Erysipelas over the centuries: notes from the history of popes

Abstract

In 2020, international media reported that the Emeritus Pope Benedict XVI (Joseph Ratzinger) appeared to be seriously ill, after travelling to Germany in the summer. The former pope was said to suffer from erysipelas of the face with recurrent episodes of acute pains. This skin infection is most common in elderly adults [1], so it comes as no surprise that it could affect the longest-living pope, Benedict XVI who recently turned 93. The Vatican plays down these rumors, without denying the disease. We are unable to confirm the alleged erysipelas of Pope Ratzinger, but the news could be an opportunity to make some historical considerations on erysipelas, analyzing other cases of popes who had suffered from this condition over the centuries. Indeed, analysis of diseases that affected famous people in the past could provide unexpected information on the evolution of medical knowledge regarding some pathologies [2, 3]. Erysipelas was a common skin infection in past times and it could affect people belonging to different social classes, including sovereigns, clergy and noblemen. The history of the Roman Catholic Church reported some cases of popes who suffered from this condition. On 16 January 1691, after three years of reign, Pope Alexander VIII (Pietro Vito Ottoboni, 1610–1691) suddenly suffered from redness and pain in the right leg—which had been already swollen for several months—and had a rise in body temperature. The personal surgeon of the pope incised the leg, releasing purulent material. Subsequently the wound was treated with an emulsifying ointment based on manna (succus fraximi) and with 20 grains of bezoar, which was believed to have the power of absorbing malignant humors.4 Bezoar stones were indeed considered as a universal antidote against any poison. The treatment did not have the desired effect and gangrene set in so that Alexander VIII died after 17 days, on 1 February. On the following day, the necroscopy performed by the surgeon Ippolito Magnani showed that the erysipelas had progressed rapidly, causing a massive gangrene of the right leg, blood clots, bowel gangrene, and pulmonary purulent degeneration [4]. Gregory XVI (Mauro Cappellari, 1765–1846) was another famous case of a pope died of erysipelas. He used to take long walks, although he often suffered from swelling of the lower limbs, perhaps due to chronic venous insufficiency or as a sign of chronic heart failure. On 25 May 1846, after a 3-hour walk, the pope’s left leg began to redden and to swell; at the same time fever appeared. Within two days, the infection spread to the entire leg and on 1 June, Gregory XVI died [5]. The necroscopy only evidenced unspecified pulmonary lesions, in addition to the infection of the leg [5]. Occlusive footwear, skin trauma and infected venous ulcer could be the origin of the erysipelas that affected Pope Cappellari. This brief historical note reported two examples of popes who died for complications caused by erysipelas. Both Alexander VIII and Gregory XVI were 81 years old, which agrees with our knowledge that erysipelas predominantly affects the elderly. The case of Alexander VIII indicates that during the seventeenth century the treatment of this skin infection was mainly based on surgical incision. The use of bezoar stones—believed as a counter-poison in that period— confirmed that ancient physicians considered purulent components of erysipelas to be a poison. They were aware that the spreading of corrupt and malignant humors through the bloodstream could cause the death. The case of Gregory XVI showed a more conservative approach in the treatment of erysipelas during the nineteenth century, avoiding incision and surgery. Although medicine had evolved from the time of Alexander VIII, abandoning the use of “magic” remedies (bezoar, manna), the evolution of the disease was, however, rapid and fatal, even in the case of Pope Cappellari. Only the advent of antibiotics and antimicrobial drugs has allowed keeping this disease under control, even if it continues to be a widespread pathology among the elderly, * Michele Augusto Riva [email protected]