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.