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Scabies Outbreak in the 14th Century: Clues from Correspondence Between Poets

woman scratching her inflamed neck

 

The deleterious effects of scabies, an infestation of the skin by the human itch mite Sarcoptes scabiei var. hominis, were well known in the Middle Ages. Here we report descriptions of medieval “itch” by Francesco Petrarca (1304-1374), called the “Father of Humanism,” and Giovanni Boccaccio (1313-1375), 2 eminent Italian poets who influenced further famous artists such as Shakespeare and Chaucer. Both of them suffered from scabies and emphasized the main features of the parasitic infestation, namely the endless itch and the skin dryness.

In 1365, Petrarca, who was aged 61, wrote to Boccaccio: “… I had and I still have, and I do not know how long it will torment me, a ugly and dry scabies, which is troublesome at all ages, but it is also dangerous at our age … Since five months, this illness oppresses me so much that the hands are prevented to use the pen and to take the food, but they serve only to scratch and scrape it … I certainly know only one thing about my illness, that it will soon leave me or I will leave it: we cannot be together for a long time.” Similarly, in 1373, Giovanni Boccaccio wrote to his friend Mainardo Cavalcanti: “… My long infirmity prevented me to write to you … I had and I still have a continuous and fiery itching and a dry scabies, to remove those arid scales and slag, there is just barely the assiduous nail at day and night … and after long scratching the scabies, the sleep is very sweet.”

Scabies is described by Petrarca as “dangerous at our age,” a statement that modern medicine has proven to be correct. The human itch mite is usually spread by direct, prolonged, skin-to-skin contact with a person who has scabies. The intense itching of scabies leads to scratching and produces skin sores; the sores sometimes become infected with bacteria such as Staphylococcus aureus or beta-hemolytic streptococci. The elderly, whose immune system is weakened, are at higher risk of complications, such as secondary skin infection or a severe form of scabies called crusted (Norwegian) scabies.

Communities of large populations lived in overcrowded cities in unsanitary conditions during the Middle Ages. Because close body contact was frequent, scabies could be easily passed, giving rise to outbreaks.1 The poets lived in different cities but reported the same disease. Their correspondence leads us to speculate that a scabies outbreak was spreading in central and northern Italy in the second half of the 14th century. It would not be so surprising that scabies’ bleeding lesions contaminated by the plague bacillus from infected bodies or animals may have further increased the number of deaths due to septicemic plagues peaking in Europe in that period.

Even in the age of effective treatment with permethrin and ivermectin, scabies still has social implications. Because of its association with sexual transmission and poor hygiene, shame and perceived stigmatization are very common. Similar to many other infectious diseases, prevalence and burden of scabies is highest in underprivileged communities. The disease is neglected and needs to be perceived as an important public health problem causing considerable morbidity in many resource-poor communities throughout the world.

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-Antonio Perciaccante, MD, Michele A. Riva, MD, PhD, Alessia Coralli, BS, Raffaella Bianucci, PhD

This article originally appeared in the October 2016 issue of The American Journal of Medicine.

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