for this disease, such as mercury, potassium iodide (1836), and Salvarsan (1909). It wasn’t until the antibiotic penicillin (Sp. penicilina) was discovered in 1928 by Scottish scientist Alexander Fleming and found to be effective for syphilis in 1943, that an effective and easy cure was finally found. Penicillin is still the drug of choice to treat the disease, during any of its four stages. Other antibiotics can be used as well for those who are allergic to penicillin.

Syphilis appeared in Europe at the end of the 15th century and the prevailing theory is that it was brought to this continent from the Americas by Columbus’s men. There are other theories, such as that there was syphilis in Europe already before Columbus’s trip but that it was confused with leprosy (Sp. lepra). However, the American source theory is most likely the true one. Be it as it may, the disease became notorious and well known in Europe when there was a major outbreak in 1494-5 in Naples, Italy, during a French Army invasion and the soldiers later spread the disease throughout Europe. The source of the disease may have been Spanish mercenaries serving the French king. Interestingly, the disease was much more lethal then than it is today, leading to certain death in a matter of months, unlike today.

Between this time and when the name syphilis became standard, the disease went by a variety of names that referred to the source of the disease in a neighboring country from which the disease was thought to have come from. Thus, in France it was mostly known as the Neapolitan disease. In Italy, Germany, Spain, and Great Britain, however, it was known as the French disease. But in the Low Countries, Portugal and North Africa, they called it the Spanish disease. In Russia is was the Polish disease and in Poland, the German disease. The Spanish name was el mal francés ‘the French disease’ or, using fancier synonyms, el morbo gálico ‘the Gallic sickness’.

Let us return now to the other human diseases caused by bacteria of the genus Treponema, which are nonvenereal infections that are spread by body contact. At least two of them are caused by subspecies of the species Treponema pallidum, namely Treponema pallidum endemicum, which causes bejel, and Treponema pallidum pertenue, which causes the contagious skin disease known as yaws. Both of these diseases affect the skin, but can go deeper and affect bone and internal organs. The third one is either another subspecies or a closely related species, Treponema carateum, and the disease it causes is known as pinta in both English and Spanish, among other names.

The first disease is known most commonly as bejel, in both English and Spanish, pronounced [ˈbɛ.ʤəɫ] or [ˈbeɪ̯.ʤəɫ] in English and [be.ˈxel] in Spanish. In English, it is also known as (nonvenereal) endemic syphilis and in Spanish as sífilis endémica or, more technically, treponematosis endémica no venérea. This disease is found primarily in arid regions of the eastern Mediterranean, the Middle East (Syria, Saudi Arabia, Iraq), the Saharan region of North Africa, and even southwest Asia. Thus, it is perhaps no surprise that the name bejel comes from Arabic, specifically Iraqi Arabic. The term bejel came into English and Spanish in the 1920s. This disease is contracted in childhood, showing typically as a minor lesions in the mouth that may go unnoticed and may go away by themselves. Later on, there may appear papular lesions of the trunk and extremities, periostitis of the leg bones, and gummatous lesions of the nose and soft palate (Sp. gomoso/a; cf. gumma above).[4]

The second, close cousin of syphilis is the disease known primarily as yaws in English, pronounced [ˈjɔz] or [ˈjɑz]. Other names that have been used in different contexts for the disease are frambœsia, Frambesia tropica, thymosis, polypapilloma tropicum, parangi, and bouba. The main Spanish name for this disease is pian, but other names, such as frambesia, have also been used at different times and in different contexts. This disease is found in equatorial regions, particularly in rural regions of Africa, Southeast Asia, and the Americas.

The name yaws is of uncertain origin, though it has been suggested that it comes from the extinct Carib language, in particular from the word yaya that means ‘sore’. The Spanish name pian is from a Tupian language spoken by the Tupi people (Sp. tupí) of South America. There are about 70 languages in the Tupi or Tupian language family, of which the best known is Guarani, a major language of Paraguay. As for the other names for the disease, the cognates Eng. frambœsia or frambesia [fɹæm.ˈbi.zɪ.ə] ~ Sp. frambesia, this is a Modern Latin word derived from French framboise ‘raspberry’ (cf. Sp. frambuesa). The reason for this name are the raspberry-like excrescences caused by this disease.

Yaws seems to have been around the longest of all these diseases. There is evidence from Homo erectus bones that yaws has been around for at least 1.6 million years. A later mutation from this bacterium was the source to the subspecies that causes bejel, and an even later mutation was the source that gave origin to syphilis.

Initially, yaws produces lesions that may break open and form ulcers. They go away after 3-6 months but then the bacterium begins to attack joints and bones. A second stage of the disease, which occurs months or even years later, results in various types of skin lesions. In about one tenth of those untreated, a tertiary stage may occur years later which results in bone, joint and soft tissue destruction that result in physical deformities.

Finally, there is another disease that is caused by what may be a different species, which has been termed Treponema carateum, though it is definitely related and perhaps also from the same species Treponema pallidum as syphilis, yaws, and bejel. The fact is that this bacterium and those that cause bejel and yaws are morphologically and serologically indistinguishable from Treponema pallidum pallidum that causes syphilis. This other disease, however, is merely a skin disease, which does not attack internal structures. The disease is known as pinta in both English and Spanish and it is endemic in the Caribbean and in Central and South America. It causes red, scaly lesions on the skin and it is transmitted by direct skin-to-skin contact through cuts and scratches.

Figure 144: Disfiguration from bejel or endemic syphilis.[i]

The name pinta comes from the Spanish adjective pinto/a that means ‘spotted’. It is a patrimonial word that comes from Vulgar Latin pĭnctus (fem. pĭncta) that means primarily ‘painted’, since it is the passive participle of the Vulgar Latin verb *pĭnctare ‘to paint, etc.’, source of Sp. pintar and Eng. paint. (The Classical Latin version of the verb was pingĕre, passive participle pictus, from which comes the derived noun pictūura, source of Eng. picture, cf. Sp. pintura ‘painting’.) Other names for this disease in Spanish are enfermedad azul ‘blue sickness’, carate (perhaps from Quechua or another South American indigenous language), empeines,[5] and mal del pinto. [6] English has also borrowed some of these Spanish names for the disease at different times, such as carate, a word that is present in at least one major English dictionary, namely Webster’s New Third International Unabridged Dictionary.

[1] According to the germ theory, diseases are caused by microorganisms. There was another precursor of this theory, namely the Roman scholar Marcus Varro in the first century BCE, but Fracastoro’s theory about the nature of contagion, infection, germs, and modes of disease transmission was much more developed. Although his theory was praised at the time it appeared, it was not tested and proved for three more centuries.

[2] Vicente Salvá was an excellent lexicographer who improved and fixed many of the errors in the Academy’s 1837 edition of its dictionary in his 1846 dictionary. Unfortunately, the Academy did not take Salvá’s improvements into account until much later.

[3] Another genus of the Spirochaetaceae family are the spirochete (spirochaete in British English), pronounced [ˈspaɪ̯.ɹǝ.kit] or [ˈspaɪ̯.ɹoʊ̯.kit]. The technical, Modern Latin term for this bacterium genus of the Spirochaetaceae family is Spirochæta (Sp. espiroqueta). Some English dictionaries seem to confuse the two terms and say that Treponema bacteria are from the genus Spirochæta, but they actually form their own genus.

[4] A papule, Sp. pápula, is ‘a small, solid, usually inflammatory elevation of the skin that does not contain pus’ (AHD). The word comes from Lat. păpŭla ‘pustule, pimple’.

The term periostitis refers to Inflammation of the periosteum (Sp. periosteo), ‘the dense fibrous membrane covering the surface of bones except at the joints and serving as an attachment for muscles and tendons’ (AHD).

[5] The word empeines or empeine is primarily the name for a skin disease, namely impetigo (see §34.3.39). The word comes from Vulgar Latin ĭmpedīgĭnem (nominative: ĭmpedīgo), from Lat. ĭmpetīgĭnem (nominative: ĭmpetīgo), ‘a scabby eruption on the skin, impetigo’. Note that there two other words empeine in Spanish, namely the one that means ‘groin’ and the one that means ‘instep (or foot or shoe)’. These last two words are derived from Lat. pĕcten (accusative pĕctĭnem), which primarily meant ‘comb’, but was also used to refer to pubic hair, the pubic bone (sharebone), and from there, perhaps also came to refer to the instep bone.

[6] The Spanish word pinto has also been borrowed into English for other things. In North America, the word can refer to a ‘a piebald horse’ (COED), that is, ‘a horse with patchy markings of white and another color’ (AHD), equivalent to mottled or pied. It is also used to describe a type of bean, ‘a speckled variety of kidney bean’ (COED). This latter use of the word only exists in the collocation pinto bean.

[i] Source:; public domain. Original caption: Disfiguring infiltration of the nose, glabella, and forehead with clustered nodules in left interciliary region of boy with endemic syphilis, Iran, 2010. (2018.05.18)

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