We see from this that the syphilis of the fifteenth century did not present precisely the same symptoms as the variety of to day. Formerly secondary and tertiary accidents supervened much more rapidly, besides being very violent in their manifestations. Besides the disease was exceedingly malignant often causing, death in a short time, which fact led many authors of that epoch to consider the symptoms due to a pestilence brought about by general causes.[40] Nicholas Massa wrote in fact, that: “The patient has pains in the head, arms, and especially the legs, which are always intensified at night. The buboes in the two groins are salutary when they suppurate. We observe a chafed and scaly condition of the palms of the hands and soles of the feet. Ulcers of a bad appearance are frequently noted on the penis; these ulcers are hard and callous and very slow in healing. In exploring the throat we often discover a relaxed condition of the uvula and the presence of sordid ulcers, which rarely suppurate. With all this eruptive process we note certain hard tumors that adhere to the skin and bone and bear the name of _gummata_. These tumors may ulcerate and produce osseous caries.”[41] We notice the same errors in all the descriptions given by the authors of the sixteenth century; they exhibit an imperfect knowledge of the symptomatology, of the genesis and primitive constitutional accidents. We see that as yet clinical medicine had no existence, and that our predecessors were ignorant of the art of co-ordinating the signs of a disease in a thoughtful manner. Nevertheless, their descriptive powers in writing on venereal diseases, as before noted, were excellent, and had the merit of exactitude and honest observation; as, Pierre Manardi observes: “The principal sign of the French disease consists in pustules coming out on the end of the penis in men and at the entrance of vulva or neck of womb among women. Most frequently these pustules ulcerate; I say frequently for the reason that I have seen patients in whom these ulcers were hard as warts, cloves or apple seeds.” Here we have the aspect of primary syphilis presented by a physician whose name will, with justice, remain attached to the disease as long as it has a history. The secondary symptoms of the malady have never been more dramatically pictured than by Fernel, who remarks: “They had horrible ulcers on them, which might be mistaken for glands, judging from size and color, from which issued a foul discharge of a villainous infecting kind, enough to give a heart-ache; they had long faces of a greenish-black complexion, so covered with sores that nothing more hideous could be imagined.”[42] Relative to the duration of secondary symptoms, under date of 1495, Marcello de Cumes wrote from the camp of Novarro that “the pustules on the face, like those of leprosy and variola, lasted a year or more when the patient was not treated.”[43]