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.