Smallpox in England in the 16th Century.
The earliest references to smallpox in England, apart from the probably incorrect one by Gaddesden early in the 14th century, occur in letters of the years 1514 and 1518. Another letter of 1514 will serve to bring out the ambiguity of the names given to diseases at the time. On June 30, 1514, Gerard de Pleine writes from London to Margaret of Savoy that he had been asked by the bishop of Lincoln why the marriage between the princess Mary and Louis XII. had been broken off (it took place shortly after), and by another great peer whether Louis XII. “avoit eu les pocques,” which last sentence has a marginal note in the printed collection of letters: “c’est la petite verole[895].” But les pocques in a letter written from London in 1514 did not mean the smallpox. In a letter of March 3, 1514, Peter Martyr writing in Latin from Valladolid to Ludovico Mendoza, says that the King of England has had a fever, and that the physicians were afraid it would turn to the pustules called variolae, but he is now well again and rises from his bed[896]. This illness of Henry VIII. happened at Richmond previous to 7th February. Although in the letter quoted there was only a fear that the illness might have turned to the pustules called smallpox, yet in the instructions of Henry VIII. to Spinelly, English ambassador in the Low Countries, sent in February, the twelfth item instructs him to say that the English king has lately been visited by a malady “nommée la petitte verolle[897].”
Four years after, on July 14, 1518, Pace writes to Wolsey from Wallingford, where the court then was, that the king was to leave next day for Bisham “as it is time; for they do die in these parts in every place, not only of the small pokkes and mezils, but also of the great sickness[898].”
These are the earliest known instances of the use of the words pocques, variola, petite verolle, “small pokkes and mezils,” as applied to particular cases of sickness, in correspondence from or relating to England. The remarks to be made upon the early usage are: first, that the word pocques, as used by one writing in French from London in 1514, did not mean smallpox, but pox; second, that the first authentic mention of smallpox happens to have been in the French form—“une maladie nommée la petitte verolle;” third, that, in the political gossip of the time the opinion of the physicians regarding the illness of the young king is given as of a fever which they feared might have turned to the pustules called “variolae;” and fourthly, that in the very first mention of the disease variola by an English name “small pokkes,” the name is modelled on the French, being coupled with the old English name “mezils.” It is impossible to infer from these references anything as to the amount of smallpox in England at the time, or even to be sure of the correctness of the diagnosis. The lax usage as between “pox” and “smallpox” is shown in a book of the year 1530 called ‘Prognosticacions out of Ipocras and Avicen,’ in which a brief reference to variola in the Latin original is translated “to prognosticate of the pockes.”
In Sir Thomas Elyot’s Castel of Health, published in 1541, children after their first infancy are said to suffer from a number of maladies, and in “England commonly purpyls, meazels and smallpockes.” That is perhaps the first use of the terms in a systematic work on medicine, not indeed by one of the faculty, but by a layman. About the same time we hear of smallpocks in an infant of noble family: a letter of May 26, 1537, from Charles duke of Suffolk to Cromwell, written from Hoxun in Suffolk, excuses his not repairing to Lincolnshire, as the king had ordered, on the ground that “his son fell sick of the smallpox and his wife of the ague[899].” “His son” was Henry Brandon, born September 18, 1535, so that he was then an infant of some twenty months; he is the same that died, with his younger brother, of the sweating sickness in July 1551.
The reference to smallpocks and meazels by Elyot in his Castel of Health is repeated in the almost contemporary Book of Children by Thomas Phaer. Whether Phaer translated that also “out of the French tongue” as he did the Regiment of Life, with which it is bound up in the edition of 1553, we have nowhere any information. In a list of forty infirmities of children, the 32nd in order is “small pockes and measels.” A later passage in the Book of Children shows how much, or how little, intelligent meaning Phaer attached to these terms: “Of smallpockes and measels. This disease is common and familiar, called of the Greeks by the general name of exanthemata, and of Plinie papulae et pituitae eruptiones. It is of two kinds:—varioli, ye measils; morbilli, called of us ye smal pocks. They be but of one nature and proceed of one cause. The signs of both are so manifest to sight that they need no farther declaration;”—but he does add some signs, such as “itch and fretting of the skin as if it had been rubbed with nettles, pain in the head and back etc.: sometimes as it were a dry scab or lepry spreading over all the members, other whiles in pushes, pimples and whayls running with much corruption and matter, and with great pains of the face and throat, dryness of the tongue, hoarseness of voice, and, in some, quiverings of the heart with sownings.” He then gives the four causes, three of them being intrinsic states of the humours, and the fourth “when the disease commenceth by the way of contagion, when a sick person infecteth another, and in that case it hath great affinity with the pestilence.” The treatment is directed towards bringing out the eruption; all occasions of chill are to be carefully avoided. More special directions are given for cases in which “the wheales be outrageous and great;” also, “to take away the spots and scarres of the small pockes and measils,” a prescription of some authors is given, to use the blood of a bull or of a hare.
The whole of Phaer’s section on smallpox and measles bears evidence of a foreign source, namely the same stock chapter from which Kellwaye drew most of his section upon the same two diseases appended to his book on the plague in 1593. Not only does Phaer speak of smallpox and measles conjointly as leaving spots and scars, but he actually renders variolae by measles, and morbilli by smallpox. Phaer was more of a literary compiler than a physician with original knowlege of diseases and their pathology. But he is not singular among the Tudor writers in taking measles to be the equivalent of variolae. William Clowes, of St Bartholomew’s Hospital, one of the most experienced practitioners of his time, does the same. His Proved Practice for all Young Chirurgeons has an appendix of Latin aphorisms “taken out of an old written coppy,” to each of which aphorisms Clowes has added an English translation: in the aphorism on variolae, that term is translated “measles,” the name of “smallpox” nowhere occurring in the book. Clowes’s translation is exactly in accordance with the English-Latin glossary of the time by Levins (1570). Levins was an Oxford fellow who had graduated in medicine and afterwards become a schoolmaster, just as Cogan, of The Haven of Health, had done. He wrote the Pathway of Health, and also compiled the Manipulus Vocabulorum. His definitions in the latter may be taken, therefore, to stand for the medical usage of the time. In this glossary, “ye maysilles” is rendered by variole, while the name of “smallpox” is omitted altogether, “a pocke” having its Latin equivalent in phagedaena, and “ye French pocke” in morbus Gallicus. In the Elizabethan dictionary by Baret, “the maisils” is defined as “a disease with many reddish spottes or speckles in the face and bodie, much like freckles in colour;” and that was the disease which the English profession then understood to be the same as the variolae of medieval writers.
I leave readers to draw their own conclusions, whether there was much or little smallpox or measles in England in the Tudor period. They may be reminded that Pace, dean of St Paul’s, in a letter from Berkshire in 1518, asserts the fatal prevalence of “smallpox and mezils,” and that the duke of Suffolk called the illness of his infant son by the name of smallpox in 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.