Nicolas Robles
Badajoz, Spain

“Nana was all covered with fine hair; a russet made her body velvety…”
—Emile Zola, Nana

The French writer Émile Zola (1840–1902), considered the leading representative of literary naturalism in his time,¹ observed people and contemporary events in his novels. Zola never ceased to get involved in social, artistic, or literary causes that seemed just to him. However, he never got involved in politics, particularly in the “Affaire Dreyfuss” that forced him into exile in London.

One of his most famous novels is Nana, which tells the story of Anne “Nana” Coupeau, a woman who becomes a famous actress and “cocotte” (courtesan) in the Second French Empire (1852–1870). She uses her beauty and charm to manipulate men, driving them to financial and emotional ruin. The novel explores the decadence of Parisian high society and the moral corruption of the time, with Nana as a symbol of that decadence. When Nana decides that she has consumed enough men, time, and money, she leaves France to see the world. She passes through places like Russia and Cairo, generating many stories back in France about her life. She finally returns to France after having contracted smallpox and stays in a room in a large hotel, where she dies as the Franco-Prussian War begins.

Most of Zola’s novels are social portraits that, following the outline of naturalism, abound with violence and drama that were sometimes too explicit in their detailed descriptions for the taste of the time. Nevertheless, for a modern reader, the absence of erotic elements in Nana may be surprising, despite clear references to promiscuity and lesbianism. But the real surprise, along with the text, is that there is no mention of venereal diseases. Syphilis and gonorrhea, among others, have accompanied sex since antiquity, and would have been familiar to Nana and her profession. Likely, the author did not want to speak about it.

Did Nana, a prostitute, really die of smallpox, nearly one hundred years after a vaccine started to be used? From a clinical point of view, syphilis² seems more likely. A rash is almost always present in secondary syphilis, and tertiary syphilis can appear 10–30 years after the initial infection.³ Gummatous syphilis, a late-stage manifestation, is characterized by soft, tumor-like growths of tissue, most commonly of the skin, bone, and liver.⁴ Cutaneous tertiary syphilis, which occurs in around 16% of all late syphilis cases, may present as skin nodules and ulcers.⁵ And while Nana is a fictional character, one might surmise that this condition could have been confused with smallpox.

References

1. Émile Zola. Wikipedia. https://en.wikipedia.org/wiki/%C3%89mile_Zola
2. Ada’s Medical Knowledge Team. Secondary Syphilis. Ada. https://ada.com/conditions/secondary-syphilis/
3. About Syphilis. CDC, Jan 30, 2025. https://www.cdc.gov/syphilis/about/index.html
4. Liu J, Sun K, Deng Y, Ding L. Case Report: The great mimicker: cerebral syphilitic gumma. Front Med (Lausanne). 2025 Jun 24;12:1600412. doi: 10.3389/fmed.2025.1600412.
5. Kłosowicz A, Pizun A, Pastuszczak M, et al. Large syphilitic gumma on the face mimicking dermatitis artefacta. Postepy Dermatol Alergol. 2022; 39:996-997.