Syphilus is presented as the first man to contract the disease, sent by the god Apollo as punishment for the defiance that Syphilus and his followers had shown him. Did syphilis originated in llamas? Gestation lasts 350-360 days, and one cria (infant llama) is born to each female almost every year. To establish criteria for distinguishing among . [85] In 2020, a group of leading paleopathologists concluded that enough evidence had been collected to prove that treponemal disease, almost certainly including syphilis, had existed in Europe prior to the voyages of Columbus. The great variety of symptoms of treponematosis, the different ages at which the various diseases appears, and its widely divergent outcomes depending on climate and culture, would have added greatly to the confusion of medical practitioners, as indeed they did right down to the middle of the twentieth century. In the Middle Ages, however, that was not the case. A new study however, has scientists getting ready to rewrite the history . [1] There may also be sores in the mouth or vagina. The origin of syphilis and the llama myth The origin of syphilis and the llama myth Parish, Lawrence Charles; Ruocco, Vincenzo 1994-01-01 00:00:00 The history of syphilis is rampant with supposition, allegation and downright fabrication. [88] Progress on uncovering the historical extent of syndromes through aDNA remains slow, however, because the spirochete responsible for treponematosis is rare in skeletal remains and fragile, making it notoriously difficult to recover and analyze. [37], Blood tests are divided into nontreponemal and treponemal tests. [86] The study began in 1932, when syphilis was a widespread problem and there was no safe and effective treatment. [11] In particular, the reliance of King Charles VIII of France on mercenary troops (some of them Spanish) at the time of his attack on Naples in the winter of 1495 had led, most historians believed, to the dissemination of the highly contagious "French pox" throughout Europe when those troops returned home to their own countries. University of Naples, Naples, Italy. Vincenzo Ruocco, Vincenzo Ruocco. [33] In comparison to azithromycin for treatment in early infection, there is lack of strong evidence for superiority of azithromycin to benzathine penicillin G.[63], For neurosyphilis, due to the poor penetration of benzathine penicillin into the central nervous system, those affected are given large doses of intravenous penicillin G for a minimum of 10 days. [121][122] Since it was a disgraceful disease, the disease was known in several countries by the name of their neighbouring country. (2020), "Ancient Bacterial Genomes Reveal a High Diversity of Treponema pallidum Strains in Early Modern Europe. Research by Marylynn Salmon has provided examples of deformities in medieval subjects that can be usefully compared to those of modern victims of the disease in medical drawings and photographs. Llamas are polygynous. Tagliacozzi's technique was to harvest tissue from the arm without removing its pedicle from the blood supply on the arm. [11][12][13], Syphilis can present in one of four different stages: primary, secondary, latent, and tertiary,[2] and may also occur congenitally. 8-10 days after death the body turns from green to red as the blood decomposes and the organs in the abdomen accumulate gas. This caused a fall in the prevalence of syphilis, leading to almost a halving of tabes dorsalis between 1914 and 1936. Syphilis causes bones to deform and leaves behind scars after the person has died. Research by Marylynn Salmon has demonstrated that deformities in medieval subjects can be identified by comparing them to those of modern victims of syphilis in medical drawings and photographs. [92] The disease reached London in 1497 and was recorded at St Batholomew's Hospital as infected 10 out of the 20 patients. Averill: Syphilis is caused by the bacterium Treponema Pallidum. [33] This theory is supported by genetic studies of venereal syphilis and related bacteria, which found a disease intermediate between yaws and syphilis in Guyana, South America. [33][36], The first well-recorded European outbreak of what is now known as syphilis occurred in 1495 among French troops besieging Naples, Italy. [46] Point-of-care testing to detect syphilis appeared to be reliable although more research is needed to assess its effectiveness and into improving outcomes in mothers and babies. The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease. Before the invention of the free flap, only local tissue adjacent to the defect could be harvested for use, as the blood supply was a vital determining factor in the survival of the flap. "The Changing Identity of the French Pox in Early Renaissance Castile." Syphilis swept across Europe in short order. (Eds. [100] At the time the causative agent was unknown but it was well known that it was spread sexually and also often from mother to child. Now, a team of scientists has examined nine skeletons with suspected syphilis from five archaeological sites in Finland, Estonia, and the Netherlands. [1][6] Other diseases caused by Treponema bacteria include yaws (T. pallidum subspecies pertenue), pinta (T. carateum), and nonvenereal endemic syphilis (T. pallidum subspecies endemicum). Expert Answers: You can use the >> operator. Where did syphilis come from? Many of the crew members who served on this voyage later joined the army of King Charles VIII in his invasion of Italy in 1495, which some argue may have resulted in the spreading of the disease across Europe and as many as five million deaths. [98]:208209 According to a 2020 study, more than 20% of individuals in the age range 1534 years in late 18th century London were treated for syphilis. The ability to sequence the entire genome is especially important for distinguishing among syndromes of treponematosis because of their close similarity. The first recorded outbreak of syphilis in Europe occurred in 1494/1495 in Naples, Italy, during a French invasion. [45], Until that time, as Fracastoro notes, syphilis had been called the "French disease" (Italian: mal francese) in Italy, Malta,[46] Poland and Germany, and the "Italian disease" in France. Therefore, they argue, treponematosis possibly including syphilisalmost certainly existed in medieval Europe. Llamas generally mate in late summer and early autumn. [20] Lesions may be painful or tender (30%), and they may occur in places other than the genitals (27%). These weren't syphilis as we know it today.. [2] This stage is characterized by the formation of chronic gummas, which are soft, tumor-like balls of inflammation which may vary considerably in size. 1527) similarly observed that syphilis was known there as "the disease of the magnates". ", Grin, E. I. "Historical Approach to the Terminology of Syphilis. Of these men, 399 had contracted syphilis before the study began, and 201 did not have the disease. The victim died in the 13th century. The same group of researchers later discovered the related organo-arsenical, Neosalvarsan. In. Highlights of this important literature include: While the absolute number of cases is still small, they keep turning up, most recently in 2015 in London and St. Plten, Austria. [6] Two-thirds of syphilitic infants are born without symptoms. The scientific name for a pig is Sus domesticus. [2] These three diseases are not typically sexually transmitted. Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Involvement of the central nervous system in syphilis (either asymptomatic or symptomatic) can occur at any stage of the infection. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. "Endemic syphilis in Bosnia: Clinical and epidemiological observations on a successful mass-treatment campaign. The aim of treatment was to expel the foreign, disease-causing substance from the body, so methods included blood-letting, laxative use, and baths in wine and herbs or olive oil. By 1947, penicillin had been shown to be an effective cure for early syphilis and was becoming widely used to treat the disease. In, Arrizabalaga, J. [21], Latent syphilis is defined as having serologic proof of infection without symptoms of disease. Its association with sex, especially sexual promiscuity and prostitution, made it an object of fear and revulsion and a taboo. Similarly, in Eastern Europe it was called "the malady of palaces". Contact tracing was also introduced. This will append data from a command to the end of a text file. [31], Syphilis is transmitted primarily by sexual contact or during pregnancy from a mother to her baby; the spirochete is able to pass through intact mucous membranes or compromised skin. The Columbian or New World theory states that syphilis was intro- duced into Europe on the return of Colum- bus in 1493. The most recent and deadliest STI to have crossed the barrier separating humans and animals has been HIV, which humans got from the simian version of the virus in chimpanzees. ", ejkov, D., Zobankov, M., Chen, L., Pospilov, P., Strouhal, M., Qin, X., majs, D. (2012). ", Arrizabalaga, Jon. Doctors infected soldiers, prisoners, and mental patientaswith syphilis and other sexually transmitted diseases, without the informed consent of the subjects, and then treated them with antibiotics. [23][26] The latent phase of syphilis can last many years after which, without treatment, approximately 15-40% of people can develop tertiary syphilis. Roberts, C. A. There is no doubt that treponematosis existed in the Americas long before contact with the Europe and Afro-Eurasia. [54] This means health care providers are required to notify public health authorities, which will then ideally provide partner notification to the person's partners. The Russians blamed the Polish. In O. Dutour, et al. Some researchers argue that syphilis was carried from the New World to Europe after Columbus' voyages, while others argue the disease has a much longer history in Europe. The location with the highest prevalence was London, at 11.373%, and the social class with the highest prevalence was unskilled working-class, at 11.781%. [25] Two years after the original infection the person will enter late latent syphilis and is not as infectious as the early phase. [6] If untreated, late congenital syphilis may occur in 40%, including saddle nose deformation, Higoumnakis' sign, saber shin, or Clutton's joints among others. (2018). [2], Cardiovascular syphilis usually occurs 1030years after the initial infection. [2] It is recommended that a treated person avoid sex until the sores are healed. During the 20th century, as both microbiology and pharmacology advanced greatly, syphilis, like many other infectious diseases, became more of a manageable burden than a scary and disfiguring mystery, at least in developed countries among those people who could afford to pay for timely diagnosis and treatment. The story about sheep or dogs or llamas is false.unprotected sex [57], Another 16th-century treatment advocated by the Italian physician Antonio Musa Brassavola was the oral administration of Root of China,[57] a form of sarsaparilla (Smilax). [2][17], Dark field microscopy of serous fluid from a chancre may be used to make an immediate diagnosis. [111][112] Whereas the purpose of this study was to observe the natural history of untreated syphilis; the African-American men in the study were told they were receiving free treatment for "bad blood" from the United States government. where did syphilis come from llamas. [57] A "Fumigation" method of administering mercury was also used, in which mercury was vaporized over a fire and the patients were exposed to the resulting steam, either by being placed in a bottomless seat over the hot coals, or by having their entire bodies except for the head enclosed in a box (called a "tabernacle") that received the steam. "A probable case of congenital syphilis from pre-Columbian Austria. The richly colored and detailed work depicts four servants preparing the concoction while a physician looks on, hiding something behind his back while the hapless patient drinks. [28] Late symptomatic neurosyphilis can develop decades after the original infection and includes 2 types; general paresis and tabes dorsalis. [51], Syphilis is a notifiable disease in many countries, including Canada,[52] the European Union,[53] and the United States. The side-effect profile of Neosalvarsan is gentler and its storage and preparation were more convenient than those of Salvarsan, which must be stored under nitrogen. [55] Giorgio Sommariva of Verona is recorded to have used mercury to treat syphilis in 1496, and is often recognized as the first physician to have done so, although he may not have been a physician. [33] This is mainly because the bacteria die very quickly outside of the body, making transmission by objects extremely difficult. Felix Milgrom developed a test for syphilis. The association of saddle nose with men perceived to be so evil they would kill the son of God indicates the artists were thinking of syphilis, which is typically transmitted through sexual intercourse with promiscuous partners, a mortal sin in medieval times. [2], It is not generally possible to contract syphilis through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing. suis infection, isolated from the joint fluid of a five month old lame alpaca, between 2000 and 2015. [20] Neurosyphilis is diagnosed by finding high numbers of leukocytes (predominately lymphocytes) and high protein levels in the cerebrospinal fluid in the setting of a known syphilis infection. The difference between rural and urban populations was first noted by Ellis Herndon Hudson, a clinician who published extensively about the prevalence of treponematosis, including syphilis, in times past. Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. [1][2], Syphilis is most commonly spread through sexual activity. In Scotland, syphilis was referred to as the Grandgore or Spanyie Pockis. [2] The most common complication is syphilitic aortitis, which may result in aortic aneurysm formation. What disease did llamas have? Ancient DNA (aDNA) holds the answer, because just as only aDNA suffices to distinguish between syphilis and other diseases that produce similar symptoms in the body, it alone can differentiate spirochetes that are 99.8 percent identical with absolute accuracy. How Did People Get Syphilis Sheep. [21][24] Many people who present with secondary syphilis (4085% of women, 2065% of men) do not report previously having had the classical chancre of primary syphilis. The Dutch called it the "Spanish/Castilian disease". [76], Paleopatholgists have known for decades that syphilis was present in the Americas before European contact. [citation needed] However, the name is misleading, as smallpox was a far more deadly disease. In adulthood, people infected as children had a certain degree of immunity that prevented serious symptoms upon reinfection. The main theory is from the Naples outbreak in 1494 when Columbus came across it on one of his voyages. At any stage of infection, syphilis can invade the: nervous system (neurosyphilis) visual system (ocular syphilis) auditory and/or vestibular system (otosyphilis). [27], Tertiary syphilis may occur approximately 3 to 15 years after the initial infection, and may be divided into three different forms: gummatous syphilis (15%), late neurosyphilis (6.5%), and cardiovascular syphilis (10%). [25] Early latent syphilis is infectious as up to 25% of people can develop a recurrent secondary infection (during which spirochetes are actively replicating and are infectious). [17], Because of the possibility of false positives with nontreponemal tests, confirmation is required with a treponemal test, such as treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs). Support us Print subscriptions US edition (2020) "Advancing the Understanding of Treponemal Disease in the Past and Present.". [20] The most common location in women is the cervix (44%), the penis in heterosexual men (99%), and anally and rectally in men who have sex with men (34%). [28] [62] In the seventeenth century, English physician and herbalist Nicholas Culpeper recommended the use of heartsease (wild pansy). In 2020, a group of leading paleopathologists concluded that enough evidence had been collected from bones and teeth to prove that treponemal disease existed in Europe prior to the voyages of Columbus. [14][74][75], Left untreated, it has a mortality rate of 8% to 58%, with a greater death rate among males. Hilariously, though, Incas did have (or perceived themselves to have) a problem with llama-banging. Early symptoms include rashes, aches, fever, and hair loss. "The origin and antiquity of syphilis: Paleopathological diagnosis and interpretation. (The fourth of the treponemal diseases is Pinta, a skin disease and therefore unrecoverable through paleopathology.) [29] The three main dental defects in congenital syphilis are Hutchinson's incisors (screwdriver shaped incisors), Moon's molars or bud molars, and Fournier's molars or mulberry molars (molars with abnormal occlusal anatomy resembling a mulberry). [27] One of the most typical deformities of treponematosis is a collapsed nasal bridge called saddle nose, usually accompanied by baldness. 3-5 days after death the body starts to bloat and blood-containing foam leaks from the mouth and nose. The first recorded outbreak of syphilis in Europe occurred in 1494/1495 in Naples, Italy, during a French invasion. Despite significant progress in tracing the presence of syphilis in past historic periods, definitive findings from paleopathology and aDNA studies are still lacking for the period before Columbus. Artificial noses were sometimes used to improve this appearance. [20] Two other tests can be carried out on a sample from the chancre: direct fluorescent antibody (DFA) and polymerase chain reaction (PCR) tests. [28] Significantly, bejel and yaws were endemic in rural, underdeveloped communities such as those of peasants medieval Europe. [90] One of the most typical deformities, for example, is a collapsed nasal bridge called saddle nose. What animal did syphilis come from? These herbivorous pack animals are not uncommon in the South American continent, where they may be found in Peru, Ecuador, Argentina, Bolivia, and Chile, among others. Paris, France: ditions Errance. [94][95] In Great Britain it was also called the "Great Pox". The Columbian Exchange: The Columbian Exchange mainly occurred during the 16th, 17th, and 18th centuries and refers to the cultural exchange that occurred between Africa, Europe, and the Americas after the arrival of Christopher Columbus in 1492. [47][failed verification], During the 16th century, it was called "great pox" in order to distinguish it from smallpox. "A pre-Columbian case of congenital syphilis from Anatolia (Nicaea, 13th century AD).". For the time, it was "front page news" that was widely known among the literate. [2][14] If a person is allergic to penicillin, ceftriaxone may be used or penicillin desensitization attempted. Others show the deformed teeth associated with congenital syphilisHutchinsons incisorsor the eye deformity ptosis that often appears in victims of the disease. Males gather a harem of around 6 females into their territorial area and then drive away aggressively all other males of breeding age which come into the area. [91], The first written records of an outbreak of syphilis in Europe occurred in 1495 in Naples, Italy, during a French invasion (Italian War of 149498). [14] Rates of syphilis among US women have remained stable during this time, while rates among UK women have increased, but at a rate less than that of men. Meningovascular syphilis involves inflammation of the small and medium arteries of the central nervous system. What animal did syphilis come from? "[42], Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treating those who are infected. Syphilis also came to humans from cattle or sheepmany centuries ago, possibly sexually". Sexually transmitted diseases (STDs) are on the rise in the U.S., to the point where even senior citizens are seeing upswings in infections. [46][47] If they are positive, it is recommended their partners also be treated. The genetic sequence of Treponema pallidum was deciphered by Claire M. Fraser and colleagues in 1998, and success in analyzing a 200-year-old example extracted from bones by Connie J. Kolman et al. Syphilis is part of a category of diseases known as treponemal disease, a group that also includes yaws, a skin infection found in tropical parts of South America, Asia, and Africa; the Chiu Chiu. [78] The situation in Europe and Afro-Eurasia has been murkier and caused considerable debate. In 1770s London, approximately 1 in 5 people over the age of 35 were infected with syphilis. Other historical names have included "button scurvy", sibbens, frenga and dichuchwa, among others. In its early stages, the great pox produced a rash similar to smallpox (also known as variola). [14] At least fifteen cases of acquired treponematosis based on evidence from bones, and six examples of congenital treponematosis based on evidence from teeth, are now widely accepted as ancient or medieval. Often they died of the disease, as did their children who were infected with congenital syphilis. [103] To the Turks it was known as the "Christian disease", whilst in India, the Hindus and Muslims named the disease after each other. These "national" names were generally reflective of contemporary political spite between nations and frequently served as a sort of propaganda; the Protestant Dutch, for example, fought and eventually won a war of independence against their Spanish Habsburg rulers who were Catholic, so referring to Syphilis as the "Spanish" disease reinforced a politically useful perception that the Spanish were immoral or unworthy. [2], Gummatous syphilis or late benign syphilis usually occurs 1 to 46 years after the initial infection, with an average of 15years. The Spanish physician Gaspare Torrella (14521520), who treated several members of the papal court, including Cesare Borgia, wrote that in southern Spain the disease he called "pudendagra" was already known as morbus curialis because of its association with the court. [20], As of 2018[update], there is no vaccine effective for prevention. [2] Treatment at this stage solely limits further progression of the disease and has a limited effect on damage which has already occurred. [23] Its infectivity is exemplified by the fact that an individual inoculated with only 57 organisms has a 50% chance of being infected. Search with google. Meningovascular syphilis involves inflammation of the small and medium arteries of the central nervous system. [14] This has been attributed to unsafe sexual practices, such as sexual promiscuity, prostitution, and decreasing use of barrier protection. 1819 J.F. (1994). [14] Several vaccines based on treponemal proteins reduce lesion development in an animal model but research continues. "The Changing Identity of the French Pox in Early Renaissance Castile." In October 2010, the U.S. formally apologized to Guatemala for conducting these experiments. The early stage of syphilis usually causes a single, small, painless sore. (1988). [61] Resistance to macrolides, rifampicin, and clindamycin is often present. Syphilis, in contrast, generally was transmitted by venereal sores holding a massive inoculation of Treponema pallidum. [44] The United States Preventive Services Task Force (USPSTF) strongly recommends universal screening of all pregnant women,[45] while the World Health Organization (WHO) recommends all women be tested at their first antenatal visit and again in the third trimester. [2][36] Blood tests are more commonly used, as they are easier to perform. According to the "Columbian" theory, the crews of Columbus brought the disease . Pigs: Pigs are a species of mammal that are widely consumed as food by humans. Despite the tradition of assigning the homeland of yaws to sub-Saharan Africa, Crosby notes that there is no unequivocal evidence of any related disease having been present in pre-Columbian Europe, Africa, or Asia. [2] The symptoms of syphilis have become less severe over the 19th and 20th centuries, in part due to widespread availability of effective treatment, and partly due to virulence of the bacteria. [38] From this centre, the disease swept across Europe. Last edited on 26 February 2023, at 23:13, European Journal of Clinical Microbiology & Infectious Diseases, "9,900-year-old skeleton of horribly disfigured woman found in Mexican cave", "New evidence for an early settlement of the Yucatn Peninsula, Mexico: The Chan Hol 3 woman and her meaning for the Peopling of the Americas", https://doi.org/10.1525/aa.1965.67.4.02a00020, https://doi.org/10.1371/journal.pntd.0001832, https://doi.org/10.1371/journal.pntd.0003261, https://doi.org/10.1371/journal.pntd.0006447, https://theconversation.com/manuscripts-and-art-support-archaeological-evidence-that-syphilis-was-in-europe-long-before-explorers-could-have-brought-it-home-from-the-americas-182114, "The Science Behind Pre-Columbian Evidence of Syphilis in Europe: Research by Documentary", "On the Origin of the Treponematoses: A Phylogenetic Approach", "Molecular studies in Treponema pallidum evolution: toward clarity? [112] Medical care, hot meals and free burial insurance were given to those who participated. [82] It argues that treponemal disease in the form of bejel and yaws was a common childhood ailment in Europe and Afro-Eurasia beginning in ancient times. Damaged teeth and bones may seem to hold proof of pre-Columbian syphilis, but there is a possibility that they point to an endemic form of treponemal disease instead. [3] There are two primary hypotheses: one proposes that syphilis was carried to Europe from the Americas by the crew(s) of Christopher Columbus as a byproduct of the Columbian exchange, while the other proposes that syphilis previously existed in Europe but went unrecognized. Marta Mirazon Lahr [2][32] Approximately 30% to 60% of those exposed to primary or secondary syphilis will get the disease. "Treponematosis in an ancient Greek colony of Metaponto, southern Italy, 580-250 BCE." Initially known as morbus gallicus (the French Disease), it soon became epidemic throughout Europe. 24-72 hours after death the internal organs decompose. [20] Lymph node enlargement frequently (80%) occurs around the area of infection,[2] occurring seven to 10days after chancre formation. The Llama's Natural Habitat Somewhat later, when the significance of the Western Hemisphere was perceived, it has been used in both pro- and anti-colonial discourse. ", Harper, K. N., Zuckerman, M. K., Harper, M. L., Kingston, J. D., Armelagos, G. J. The first magic bullet was fired at syphilis on this day in 1909. [10][20] Three other human diseases are caused by related Treponema pallidum subspecies, including yaws (subspecies pertenue), pinta (subspecies carateum) and bejel (subspecies endemicum). ", Majander, K., Pfrengle, S., Kocher, A., , Khnert, D., Krause, J., Schuenemann, V. J. [86] At least fifteen cases of acquired treponematosis based on evidence from bones, and six examples of congenital treponematosis based on evidence from teeth, are now widely accepted. Such a difference would have been politically dangerous to elites, especially if it became known that they were responsible for spreading syphilis. "The Changing Identity of the French Pox in Early Renaissance Castile." Nature Transformed is an interactive curriculum enrichment service for teachers, offering them practical help in planning courses and presenting rigorous subject matter to students. [53] The Canon of Medicine (1025) by the Persian physician Ibn Sina suggested treating early stages of leprosy with mercury; during an early European outbreak of the disease, Francisco Lopez de Villalobos compared this to syphilis, though he noted major differences between the diseases. [57] The goal of mercury treatment was to cause the patient to salivate, which was thought to expel the disease. [50] The USPSTF also recommends screening among those at high risk. These are referred to as the "Columbian" and "pre-Columbian" hypotheses.[9]. By 1911, the figure for London was 11.4 per cent, about half that of the 1770s. Lawrence Charles Parish, Lawrence Charles Parish. [6] During 2015, it caused about 107,000 deaths, down from 202,000 in 1990. An antimicrobial used for treating disease was the organo-arsenical drug Salvarsan, whose anti-syphility properties were discovered in 1908 by Sahachiro Hata in the laboratory of Nobel prize winner Paul Ehrlich. Syphilis got its name from a poem written by a Renaissance scholar in the 1500s. Did syphilis originated in llamas? [62] Doxycycline and tetracycline are alternative choices for those allergic to penicillin; due to the risk of birth defects, these are not recommended for pregnant women. ), Cole, G. and T. Waldron (2011) "Apple Down 152: a putative case of syphilis from sixth century AD Anglo-Saxon England. When it begins: The latent stage of syphilis begins after the rash and other signs and symptoms clear. [81] Brant also created artistic creations showing religious and political views of syphilis, especially with a work showing Saint Mary and Jesus throwing lightning to punish or cure those afflicted by syphilis, and he also added Holy Roman Emperor Maximilian I in the work, being rewarded by Mary and Jesus for his work against the immoral disease, to show the strong relationship between church and state during the 16th and 17th centuries.[82].