“The most harmful popular misconceptions”: Petechial Fever and Charlatanry in nineteenth-century Italy
Lea-Marie Trigilia
In 1817, an Italian physician named Giovanni Paganini wrote a letter to a parish priest concerning petechial fever and the most effective measures to counteract it. This letter, published under the title Lettera d’un medico di Citta’ ad un parroco di Campagna su la Febbre Petecchiale e i sui preservativi in contro di essa (Engl.: “Letter from a City Doctor to a Countryside Parish Priest on Petechial Fever and the Preventive Measures Against It”) was originally written in response to the clergyman’s request as to how to best manage the outbreak epidemic.1 The subject and importance of the correspondence ought to be viewed against the backdrop of a series of fever outbreaks that affected the entire European region in the early decades of the nineteenth century, their spread and toll exacerbated by the movement of peoples caused by the Napoleonic Wars2 as well as the famines brought about by the so-called “year without a summer” in 1816.3 In the literature, these events are described as a “long series of crises” that culminated in 1817,4 which has been branded as “l’anno del tifo petecchiale” (“the year of petechial typhus”),5 one of the many febrile illnesses that are of interest to our project and will be the concern of this article.
As is often the case with many historical disorders, but particularly febrile ones, it is rather difficult to pin down exactly what ‘petechial fever’ was, because different physicians had divergent definitions of the disease, its symptomatology, and aetiology. This is especially symptomatic for the period in question, when a plethora of types and variations of fever(s) coexisted. The concept of ‘fever’ was at times considered a disease in its own right, and at others, as an ‘order’ of disease in the era’s categorisations. Giovanni Capsoni, another physician writing about the petechial fever of 1817, for example, speaks of different types of this disease depending, among other things, on the type of fever that presented itself as a symptom during the course of the illness.6
Our Dr Paganini, in turn, does not devote much space to the nature of the illness in his letter. He is certain that both his addressee and the general public, to whom the information provided in the document was intended for, were so familiar with the disease in question that he rendered it “useless” (“inutile”) to further address the subject.7 In addition to outlying the measures to counteract petechial fever, he is mainly concerned with describing the “most harmful popular misconceptions” regarding its cure and prevention – those which must be combated (“le false opinioni popolari più dannose da combattere”).8 This declaration of war not only applied to popular beliefs regarding the nature and origin of the fever, but also to a specific group of people: ciarlatani, or charlatans, who, Paganini states disdainfully, “mainly in times of epidemic open their shops and do their business” (“[e]gli è principalmente nell’epoche sciagurate d’epidemie che i Ciarlatani aprono le loro botteghe e fanno bene i fatti loro”).9 In this respect, this source is highly interesting for our research on the history of fever(s), mainly for questions that go beyond their nature, classification, and frequency.
![Giovanni Paganini, Lettera d’un medico di Citta’ ad un parroco di Campagna su la Febbre Petecchiale e i sui preservativi in contro di essa, Milan 1817, [Bibl. Alessandrina: XIII d 50 e].](https://backend.hist.uni-heidelberg.de/sites/default/files/styles/img_free_aspect_0005/public/2025-08/2025-06-20_16.34.00.jpg?itok=dU5pyI0o)
Especially this last quotation brings into evidence the tension-filled relationship between formally educated physicians (in this case, Giovanni Paganini) and ‘popular’ medical practices and remedies (embodied here, partly, by the so-called ‘ciarlatani’). This dichotomy, though, is a rather tricky one to name or determine, particularly when speaking of the past. As the historian David Gentilcore put it in his seminal, in-depth study of ‘charlatans’ in early modern Italy, concepts such as ‘formal’ or ‘popular’ can be anachronistic, misleading, or plainly inaccurate. He instead opts for the medical anthropological model of ‘formal’ vs. ‘informal’ medicine, since this focuses not on divergence, but rather on practices and reception.10
Finding a precise definition or veracious representation of what a charlatan historically was is equally tricky, since most surviving documents reflect the rather hostile attitude towards them. While in the early modern period charlatans enjoyed a mixed reputation among learned physicians,11 the transition from Galenic to ‘modern medicine’ of the eighteenth century was finalised at the time of the petechial outbreaks in Europe.12 The concomitant professionalisation and tougher regulation of medical practice led to formally trained doctors having a better position vis-à-vis the rest of the medical marketplace, which consequently led to an ousting of charlatans.13 This fostered the fixation of a demarcation line between ‘formal’ and ‘informal’ medicine and accounts for the antagonistic undertone we encounter among medics in the early nineteenth century,14 our own Giovanni Paganini being no exception.
He insinuates, for one, that charlatans were mainly professionally motivated by greed, and a certain degree of malice, stating that they “would like an epidemic to break out every new moon so that they can sell their preservatives and enrich themselves at the expense of the poor people, who […] have always been the laughing stock of these impostors.”15 It goes without saying that this discreditation of the charlatan’s profession widely contributed to the construction of the learned physicians’ reputation,16 here, for example, implying that, unlike charlatans, they were not financially motivated to exercise their vocation and would never treat their patients with such dishonesty. The aforementioned consolidation of the medical profession around this time accounts also for the confident tone that Paganini employs when criticising the countryside charlatans.
Beyond such disputes and tensions, studying the phenomenon of charlatans is essential within the history of science and medicine. As the historian-anthropologist Irina Podgorny put it, “[charlatans] actually represent one of the many phenomena deeply rooted in European medical traditions and in the continuous transfer of objects and therapies between all continents.”17 Furthermore, informal medicine played an important role with the ‘common people’, especially since during this period of institutionalisation, charlatans were relegated more and more to rural areas.18 This serves as an explanation for the preoccupation of the countryside parish priest (the “parroco di campagna”), who seeks the help of the city doctor Paganini (the “medico di città”). It also tells us what learned doctors thought of the ‘common people’, described by Paganini as “naturally fond of wonderful things” (“amante per natura delle cose meravigliose”) which are “easier to perform, despite the wise and prudent advice of enlightened doctors” (“più facili ad eseguirsi, sprezza i consgli saggi e prudenti de’ Medici illuminati”).19 The promise of a quick cure guaranteed by charlatans was seductive to the general public.
Resorting to Gentilcore once again, charlatans’ remedies “have a history that is intimately intertwined with that of ‘official’ medicine”.21 Examining them can help us better assess the history of fevers as well as the medication and preventive measures that were used to avert and/or treat them. The therapeutics against petechial fever which the erudite medics disapproved of, and with which charlatans made their money were, among surely many others, “garlic, rue, camphor, musk, cinchona, brandy, wine, vinegar known as ‘four thieves vinegar’, to be taken internally or used externally, […] or similar drugs, to be worn on the chest or hung around the neck, and superstitious use of certain amulets”.22 The worst of such preservatives were the “stimulants, such as spirits, camphor, musk, cinchona, wine, and the like” (“in mezzo a tutti i preservativi appartengono alla classe degli stimolanti, quali sono i liquiri spiritosi, la canfora, il muschio, la china, il vino e simili”). When taken against petechial fever, they would have a counterproductive effect, predisposing the body “to inflammatory diathesis and make the disease much more serious in the event of infection” (“che predispongono il corpo alla diatesi infiammatoria, e rendono più grave assai la malattia nel caso in cui si abbia preso il contagio”).23 Paganini himself, in turn, opted for letting the illness take its course while treating the “dangerous symptoms” (“moderarne i sintomi pericolosi”).24
![Giovanni Paganini, Lettera d’un medico di Citta’ ad un parroco di Campagna su la Febbre Petecchiale e i sui preservativi in contro di essa, Milan 1817, [Bibl. Alessandrina: XIII d 50 e], p. 10.](https://backend.hist.uni-heidelberg.de/sites/default/files/styles/img_free_aspect_0005/public/2025-08/blogpost.jpg?itok=3EBdqaRZ)
The wave of fever epidemics in early nineteenth century Italy and especially the source discussed in this article not only reveal exactly which practices and remedies were the ones that, in this particular case of fever prevention, were the most used and regarded as most controversial by learned medical practitioners. We also gain insights as to who the consumers of these goods were, at a time when, as previously stated, formal medicine had presumably acquired a monopolistic status within the medical marketplace. It was mostly people from outside urban centres, i. e. the countryside, who seemed to have been, in the opinion of professionals such as Paganini, more prone to buy and utilise the products sold by charlatans. Such remedies were attractive for the ‘common people’ because they, in times of despair and uncertainty, offered either immunity or a quick cure, which learned physicians could not provide so swiftly.25 In conclusion, the history of fevers is not complete if we stop short of regarding ‘informal’ medical practices and remedies that were presented as alternatives to those offered (or not) by ‘learned’ physicians. In addition, a look at these ‘informal’ medical practices reveal more to us about the medicines and methods obtained and employed by the common people, the lower classes and the inhabitants relegated to the countryside.
References
[1] Giovanni Paganini, Lettera d’un medico di Citta’ ad un parroco di Campagna su la Febbre Petecchiale e i sui preservativi in contro di essa, Milan 1817, [Bibl. Alessandrina: XIII d 50 e].
[2] Rino Cigui, ‘Epidemie e Carestie nell’ottocento istriano. Il tifo petecchiale e la fame del 1817 a Rovigno, Atti 40 (2010), pp. 365–391, here p. 367.
[3] Miroslav Bertoša, ‘«Lienteria Cronica» e «Febbre Consuntiva». La fame, il tifo petecchiale e la morte a Cittanova nel 1817’, Atti 19 (1988-1989), pp. 181–195, here p. 181 and Sergio De Iasio and Rosa Boano, ‘Effetti dell'epidemia di tifo del 1816-1817 nella comunità costiera di Termoli (CB)’, in Olga Rickards (ed.), Destinazione Uomo. XXII Congresso dell'Associazione Antropologica Italiana, Rome 2017, pp. 70–1. The year without a summer had its origins in the explosion of the Tambora volcano in 1815 in Indonesia: Wolfgang Behringer, Tambora und das Jahr ohne Sommer, Munich 2015. Contemporaries also blamed the harsh winter and odd temperatures, see: Dino Rabai, ‘Epidemie nella Vigevano Ottocentesca’, I Quaderni della Società Storica Vigevanese 3, [15 August 2025].
[4] Cigui, ‘Epidemie e Carestie’, p. 367.
[5] Bertoša, ‘Lienteria Cronica’, p. 181.
[6] Giovanni Capsoni, Storia Della Malattia Petecchial-Contagiosa Che Ha Regnato, Principalmente Per Tutto Il 1817, Nella Provincia Di Milano, Pavia 1820, , [15 August 2025], p. 73.
[7] Paganini, Lettera, p. 3.
[8] Ibid.
[9] Ibid., S. 10.
[10] David Gentilcore, Medical Charlatanism in Early Modern Italy, Oxford/New York 2006, p. 52.
[11] Gentilcore, Medical Charlatanism, p. 106f. Indeed, the existence of charlatans was a source of income for the Protomedicato, the highest medical authority in early modern Italy, by way of issued licence fees.
[12] Gentilcore, Medical Charlatanism, p. 61.
[13] Ibid., p. 149f.
[14] See for example the case in Latin America, where charlatans and learned physicians also stood at odds with one another: Stefanie Gänger, ‘In their Own Hands: Domestic Medicine and ‘the Cure of all Kinds of Tertian and Quartan Fevers’ in Late-Colonial Lima’, Colonial Latin American Review 25/4 (2016), pp. 492–511.
[15] Paganini, Lettera, p. 10. Original quotation: “Vorrebbero costoro che scoppiasse un’epidemia ad ogni luna nuova per vendere i loro preservativi ed arrichchire alle spalle del povero popolo, che a memoria d’uomini è sempre stato lo zimbello di questi impostori.” These negative connotations persist in nowadays depictions of what a charlatan is, with the Merriam-Webster Collegiate (“a pretender to medical skill”) and the Oxford English dictionaries (“an empiric who pretends”) emphasising the aspect of pretence in their definitions of the word, and thus mirroring our very own modern beliefs, cf.: Gentilcore, Medical Charlatanism, p. 1. The Italian Treccani also defines ciarlatano as an impostore (impostor) and gabbamondo (swindler).
[16] Gentilcore, Medical Charlatanism, p. 59.
[17] Irina Podgorny, Charlatanes. Crónicas de Remedios Incurables, Buenos Aires 2012, p. 15; Gentilcore, Medical Charlatanism, p. 2 comes to a similar conclusion.
[18] Gentilcore, Medical Charlatanism, p. 149.
[19] Paganini, Lettera, p. 11.
[20] Gentilcore, Medical Charlatanism, p. 264.
[21] Ibid., p. 200.
[22] Ibid., p. 10f. Original: “L’aglio, la ruta, la canfora, il muschio, la china, l’acquavite, 11 il vino, l’aceto così detto de’ quattro ladri, da prendersi internamente, o da usarsi esternamente, varj sacchetti ripieni di queste, o di simili droghe, da portare sul petto, od appesi al collo, e l’uso ocndannato e supersitzioso d’alcuni amuleti, sono le cose raccomandate dai Ciarlatani.”
[23] Ibid., p. 11.
[24] Paganini, Lettera, p. 6.
[25] Gentilcore, Medical Charlatanism, p. 264.
