imj_635.Reed.fm Internal Medicine Journal 2004; 34: 684–686 OCCASIONAL MEDICAL HISTORY SERIES The codpiece: social fashion or medical need? C. S. REED Sydney, New South Wales, Australia The male dress style of the higher classes of European society was revolutionised in the early years of the Renaissance. The codpiece was introduced into the male tunic. The codpiece had proportions that were at times grotesque, and so extreme that the question of the purpose of its use arises. Art gallery guides speculate that the codpiece represented a statement of the virility of the individual and could be looked on as a sex promotion object. This is clearly the impression gained from, for example Holbein’s portrayal of Henry VIII, arms akimbo, broad shouldered, groin thrust forward, the very epitome of a lusty male. The codpiece, however, may have been a disguise for underlying disease. Italy was the leader in many concepts of the new fashions in the Renaissance. For men, there was a change from the narrow-waisted vertical line to the more horizontal.1 Among the wealthier, the trend in the very late fifteenth century appears to be towards longer hose and shorter doublets leading to a space in which the male genitals may have been exposed if not covered. In Italy, assuming that paintings of the time accurately reflect the dress of the day, artists included the display of the codpiece as a dramatic element of male costume. In Italy, the codpiece was called a sacco and in France, a braguette. The common peasant was accustomed to wearing breeches, which were tied around the waist and are often illustrated as showing a gap in the anterior or genital area.2 The area appears to have been covered by a cloth garment. As early as 1460, Towneley described ‘a kodpese like a pockett’.3 Germanic soldiers, or the Lands- knecht,4 clearly show codpieces around 1530. The Swiss had the plunderhose, or devil’s pants, which were similar in appearance to the Germanic codpiece. Further examples of the codpieces amongst everyday peasants can be found in the sixteenth century and possibly has persisted, with a little more refinement, in the flap of the trousers of the Bavarian lederhosen. In many suits of armour the codpieces are visible, whether this was needed for protection, for outward display, or to disguise underlying disease is open to conjecture. In the suit of armour of King Henry VIII displayed in the Tower of London, the codpiece is extremely prominent. In England, in 1555, Eden, commented, ‘The men enclose their privic members in a gourde cutte after the fashion of a codde-piece’.3 Reginald Scot, in 1564, wrote ‘He made the young man untrusse his codpice point’.3 Shakespeare had references to codpieces,3 and even as late as 1648, Herrick, made an amusing comment about the codpiece still in use then among some men: ‘If the servants search, they may descry, in his wide codpiece, dinner being done, two napkins cramm’d up, and a silver spoone’.3 It has been assumed that the fashion of genital promo- tion was de rigeur, however, no thought appears to have been given to the possibility that the codpiece fashion developed because of necessity and not by whim. From 1495 onwards a pandemic of a new disease swept across Europe and was a great plague. The disease caused foul and large volumes of mixed pus and blood to be discharged from the genital organs and the swellings in the adjacent groin tissue. The mess would require bulky woollen wads and woven cloth bandages to be applied, distorting the whole of the genital area and the lower abdomen. The new disease was syphilis, and in all probability was not a new disease; there are descriptions of illnesses involving the fundamental findings for the diagnosis of syphilis from ancient times. These clinical essentials being an ulcer involving the genitals area, swelling of the adjacent groin tissues, the presence of pus discharge from the buboes, lack of sex bias, involvement of all generations, usually contracted by venereal contact. In the fifteenth century, the new disease appeared but some debate exists about where and when. Fulgusi described it in 1492, Pomarus witnessed the disease in Saxony in 1493 and Sprengle outlines that the disease existed in 1493 at Auvergne, Lombardy, Halle, Mark Brandenburg and Micklenburg.5 It was at the siege of Naples in 1495 by the French King Charles VIII, that the new disease found the circumstances favourable to proliferate and the disease’s virulence appears to have a reached a new high. It spread rapidly among the army and it is said that almost one- twentieth of the population suffered from the disease.6 It is clearly impossible to verify that these are true statistics, but enough to say that the disease is recognised by Correspondence to: Con Scott Reed, 18A/2 Brady Street, Mosman, NSW 2088, Australia. Email: conscott@ozemail.com.au Received 14 November 2003; accepted 28 November 2003. Funding: None Potential conflicts of interest: None The codpiece: fashion or medical need? 685 Internal Medicine Journal 2004; 34: 684–686 medical authorities as being a true virulent epidemic of major proportions. As Young writes about Charles and his further campaigns in Italy, ‘meantime his army, wasted by excesses in Naples, was rapidly dwindling by disease’.6 The concurrence in time of the Naples outbreak in 1495 later led to the theory that Christopher Columbus and his men had imported syphilis from America following their historic voyage of 1492. There exists virtually no evidence to support this supposition.6 The word syphilis was first used by the poet-physician Fracastor of Verona (1483–1553) in a poem published in 1530. In the 35 years immediately prior to this, the disease or other diseases manifesting similar symptoms and mistaken for it, had spread widely over Europe. The entomology of the word, syphilis, is uncertain but probably derives from the Greek words meaning swine and love. The hero of Fracastor’s poem was a swineherd or shepherd boy whose name was Syphilis who was affected by the disease, which now bears his name. Fracastor’s poem was translated into English in 1686 by Nahum Tate with the title: ‘Syphilis; or a poetical history of the French disease’. The Italians and Neapolians called syphilis the Mal Françoise, the English called it the French Pox, and the French called it the Mal de Naples. The Flemish named it the Spanish Pox and similar derogatory names were used in other countries if political mileage was to be made.5 Fracastor’s description of the disease published in 1546 tells of a disease of much greater virulence than that seen today in all except the rare malignant congen- ital syphilis. He states in part: Those affected were sad, weary, and cast-down; they were pale, most of them had sores on the genital organs … they were obstinate. When they were cured in one place, it appeared in another, and the treatment had to be recommenced. Afterwards pustules arose on the skin, covered with a crust; at first they were small; afterwards they increased to the size of an acorn, … in some cases the pustules were small and dry, in others large and moist; in some livid; in others whitish and rather pale; in others hard and reddish. They always broke in a few days, and constantly discharged an incredible quantity of stinking matter as soon as open; they were so many true phagedaenic ulcers, which destroyed not only the flesh, but even the bones. The poet/physician, Fracastor, continued: such were the symptoms of the disease at its commencement; but I speak of a past time, for now although the disease is still prevalent, it nevertheless appears to differ from what it was then, over the last 20 years [i.e. back to 1520] there were fewer pustules and more gummy tumours … a circumstance, which has astonished everybody, is the falling of the hair.5 This mutation in the virulence of syphilis is attested to by the other writers of the time and a wealth of literature existed to record that towards the end of the 16th Century, the epidemic form of the disease had virtually disappeared although smaller outbreaks are on record. The treatment of the disease was for the most part empirical with multiple agents applied locally, which along with the bulky dressings would give large frontal bulges, impossible to hide. The problem would present the tailors with a challenge that appears to have been met by them featuring the mass with the codpiece, while also appearing to advertise the wearer’s virility. The develop- ment of the codpiece worn by powerful and prominent leaders would not only solve the problem but also start a new fashion trend for the Court followers. The medical undergraduate of the pre-penicillin era were taught a ribald line about the treatment of syphilis: ‘One night with Venus, six months with Mercury’. Mercury was introduced into medicine by the Arab phys- icians,5 including the distinguished physicians Rhazes, Avicenna, Mesue and others. It was used for therapy against lice, impetigo, itch and other cutaneous eruptions. The empirical therapists were more vigorous in their application and because of their excesses, brought the drug into discredit. The patients, worn out by the toxic effects of mercury, may have died because of the therapy. The remedy became worse than the disease. The mercuric ion is corrosive: chronic poisoning could cause tremor, shaking of the tongue and lips and mental effects.7 The combination being well known to the hatter’s trade when terms such as ‘hatters shakes’ and ‘mad as a hatter’ are still used. The most commonly used topical ointment was a mixture of mercuric oxide and sulphide, cinnabar, which was a vivid scarlet in colour, and one of its draw- backs was the ‘staining of the linen’.8 Is it all surprising then that the codpieces were painted a vivid scarlet if indeed they were applying cinnabar ointment? Lombardy was an area with multiple independent duchies. It was essential that members of the noble families were seen regularly at their home courts. The times were politically turbulent with internecine violence commonly occurring between the city-states of Milan, Sienna, Mantua, Piacenza and Florence, to name but a few. Failure to be seen would bring rumours of death, kidnapping or changes of allegiance by the family member. Among the illustrations of the Italian codpieces, those painted by Bronzino9 are of great interest as they depict members of the Medici family and those closely related to them. Bronzino, a court painter to the Medici, was said to paint in a ‘cold calculated style’.9 Vasari, his friend, praises his portraits, as they are so lifelike and not given to flattery. He was the creator of the Court of Mannerism which dominated Florentine painting for more than half a century. Cosimo commissioned Bronzino to paint the portraits of all the Medici family; these now reside mainly in the Uffizi Gallery in Florence. To support a possibility of syphilis playing a part in the medical use of the codpiece, there should be evidence of family group showing premature deaths or insanity, and that the female members of the family may have had frequent miscarriages, or weak and sickly children. What more dysfunctional family could exist than that of Cosimo d’Medici and Eleanora de Toledo? They had 11 children in all. Maria was seemingly intelligent but died aged 16 from unknown cause. 686 Reed Internal Medicine Journal 2004; 34: 684–686 Lucrezia died at 17 from unknown cause. Francis was unstable and unenergetic but lived to the age of 46. Giovanni was made a Cardinal at age 13 and died of ‘malignant fever’ aged 19. Garzia died at 16 but had caused his parents some concern by his slow speech development and was ‘slightly backwards’ which was used to explain a vicious table-knife attack on his brother Giovanni. Pieto murdered his wife under barbaric circumstances when she was 22, but Isobella lived to 39 and Ferdinand was said to be capable and full of energy. A tragic family but for each death there appears to be a satisfactory explanation, contrived or real? The portrait of Cosimo de Medici I,10 painted by Pontormo (Jacobo Carucci 1494–1557) in approxi- mately 1537, was as an 18-year-old shortly after he had won a battle for the leadership of the Florentine State. The portrait is said to be the first example of his use of painting for the purpose of propaganda.11 He shows a prominent codpiece as also, and even more dramatically, was that shown in his cousin Guidobaldo della Rovere, Duke of Urbino, painted in 1532 when Bronzino was for a short time at Pesaro filling the role of court painter (Fig. 1).12 Cosimo had visited Naples in 1535, probably in the company of Alessandro de Medici: is it possible that he contracted syphilis on this trip whilst in the midst of the major outbreak area? Also closely connected with the Medicis was Ludovico Capponi, who was painted by Bronzino displaying a well-marked codpiece. Stefano Colonna, painted by Bronzino in 1546 was one of the leading condottiere of the sixteenth century and was appointed by Cosimo as lieutenant of his armies. The ‘Allegory with Venus and Cupid’ by Bronzino painted in the 1540s, now in the National Gallery, London, has been interpreted as a direct referral to the dangers of syphilis. Is it too much to suggest that he was intimately involved with this knowledge as the problem was present in the group among whom he worked? Once the fashion of a codpiece had been firmly estab- lished by the leaders of the day, many men may have followed suit solely to be in fashion. Codpieces did appear frequently amongst soldiers, however, are they followers or sufferers; fashion victims or disease victims? While many portraits of leaders of the time such as those of Francis I, Emperor Charles V and Henry VIII include codpieces, by the time of Queens Mary and Eliz- abeth of England, the fashion had disappeared. REFERENCES 1 Adam A, Black C. Ceremonial Costumes. London: Mansfield; 1980. 2 Black JA, Garland MW. A History of Fashion. New York: M. W. Morrow & Co.; 1975. 3 Burchfield RW, ed. The Oxford English Dictionary, 2nd edn. Oxford: Claredon Press; 1988. 4 Laver J. Concise History of Costume. London: Thames and Hudson; 1969. 5 Lancereaux E. A Treatise on Syphilis. London: The New Sydenham Society; 1868. 6 Young GF. The Medici. London: John Murray; 1909. 7 Isselbacher KJ, Adams RD, Braunwald E, Petersdorf RG, Wilson JD, eds. Harrison’s Principles of Internal Medicine, 9th edn. New York: McGraw-Hill Book Co; 1980. 8 Duhring LA. Diseases of the Skin. Philadelphia: Lippincott & Co.; 1881. 9 McCorquodale C. Bronzino. London: Jupitor Books; 1981. 10 Belloli A, ed. The Handbook of the J. Paul Getty Museum. Malibu, CA: J. Paul Getty Museum; 1991. 11 Lee D, ed. Themes and variations. Art Review 1994; 46: 44–5. 12 Baccheschi, ed. L’Opera Completa del Bronzino. Milan: Rizzoli; 1973. Figure 1 Ritratto di Guidobaldo della Rovere, Duke of Urbino (Bronzino, 1532).12 Reproduced with the kind permission of the Ministry of Arts and Cultural Activities, Italty. Any unauthorised use of the reproduced image in any form is prohibited.