CHAPTER VIII.

THE FRENCH POX. One great epidemic disease of the first Tudor reigns, which brought consternation and distress to multitudes, makes hardly any appearance in the English records of the time, and no appearance at all in the writings of the English profession. Long after, in 1576, William Clowes, surgeon to St Bartholomew’s Hospital, first broke the professional silence about _lues venerea_ in England, and in his larger work of 1579 he gave a number of startling facts and figures of its then prevalence in London. But the great epidemic outburst of that disease in Europe began in the last years of the 15th century; its ravages on the epidemic scale are supposed to have lasted for twenty or thirty years from 1494; and its subsequent prevalence is assumed, not without reason, to have been of a milder type and within narrower limits. We hear of it, in England, from the political side, at the time when popular arguments were wanted against the Romish mass-priests and against the monasteries and the orders of friars. In the practical reasoning of Englishmen the scandalous lives of priests, monks and friars made the strongest argument for the policy which the king had adopted towards Rome; and it so happened in those very years that a scandalous life was betrayed, and made odious in more than sentiment, by bearing an outward and visible sign. The epidemic of _morbus Gallicus_ arose at an unfortunate time for the pretensions of Rome, or, perhaps, it was itself part of the march of events. In Simon Fish’s _Supplication of Beggars_, which was compiled in 1524 and was read to Henry VIII. shortly after, the weightiest plea is the charge of scandalous conduct resting upon the priests. In the inquisitions which preceded the suppression of the monasteries, the same plea is, justly or unjustly, brought to the front in the case of one abbey after another. So close did the association of a scandalous vice and its attendant disease become with the priesthood that James I., writing long after concerning the sentiments of his mother, Mary the queen of Scots, represents her as forbidding the archbishop “to use the spittle” in his own baptism, for the reason that she would not have “a pokie priest to spet in her child’s mouth[826].” These, says king James, were “her owne very words;” at all events, “a pocky priest” may be accepted as a phrase of the time. The fact that the epidemic of syphilis in England was used to discredit Romish priests is one of the few indications that we have of its existence in this country. Wide and deep as the commotion must have been which it caused, it found hardly any more permanent expression than the private talk of the men of those days. It was otherwise on the Continent. There, indeed, a copious literature sprang up, of which some thirty works remain, from the essay of Conrad Schellig of Heidelberg, printed without date or place, but ascribed to the year 1494 or 1495, down to the elaborate survey of the disease by Nicolas Massa of Venice in 1532. The single work extant in England from that, the earliest and greatest, period of the disease, is a poor piece of manuscript in the Sloane collection, translated from some foreign author, and entitled, “The tretese of the pokkis: and the cure by the nobull counsell of parris[827].” One of its cases is that of a man, aged forty, with two broad and deep, corroding and painful sores on his leg; another is of a bishop of Toledo, who had “pustules” and nocturnal pains “as if the bones would part from the flesh.” The vague meaning of the term pox is shown in one phrase, “paynes, viz. aches and pokkis.” It was nothing unusual abroad to give cases, and to authenticate them with the names of the sufferers. Thus Peter Pinctor, physician to the pope Alexander Borgia, in a notorious but exceedingly scarce work published in 1500, enters fully into the truly piteous case of the cardinal bishop of Segovia, major-domo of the Vatican, “qui hunc morbum patiebatur cum terribilibus et fortissimis doloribus, qui die ac nocte, praecipue in lecto, quiescere nec dormire poterat,” as well as into the case of Peter Borgia, the pope’s nephew, “in quo virulentia materiae pustularum capitis corrosionem in pellicaneo [pericranio] et in craneo capitis sui manifeste fecit[828].” Contrasted with the copious writing and recording of cases abroad, the English silence is remarkable. The origin of our first printed book on the subject is characteristic. A literary hack of the time, one Paynel, a canon of Merton Abbey, had translated, among other things, the _Regimen Salernitanum_, a popular guide to health several hundred years old. Going one day into the city to see the printer about a new edition, he was asked by the latter to translate the essay on the cure of the French pox by means of guaiacum (or the West-Indian wood) “written by that great clerke of Almayne, Ulrich Hütten, knyght.” For, said the printer, “almost into every part of this realme this most foul and peynfull disease is crept, and many soore infected therewith.” Ulrich von Hütten’s personal experience of the guaiacum cure was accordingly translated from the Latin, in 1533, and proved a good venture for the printer, several editions having been called for[829]. The translation has no notes, and throws no light on English experience. It is not until 1579, when Clowes published his essay on the morbus Gallicus, that we obtain any light from the faculty upon the prevalence of the malady in England. Meanwhile it remains for us to collect what scraps of evidence may exist, in one place or another, of this country’s share in the original epidemic invasion during the last years of the 15th century. Earliest Notices of the French Pox in Scotland and England. The first authentic news of it comes from the Council Register of the borough of Aberdeen under the date 21st April, 1497[830]:-- “The said day, it was statut and ordanit be the alderman and consale for the eschevin of the infirmitey cumm out of Franche and strang partis, that all licht weman be chargit and ordaint to decist fra thar vicis and syne of venerie, and all thair buthis and houssis skalit, and thai to pas and wirk for thar sustentacioun, under the payne of ane key of het yrne one thar chekis, and banysene of the towne.” The next news of it is also from Scotland, from the minutes of the town council of Edinburgh, wherein is entered a proclamation of James IV., dated 22 September, 1497[831]:-- “It is our Soverane Lords Will and the Command of the Lordis of his Counsale send to the Provest and Baillies within this bur{t} that this Proclamation followand be put till execution for the eschewing of the greit appearand danger of the Infection of his Leiges fra this contagious sickness callit the _Grandgor_ and the greit uther Skayth that may occur to his Leiges and Inhabitans within this bur{t}; that is to say, we charge straitly and commands be the Authority above writtin, that all manner of personis being within the freedom of this bur{t} quilks are infectit, or hes been infectit, uncurit, with this said contagious plage callit the _Grandgor_, devoyd, red and pass fur{t} of this Town, and compeir upon the sandis of Leith at ten hours before none, and their sall thai have and fynd Botis reddie in the havin ordanit to them be the Officeris of this bur{t}, reddely furneist with victuals, to have thame to the _Inche_ [the island of Inch Keith in the Firth of Forth], and thair to remane quhill God proviyd for thair Health: And that all uther personis the quilks taks upon thame to hale the said contagious infirmitie and taks the cure thairof, that they devoyd and pass with thame, sua that nane of thair personis quhilks taks sic cure upon thame use the samyn cure within this bur{t} in pns nor peirt any manner of way. And wha sa be is foundin infectit and not passand to the _Inche_, as said is, be _Mononday_ at the Sone ganging to, and in lykways the said personis that takis the sd Cure of sanitie upon thame gif they will use the samyn, thai and ilk ane of thame salle be brynt on the cheik with the marking Irne that thai may be kennit in tym to cum, and thairafter gif any of tham remains, that thai sall be banist but favors[832].” Sir James Simpson, with his indefatigable research over antiquarian points[833], has brought together evidence of payments from the king’s purse to persons infected with the “Grantgore” at Dalry, Ayrshire, in September, 1497, at Linlithgow on 2nd October, 1497, at Stirling on the 21st February, 1498 (“at the tounne end of Strivelin to the seke folk in the grantgore”), at Glasgow (also “at the tounn end”) on 22nd February, 1498, and again at Linlithgow, 11th April, 1498. He quotes also from a poem of William Dunbar, written soon after 1500, on the conduct of the Queen’s men on Fastern’s e’en, the terms “pockis” and “Spanyie pockis.” From Sir David Lyndsay’s poems, of much later date, and from other references, he makes out that “grandgore” or “glengore” was the usual name in Scotland down to the 17th century. Grandgore means _à la grande gorre_, which is the same as _à la grande mode_. This name was given for a time in France to the great disease of the day, but it was soon superseded by _vérole_. Scotland is the only country where “grandgore” became established as the common name of the pox. Before leaving the Scots evidence, two other ordinances may be quoted from the town council records of Aberdeen. In a long list of regulations under date the 8th October, 1507, there occur these two[834]:-- “Item, that diligent inquisitioun be takin of all infect personis with this strange seiknes of Nappillis, for the sauetie of the town; and the personis beand infectit therwith be chargit to keip thame in ther howssis and uther places, fra the haile folkis.” “Item, that nayne infectit folkis with the seiknes of Napillis be haldin at the common fleschouss, or with the fleschouris, baxteris, brousteris, ladinaris, for sauete of the toun, and the personis infectit sall keip thame quyat in thar housis, zhardis, or uther comat placis, quhill thai be haill for the infectioun of the nichtbouris.” “Sickness of Naples” is a reference to the well-known diffusion of the disease all over Europe by the mercenaries of Charles VIII. of France, dispersing after the Italian war and the occupation of Naples. For England the first known mention of the pox is several years later than the Scots references, although that proves nothing as to its actual beginning in epidemic form. In the book of the Privy Purse Expenses of Elizabeth of York, queen of Henry VII., there is an entry under the date of March 15, 1503, of a sum of forty shillings paid on behalf of John Pertriche “oon of the sonnes of mad Beale;” which sum appears to have been what the youth cost her majesty for board, clothes, education, and incidental expenses, during the year past. The various items making up the sum of forty shillings are: his diets “for a year ending Christmas last past,” a cloth gown, a fustian coat, shirts, shoes and hose, “item, for his learning, 20_d._ item for a prymer and saulter 20_d._ And payed to a surgeon which heled him of the Frenche pox 20_s._ Sm̅{a.} 40_s._” It will be observed that the surgeon’s bill was as much as all his other expenses for the year together[835]. The London chronicler of the time is alderman Robert Fabyan; but although Fabyan, writing in the first years of the 16th century, uses the word “pockys” to designate an illness of Edward IV. during a military excursion to the Scots Marches in 1463, or long before the epidemic invasion from the south of Europe, he says nothing of that great event itself. There is a record, however, of one significant measure taken in the year 1506, the suppression of the stews on the Bankside in Southwark. These resorts were of ancient date, and for long paid toll to the bishop of Winchester. In 1506 there were eighteen of them in a row along the Surrey side of the river, a little above London Bridge; they were wooden erections, each with a stair down to the water, and each with its river front painted with a sign like a tavern, such as the Boar’s Head, the Cross Keys, the Gun, the Castle, the Crane, the Cardinal’s Hat, the Bell, the Swan, etc. These houses, says Stow, were inhibited in the year 1506, and the doors closed up; but it was not long ere they were set open again, the number being at the same time restricted to twelve[836]. They had been suppressed once before, at the earnest demand of the citizens, in the reign of Henry IV., and it appears from a sermon of Latimer’s that they were again suppressed about the year 1546. Thus Shakespeare had several precedents in London for the situation which he creates in a foreign city, in _Measure for Measure_. The next reference that I find to it is an oblique one, by Bernard André in his _Annals of Henry VII._ On the occasion of mentioning the sweating sickness of 1508, he says the latter disease occurred first in England about four-and-twenty years before, and that it was “followed by a far more detestable malady, to be abhorred as much as leprosy, a wasting pox which still vexes many eminent men” (“multos adhuc vexat egregios alioquin viros tabifica lues[837]”). Bernard André’s association of the pox with the sweating sickness, as of one new disease following another, is in the same manner as the reference to it by Erasmus. In a letter from Basle, in August, 1525, to Schiedlowitz, chancellor of Poland, he discourses upon the sickliness of seasons and the mutations of diseases[838]: Until thirty years ago England was unacquainted with the sweat, nor did that malady go beyond the bounds of the island. In their own experience they had seen mutations:--“nunc pestilentiae, nunc anginae, nunc tusses; sed morbum morbus, velut ansam ansa trahit; nec facilé cedunt ubi semel incubuere.” He then proceeds: “But if one were to seek among the diseases of the body for that which ought to be awarded the first place, it seems to my judgment that it is due to that evil, of uncertain origin, which has now been for so many years raging with impunity in all countries of the world, but has not yet found a definite name. Most persons call it the French pox (_Poscas Galleas_), some the Spanish. What sickness has ever traversed every part of Europe, Africa and Asia with equal speed? What clings more tenaciously, what repels more vigorously the art and care of physicians? What passes more easily by contagion to another? What brings more cruel tortures? Vitiligo and lichens are deformities of the skin, but they are curable. This lues, however, is a foul, cruel, contagious disease, dangerous to life, apt to remain in the system and to break out anew not otherwise than the gout.” Whether it was from some mistaken theory of contagiousness or for other reasons, a fellow of Merton was ordered to leave in 1511 because he had the French pox[839]. In the English history nothing appears above the surface until the beginning of the movement against the papal supremacy and in favour of Reformation. That was a time of public accusations of all kinds, and among the rest of opprobrious references to the pox. In Simon Fish’s _Supplication of Beggars_[840], which was written in 1524, certain priests are thus hyperbolically spoken of: “These be they that have made an hundred thousande ydel hores in your realme, which wold have gotten theyr lyvinge honestly in the swete of their faces had not there superfluous riches illected them to uncleane lust and ydelnesse. These be they that corrupte the hole generation of mankynd in your realme, that catch the pockes of one woman and beare it to another, ye some one of them will boste amonge his felowes that he hath medled with an hundreth wymen.” In the year 1529, there is a more painful and most undignified charge. In the Articles of Arraignment of Wolsey in the House of Peers, the sixth charge is: “The same Lord Cardinall, knowing himself to have the foul and contagious disease of the great pox, broken out upon him in divers places of his body, came daily to your Grace [the King], rowning in your ear, and blowing upon your most noble Grace with his perilous and infective breath, to the marvellous danger of your Highness, if God of his infinite goodness had not better provided for your Highness. And when he was once healed of them, he made your Grace believe that his disease was an impostume in his head, and of none other thing[841].” Among the glimpses of contemporary manners in Bullein’s _Dialogue of the Fever Pestilence_ (1564), there is one referring to the pox; Roger, the groom, soliloquizes thus: “her first husband was prentice with James Elles, and of him learned to play at the short-knife and the horn thimble. But these dog-tricks will bring one to the poxe, the gallows, or to the devil[842].” Bullein, in his more systematic handbook to health, promises to treat of the pox fully, but omits to do so. In one place he refers to the wounds of a young man who fell into a deep coal-pit at Newcastle as having been healed “by an auncient practisour called Mighel, a Frencheman, whiche also is cunnynge to helpe his owne countrey disease that now is to commonly knowen here in England, the more to be lamented: But yet dayly increased, whereof I entinde to speake in the place of the Poxe.” But the only other reference is (in the section on the “Use of Sicke Men and Medicine,”) to certain drugs “which have vertue to cleanse scabbes, iche, pox. I saie the pox, as by experience we se there is no better remedy than sweatyng and the drinkyng of guaiacum,” etc[843]. A good instance of the oblique mode of reference to the malady occurs in another dialogue by a surgeon, Thomas Gale[844]. The pupil who is being instructed tables the subject of “the morbus,” which he farther speaks of as “a great scabbe;” whereupon Gale pointedly takes him to task for the affectation of “the morbus;” any disease, he says, is the morbus; what you mean is the morbus Gallicus. About the same date, 1563, a casual reference is made to the wide prevalence of the pox by John Jones in his _Dyall of Agues_. In illustration of the fact that various countries originate different forms of pestilence, as the Egyptians the leprosy, the Attics the joint-ache, the Arabians swellings of the throat and flanks, and the English the sweating sickness, he instances farther, “the Neapolitans, or rather the besiegers of Naples, with the pockes, spread hence to far abroad through all the parts of Europe, no kingdom that I have been in free--the more pity[845].” English Writings on the Pox in the 16th Century. The first original English writer on the pox was William Clowes. In his treatise[846] of 1579, dedicated to the Society of the Barbers and Chirurgions, he says that he had been bold “three years since to offer unto you a very small and imperfect treatise of mine touching the cure of the disease called in Latine _Morbus Gallicus_, the which, forasmuch as it was at that time rather wrested from me by the importunitye of some of my frendes, upon certain occasions then moving, than willingly of my selfe published, it passed out of my handes so sodeinly and with so small overlooking or correction,” that he now in 1579 reissues it in a revised and corrected form. “The Morbus Gallicus or Morbus Neapolitanus, but more properly Lues Venera, that is the pestilent infection of filthy lust, and termed for the most part in English the French Pocks, a sicknes very lothsome, odious, troublesome and daungerous, which spreadeth itself throughout all England and overfloweth as I thinke the whole world.” He then characterises the vice “that is the original cause of this infection, that breedeth it, that nurseth it, that disperseth it.” In the cure of the malady he has had some reasonable experience, and no small practice for many years. According to the following passage, St Bartholomew’s Hospital, to which Clowes was surgeon, was three parts occupied by patients suffering from this malady:-- “It is wonderfull to consider how huge multitudes there be of such as be infected with it, and that dayly increase, to the great daunger of the common wealth, and the stayne of the whole nation: the cause whereof I see none so great as the licentious and beastly disorder of a great number of rogues and vagabondes: The filthye lyfe of many lewd and idell persons, both men and women, about the citye of London, and the great number of lewd alehouses, which are the very nests and harbourers of such filthy creatures; By meanes of which disordered persons some other of better disposition are many tymes infected, and many more lyke to be, except there be some speedy remedy provided for the same. I may speake boldely, because I speake truely: and yet I speake it with very griefe of hart. In the Hospitall of Saint Bartholomew in London, there hath bene cured of this disease by me, and three (3) others, within this fyve yeares, to the number of one thousand and more. I speake nothing of Saint Thomas Hospital and other howses about this Citye, wherein an infinite multitude are dayly in cure.... For it hapneth in the house of Saint Bartholomew very seldome but that among every twentye diseased persons that are taken in, fiftene of them have the pocks.” Like the earlier writers on the Continent he recognizes that the disease is communicated in more ways than one; he speaks of “good poor people that be infected by unwary eating or drinking or keeping company with those lewd beasts, and which either for shame will not bewray it, or for lack of good chirurgions know not how to remedy it, or for lack of ability are not able otherwise to provide for the cure of it.” In so far as Clowes follows his own experience, he is under no illusion as to the nature and circumstances of the French pox. But he goes on to append a pathology of the disease, which is taken from foreign writers and reflects the bewilderment of the faculty over the constitutional effects of the malady. As Erasmus said, in the letter quoted, it went all through the body, “not otherwise than the gout.” When it was first observed, it appeared to be constitutional from the outset. More particularly it covered the skin with “pustules” or “whelks” as if it had been a primary eruption like variola, to which it was compared; hence the names “great pox” and “small pox.” It was not until long after that our present pathology of primary, secondary and tertiary effects was worked out; in the earliest writings the constitutional effects were referred to an “inward cause,” as Clowes says, to some idiopathic corruption of the humours having the liver for their place of elaboration, or _minera morbi_. Thus the learned explanation of the malady, which Clowes adopts from foreign writers more skilled than himself in such disquisitions, has no organic unity with his own common-sense observations. In his _Proved Practice_ he defers still farther to the academical view, as given in the treatise of John Almenar, a Spanish physician[847]. Although Clowes, in 1579, testifies to the very wide prevalence of the disease, to so great an extent, indeed, that it occupied the hospitals more than all other diseases put together, yet there is reason to think that it had by that time lost the terrible severity of its original epidemic type. The usual statement is that the disease abated both in extent and in intensity within twenty or thirty years of the Italian outbreak among the soldiery in 1494-96. A contemporary and ally of Clowes, John Read, of Gloucester, published in 1588 a volume of translations, from the Latin manuscript of the English surgeon of the 14th century, John Ardern, on the cure of fistulas, and from the treatise on wounds, etc. by the Spanish surgeon Arcaeus (Antwerp, 1574)[848]. In the latter he finds the following passage, which seems to describe the _morbus Gallicus_ on its first appearance:-- “The French disease did bring with it a kind of universal skabbe, oftentimes with ring wormes, with the foulness of all the body called vitiligo and alopecia, running sores in the head called acores, and werts of both sortes, and many times with flegmatic or melancholic swellings or ulcers corrosive, filthie and cancrouse, and also running over the body, together with putrifying of the bone, and many times also accompanied with all kind of grief, with fevers, consumptions, and with many other differences of diseases.” Read’s own remarks draw an explicit contrast between the disease on its first appearance and in his own later experience. Everyone knows now, he says, how to treat the French pox, “the disease daylie dying and wearing away by the exquisite cure thereof”--which may be taken to mean, at least, a notable mitigation of the constitutional effects[849]. The treatment, however, must have been much less effective then than now. Clowes speaks of a class who “either for shame will not bewray it, or for lack of good chirurgions know not how to remedy it, or for lack of ability are not able otherwise to provide for the cure of it.” The expense of a cure would have been considerable, to judge by the case given above from an account-book of the year 1503. Unable to employ “good chirurgions,” the poorer class would resort to quacks, of whose practice, in that and other diseases, we have some glimpses both from Clowes in London and from Read in Gloucester and Bristol. Of one irregular practitioner Clowes says, “He did compound for fifteen pound to rid him within three fits of his ague, and to make him as whole as a fish of all diseases.” There was still a lower order of empirics, whom Clowes disdained to contend with: “Yet I do not mean to speak of the old woman at Newington, beyond St George’s Fields, unto whom the people do resort as unto an oracle; neither will I speak of the woman on the Bankside, who is as cunning as the horse at the Cross Keys; nor yet of the cunning woman in Seacole Lane, who hath more skill in her cole-basket than judgment in urine, or knowledge in physic or surgery”--nor of many others who are compared to “moths in clothes,” to “canker,” and to “rust in iron.” Read gives an account of a travelling mountebank, which is too graphic to be omitted: “In this year, 1587, there came a Fleming into the city of Glocester named Woolfgange Frolicke, and there hanging forth his pictures, his flags, his instruments, and his letters of mart with long lybells, great tossells, broad scales closed in boxes, with such counterfeit shows and knacks of knavery, cozening the people of their money, without either learning or knowledge. And yet for money got him a licence to practise at Bristow. But when he came to Gloceter, and being called before some being in authority by myself and others, he was not able to answer to any one point in chirurgerie; which being perceived, and the man known, the matter was excused by way of charity, to be good to straungers.” One of the most systematic and detailed surgical treatises of the time, John Banister’s book on the “general and particular curation of ulcers” (1575), is significant for the indirect way in which it refers to the lues venerea. Thus at folio 25, “the malignant ulcer called cacoethes” is described without anything said of a venereal origin, but the specific guaiacum is given among the remedies. The same is the ease on the 31st and 32nd leaves, which treat of “filthie and putrefied ulcers,” guaiacum being again prescribed. At folio 51, on ulcers of the mouth, it is said, “If it proceed a morbo venereo, then first begin with due purgation, and prescribe the party a thin diet with the decoction of guaiacum, and use ointments requisite for that disease, strengthening the inner parts. Use twice a day a sublimated water, as is afore written, to touch the ulcer with lint rolled therein: Rec. Aqua Rosar.} an. two & Plantag.} ounces, Sublimati i dragme. Boil them in a glass bottel till the sublimate be dissolved.” On fol. 57, he describes “ulcers of the privie parts,” among which are corroding ulcers, but without reference to the lues. It is in the section headed, “To prepare the humours” (fol. 61) that the most explicit reference occurs: “When the ulcers proceed through the French pockes, a thinne diet must be used, with the decoction of guaiacum or use universall unctions ex Hydrargyro[850].” In 1596 there appeared Peter Lowe’s essay on _The Spanish Sickness_[851], which is purely a product of experience abroad, his own or of others, and is mainly doctrinal or theoretical. The other properly English works on the subject are all subsequent to the Restoration, and do not come into the period of this volume, nor, from an epidemiological point of view, into this work at all. The evidence as to the wide prevalence of the pox in high and low becomes abundant in the writings and memorials of the reign of James I. The effects of the disease, as they would have been commonly remarked at this period, are summed up in a well-known passage in _Timon of Athens_. It would serve no purpose to collect the numerous references from Puritan sermons, moral and descriptive essays, plays, and letters of the time. An anonymous work of the year 1652 actually couples “the plague and the pox,” and shows “how to cure those which are infected with either of them[852].” One more piece of evidence may be given for London in the year 1662, or the beginning of the Restoration period,--a date which brings us down a century and a half from the epidemic invasion with which we are more immediately concerned; but the information for 1662 will serve to show how the existence of the disease was still viewed _sub rosa_, and it may help one to realize what its prevalence and its serious effects on the public health must have been continuously in the generations before, and most of all in the generation which experienced the full force of it as an epidemic[853]. The London bills of mortality, setting forth the several causes of death, were first printed in 1629. The entry of the French pox is in them from the beginning, and the annual total of deaths set down to it is considerable, approaching a hundred in the year. But according to Graunt, who made the bills of mortality the subject of a critical study in 1662[854], they were defective or incorrect in their returns of deaths due to the pox:-- “By the ordinary discourse of the world, it seems a great part of men have, at one time or other, had some species of this disease ... whereof many complained so fiercely, etc.” He then explains, with reference to the deaths entered as due to it in the bills of mortality: “All mentioned to die of the French pox were returned by the clerks of St Giles’ and St Martin’s in the Fields only, in which place I understand that most of the vilest and most miserable houses of uncleanness were; from whence I concluded that only _hated_ persons, and such whose very noses were eaten off were reported by the searchers to have died of this too frequent malady”--the rest having been included under the head of consumption. Origin of the Epidemic of 1494. The French pox, as it was called in England (also the great pox and simply the pox), or the Spanish pox, as it was called in France, or the sickness of Naples, or the grandgore, is one of the epidemic diseases concerning which it seems fitting to say something of the antecedents, in addition to what has been said of its arrival as an epidemic in this country, and of its prevalence therein. But this will have to be said very briefly, and without entering upon the pathology or ultimate nature of the disease. The numerous foreign writings upon it during the first years of its spread over Europe are all singularly at a loss to account for its origin. One of the earlier guesses was that it arose out of leprosy, as if a graft or modification of that medieval disease, replacing it among the maladies of the people. The occasion of that hypothesis seems to have been the lax diagnosis of leprosy itself, a laxity which goes as far back as Bernard Gordonio and Gilbert, if not farther back. Many things were called _lepra_ which were not elephantiasis Graecorum, and among those things the lues venerea in the Middle Ages was undoubtedly included. At a time when true leprosy was disappearing or had already disappeared from Europe, a new form of disease, which came suddenly into universal notice although by no means then first into existence, seemed to be the successor of leprosy, evoked out of it, and even caught from the leprous by contagion. That is the view of Manardus, in a passage quoted in the sequel,--that syphilis began in certain most particular circumstances at Valencia, in Spain, the source of all the subsequent contamination of Europe having been a certain soldier of fortune who was _elephantiosus_ or leprous. In the infancy of a science it is natural to assign to some such single and definite source a new phenomenon which was really called forth by a concurrence of causes[855]. Another guess of the same kind was the famous theory, which found a truly learned defender in Astruc last century and has had supporters more recently, that the lues venerea came from the New World with the returning ships of Columbus. There never was any considerable body of facts, consistent as regards times and places, in support of that theory; and, on antecedent grounds, the objection to it was that it is as difficult, to say the least, to conceive of the origin of such a disease among the savages of Hispaniola as among the natives of Europe. “Here or nowhere is America” is the proper retort to all such visionary theories put upon the distant and the unknown. The American theory is now hopelessly dead; the more that the New World became known, the less did syphilis appear to be indigenous to it: indeed the disease followed the track of Europeans, and those parts of the American continent, north and south of the Isthmus, which were longest in being reached by the civilisation of the Old World, were also longest in being reached by the lues venerea[856]. The name “sickness of Naples,” which occurs in the Aberdeen records as early as 1507, indicates the common opinion of the laity as to the origin and means of diffusion of the strange malady. In the passage above quoted from Jones’s _Dyall of Agues_, it will be seen that he refers it to “the besiegers of Naples.” The besiegers of Naples were the mercenaries of Charles VIII. occupying it in the beginning of the year 1495, although there was no real siege. The new disease was at the time, rightly or wrongly, traced to them while they occupied Italy, and its diffusion over Europe was justly traced to their dispersion to their several countries at the end of the campaign. There is medical testimony that the malady appeared in 1495 among the Venetian and Milanese troops which were banded against Charles VIII. at the siege of Novara. Marcellus Cumanus, of Venice, who was surgeon to the forces, thus speaks of the event, in certain _Observationes de Lue Venerea_ which he wrote on the margin of Argelata’s work on Surgery[857]: “In Italy, in the year 1495, owing to celestial influences, I have myself seen, and do testify that, while I was in the camp at Novara with the troops of the Lords of Venice and of the Lords of Milan, many knights and foot-soldiers suffered from an ebullition of the humours, producing many pustules in the face and through the whole body; which pustules commonly began under the prepuce or without the prepuce, like a grain of millet-seed, or upon the glans, attended by considerable itching. Sometimes a single pustule began like a small vesicle without pain, but with itching. Being broken by rubbing, they ulcerated like a corrosive _formica_, and a few days after, troubles began from pains in the arms, legs and feet, with great pustules. All the skilled physicians had difficulty in curing them.... Without medicines, the pustules upon the body lasted a year or more, like a leprous variola.” He then gives many other details of symptoms and treatment. For the year after, 1496, two German writers, who were not surgeons but occupied with affairs of state, Sebastian Brant (author of the _Ship of Fools_) and Joseph Grünbeck, have described the disease, apparently in connexion with the troops serving in Italy under Maximilian I. against the invading army of Charles VIII. Thus, there is sufficient evidence that the malady in its first two or three years of epidemic prevalence, was associated with a state of war on Italian soil, in the persons of French troops (and mercenaries of all nations), of Venetian and Milanese troops, and of the German troops of the Emperor. But the German writers are clear that the disease did not originate on Italian soil, at the siege of Naples or elsewhere. Thus Brant in his poem of 1496 assigns to it an origin in France, and a dispersion within a year or two over all Europe[858]: “Pestiferum in Lygures transvexit Francia morbum, Quem _mala de Franzos_ Romula lingua vocat. Hic Latium atque Italos invasit, ab Alpibus extra Serpens, Germanos Istricolasque premit; Grassatur mediis jam Thracibus atque Bohemis Et morbi genus id Sarmata quisque timet. Nec satis extremo tutantur in orbe Britanni Quos refluum cingit succiduumque fretum. Quin etiam fama est, Aphros penetrasse Getasque Vigue sua utrumque depopulare polum.” Grünbeck, who wrote briefly on the disease in 1496, returned to the subject at much greater length in 1503, when he was secretary to the Emperor Maximilian, his later treatise, _De Mentulagra, alias Morbo Gallico_, being, indeed, among the best that the epidemic called forth. Hensler doubts whether Grünbeck was himself in Italy, so as to observe the ravages of the disease among the troops of the Emperor (including Venetians and Milanese) at the sieges of Pisa and Leghorn in the summer of 1496, and among the opposing troops of Charles VIII. Be that as it may, the following is from Grünbeck’s description[859]: “O! quid unquam terribilius et abominabilius humanis sensibus occurrit! Difficile est dictu, creditu fere impossibile, quanta foeditatis, putredinis et sordium colluvione, quantisque dolorum anxietatibus nonnullorum militum corpora involuerit. Aliqui etiam a vertice ad usque genua quodam horrido, squalido, continuo, foedo et nigro _scabiei_ genere, nulla parte faciei, (solis oculis exemtis), nec colli, cervicis, pectoris vel pubis immuni relicta, percussi, ita sordidi abominabilesque effecti sunt, qui ab omnibus commilitonibus derelicti, ac etiam in plano et nudo campo sub dio emarescentes, nihil magis quam _mortem_ expetiverunt.... At his omnibus nihil vel parum proficientibus, et morbo ipso non contento hoc hominum numero, ut eos solos tantis passionum cruciatibus afficeret, venenum contagiosum in multos spectantes Italos, Teutones, Helveticos, Vindelicos, Rhaetos, Noricos, Batavos, Morinos, Anglicos, Hispanos, et alios quos belli occasio in copias conscripserat, transfudit.... Interea temporis, per clandestinam Gallorum abitionem, exercitus fuerunt dissoluti,”--Grünbeck himself proceeding with some merchants to Hungary and thence to Poland[860]. How came this terrible infection to be among the troops of all nations on Italian soil in the years 1494, 1495 and 1496? Sebastian Brant clearly states that the French brought it with them, and that it spread first over Liguria. Grünbeck says that it was seen _primo super Insubriam_, or the Milanese, on which it rested like a dense cloud, until it was scattered by the winds over the whole of Liguria, and so found its way into the armies in Italy. Beniveni, of Florence, who wrote in 1498, says that it came to Italy from Spain, and from Italy was carried to France. Thus we have a theory of a Spanish origin, of a French origin, and perhaps also of a native Italian origin--all agreeing that Italy during the state of war from 1494 to 1496 was the theatre of its first ravages on the great scale, and the source from which the disease was brought to all the countries of Europe by the returning soldiery. The solution of the difficulty is to be looked for in the inquiries after still earlier notices of the _lues venerea_. It is beyond the purpose of this book to enter upon that large subject, farther than has already been done with the object of proving the generic use of the medieval term _lepra_. It is now accepted by competent students of medical history that the same disease, with all varieties or modes of primary, secondary or tertiary, existed in antiquity and in the Middle Ages, although secondaries and tertiaries may not have been ascribed to their primary source. But what specially concerns us here is the question whether the malady was anywhere beginning to be more noticeable in the years immediately preceding the great military explosion on Italian soil. On that point there is some evidence from more than one source, that the malady was sufficiently prevalent in the south of France to be a subject of remark previous to the French expedition to Italy, that it had found its way to the ports of Spain (Barcelona and Valencia), and that the troops of Charles VIII., if not also that youthful monarch himself, carried it across the Alps into Liguria, and so gave it that start on Italian soil which the state of war for the next two years raised to the power of a virulent and diffusive epidemic[861]. The best piece of evidence of its prevalence in Languedoc and its spreading thence to the adjoining coast of Spain is found in a letter of the 18th April, 1494 (four months before Charles VIII. entered Italy), written by Nicolas Scyllatius just after arriving at Barcelona[862]. The province of Narbonne, he says, a part of France adjoining Spain, now sent forth another vice. Women felt it most; it infected neighbours by contact; it has lately invaded Spain, hitherto untouched by it. “I was horrified,” he continues, “on first landing at Barcelona; for I met with many of the inhabitants who were seized by that contagion. On my inquiring of the physicians (for with these I held converse during nearly all that journey), they assured me that the new _lues_ had been derived from truculent France.” In keeping with this entirely credible testimony is the statement of Torella, a native of Valencia, who wrote one of the earlier essays on the new disease (“De Pudendagra”) in November, 1497. The disease first broke out, he says, in Auvergne in 1493 (incepit, ut aiunt, haec maligna aegritudo anno 1493 in Alervnia), and so came in the way of contagion to Spain and the Islands [to Sardinia, where he was bishop, and to Corsica], and to Italy, creeping in the end over all Europe, and, if one may so speak, over the whole globe[863]. Torella thus confirms the Barcelona traveller so far as regards importations from the south of France to the neighbouring ports, the former writer naming Auvergne as the endemic seat of the malady, whereas the latter gives Narbonne. Another piece of evidence, that the pox was in Valencia, as well as in Barcelona, before the expedition of Charles VIII., is found in a story told by Manardus of Ferrara (1500), a story which is wholly improbable so far as concerns the origin of syphilis, at a stated time and place, out of a case of leprosy, but is entirely credible so far as regards the grossness of its circumstances: “Coepisse hunc morbum per id tempus, dicunt, quo Carolus, Francorum rex, expeditionem Italicam parabat: coepisse, autem, in Valentia, Hispaniae Taraconensis insigni civitate, a nobili quodam scorto, cujus noctem elephantiosus quidam, ex equestri ordine miles, quinquaginta aureis emit; et cum ad mulieris concubitum frequens juventus accurreret, intra paucos dies supra quadringentos infectos; e quorum numero nonnulli, Carolum Italiam petentem sequuti, praeter alia quae adhuc vigent importata mala et hoc addiderunt[864].” The evidence that follows is not so explicit, but it has strong probability. The progress of Charles VIII. from France to Italy in the autumn of 1494 has been told by Philip de Comines in his _Cronique du Roy Charles VIII._, first printed at Paris in 1528, nineteen years after the author’s death. De Comines accompanied his master, the French king, as far as Asti; he was then sent on a mission to Venice, and rejoined the king at Florence. But De Comines, who was no gossip, omits one interesting fact near the beginning of the journey to Italy, which has been preserved for us in a contemporary work (1503) called _La Cronique Martiniane_, or chronicle of all the popes down to Alexander Borgia lately deceased[865]. This chronicle relates as follows concerning Charles VIII.’s journey:--“Il se arresta premierement aucuns jours a Lyon, doubteux s’il passeroit les mons, car il y estoit detenu pour les delices et plaisances de la cité et pour les folles amours de aucunes gorrieres lyonnoises. Mais quant l’air devint pestilent, il s’en tyra à Vienne, citè de Daulphinè.” His great army had already passed the Alps and arrived in the country of Asti: it is said to have consisted, in round numbers, of 3600 men-at-arms, 6000 bowmen, 8000 pikemen, and 8000 with arquebuses, halberds, two-handed swords, or other arms, together with a heavy artillery train of 8000 horses. A large part of this force were Swiss; another part were Gascons[866]. Charles VIII. left Vienne on the 23rd of August, and crossed Mont Genèvre on the 2nd September, whence he proceeded direct by Susa and Turin, joining his army at Asti on September 9. At Asti, says De Comines, he had an illness, which caused that minister to delay setting out on his mission to Venice for a few days. The original printed text of De Comines’ _Chronique_ (Paris, 1528), says that the author remained at Asti a few days longer “because the king was ill of the smallpox (_de la petite verolle_) and in peril of death, for that the fever was mixed therewith; but it lasted only six or seven days, and I set out upon my way.” The next edition has no change but “in great peril of death” (_en grant peril de mort_), instead of merely “in peril.” Now, where did this diagnosis of _petite verolle_ come from? Nothing is said of smallpox being prevalent at the time among the troops or along their route. The name _petite verolle_ itself did not exist in 1494; it came into existence with _grosse verolle_, having being made necessary by the latter; and the first that we hear of _grosse verolle_ is when the Italian campaign was over and the pox was raging in Paris, the Parlement of Paris, on the 6th of March, 1497, having made an ordinance against a certain contagious malady “nommée la _grosse verole_,” which had been in the kingdom and in the city of Paris since two years. Probably Comines deliberately wrote “_petite verolle_” in his manuscript, having composed the latter subsequent to 1498, or at a time when the terms _verolle_, or _grosse verolle_, and _petite verolle_, were passing current and were known in their respective senses. The causes or circumstances of the king’s malady at Asti are not enlarged upon by De Comines, farther than that he makes a somewhat disjointed remark, that all the Italian wines of that year were sour and that the season was hot, which would have had as little to do with the one kind of pox as with the other. Nor is anything said of smallpox spreading among those near the king[867]. The whole sequence of events, from the “folles amours” of Lyons to the sharp sickness at Asti, has suggested to historians, who have no medical theory to advocate, that it was not really _petite vérole_ that the king suffered from, but _grosse vérole_. Martin says that Charles VIII. recommenced at Asti his Lyons follies and that he became violently sick, “of the smallpox, says one, or, perhaps, of a new malady which began to show itself in Europe,” meaning syphilis. To show that such infection was already possible, he quotes an ordinance of the provost of Paris April 15, 1488, enjoining “the leprous” to leave the capital. This is very like Edward III.’s order to the London “lepers” a century and a half earlier, in which the reasons given (the frequenting of stews, the pollution of their breath, &c.) point somewhat clearly to the nature of their “leprosy.” An order for the banishment of “lepers” from Paris in 1488 must have been occasioned by some unusual risk of contamination, just as the London order of 1346 would have been. It is in that sense that the French historian regards it; the ordinance, he says, “concernait probablement déjà les syphilitiques confondus avec les lépreux[868].” De Comines, who is the authority for the diagnosis of smallpox, had inserted the word _petite_ before _verolle_ for reasons best known to himself. I shall show in the next chapter, upon smallpox and measles in England, that the ambiguous teaching of the faculty as to the nature and affinities of the pox proper within the first years of its epidemic appearance gave a ready opportunity of calling the _grosse vérole_ by the name of _petite vérole_ in circumstances where it was polite, or prudent, or convenient so to do. The only importance of a correct diagnosis of the king’s malady is that the case of one would have been the case of many. The indications all point to a somewhat unusual prevalence of _lues venerea_ previous to the autumn of 1494, in the luxurious provinces of southern France as well as in the capital. Beyond doubt, the malady had already spread by contagion to the great Spanish ports nearest the Gulf of Lyons. The expedition of Charles VIII. passed through that region on its route over the Alps. According to Sebastian Brant, it was the French who brought the disease into Liguria, and, according to Grünbeck, it issued, _Gallico tractu, ab occidentali sinu_, gathered like a dense cloud _super Insubriam_ (the Milanese), and was thence dispersed, as if by the winds, over the whole province of Liguria. But for the circumstances of the military expedition of 1494, and the state of war in Italy for two years after, it is conceivable that the unusual prevalence in France of a very ancient malady would have had little interest for Europe at large, although the cities on the nearest coast of Spain appear to have already shared the infection. That unusual prevalence in the south of France has in it nothing of mystery; the period was the end of the Middle Ages, distinguished by a revival of learning, of trade and commerce,--a revival of most things except morals. But, assuming that there was such unusual prevalence above the ancient and medieval level, it may still seem unaccountable that a great European epidemic, of a most disastrous and fatal type, should have been engendered therefrom. There are, however, many parallel cases, on a minor scale from modern times, of a peculiar severity of type, of inveteracy, and of communicability by unusual ways, having been cultivated from commonplace beginnings, among unsophisticated communities about the Baltic and Adriatic, the people being without resident doctors and unfamiliar with such a disease and its risks. These have been collected and analyzed by Hirsch, whose conclusion is that “the mode of origin, and the character of these endemics of syphilis, appear to me to furnish the key to an understanding of the remarkable episode of the disease in the 15th century,--an episode which entirely resembles them as regards its type, and differs from them only as regards extent[869].” Referring the reader for farther particulars to the work quoted, I shall leave the antecedents of the epidemic of pox in the end of the 15th century to be judged of according to the probabilities thus far stated.