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.
CHAPTER IX.
SMALLPOX AND MEASLES.
With our modern habit of seeking out the matter of fact, of going back to the reality and of reconstructing the theory, it is not easy for us to understand how completely the medieval world of medicine was enslaved to authority and tradition even in matters that were directly under their eyes. It was thought a great thing that Linacre, of Oxford, in the first years of the 16th century, and Caius, of Cambridge, some fifty years later, should have gone back to Galen for their authority, passing over the Arabians who had been the interpreters of classical medicine all through the Middle Ages. Their editions of forgotten medical works of the Graeco-Roman school were a step forward in scholarship, and they opened the way to the first-hand observations of disease which really began some hundred years after with the writings of Willis, Sydenham and Morton. But smallpox and measles were not Galenist themes, they were peculiarly Arabian; and the very moderate share that England took in the medical Revival of Learning made no difference to the paragraphs or chapters on those diseases that were circulating in the medieval compends. While the Arabian or Arabistic writers of Spain, of Salerno, and of Montpellier were the depositaries and interpreters of the Galenic teaching, they were also the first-hand authorities upon some matters of specially Arabian experience, of which smallpox and measles were the chief. Whatever was said of those two epidemic maladies abroad, in the systematic works of Gordonio and Gilbert, and in the later compilation of Gaddesden in England, was not only of Arabian origin, but it was all that was known of them. Rhazes, the original Arabic writer on smallpox and measles about the beginning of the 11th century, supplied both the doctrine and the experience. His observations and reasonings, altered or added to by his later countrymen, passed bodily into the medical text-books of all Europe. The interest in the treatise of Rhazes was so great that it was printed in 1766 by Channing, of Oxford, in Arabic with a Latin translation, and in an English translation from the original by Greenhill, of Oxford, in 1847.
In the literature we took over smallpox from the Arabians; but had we no native experiences of the disease itself, and, if so, when did it first appear in this country? One can hardly attempt an answer to these questions even now without stirring up prejudice and embittered memories. It has been the fate of smallpox, as an epidemological subject, to be invested with bigotry and intolerance. Whoever has maintained that it is not as old as creation has been suspected in his motives; anyone who shows himself inclined to put limits to its historical duration and its former extent in Britain is clearly seeking to belittle the advantages that have been derived during the present century from vaccination.
The wish to establish the antiquity of the smallpox in Europe has been as strong as the wish to overthrow the antiquity of the great pox. While undoubted traces of the latter in early times have been covered over with the generic name of leprosy, the vaguest reference to “pustules” or spots on the skin have been turned by verbalist ingenuity to mean devastating epidemics of smallpox. I am here concerned only with Britain, and must pass over the much-debated reference by Gregory of Tours to epidemics in the 6th century, the period of the Justinian plague. But in England the epidemic which stands nearest in our annals to the great plague of the 6th century, the widespread infection described by Beda as having begun in 664 and as having continued in monasteries and elsewhere for years after, has been claimed by Willan as an epidemic of smallpox[870]. Willan, with all his erudition, was a dermatologist, and acted on the maxim that there is nothing like leather. His contention in favour of smallpox has been referred to in the first chapter, dealing with the plague described by Beda, and need not farther concern us. It is not in England that we find evidence of smallpox in those remote times but in Arabia.