1538. They may be farther helped to a conclusion by the following curious

instance which has been recorded by John Stow. Among the miscellaneous collections of that antiquary preserved in the Lambeth Library[900], there is a narrative of the troubled conscience of Master Richard Allington, esquire, a gentleman who appears to have lent money at high interest. Believing himself to be dying on November 22, 1561, he summoned to his bedside at eight in the evening the Master of the Rolls (“Sir John of the Rolls”), two doctors of the law and two other lawyers. He began: “Maisters, seinge that I muste nedes die, which I assure you I nevar thought wolde have cum to passe by this dessease, consyderinge it is but the small pockes, I woulde therefore moste hertely desyre you in the reuerence of God and for Christes passions sake to suffer me to speake untyll I be dede, that I may dyscharge my conscens” etc. He then explains that “no man had so especial tokens of God’s singular grace, and so litele regarded them as I have done,” and goes on to mention particular acts of usury and to offer restitution to the amount of some hundred pounds or more. It had occurred to him to do so the second night after he fell sick, being in perfect memory lying in his bed broad awake, but with puppets dancing around him. After entrusting the lawyers at his bed side with these restitutions, he asked the Master of the Rolls to read to him certain of the penitential Psalms which the sick man had selected as appropriate. “And then he thought he should have died, but then broth being given unto him, he revived again and fell to prayer and gave himself wholly to quietness;” and there the narrative ends. It appears from a reference in Stow’s _Survey of London_ that he did die in 1561, and that his widow was left well off: for she afterwards built one of the finest of the new houses that were now beginning to line the highway of Holborn almost as far out as St Giles’s in the Fields. This is the first recorded case of smallpox in English. According to the patient’s own view, smallpox was not usually a formidable disease, nor does it appear that the Master of the Rolls and four other eminent lawyers (Dr Caldwell, Dr Good, Mr Garth, and Mr Jones) had been apprehensive of catching it. One finds no other evidence of the existence of smallpox in London or elsewhere in England until it is mentioned in a letter of 1591 and in the essay of Kellwaye, 1593, which asserts the occurrence of “smallpox and measles” in almost the same language as Phaer’s earlier _Book of Children_ and for the most part under the same foreign inspiration. From Scotland we have a single reference in Dr Gilbert Skene’s essay on the plague, published in 1568, from the terms of which one may suppose that he is giving his own experience. The season, he says, will sometimes foretell the plague, as well as other diseases: “Siclyk quhen pokis or sic pustulis are frequent, not onlie amangis barnis, but also amangis those quha be of constant or declynand aige--greit frequent south and south-vest vyndis.” In a similar passage on the previous page he couples “pokis, mesillis and siclike diseisis of bodie[901].” In a letter of August 26, 1591, written to a member of queen Elizabeth’s court, it is said: “Hir Higness wold you should remove from that place where the smalle pocks were, to take the fresh and clere ayre, the better to purge ye from the infection[902].” In 1593 we come to the first systematic English essay on the disease, appended to the treatise on the plague by Simon Kellwaye[903]. The author is otherwise unknown as a medical writer, but he is commended in a preface by George Baker, a court surgeon, for his “good and zealous intent and sufficiencie in his profession.” In appending an essay on smallpox to a treatise on the plague he follows the example of the Salernian treatise of Alphanus, which also affords him most of his systematic materials in both diseases, filtered through Ambroise Paré and other writers. Kellwaye claims, however, to have incorporated native experience: “which work I have collected and drawn from sundry both auncient and later writers, the which being shadowed under the calm shroud of auncient consent and strengthened with the abundant sap of late experience (as well mine own as others) I here present the same.” In the treatise on the plague (fol. 2) he mentions smallpox as among the forerunners or prognostics of that disease: “When the smalle poxe doth generally abound both in young and old people.” In the separate essay on the smallpox (fol. 38), its interest is again that of a forerunner or sequel of the plague, according to the foreign teaching of the time: “For that oftentimes those that are infected with the plague are in the end of the disease sometimes troubled with the smallpockes or measels, as also by good observation it hath been seen that they are forerunners or warnings of the plague to come, as Salius and divers other writers do testify, I have thought good and as a matter pertinent to my former treatise” etc. He proceeds: “I need not greatly to stand upon the description of this disease because it is a thing well known unto most people.” It begins with a fever; then shortly after there arise small red pustules upon the skin throughout all the body, which come forth more or less intermittently; “In some there arise many little pustules with elevation of the skin, which in one day do increase and grow bigger, and after have a thick matter growing in them, which the Greeks call exanthemata or ecthymata; and after the Latins variola, in our English tongue the smallpockes; and here some writers do make a difference betwixt variola and exanthemata: for, say they, that is called variola when many of those pustules do suddenly run into a clear bladder, as if it had been scalled, but the other doth not so; yet are they both one in the cure.” He recognizes the contagious property of the disease, calling it “hereditable:” “For we see when one is infected therewith, that so many as come near him (especially those which are allied in the same blood) do assuredly for the most part receive the infection also.” His _Practica_ are taken almost entirely from the Arabian writers, as filtered through Gaddesden, one of them being the prevention of pitting by opening the pocks with a gold pin or needle. He had heard, however, “of some which, having not used anything at all, but suffering them to dry up and fall of themselves without picking or scratching, have done very well, and not any pits remained after it.” He then refers to complications, such as ulcerations of the skin, soreness and ulcerations of the mouth (_aphthae_), soreness of the tonsils, and glueing together of the eyelids, all of which are stock paragraphs in the foreign writers of the time and are probably transferred from the latter. Also he goes a considerable way towards the separation of measles from smallpox, which was not fully effected in England until the century following: “What the measels or males are:--many little pimples which are not to be seen but only by feeling with the hand are to be perceived; they do not maturate as the pocks doth do, nor assault the eyes” etc. About ten years after Kellwaye’s essay, there began, in 1604, the classification of the deaths in London by the Company of Parish Clerks: but it was not until 1629 that their weekly and annual bills were regularly printed. In the first printed bills, “Flox, smallpox and measles” appear as one entry. The meaning of “flox” seems to be explained by Kellwaye’s remark: “And here some writers do make a difference betwixt variola and exanthemata; for, say they, that is called variola when many of those pustules do suddenly run into a clear bladder as if it had been scalled, but the other doth not so.” That is the distinction between confluent smallpox and discrete; and the most probable explanation of “flox” is that it stands for the confluent kind, or for the pustules that run together into a clear bladder. Smallpox in the 17th Century. The gradual rise of smallpox to prominence in England about the end of the Elizabethan period and in the first years of the Stuarts cannot fail to strike anyone who is occupied with the English records of disease as a whole. Smallpox and measles may have been, and almost certainly were, observed in England in the earlier part of the 16th century; but they make no such figure in the records, domestic and other, as they do from the beginning of the 17th century onwards. Perhaps the first mention of smallpox, in English literature proper, occurs in a collection of lyrical poems published in 1602[904]. In some verses “Upon his Ladies sicknesse of the Small Pocks,” the poet, Th. Spilman, apostrophises the “cruel and impartial sickness” and asks,-- Are not these thy steps I trace In the pure snow of her face? Th’ heavenly honey thou dost suck From her rose cheeks, might suffice; Why then didst thou mar and pluck Those dear flowers of rarest price? In two letters of Dr Donne, dean of St Paul’s, written probably a few years before his death in 1631, reference is made to the smallpox in London. In the one he says: “At my return from Kent to my gate, I found Peg had the pox: so I withdrew to Prickham and spent a fortnight there. And without coming home, when I could with some justice hope that it would spread no farther amongst them (as I humbly thank God it hath not, nor much disfigured her that had it), I went into Bedfordshire” etc. This dread of smallpox infection is quite unlike anything that we meet with in the earlier 16th-century domestic memorials; in them it is only the infection of the plague that comes in. Donne’s other reference is to the sickness of my lord Harrington: “a few days since they were doubtful of him; but he is so well recovered that now they know all his disease to be the pox and measles mingled[905].” Cases of smallpox among the upper classes are occasionally mentioned in the letters written by Chamberlain to Carleton in the reigns of James I. and Charles I.[906]. On December 17, 1612, “The Lord Lisle hath lost his eldest son, Sir William Sidney, by the smallpox, which were well come out.” On December 31, the same year, Carleton, writing from abroad, mentions that the duke of Mantua had died of the smallpox about three weeks since, of which he buried his only son not three weeks before. Also on December 31, Chamberlain writes to him, that the Lady Webbe was sick of the smallpox, of which, he says in another letter, she died: “She was grown a very proper woman, but loved the town too well, which in a short time would have drawn her and her husband dry as well in purse as in reputation.” It is the year 1614 that is given (by Horst) as the worst season of smallpox all over Europe and the East; England is mentioned by the foreign writer as among the countries affected, but there is no trace of an epidemic in our own records. On April 20, 1616, Chamberlain mentions the case of the duke of Buckingham, the favourite; “he hath been crazy of late, not without suspicion of the smallpox, which, if it had fallen out, _actum est de amicitia_. But it proves otherwise.” Buckingham’s illness, for which he took much physic, produced an imposthume on his head (an effect which followed in the more notorious illness of Wolsey), and he is elsewhere said to be suffering from the _morbus comitialis_. The suggestion of smallpox appears to be the same euphemism which was resorted to in the cases of other exalted personages. On August 21, 1624, having written of the great mortality from fevers, Chamberlain adds: “Lady Winwood, hearing that her only daughter was fallen sick of the smallpox at Ditton and that they came not out currently,” had gone to her. On December 18, 1624, “the Lady Purbeck is sick of the smallpox, and her husband is so kind that he stirs not from her bed’s feet.” In the first week of June, 1625, the famous composer Orlando Gibbons died at Canterbury, not without suspicion of the plague[907], but according to another opinion of the smallpox[908]. With the year 1629, the causes of death in London began to be published by Parish Clerks’ Hall in a rough classification, smallpox being a regular item from year to year. For the first eight years the deaths from “flox, smallpox, and measles” were as follows: 1629 72 1630 40 1631 58 1632 531 1633 72 1634 1354 1635 293 1636 127 The greatest epidemic, it will be seen, was in 1634[909]. For the years 1637-1646, the figures are lost (owing to Graunt’s omitting them in his Table of 1662, for want of room). But it is known from letters that the autumn of 1641 was a season of severe smallpox as well as plague. Thus on August 26, “both Houses grow very thin by reason of the smallpox and plague that is in the town, 133 dying here this week of the plague, and 118 of the smallpox, 610 in the whole of all diseases.” On September 9, a letter from Charing Cross says: “Died this week of the plague 185, and of the smallpox 101.” The plague mortality continues to be mentioned in subsequent letters, but the references to smallpox cease[910]. On July 16, 1642, one excuses his attendance on some State business because he is sick of the smallpox[911]. About the Restoration the references to smallpox become more numerous[912]. A letter of January 4, 1658 (1659), speaks of “much sickness in the town [London], especially fevers, agues and smallpox.” On February 7, 1660, the earl of Anglesey is dead of the smallpox. In September, 1660, Lord Oxford had a severe attack and recovered; at the same time the duke of Gloucester, on the 8th September, was diagnosed by the doctors to have “a disease between the smallpox and the measles; he is now past danger of death for this bout, as the doctors say.” However he died on 14th September, in the tenth day of the disease, with remarkable evidences (post mortem) of internal haemorrhage, having bled freely at the nose a few hours before his death. The eruption had “come out full and kindly” at the beginning, so that it was not the ordinary haemorrhagic type. On the 20th December, 1660, the princess Henrietta goes to St James’s for fear of the smallpox. On the 16th January, 1660 (? 1661), “the princess is recovered of the measles.” Letters from a lady at Hambleton to her husband in London, May 26, 1661, speaks of smallpox raging in the place, and in the house of her nearest neighbour, her own children having the whooping-cough. In the bills of mortality of those years the deaths in London from smallpox and measles were as follows: 1647 139 1648 401 1649 1190 1650 184 1651 525 1652 1279 1653 139 1654 832 1655 1294 1656 823 1657 835 1658 409 1659 1523 1660 354 1661 1246 1662 768 1663 411 1664 1233 1665 655 1666 38 These figures bring us down to the period of Sydenham, who was the first accurate observer of smallpox in London. With his writings, and with those of Willis and Morton, we begin a new era in the history of epidemics in England. We find, for the first time in the history, an adequate discussion of the epidemiological and clinical facts by the ablest men in the profession. But, as the new era is at one and the same time marked by the cessation of plague and by the enormous increase of various fevers, as well as of smallpox, it falls without the limits of this volume, making, indeed, the appropriate beginning of the new kind of epidemic history which is characteristic of England from the Restoration and the Revolution down to the end of the 18th century. It is clear, from the instances above given, that smallpox was already at the beginning of the 17th century becoming a pest among the upper classes. But to anyone who studies the history over continuous periods it is equally clear that its prominence was then something new and that the horror and alarm which it caused became greater as the 17th century approached its close. And so as not to leave the history of smallpox at this point with a wrong impression of its general virulence, it may be added that Dr Plot, writing of Oxfordshire in 1677, says: “Generally here they are so favorable and kind, that be the nurse but tolerably good, the patient seldom miscarries[913].” Smallpox in Continental Writings of the 16th century. It would be beside the purpose of this work to follow the history of smallpox and measles on the continent of Europe. But it will be necessary to say a few words on the contemporary foreign writings upon these diseases, as it is chiefly teaching from a foreign source that we detect in the English authors of the 16th century. It might be inferred from the classical work of Fracastori[914], published in 1546, that smallpox and measles were frequent and familiar diseases in the author’s experience at Verona. At the same time it is clear that even he, original observer as he was, is in places merely repeating the old statements of the Arabian writers. Thus his statement that everyone has smallpox or measles sooner or later, is the old Arabian tradition or experience, usually joined to the explanation that the cause of that universality was the nourishment of the foetus by the retained and impure menstrual blood, so that all children had to free their constitutions of a congenital impurity sooner or later. So far as Fracastori’s originality comes in, it is clear that he does not regard smallpox and measles as serious troubles. In his second chapter he says: “First we must treat of those contagious maladies which, although contagious, are not called pestilential, because, for the most part, they are salubrious. Of such are variolae and morbilli. By variolae are understood those which are called also varollae by the common people, from their likeness, I suppose, to the pustules called vari. By morbilli are understood those which the common people style fersae, so-called perhaps from _fervor_. But of these the Greeks do not appear to have treated under any other name than exanthemata. They happen principally in children, rarely in men, most rarely in old people. But they seem to befall all men once in life, or to be apt to befall them unless a premature death removes the individual. In boys the malady is more benign than in adults. For the more part, as already said, they are salubrious, since this ebullition of the blood is something of a purification of the same. It afflicts more or less according to the density of the blood and as the vice is apt or not to be separated from it. If the blood be more pituitous, the pustules are variform, white, round and full of a kind of mucus; but if it be more bilious the pustules break forth more of a dry sort. Where the disease has happened once it is not apt to recur; but there are cases where it has happened more than once.” In the brief account by Fracastori, all the points are stated for measles and smallpox together; and the opinion is twice put forward that an attack was salubrious as purifying the blood or as freeing it from some vice--an opinion which is still popularly held. It is not until the latter half of the 16th century that we come to real epidemiological records of smallpox on the Continent,--the works by Donatus on smallpox and measles at Mantua in 1567, and by Betera upon epidemics at Brescia in 1570, 1577 and 1588, in which the more malignant types of smallpox were seen[915]. The treatise most used was that of Alphanus, published at Naples in 1577[916]; it was on plague and pestilential fever, with an appendix on smallpox. Either it or Ambroise Paré’s chapters seem to have furnished the greater part of the English essay by Kellwaye on the plague and smallpox. In Ambroise Paré’s references to smallpox there occurs one singular line of remark which will serve to bring us back to etymology and to the great pox[917]. The _petite vérole_, he says, has a resemblance to the _grosse vérole_ as sometimes attacking the bones. He had seen that in smallpox cases not only in 1568 but on other occasions: and he gives the details of two cases of smallpox, apparently with periostitis and necrosis, which he compares to cases of the great pox. To express in one word the meaning of such cases, he says, the smallpox and _rougeolle_, not having been well purged, give rise to various troublesome accidents, as the great pox does. One cannot read Paré’s chapters on the _grosse vérole_ and the _petite vérole_ without detecting an inclination to compare them or class them together in nosological characters. The comparison or classification is by no means explicit; but it seems to be in his thoughts, and he would seem, accordingly, to have held until a late period of the 16th century a view of the two diseases which was not unusual at the beginning of that century (as in the treatise of Pinctor and in the accounts of the dreadful mortality of Indians in Hispaniola and Mexico[918]), and was expressed in the popular names given to each disease in France and in England.