Chapter VII…

Chapter VII

GAOL FEVERS, INFLUENZAS, AND OTHER FEVERS IN THE TUDOR PERIOD.

The Common Gaols of England date from the Council of Clarendon, in 1164, by the articles of which the limits of civil and ecclesiastical jurisdiction were fixed, and the quarrel between archbishop Becket and Henry II. reduced to terms. In obedience to Article VII. of the Council, gaols were built, the chief among them having been at Canterbury, Rochester, Huntingdon, Cambridge, Malmesbury, Sarum, Aylesbury, and Bedford[782]. Little is heard of the unwholesomeness of prison life until the medieval period is nearly over--not indeed because the prisons were better managed than they were later. “In the year 1385,” says Stow, “William Walworth gave somewhat to relieve the prisoners in Newgate; so have many others since.” One benefactor brought a supply of water into Newgate; another, the famous Whittington, left money actually to rebuild the gaol, which was done in 1422. For several years before that, Newgate had been notorious. An ordinance of 7 Henry V. (1419) for the re-establishment of the debtor’s prison at Ludgate, so that debtors need not have to go to Newgate gaol, was made in compliance with a petition which said that, in “the hateful gaol of Newgate, by reason of the fetid and corrupt atmosphere, many persons committed to the said gaol are now dead[783].” The greatest mortality must have been, according to Stow, in 1414, when the gaolers of Newgate and Ludgate died, and sixty-four prisoners in Newgate[784].

More than a century after, in 1522, there occurred the first of a series of gaol-fever tragedies, which were well calculated to produce the effect ascribed by Aristotle to scenic tragedy, provided only the workings of cause and effect had been more apparent. The first of these historical Black Assizes occurred on the occasion of the gaol delivery at the Castle of Cambridge in Lent, 1522. The facts, which appear to be given nowhere but in Hall’s Chronicle (of almost contemporary authority), are less fully related than for some of the later instances of the same strange visitation; but there is no mistaking the air of reality and the generic likeness.

Cambridge Black Assizes.

In the 13th year of Henry VIII. at the Assize held in the Castle of Cambridge in Lent, “the justices and all the gentlemen, bailiffs and other, resorting thither, took such an infection, whether it were of the savour of the prisoners, or of the filth of the house, that many gentlemen, as Sir John Cut, Sir Giles Arlington, Knights, and many other honest yeomen, thereof died, and almost all which were present were sore sick, and narrowly escaped with their lives[785].”

It is to be observed that nothing is said of the prisoners being infected: they were brought from the dungeons to stand their trial in due course, and the gentlemen and yeomen attending the court officially or as jurors, or otherwise, were poisoned by their presence. This early chronicle indicates as the cause, “the savour of the prisoners, or the filth of the house;” and Bacon, in touching upon that class of incidents nearly a century later, indicates “the smell of the gaol,” but says nothing of cases of fever among the prisoners, having no warrant in the evidence for doing so.

Before we come to consider the condition of England in the Tudor period, with the policy of Henry VIII. for the repression of beggary and crime, and the appearance of “new fevers” or “strange fevers” and “laskes” in the chronicles and other records of the time, it will be desirable to make out as accurately as possible the clinical type of the Assizes fever, and its circumstances. For that purpose we must turn to the next recorded outbreak on the occasion of the Assizes at Oxford in 1577, which happens to have been somewhat fully described as a memorable event in the register of Merton College. The entry in the Merton register appears to have been made within a few weeks of the event[786].

Oxford Black Assizes.

The Assizes met on the 5th and 6th July, 1577, in the Castle and Guild Hall. Those only fell ill, whether in Oxford itself or after leaving, who had been present at the Assizes. The two judges (Robert Bell, Chief Baron of the Exchequer and John Barrham, sergeant-at-law), the sheriff of the county, two knights, eight squires and justices of the peace, several gentlemen and not a few of their servants, the whole of the grand jury with one or two exceptions--these all had not long left Oxford when they were seized with illness and died (statim post fere relictam Oxoniam mortui sunt). In Oxford itself, on the 15th, 16th and 17th July, some ten or twelve days after the Assizes, about three hundred fell ill; and in the next twelve days there died (“ne quid errem”) one hundred scholars, besides townsmen not a few. Five died in Merton College, including one fellow, the names of four being given who died on the 24th, 27th, 28th and 29th July. Every college, hall, or house had its dead. Women were not attacked, nor indeed the poor; nor did the infection spread to those who waited on the sick or came to prescribe for them. Only those who had been present at the Assizes caught the fever. The symptoms are described as follows:

The patients laboured under pain both of the head and of the stomach; they were troubled with phrensy, deprived of understanding, memory, sight, hearing and their other senses. As their malady increased, they took no food, could not sleep, and would not suffer attendants or watchers to be near them; their strength was remarkable, even in the approach of death; but if they recovered they fell into the extreme of weakness. No complexion or constitution was spared; but those of a choleric habit were most obnoxious to the disease. The affected persons suddenly became delirious and furious, overcoming those who tried to hold them; some ran about in courts and in the streets after the manner of insane persons; others leapt headlong into the water. The spirits of all the people were crushed; the physicians fled, and the wretched sufferers were deserted. Masters, doctors, and heads of houses left almost to a man. The Master of Merton remained, longe omnium vigilantissimus, ministering sedulously to the sick. The pharmacies were soon emptied of their conserves, oils, sweet waters, pixides and every kind of confection.

This sudden epidemic, which began on the 15th--17th July, did not last long; within the space of one month the city was restored to its former health, so that one wonders, says the registrary of Merton, to see already so many scholars and so many townsmen abroad in the streets and walks.

The infection was suspected by many, says the same eyewitness, to have arisen either from the fetid and pestilent air of thieves brought forth from prison, of whom two or three died in chains a few days before (quorum duo vel tres sunt ante paucos dies in vinculis mortui), or from the devilishly contrived and obviously papistical spirits called forth “e Lovaniensi barathro,” and let loose upon the court secretly and most wickedly.

The latter explanation arose out of the heated feelings of the time against papist plotters, and has no farther interest. But the statement that two or three of the prisoners had died in chains a few days before has a great interest, as showing the kind of treatment to which they had been subjected while awaiting the gaol delivery. A strange confirmation of the truth of the statement came to light many years after. When John Howard visited the Oxford gaol in 1779, in the course of his humane labours on behalf of the prisoners, he was told by the gaoler that, some years before, wanting to build a little hovel and digging up stones for the purpose from the ruins of the court, which was formerly in the Castle, he found under them a complete skeleton with light chains on the legs, the links very small. “These,” says Howard, “were probably the bones of a malefactor who died in court of the distemper at the Black Assize[787].”

Next to the Merton register’s account, we may take that of Thomas Cogan, a graduate in medicine of Oxford, sometime fellow of Oriel, but probably removed to Manchester previous to 1577. Wherever Cogan got his information, he acknowledges no source of the following in his Haven of Health, 1589:

“What kind of disease this should be which was first at Cambridge [in 1522] and after at Oxford, it is very hard to define, neither hath any man (that I know) written of that matter. Yet my judgment is, be it spoken without offence of the learned physicians, that the disease was Febris ardens, a burning fever. For as much as the signes of a burning ague did manifestly appear in this disease, which after Hollerius be these: Extreame heate of the body, vehement thirst, loathing of meate, tossing to and fro, and unquietnesse, dryness of the tongue rough and blacke, griping of the belly, cholerick laske, cruell ake of the head, no sound sleepe, or no sleepe at all, raving and phrensie, the end whereof, to life or death, is bleeding at the nose, great vomitting, sweate or laske. And this kind of sicknesse is one of those rods, and the most common rod, wherewith it pleaseth God to brake his people for sin.... And this disease indeed, as it is God’s messenger, and sometimes God’s poaste, because it commeth poaste haste, and calleth us quickly away, so it is commonly the Pursuivant of the pestilence and goeth before it.... And certainly after that sodaine bane at Oxford, the same yeare, and a yeare or two following, the same kind of ague raged in a manner over all England, and tooke away very many of the strongest sort, and in their lustiest age, and for the most part, men and not women nor children, culling them out here and there, even as you should chuse the best sheepe out of a flocke. And certaine remedy was none to be found.... And they that took a moderate sweate at the beginning of their sickness and did rid their stomachs well by vomit sped much better. Yet thanks be to God hitherto no great plague hath ensued upon it.”

Besides these medical particulars, he gives certain dates and numbers. It began, he says, on the 6th of July, from which date to the 12th of August next ensuing there died of the same sickness five hundred and ten persons, all men and no women: the chiefest of which were the two judges, Sir Robert Ball, lord chief baron, and maister Sergeant Baram, maister Doile the high sheriff, five of the justices, four councillors at law and an attorney. The rest were jurors and such as repaired thither.

An account not unlike Cogan’s is given by Stow in his Annales (p. 681);

“The 4, 5 and 6 dayes of July were the assizes holden at Oxford, where was arraigned and condemned one Rowland Jenkes for his seditious toung, at which time there arose amidst the people such a dampe, that almost all were smothered, very few escaped that were not taken at that instant: the Jurors died presently. Shortly after died Sir Robert Bell, lord chief baron, Sir Robert de Olie, Sir William Babington, maister Weneman, maister de Olie, high sheriff, maister Davers, maister Harcurt, maister Kirle, maister Phereplace, maister Greenwood, maister Foster, maister Nash, sergeaunt Baram, maister Stevens, and there died in Oxford 300 persons, and sickned there but died in other places 200 and odde, from the 6th of July to the 12th of August, after which died not one of that sicknesse, for one of them infected not another, nor any one woman or child died thereof.”

Stow’s account differs from that of the Merton College register in several important particulars. The latter is explicit that the sickness appeared among the scholars and townsmen of Oxford on the 15th, 16th and 17th of July, or after an interval of ten days or more, and that the deaths amongst those who had come to Oxford on Assize business did not occur in Oxford but on their return home. On the other hand, Stow makes out the Oxford people to have been smothered by the damp which arose in the court itself: “very few escaped that were not taken ill at that instant;” next come the deaths of the jurors, and “shortly after” those of the judges and other high officials, whose names are given by Stow more fully than by anyone. His total of deaths, the same as Cogan’s, is 300 in Oxford and 200 and odd of persons who had left Oxford, and his dates, “from the 6th of July to the 12th of August,” are also the same as Cogan’s.

Wood’s account is for the most part taken from the Merton register and in part from the very different version in Stow’s Annals; but he has the following new matter: “Above 600 sickened in one night, as a physician that now lived in Oxford attesteth, and the day after, the infectious air being carried into the next villages, sickened there an hundred more[788].” That, of course, is very unlike the Merton College account, which is explicit that no one caught the fever who had not been in the court. The Oxford physician whose authority is given for the six hundred cases in Oxford in one night, and the extension next day to villages around, is Dr George Ethredge, or Ethryg, a physician and learned Greek scholar living in Oxford at the time and keeping a boarding-house, called George Hall, for the sons of Catholic gentlemen. In 1588 he published a small volume of comments upon some books of Paulus Aegineta, which is the authority given by Wood[789]. On discovering the passage, one finds that it was not 600 in one night, but “sexaginta” or 60, and that the occasion on which more than sixty were taken ill at once in a single night at Oxford, and nearly a hundred next day in the adjacent villages, “whither the infected air had by chance been borne,” was not that of the gaol-fever in 1577 but of the sweating sickness in 1551. An extension in the atmosphere to the villages around is just what would have happened in the sweating sickness, a disease in that as in other respects closely analogous to influenza. Ethredge says that, on the particular occasion, “hardly any of the Oxford people died”--a statement which should of itself have prevented Wood’s mistake, even if the reference to the same disease having “at the same time” cut off the two sons of the duke of Suffolk “at Cambridge” (therefore a less healthy place than Oxford where hardly any died) had not quite clearly pointed to the sudor Britannicus, which is actually named in the context (“sic enim vocant”)[790].

Although, in the passage quoted, it is the sweating sickness at Oxford in 1551 that Ethredge refers to, he does also refer to the gaol fever of 1577 in another passage which has hitherto escaped notice.

In the section of his book next following, entitled “De Curatione morborum populariter grassantium, et de Peste,” he says that he had used a certain prescription of aloes, ammoniacum and myrrh rubbed together in wine, for himself as well as for others in a serious contagion, “quae fuit in martiali sede cum ibi essem,” and also, with happy effect, upon many “in the most cruel pest at Oxford which carried off Judge Bell and ever so many more; one gentleman, I could not persuade to try this medicine, whom therefore I commended to God, and four days after he was dead. Concerning that pestilential fever, many colloquies took place between me and two most learned physicians; and, as to the kind of this contagion, we all agreed (manibus et pedibus in hanc sententiam itum est) in a sentence which I quoted from Valescus, who sayeth thus: Those sicknesses are dangerous in such wise that the physicians may be for the most part deceived; for we see a good hypostasis in the urine, and some other good signs, yet the sick person dies”--a remark which often recurs in the early writings on plague.

It has taken longer than usual to determine the matter of fact as to the fever of the Oxford Black Assizes, because an erroneous version passes current on respectable authority; but enough has perhaps been said to enable us to pass from the matter of fact to the matter of theory[791].

The theory of the gaol fever at Oxford, in 1577, was not attempted by any writer at the time, nor indeed has it been so in later times; but the significance of the outbreak has been recognized and admitted. An Oxford scholar, Dr Plot, writing just a century after (1677) mentions the statement that a “poisonous steam” broke forth from the earth, having probably in his mind Stow’s imaginative explanation, that a damp arose amongst the people and smothered them, very few escaping that were not taken at that instant. Plot then proceeds:--

“But let it not be ascribed to ill fumes and exhalations ascending from the earth and poysoning the Air, for such would have equally affected the prisoners as judges, but we find not that they dyed otherwise than by the halter, which easily perswades me to be of the mind of my lord Verulam (Nat. Hist. cent. X. num. 914) who attributes it wholly to the smell of the Gaol where the prisoners had been long, close, and nastily kept.”

We know, indeed, from the register of Merton that “two or three of the prisoners died in chains a few days before,” which is a sufficient indication of the state they were kept in, but is no warrant for Anthony Wood’s free rendering of the words: “of whom two or three, being overcome with it [i.e. with the “nasty and pestilential smell of the prisoners”] died a few days before the Assizes began.” Two or three prisoners died in their chains with symptoms undescribed; and although typhus among the inmates of gaols has often occurred, it has also been wanting in many cases where the filth and misery might have bred it in the prisoners themselves[792].

Bacon’s judgment on the case, referred to above, was based upon a strict scrutiny of the evidence, and does not transcend the evidence. He attributes the infection that arose in the court to “the smell of the gaol;” and so as not to assume a smell which does not appear to have attracted any particular notice at the time, he is careful to explain in what sense he means the smell of the gaol:

“The most pernicious infection,” he says, “next the plague, is the smell of the jail, when prisoners have been long and close and nastily kept; whereof we have had in our time experience twice or thrice; when both the judges that sat upon the jail, and numbers of those that attended the business or were present, sickened upon it and died. Therefore it were good wisdom, that in such cases the jail were aired before they be brought forth....

“Leaving out of question such foul smells as be made by art and by the hand, they consist chiefly of man’s flesh or sweat putrefied; for they are not those stinks which the nostrils straight abhor and expel, that are most pernicious; but such airs as have some similitude with man’s body, and so insinuate themselves and betray the spirits[793].”

Exeter Black Assizes.

The next Black Assizes occurred at Exeter in 1586, nine years after the Oxford tragedy. The Exeter incident has had the fortune to be chronicled by a person as competent as was the writer in the Merton College register in the former case, namely by John Hoker alias Vowell, chamberlain of the city, and its representative in Parliament, a lawyer of good education, who must have been conversant with all the circumstances, and wrote his account within six months. He is known as the chief contributor to the second edition of Holinshed’s Chronicle, in which the history is brought down to 1586, his name appearing on the title-page. It is in that work that he inserted his account of the Exeter Black Assizes, written in October, 1586. The margin bears the words:

“The note of John Hooker alias Vowell;” and the text of the note is as follows[794] (III. pp. 1547-8):--“At the assizes kept at the citie of Excester, the fourteenth daie of March, in the eight and twentieth yeare of hir majesties reigne, before Sir Edmund Anderson, Knight, lord chief justice of the common pleas, and sargeant Floredaie, one of the barons of the excheker, justices of the assises in the Countie of Devon and Exon, there happened a verie sudden and a strange sickenesse, first amongst the prisoners of the Gaole and Castell of Exon, and then dispersed (upon their triall) amongst sundrie other persons; which was not much unlike to the sickenesse that of late yeares happened at an assise holden at Oxford, before Sir Robert Bell, Knight, lord chiefe baron of the excheker, and justice then of that assise....

The origin and cause thereof diverse men are of diverse judgment. Some did impute it, and were of the mind that it proceeded from the contagion of the gaole, which by reason of the close aire and filthie stinke, the prisoners newlie come out of a fresh aire into the same are in short time for the most part infected therewith; and this is commonlie called the gaole sickenesse, and manie die thereof. Some did impute it to certain Portingals, then prisoners in the said gaole. For not long before, one Barnard Drake, esquire (afterwards dubbed Knight) had beene at the seas, and meeting with certeine Portingals, come from New-found-land and laden with fish, he tooke them as a good prize, and brought them into Dartmouth haven in England, and from thense they were sent, being in number about eight and thirtie persons, unto the gaole of the castell of Exon, and there were cast into the deepe pit and stinking dungeon[795].

These men had beene before a long time at the seas, and had no change of apparell, nor laine in bed, and now lieing upon the ground without succor or reliefe, were soone infected; and all for the most part were sicke, and some of them died, and some one of them was distracted; and this sickenesse verie soone after dispersed itselfe among all the residue of the prisoners in the gaole; of which disease manie of them died, but all brought into great extremities and were hardly escaped. These men, when they were to be brought before the foresaid justices for their triall, manie of them were so weak and sicke that they were not able to goe nor stand; but were caried from the gaole to the place of judgement, some upon handbarrowes, and some betweene men leading them, and so brought to the place of justice.

The sight of these men’s miserable and pitifull cases, being thought (and more like) to be hunger-starved than with sickenesse diseased, moved manie a man’s heart to behold and look upon them; but none pitied them more than the lords justices themselves, and especially the lord chief justice himselfe; who upon this occasion tooke a better order for keeping all prisoners thenseforth in the gaole, and for the more often trials; which was now appointed to be quarterlie kept at every quarter sessions and not to be posted anie more over, as in times past, untill the assises.

These prisoners thus brought from out of the gaole to the judgment place, after that they had been staied, and paused awhile in the open aire, and somewhat refreshed therewith, they were brought into the house, in the one end of the hall near to the judges seat, and which is the ordinarie and accountable place where they do stand to their triales and arraignments. And howsoever the matter fell out, and by what occasion it happened, an infection followed upon manie and a great number of such as were there in the court, and especially upon such as were nearest to them were soonest infected. And albeit the infection was not then perceived, because every man departed, (as he thought), in as good health as he came thither; yet the same by little and little so crept into such as upon whom the infection was seizoned, that after a few daies, and at their home coming to their owne houses, they felt the violence of this pestilent sicknesse; wherein more died, that were infected, than escaped. And besides the prisoners, manie there were of good account, and of all other degrees, which died thereof; as by name sargeant Floredaie who then was the judge of those trials upon the prisoners, Sir John Chichester, Sir Arthur Basset, Sir Barnard Drake, Knight[796]; Thomas Carew of Haccombe, Robert Carie of Clovelleigh, John Fortescue of Wood, John Waldron of Bradfeeld and Thomas Risdone, esquires and justices of the peace.

... Of the plebeian and common people died verie manie, and especiallie constables, reeves, and tithing men, and such as were jurors, and namelie one jurie of twelve, of which there died eleven.

This sicknesse was dispersed throughout all the whole shire, and at the writing hereof in the time of October, 1586, it is not altogether extinguished. It resteth for the most part about fourteene daies and upwards by a secret infection, before it breake out into his force and violence.”

Here we have the same incubation-period as in the Oxford fever, about fourteen days. But in the Exeter case, we have it clearly stated that an infection arose in the prison from the poor Portuguese sailors or fishermen who had been thrown into “deep pit and stinking dungeon” after their capture on the high seas by Sir Bernard Drake, that the infection attacked the other prisoners, that many of the prisoners died and all were brought to extremities, and that those who stood their trial were then in a most feeble state, although they seemed to the pitying spectators to be more starved than diseased.

So far as concerned the infection in the Assize Court, among the lawyers, county gentry, and officials, jurors and others, it was of the same tragic kind as at Oxford in 1577 and at Cambridge in 1522, and, as we shall see, on several occasions in the eighteenth century. But the Exeter case has some features special to itself. Within the gaol were both English felons and thirty-eight Portugals, who had become subject to capture on their way home from the banks of Newfoundland with boatloads of stock-fish, and to treatment as felons, because Spain and England were at war. Within the gaol there seems to have been also a gradation of misery, a deep pit and stinking dungeon, “in the lowest deep a lower deep,” to which were consigned the men of foreign breed, the Portugals. It was among them that deaths first occurred, in what special form we know not. From them an infection is clearly stated by Hoker to have spread through the gaol at large, and to have made many of the prisoners so weak that they had to be carried into court. This is quite unlike what we read of in the Cambridge and Oxford cases, in neither of which was illness noted in the prisoners or asserted of them, although at Oxford two or three had died in chains a few days before. In the Exeter case there were three circles of the damned instead of two only: nay there were four. Farthest in were the Portugals, next to them were the native English felons, then came those present on business or pleasure at the Assizes, and lastly there were the country people all over Devonshire for many months after. We must take all those peculiarities of the Exeter gaol-fever together, and explain them one by another. It was a somewhat elaborated poison. It had passed from the foreign prisoners to the English, and in the transmission had, as it were, consolidated its power; hence, when the prisoners did give it to those who breathed their atmosphere in court, the infection did not limit itself to them, as it certainly did at Oxford and, so far as anything is said, at Cambridge also, and as it usually does in typhus-fever; but it became a volatile poison, it developed wings and acquired staying power, so that its effects were felt over the county of Devon for at least six months longer.

Poverty and Vagrancy in Tudor England.

The Black Assizes of Cambridge (1522), of Oxford (1577), and of Exeter (1586) cast, in each case, a momentary and vivid light upon the state of England in the Tudor period as late as the middle of the reign of Elizabeth. It has been pointed out in a former chapter that prices and wages were favourable to the cultivators of the soil in the fifteenth century, that the English yeomanry sprang up in that period, that village communities and trading towns prospered although their morals were none of the best, and that the civil wars of York and Lancaster were so far from injuring the domestic peace of England that they even secured it. It was the observation of Philip de Comines, more than once quoted before, that England had the “peculiar grace” of being untroubled at large by the calamities of her civil wars, because kings and nobles were left to settle their quarrels among themselves. “Nothing is perfect in this world,” says the French statesman, who did not like independence of spirit among the lower orders. But he recognizes the fact as peculiar to England in the fifteenth century; and there can be little doubt about it.

The civil wars were hardly over when the troubles of the common people began. Here, if anywhere, is the turning-point brought into Goldsmith’s poem of “The Deserted Village:”

A time there was, ere England’s griefs began, When every rood of ground maintained its man.

Deserted villages became a reality in the last quarter of the fifteenth century, and throughout the century following. We hear of this depopulation first in the Isle of Wight, where it affected the national defence and therefore engaged the attention of the State. Two Acts were passed in 1488-9, cap. 16 and cap. 19 of 4 Henry VII. The first declares that “it is for the security of the king and realm that the Isle of Wight should be well inhabited, for defence against our ancient enemies of France; the which isle is late decayed of people, by reason that many towns and villages have been let down, and the fields dyked and made pastures for beasts and cattle.” The second relates that

“Great inconveniences daily doth increase by desolation and pulling down and wilful waste of houses and towns, and laying to pasture lands which customably have been used in tilth, whereby idleness, ground and beginning of all mischiefs, daily do increase; for where in some towns two hundred persons were occupied and lived by their lawful labours, now be there occupied two or three herdsmen, and the residue fall into idleness.” The remedy enacted is that no one shall take a farm in the Isle of Wight which shall exceed ten marks, and that owners shall maintain, upon their estates, houses and buildings necessary for tillage.

An instance of the same depopulation is given by Dugdale in Warwickshire: seven hundred acres of arable land turned to pasture, and eighty persons thrown out of employment causing the destruction of sixteen messuages and seven cottages. An instance of the same kind has already been quoted from the neighbourhood of Cambridge as early as 1414; but it is not until the settlement of the dynastic quarrels and jealousies, partly on the victories of Edward IV. at Barnet and Tewkesbury in 1471, and completely after the victory of Henry Tudor at Bosworth in 1485, that agrarian troubles became general. Then began the famous enclosures--enclosures both of the “wastes” of the manors, and of the open cultivated fields of the manors in which all the orders of villagers had their share of tenancy.

A few years after, in 1495, the number of vagabonds and beggars had so increased, of course in consequence of the enclosures, that a new Act was required, cap. 2 of the 11th of Henry VII. “Considering the great charges that should grow for bringing vagabonds to the gaols according to the statute of 7 Richard II., cap. 5, and the long abiding of them therein, whereby it is likely many of them would lose their lives:” therefore to put them in the stocks for three days and three nights upon bread and water, and after that to set them at large and command them to avoid the town, and if a vagabond be taken again in the same town or township, then the stocks for four days, with like diet. The deserving poor, however, were to be dealt with otherwise, but in an equally futile manner. In 1503-4, by the 19th of Henry VII. cap. 12, the period in the stocks was reduced to one day and one night (bread and water as before), probably in order that all vagabonds might have their turn.

The most correct picture of the state of England under Henry VII. and Henry VIII. is given by Sir Thomas More. The passages in his Utopia, relating to the state of England may be taken as veracious history. A discussion is supposed to arise at the table of Morton, archbishop of Canterbury, who was More’s early patron, and who died in 1500. “I durst boldly speak my mind before the Cardinal,” says the foreign observer of our manners and custom, Raphael Hythloday; and then follows an account of the state of England which lacks nothing in plainness of speech.

“But let us consider those things that chance daily before our eyes. First there is a great number of gentlemen, which cannot be content to live idle themselves, like drones, of that which other have laboured for: their tenants I mean, whom they poll and shave to the quick by raising their rents (for this only point of frugality do they use, men else through their lavish and prodigal spending able to bring themselves to very beggary)--these gentlemen, I say, do not only live in idleness themselves, but also carry about with them at their tails a great flock or train of idle and loitering serving-men, which never learned any craft whereby to get their living. These men, as soon as their master is dead, or be sick themselves, be incontinent thrust out of doors.... And husbandmen dare not set them a work, knowing well enough that he is nothing meet to do true and faithful service to a poor man with a spade and a mattock for small wages and hard fare, which being daintily and tenderly pampered up in idleness and pleasure, was wont with a sword and a buckler by his side to strut through the street with a bragging look, and to think himself too good to be any man’s mate.

Nay, by Saint Mary, Sir, (quoth the lawyer), not so. For this kind of men must we make most of. For in them, as men of stouter stomachs, bolder spirits, and manlier courages than handicraftsmen and ploughmen be, doth consist the whole power, strength and puissance of our army, when we must fight in battle.”

So much for the serving-men of the rich, apt to be discarded to swell the ranks of poverty and crime. But further:--

“There is another cause, which, as I suppose, is proper and peculiar to you Englishmen alone.--What is that? quoth the Cardinal.--Forsooth, my lord, quoth I, your sheep that were wont to be so meek and tame, and so small eaters, now, as I hear say, be become so great devourers and so wild that they eat up and swallow down the very men themselves. They consume, destroy and devour whole fields, houses and cities. For look in what parts of the realm doth grow the finest and therefore dearest wool, these noblemen and gentlemen, yea and certain abbots, (holy men, no doubt), not contenting themselves with the yearly revenues and profits that were wont to grow to their forefathers and predecessors of their lands, nor being content that they live in rest and pleasure, nothing profiting yea much annoying the weal public leave no ground for tillage; they inclose all into pastures; they throw down houses; they pluck down towns and leave nothing standing, but only the church to be made a sheep-house. And as though you lost no small quantity of ground by forests, chases, lawns, and parks, these holy men turn all dwelling-places and all glebe-land into desolation and wilderness. Therefore the one covetous and insatiable cormorant and very plague of his native country may compass about and inclose many thousand acres of ground together within one pale or hedge; the husbandmen be thrust out of their own, or else either by cunning and fraud, or by violent oppression they be put besides it, or by wrongs and injuries they be so wearied that they be compelled to sell all. By one means, therefore, or by other, either by hook or crook, they must needs depart away, poor silly wretched souls, men, women, husbands, wives, fatherless children, widows, woeful mothers with their young babes, and their whole household small in substance and much in number as husbandry requireth many hands. Away they trudge, I say, out of their known and accustomed houses, finding no place to rest in. All their household stuff, which is very little worth, though it might well abide the sale, yet being suddenly thrust out, they be constrained to sell it for a thing of nought. And when they have wandered abroad till that be spent, what can they then else do but steal, and then justly, pardy! be hanged, or else go about a begging. And yet, then also they be cast in prison as vagabonds, because they go about and work not; whom no man will set a work, though they never so willingly profer themselves thereto.”

Thus were the gaols filled. The policy of Henry VIII. was to hang for petty theft--“twenty together upon one gallows.” And yet the lawyer, the defender of the king’s firm rule, “could not choose but greatly wonder and marvel, how and by what evil luck it should come to pass that thieves nevertheless were in every place so rife and rank.”

These descriptions of the state of England were written about 1517, and the recitals in various Acts of Henry VIII. bear them out. Thus, in 1514 and 1515 (6 Hen. VIII. cap. 5, and 7 Hen. VIII. cap. 1), the towns, villages and hamlets, and other habitations decayed in the Isle of Wight are to be re-edified and re-peopled. In 1533-4 (25 Hen. VIII. cap. 13), there is a more comprehensive Act against the aggrandisements of pasture-farmers, “by reason whereof a marvellous multitude of the people of this realm be not able to provide meat, drink and clothes necessary for themselves, their wives, and children, but be so discouraged with misery and poverty that they fall daily to theft, robbery, and other inconvenience, or pitifully die for hunger and cold.” Some greedy and covetous persons have as many as 24,000 sheep: no one to keep above 2,000 sheep under the penalty of 3_s._ 4_d._ for every sheep kept by him above that number. Ten years after comes the well-known Act relating to the decay of towns[797] (35 Hen. VIII. cap. 4).

Besides these recitals in Acts of Parliament, we have other glimpses of the causes of agrarian distress. Thus, in a letter of June 24, 1528, from Sir Edward Guildford to Wolsey: Romney Marsh is fallen into decay; there are many great farms and holdings in the hands of persons who neither reside on them, nor till, nor breed cattle, but use them for grazing, trusting to the Welsh store cattle[798].

In Becon’s Jewel of Joy, written in the reign of Edward VI. the same condition of things is described:

“How do the rich men, and specially such as be sheepmongers, oppress the king’s liege-people by devouring their common pastures with their sheep, so that the poor people are not able to keep a cow for the comfort of them and of their poor family, and are like to starve and perish for hunger, if there be not provision made shortly.... Rich men were never so much estranged from all pity and compassion toward the poor people as they be at this present time.... They not only link house to house, but when they have gotten many houses and tenements into their hands, yea whole townships, they suffer the houses to fall into utter ruin and decay, so that by this means whole towns are become desolate and like unto a wilderness, no man dwelling there except it be the shepherd and his dog.” The interlocutor in the dialogue answers: “Truth it is. For I myself know many towns and villages sore decayed; for whereas in times past there were in some town an hundred households, there remain not now thirty; in some fifty, there are not now ten; yea (which is more to be lamented) I know towns so wholly decayed that there is neither stick nor stone, as they say.... And the cause of all this wretchedness and beggary in the common weal is the greed of gentlemen which are sheepmongers and graziers[799].”

Again, in Bullein’s Dialogue of the Fever Pestilence (1664), the groom Roger who accompanies the citizen and his wife to the country, in the direction of Barnet, points out an estate on which the rents had been raised; the fields had been turned into large pastures, and all the houses pulled down save the manor house: “for the carles have forfeited their leases and are gone a-begging like villaines, and many of them are dead for hunger.”

Vagabonds, beggars, valiant beggars, sturdy beggars, and ruffelers continue to occupy the pages of the Statute Book for many years. In 1530-31 (a long and elaborate Act), and in 1535-6, they are to be repressed by the stocks, by whipping, and ear-cropping; “and if any ruffeler, sturdy vagabond, or valiant beggar, having the upper part of the right ear cut off as aforesaid, be apprehended wandering in idleness, and it be duly proved that he hath not applied to such labours as have been assigned to him, or be not in service with any master, that then he be committed to gaol until the next quarter sessions, and be there indicted and tried, and, if found guilty, he shall be adjudged to suffer death as a felon.” A still more distracted Act was made by the Lord Protector in 1547 (1 Ed. VI. cap. 3): if the vagabond continue idle and refuse to labour, or run away from work set him to perform, he is to be branded with the letter V, and be adjudged a slave for two years to any person who shall demand him, to be fed on bread and water and refuse-meat, and caused to work in such labour, “how vile soever it be, as he shall be put unto, by beating, chaining, or otherwise.” If he run away within the two years, he is to be branded in the cheek with the letter S, and adjudged a slave for life; and if he run away again he is to suffer death as a felon. Similar provisions are made for “slave-children;” while the usual exceptions are brought in for the impotent poor. The above statute remained in force for only two years, having been from the first a monstrous insult to the intelligence of the nation, and never applied. It was succeeded by two meek-spirited Acts, 3 and 4 Ed. VI. cap. 16, and 5 and 6 Ed. VI. cap. 2, in which the impotent poor are provided for:--collectors in church to “gently ask and demand alms for the poor.” By the 1st of Mary, cap. 13, the collections for the poor were made weekly. When Elizabeth came to the throne, greater pressure was put upon the well-to-do to support the poor: by the Act of 5 Eliz. cap. 3 (1562-3) those who obstinately refused voluntary alms might be assessed. A more important Act of Elizabeth was that of her 14th year (1572-3) cap. 5, “For the Punishment of Vagabonds and for Relief of the Poor and Impotent.” A vagabond, as before, is to be whipped, and burnt on the ear; for a second offence to suffer death as a felon “unless some honest person will take him into his service for two whole years;” and for a third offence to suffer death and loss of lands and goods, as a felon, without allowance of benefit of clergy or sanctuary. Aged and infirm poor, by the same Act, are to be cared for by “overseers of the poor” in every parish, and to have abiding places fixed for them. In 1575-6 (18th Eliz. cap. 3), the Act of 1572-3 was amended and explained: “collectors and governors of the poor” are to provide a stock of wool, hemp, iron etc. for the poor to work upon, and “houses of correction,” or Bridewells, are to be built-one, two or more in every county for valiant beggars or such other poor persons as refuse to work under the overseers or embezzle their work. The last and greatest poor-laws of Elizabeth’s reign were those of her 39th year (1597-8) caps. 3 and 4 and her 43rd year (1601) cap. 2. These remained the basis of the English poor-law down to a recent period. Overseers of the poor are appointed in every parish--the churchwardens ex officio and four others appointed by the justices in Easter week: the overseers to meet once a month in the parish church after divine service on the Sunday: contributions to be levied by the inhabitants of any parish among themselves, or the parish or hundred to be taxed by the justices, failing the contributions, or, if the hundred be unable, then the county to be rated “in aid of” the parishes.

These being the developments of the poor-law and the law against vagabonds to the end of the Tudor period, we may now return to our particular illustrations, and more especially to the illustrations from popular sickness.

Under the year 1537, one of the citizen chroniclers of London has an entry, “Began a collection for the poor, and a great number cured of many grievous diseases through the charity thereof.” Under 1540, he records that “the collection for the poor people ceased[800].” Preaching before Edward VI. on the fourth Sunday in Lent, 1550, Thomas Lever, Master of St John’s College, Cambridge, said: “O merciful Lord! what a number of poor, feeble, halt, blind, lame, sickly--yea with idle vagabonds and dissembling caitiffs mixed among them, lie and creep, begging in the miry streets of London and Westminster[801].” In May, 1552, Ridley wrote to Cecil that the citizens were willing to provide for the poor “both meat, drink, clothing and firing;” but they lacked lodging, and he wanted the king to give up Bridewell “to lodge Christ in,” or in other words, the poor “then lying abroad in the streets of London.”

Coming to the middle of Elizabeth’s reign, in the year 1579 we find, in an essay dedicated to the queen by Dr John Jones upon general topics of health and morals, an account of poverty and crime which reads little better than Sir Thomas More’s for 1517. In his 31st chapter on “The great cost that the commonwealth is at daily in relieving the poore: Of the number of them that are yeerly executed,” he speaks of the new poor-rate as “a greater tax than some subsidies,” and as a “larger collection than would maintain yeerly a good army;” and, of the felons as “a mightier company of miserable captives than would defend a large country, as in the records of the Clerks of the Peace and of the Assize may easily be seen.”

Even from the outset, the poor-rate does not appear to have met the difficulty:

“And yet housekeepers be but little less discharged, if ye note the continual resort of the needy, especially in the country and towns that be incorporate, the poor (as they say) not much the more aided, as by the moan they make to travellers may be easily gathered, nor theft and wickedness the less practised. For what misery it is to see condemned at one assize in a little shire thirty-nine, notwithstanding the clemency of the Judges, and three hundred and odd in one Diocese to do penance or fine for their loose living in a year. But these be the meanest sort only, for the others scape as though it were in them no offence. And in one gaol of prisoners three hundred and upwards at one time, whereof a great part perhaps may be through negligence of justice or cruelty, that otherwise might be punished answerably to the offences lawfully.”

He then refers to the Bridewells “so charitably and politicly appointed by the late Act of Parliament, although not yet in every shire erected.” The Act of Parliament was that of 1572 and the Bridewells were the houses of correction for vagrants, the first type of workhouses, and so named after the Bridewell in Fleet Street, which was given by Edward VI. from being a royal residence to be a refuge of the poor. So far as fever was concerned, it mattered little whether the Bridewell were a poor-house or a prison, for in later times gaol fever and workhouse fever were both synonyms for typhus.

It would not have been surprising to find this enormous extent of pauperism, vagrancy and crime attended by the distinctive morbus pauperum, typhus-fever. But we are here concerned only with the evidence, and not with antecedent probabilities. The records are, of course, very imperfect. The gaol-fevers of Cambridge, Oxford and Exeter attracted much notice because they touched the governing class. There may have been much more gaol-fever unrecorded. Hoker, in his account of the Exeter fever, does indeed say: “and this is commonly called the gaol sickness, and many die thereof;” and, in a petition to the Crown, March, 1579, the Queen’s Bench prison in Southwark is said to contain twice its complement, there is in it a disease called “sickness of the house,” and near a hundred had died of that sickness in the prison during the previous six years[802]. We shall not be able to give colour to our epidemiological history by other such instances from the Tudor period[803]; even for plague itself, the records of particular outbreaks are meagre and almost certainly only a part of the whole. The epidemics which shall occupy us for the rest of this chapter are those that had a general prevalence over the country on two or three occasions, the same general prevalence of fever that recurs at shorter intervals in the Stuart period and in the eighteenth century.

Hitherto we have attempted to work out the history of epidemics in Britain without reference to the epidemics in other countries, except in the case of the Black Death, which had remarkable antecedents in the remote East, and in the case of the English Sweat of 1528, which overran a great part of the Continent in 1529 and 1530. To have attempted a parallel record of epidemics abroad would have served inevitably to confuse the vision; for the annals of pestilence in all Europe would have been from year to year an unrelieved record of sickness and death, an unnatural continuance or sequence, from which the mind turns away. The several countries of Europe, and the several cities, had each their turn of plague; but they had each, also, their free intervals, sometimes very long intervals, as we have seen in the case of Aberdeen with no plague for nearly two generations in the sixteenth century. The epidemiography of each country should therefore be kept apart; and within a given country care should be taken to prevent the illusion of universal sickness, which is apt to be created in the bringing of scattered centres of disease (such as plague) together in the same page.

But there are instances of what are called pandemics, or universal epidemics, of sickness. The Black Death was one such, covering a period of perhaps four years in Europe, from 1347 to 1350, the curve of the disease in each locality lasting about six months. With the beginning of the modern period we come to more frequent pandemics, not of plague, but of minor or milder forms of pestilential infection. On the continent of Europe these were in part related to the state of war, which may be taken as beginning with the invasion of Italy by Charles VIII. of France in 1494. Typhus-fever, or war-fever with famine-fever, now begins to be a familiar form of sickness--in 1498, 1505, 1510, 1528, and so on. Other forms are putrid sore throat, dysentery, and varieties of fever included under influenza. The various forms were apt to occur together or in succession, so that epidemiography has a “Protean” character. This epidemic Proteus is at once a great difficulty and a most instructive fact. It opens up the very old doctrine of “epidemic constitutions” of the air, which to many moderns savours of unscientific vagueness; and it brings us face to face with degrees or kinds of infectiveness which are, in matter of fact, more wonderful or more incomprehensible than the deadlier infections, such as the plague or Asiatic cholera. The most familiar instance of the kind is influenza.

Influenza.

Influenza enters undoubtedly into the Protean infections of the sixteenth century, and is itself no small part of the Proteus. But what is influenza? The name is comparatively modern--Italian of the 18th century--and appears to mean defluxion or catarrh, not in the familiar sense only, but as derived from the comprehensive pathological doctrine of humours: thus the Venetian envoy in London called the sweat of 1551 an “influsso.” It is open to us to include much or little under influenza; but the name itself, having its root in an obsolete doctrine of humours, can never be made exact or scientific. Usage has applied it to all universal colds and coughs; and it has been applied capriciously to some universal fevers, but not to others. There are two tolerably clear references to its prevalence in England before the peculiarly unwholesome state of Europe began with the modern age. Under the year 1173, the chronicle of Melrose enters “a certain evil and unheard-of cough” (tussis quaedam mala et inaudita), which affected everyone far and near, and cut off many.

One of the St Albans chroniclers, an unknown writer who kept a record from 1423 to 1431 (reign of Henry VI.), has the following entry under the year 1427: “In the beginning of October, a certain rheumy infirmity (quaedam infirmitas reumigata) which is called ‘mure’ invaded the whole people, and so infected the aged along with the younger that it conducted a great number to the grave[804].” A good deal is said in this brief passage, and all that is said points to influenza--the rheumy nature of the malady, the universality of incidence, presumably the suddenness and brief duration, the deaths among the aged and the more juvenile. It is known also that a similarly general malady was prevalent the same year in Paris, where it bore the name of ladendo; the particulars given in the French record of it leave no doubt that it was influenza.

The singular name of pestilentia volatilis given by Fordoun to two epidemics in Scotland in his own lifetime, one which began at Edinburgh in February, 1430 (1431 new style), and the other at Haddington in 1432, suggests that they may have been influenzas, but there is nothing more than the name to indicate their nature. Those years are not known to have been years of influenza in any other country of Europe: the record of the malady passes direct from 1427 to 1510. There was certainly a great wave of influenza over Europe in 1510, under the names of cocqueluche and coccolucio. It is said to have come up from the Mediterranean coasts and to have extended to the shores of the Baltic and North Seas; its prevalence in Britain is likely enough, and is indeed asserted in one foreign account, but there is no known native notice of it. Abroad, it had the usual character of suddenness, simultaneity and universality, and the symptoms of heaviness, prostration, headache, restlessness, sleeplessness, and for some time after a violent paroxysmal cough, like whooping-cough. None died except some children; in some it went off with a looseness, in others by sweating[805]. The mention of sweating in the influenza epidemic of 1510 is not without importance. It may serve to explain a remark by Erasmus, in a letter of 25th August, 1511, from Queens’ College, Cambridge, that his health was still rather doubtful “from that sweat” (a sudore illo[806]); the sweat can hardly have been the sweating sickness of 1508, three years before, but the still unsettled health of Erasmus in 1511 may perhaps have been the dregs of the influenza of 1510.

The next great European epidemic of influenza was in 1557, for which I shall produce medical evidence of England sharing in it, probably during that year and certainly in the one following. But the intervening years afford some notices of sickness in England, which was neither so severe as plague at one end of the pestilential scale nor altogether mild at the other, being forms of illness which contemporaries pronounced to be “new” and “strange,” and appear to have been of the nature of pestilent fever and dysentery.

Neither typhus nor dysentery was really new to England in the sixteenth century; on the contrary, they were (with putrid sore throat and lientery) the common types of disease in the great English famines which came at long intervals, as described in the first chapter. But on the continent of Europe typhus and dysentery and putrid sore throat (angina maligna) began with the modern age to appear as if capriciously, and independently of such obvious antecedents as want, although some of the epidemics of typhus and dysentery were clearly related to the hardships of warfare[807]. Typhus, indeed, was a disastrous malady on the Continent in those years, notably in 1528 in Spain, where it was known as “las bubas,” and in France, where it was called “les poches”--both names relating to the spots on the skin, and both more strictly applicable to the eruptions of the lues venerea, which was then also rampant.

Apart from the gaol fever at Cambridge in 1522, the first mention of those new epidemics in England since the end of the medieval period is under the year 1540: “This said xxx and two year [of Henry VIII.] divers and many honest persons died of the hot agues and of a great lask throughout the realm[808].” The “lask” was dysentery, (Stow, in chronicling the epidemic in his much later Annales calls it “the bloody flux”), and the “hot agues,” according to later references under that name, appear to have been influenza in the sense of a highly volatile typhus[809]. All that we know of the circumstances of this epidemic is that the summer was one of excessive drought, that wells and brooks were dried up, and that the Thames ran so low as to make the tide at London Bridge not merely brackish but salt.

The spring and summer of 1551 were the seasons of the last outbreak of the sweat in England, which curiously coincided with another epidemic of influenza (cocqueluche) in France. The years from 1555 to 1558 were a sickly period for all Europe, the diseases being of the types of dysentery, typhus, and influenza. The most authentic particulars are given under the years 1557 and 1558; and those for England, which specially concern us, are now to be given. Wriothesley, a contemporary, enters under the year 1557: “This summer reigned in England divers strange and new sicknesses, taking men and women in their heads; as strange agues and fevers, whereof many died[810].” Under the year 1558, the continuator of Fabyan’s chronicle says: “In the beginning of this mayor’s year died many of the wealthiest men all England through, of a strange fever[811].”

Some light is thrown upon the sickness, general throughout England in 1557-8, also by Stow in his Annales. Before the harvest of 1557 corn was at famine prices, but after the harvest wheat fell to an eighth part of the price (5_s._ the quarter), the penny wheaten loaf being increased from 11 oz. to 56 oz.! In the harvest of 1558, he goes on, the “quartan agues continued in like manner, or more vehemently than they had done the last year passed, where-through died many old people and specially priests, so that a great number of parishes were unserved and no curates to be gotten, and much corn was lost in the fields for lack of workmen and labourers[812].” Harrison, canon of Windsor, says that a third part of the people of the land did taste the general sickness, which points to influenza[813].

The year 1557 was certainly remarkable on the continent of Europe as a year of widely prevalent “pestiferous and contagious sickness,” which was described by numerous medical writers. That universal epidemic, or pandemic, is usually counted as one of the great historical waves of influenza; and in the annals of that wonderful disease it stands the first which was well recorded by competent foreign observers, including Ingrassias, Gesner, Rondelet, Riverius, Dodonaeus, and Foreest. The corresponding sickness in England in 1557 (still more severe in 1558), which carried off many of the wealthiest men, and made so great an impression that it is noticed by Stow and Speed, has missed being noticed by English physicians, with a single exception, and that a casual one. If the continental physicians had not been copious in writing on several occasions when our English physicians were silent, such as the epidemic of syphilis in 1494-6, the English sweat of 1529, and the influenza of 1557-8, it might appear ungracious to remark upon the scanty literary productiveness of the profession in the Tudor period. Whoever attempts medical history for England will soon feel our deficiency in materials, and become disposed to envy the easier task of the foreign historian. The academical physicians of the time hardly ever wrote. The men who wrote on medicine were laymen like Sir Thomas Elyot, who justified his interest therein by the example of men of his own rank like Juba, king of Mauritania, and Mithridates, king of Pontus; or they were irregular practitioners desirous to advertise themselves; or booksellers’ hacks like Paynel; or such as Cogan, a schoolmaster and a physician in one. The modern reader will be surprised at the common burden of the prefaces of medical (and perhaps other) books in the Tudor period,--the intolerable nuisance of “pick-faults,” “depravers,” and cavillers, who sat in their chairs and criticised; and if the modern reader happen to be in quest of authentic facts, he can hardly fail to sympathise with Phaer, when he addresses the academical dog-in-the-manger with the Horatian challenge: “Si quid novisti rectius istis, candidus imperti; si non, his utere mecum.”

It is possible, however, to collect a few particulars of the prevalent sickness of 1558 in England from casual notices of it. Thus, it comes into a letter to the queen, of September 6, by Lord St John, governor of the Isle of Wight, from his house at Letley, near Southampton: sickness affected more than half the people in Southampton, the Isle of Wight and Portsmouth (those places being filled with troops under St John’s command), and the captain of the fort at Sandown was dead[814]. Curiously enough we get an intimate glimpse of this epidemic from a book published some years after, the Dyall of Agues by Dr John Jones. In his chapter “Of the Sweating Fevers” (chapter xiv), after illustrating from Galen the proposition that a sweat may not be critical and wholesome, but τυφώδης or typhus-like, attending the seizure from its outset and “the same said sweat little or nothing profiting,” he proceeds to point his remarks by his own experience:

“I had too good experience of myself in Queen Mary’s reign, living at Lettlé in my good lord’s house, the right honourable Lord St John, beside Southampton, the which, notwithstanding the great sweat, it was long after before I recovered of my health, so that the said sweat did nothing profit.”

He then proceeds to compare the sweat, almost certainly the epidemic mentioned in St John’s despatch of 6th September, 1558, with the sweating sickness of 1551:

“So in our days, even in King Edward VI.’s reign, it brought many to their long home, as some of the most worthy, the two noble princes of Suffolk, imps of honour most towardly, with others of all degrees infinite many; and the more perished no doubt for lack of physical counsel speedily[815].”

The next that we hear of this epidemic of the autumn of 1558, is in a despatch from Dover, 11 p.m. 6th October: the writer has “learnt from the mayor of Dover that there is no plague there, but the people that daily die are those that come out of the ships, and such poor people as come out of Calais, of the new sickness[816].” A despatch of 17th October, 1558, from one of the commissioners for the surrender of Calais, Sir Thomas Gresham, at Dunkirk, to the Privy Council, says that he “returned hither to write his letter to the queen, and found Sir William Pickering very sore sick of this new burning ague. He has had four sore fits, and is brought very low, and in danger of his life if they continue as they have done[817].”

Here we have the same term “new sickness” and “new burning ague” as in the two English chronicles under the year before--the “strange and new sicknesses” which “took men and women in their heads,” and the “strange agues and fevers.” The very general prevalence in Southampton, Portsmouth and the Isle of Wight suggests influenza; the symptom of sweating described by Jones for his own case during that prevalence is in keeping with what we hear of the influenzas of the time from foreign writers, and so is the long and slow convalescence; the fact of one person having had four sore fits of “this new burning ague” is more like influenza than typhus.

The severe mortalities in the autumn of 1558 at Loughborough and Chester are put down to “plague,” and they may, of course, have been circumscribed outbursts of the old bubo-plague. If, however, they were part of the general prevalence of hot or burning agues, which we may take to have been influenza or a very volatile kind of typhus, they would indicate a degree of fatality in the latter somewhat greater than more recent influenzas have had. A high death-rate is, indeed, demonstrable for the year 1558, from parish registers, by comparing the deaths in that year with the deaths in years near it, and by comparing the deaths with the births in 1558 itself.

The registers of christenings and burials, which had been ordered first in 1538, were kept in a number of parishes from that date; and from 1558, when the order for keeping them was renewed by queen Elizabeth, they were generally kept. Dr Thomas Short, a man of great industry, about the middle of last century obtained access to a large number of parish registers, and worked an infinite number of arithmetical exercises upon their figures[818]. His abstract results or conclusions are colourless and unimpressive, as statistical results are apt to be for the average concrete mind; nor can they be made to illustrate the epidemic history of Britain with the help of his companion volumes, ‘A General Chronological History of the Air, Weather, Seasons, Meteors etc[819].’, for these extraordinary annals are for the most part loosely compiled from foreign sources, bringing into one focus the most scattered references to disease in any part of Europe, and that too without criticism of authorities but often with surprising credulity and inaccuracy. That so much statistical or arithmetical zeal and exhaustiveness (in the work of 1750) should go with so total a deficiency of the critical and historical sense, (in the work of 1749) is noteworthy, and perhaps not unparalleled in modern times. Short’s history is mostly foreign, but his statistics, which are English, may be used to illustrate and confirm what can be learned of sicknesses in England in the ordinary way of historical research.

Thus, the period from 1557 to 1560 stands out in Short’s table as one of exceptional unhealthiness both in country parishes and in market towns, the unhealthiness being estimated by the excess of burials over christenings.

Country Parishes.

Registers Unhealthy Baptised Buried Year examined Parishes in same in same

1557 16 7 62 181 1558 26 11 171 340 1559 34 12 145 252 1560 38 6 100 162 1561 41 1 19 32

Market Towns.

Registers Unhealthy Baptised Buried Year examined Towns in same in same

1557 4 2 262 381 1558 4 2 104 159 1559 5 3 102 149 1560 8 3 134 201 1561 8 3 276 399 1562 8 1 58 71

Short’s collection of parish registers appears to have represented many English counties, although there is no clue to their identity in the tables from which these figures are taken. The heavy mortalities in the registers correspond exactly to the epidemic years as otherwise known, and may be said to bear witness to the extent or generality of the epidemic infection.

The next that we hear of malignant fevers in England is the outbreak at Oxford in 1577, following the Assizes. Anthony Wood says of it: “Some thought that this Oxford mortality was the same that Leonard Fuchsius styles sudor Anglicus.” Cogan, a contemporary, says:

“And certainly after that sudden bane at Oxford, the same year and a year or two following, the same kind of agues raged in a manner all over England, and took away very many of the strongest sort in their lustiest age, and for the most part men and not women nor children, culling them out here and there, even as you should choose the best sheep out of a flock. And certain remedy was none to be found.... And they that took a moderate sweat at the beginning of their sickness, and did rid their stomachs well by vomit, sped much better.”

This is partly confirmed by Short’s abstracts of the parish registers. Thus in 1580, of sixty registers examined, ten showed unhealthiness, the births being to the deaths as 248 to 284. In 1582, seven country parishes were markedly unhealthy, the births being to the deaths as 140 to 244. In market towns the incidence is not so striking: in 1580, four towns out of sixteen examined showed an unhealthy birth-rate, 237 births to 276 deaths. It is in 1583 that the disparity becomes greatest in these towns: three out of the sixteen in the list were notably unhealthy, the deaths being 1062 and the births 467. But it is the obvious defect of Short’s method that we have no means of knowing whether that mortality may not have been largely from plague, and not from fever or other form of epidemic sickness.

The only year between 1558 and 1580 in Short’s tables, which stands out as decidedly unhealthy both in country parishes and market towns is 1570, while the years from 1573 to 1575 are less healthy than the average. Those were years of war, and of war-typhus, on the Continent, as the foreign writings show, but there are no records of the kind of sickness in England.

One glimpse of the prevalence of those fevers of 1580-82 is got from a letter of the earl of Arundell to Lord Burghley, October 19, 1582. The earl had left his house in London because it was so “beset and encompassed” by plague; while, as to his country house: “The air of my house in Sussex is so corrupt even at this time of the year as, when I came away, I left xxiv sick of hot agues.” He therefore begs the loan of the bishop of Chichester’s house till such time as the vacancy in the see should be filled up[820].

The widespread volatile sicknesses of 1557-8 and 1580-2, which are grouped under the generic name of influenza, were related in time to great epidemics of the far more deadly bubo-plague. These plague outbursts were less noticeable in England than abroad. Thus in 1557 there were most disastrous epidemics of true bubo-plague in several towns of the Low Countries, and in 1580 there was at Cairo one of the worst epidemics in the whole history of plague from its beginning. The years preceding 1580 were also plague-years in many parts of Europe (Padua, Mantua, Venice, Messina, Palermo, Lisbon, Brussels). Those years were also the occasion of the first great and disastrous epidemics of diphtheria (garottillo) in Spain. Then come the epidemics of typhus; and at the far end of the pestilential scale the flying waves of influenza. A relation of influenza to other prevalent infections has been one of the theories of its nature, especially the relation to epidemics of Asiatic cholera.

In that view influenza looks as if it were a volatile product, a swifter and more superficial wave on the top of some slower and more deadly earth-borne virus. As the old writers said, it was a levis corruptio aeris, a diluted virus as it were, mild in proportion to its volatility and swiftness, but in universality equalling in its own milder way the universality of the plague of Justinian’s reign or of the Black Death.

Now, the same century and the same state of society which witnessed the most remarkable of those flying ripples of infection over the whole surface of Europe witnessed also some waves of infection which did not travel so far, nor were mere influenzas. The English sweat travelled over England in that way; it was called the posting sweat, because it posted from town to town: thus in 1551 it suddenly appeared one day in Oxford, and next day it was in the villages around, as if carried in the air; in like manner it posted to Devonshire, to Leicestershire, to Cheshire, and doubtless all over England, like the influenzas of recent memory. And while the English sweat was thus flying about in England, influenza was flying about the same year (1551) in France, a country which never suffered from any of the five sweating sicknesses of 1485-1551. Again, the influenza in England in 1558 had the symptom of sweating so marked that it was compared to the true sweat of 1551 by Dr Jones, who himself suffered from it. Also the influenza of 1580 all over Europe had so much of a sweating character that in some places they said the English sweat had come back. Lastly, the gaol-fever of Oxford in 1577 was thought by some to present the symptoms described by Leonard Fuchs for sudor Anglicus; and Cogan, an English medical writer then living, specially mentions the phenomenon of sweating (as well as the intestinal profluvium called a “lask”), both at Oxford and in the more widely prevalent diseases of that year and the years following. The gaol-fever of Exeter in 1586 illustrates still another side of the question; it diffused itself--probably by other means than contact with the sick--all over the county of Devon, and had not ceased six months after it began in the month of March at Exeter. The Devonshire diffusion was like the spreading circles in a still pool. The spread of influenza was like the flying ripples on a broad surface of water. The spread of plague, on the occasions when it was universal, was like the massive rollers of the depths, the onward march of cholera from the East having, in our own times, illustrated afresh the same momentum.

In using hitherto the name of influenza for the universal fevers in England in 1557-58 and in 1580-82, I have done so because those years are usually reckoned in the annals of influenza. But the name is at best a generic one, and need not commit us to any nosological definition. I shall have to deal at more length with this question in the tenth chapter, when speaking of the fevers of 1657-59 described by Willis and Whitmore, two competent medical observers; in those years the vernal fever was a catarrhal fever, or influenza proper, while the fever of the hot and dry season, autumnal or harvest-fever, was a pestilential fever, a spotted fever, a burning ague, a contagious malignant fever. There were also differences in their epidemological as well as in their clinical characters, the influenza wave being soonest past. But so far as regarded universality of diffusion and generality of incidence, both types were much alike.

Molineux, writing in 1694, a generation after Willis, “On the late general coughs and colds,” brought into comparison with them another epidemic which he had observed in Dublin in the month of July, 1688: “The transient fever of 1688 ... I look upon to have been the most universal fever, as this [1693] the most universal cold, that has ever appeared[821].”

When we come to the 18th century, to great epidemics not only in connexion with famine in Ireland, but also in England, we shall find the same diffusiveness associated with the clear type of disease which we now call typhus. Influenza is the only sickness familiar to ourselves which shows the volatile character, and we are apt to conclude that no other type of fever ever had that character. But, without going farther back than the 18th century we shall find epidemics of spotted typhus resting like an atmosphere of infection over whole tracts of Britain and Ireland, town and country alike; and even if we give the name of influenza to the epidemical “hot agues” with which we are here immediately concerned, in the years 1540, 1557-8, and 1580-82, we may also regard them as in a manner corresponding to, if not as embracing, the types of fever that prevailed from time to time over wide districts of country in the centuries following.

The term “ague,” often used at the time, is no more decisive for the nosological character than the term “influenza.” Ague originally meant a sharp fever (febris acuta, ὄξυς), and in Ireland, from the time of Giraldus Cambrensis down to the 18th century, it meant the acute fever of the country, which has not been malarial ague, in historical times at least, but typhus. “Irish ague” was in later times a well-understood term for contagious pestilential fever or typhus. In the Dyall of Agues by Dr John Jones (1564 ?), just as in the writings of Sydenham a century later, intermittents were mixed up with continued fevers which had nothing malarial in their cause or circumstances. Thus, Jones has a chapter on “Hot Rotten Agues,” which he identifies with the synochus or continued fever of the Greeks; in another chapter on “The Continual Rotten Ague,” he locates the continued fevers within the vessels and the “interpolate” without their walls, and proceeds:

“It happeneth where all the vessels, but most chiefly in the greatest which are annexed about the flaps of the lungs and spiritual members, all equally putrefying, which often happeneth, as Fuchsius witnesseth, of vehement binding and retaining the filth in the cavity or hollowness of the vessels, inducing a burning heat. Wherefore, this kind of fever chanceth not to lean persons, nor to such as be of a thin constitution and cold temperament, nor an old age (that ever I saw), but often in them which abound with blood and of sanguine complexion, replenished with humour, fat and corpulent, solemners of Bacchus’ feasts,--gorge upon gorge, quaff upon quaff--not altogether with meat or drink of good nourishment but of omnium gatherum, as well to the destruction of themselves as uncurable to the physician, as by my prediction came to pass (besides others) upon a gentleman of Suffolk, a little from Ipswich, who by the causes aforesaid got his sickness, and thereof died the ninth day, according to my prediction, as his wife and friend knoweth.”

Again, in his eighth chapter, “Of the Pestilential Fever, or Plague, or Boche [Botch],” he remarks upon the varying types of pestilential diseases, mentioning among other national types the English sweat:

“As we, not out of mind past, with a sweat called stoupe galante, as that worthy Doctor Caius hath written at large in his book De Ephemera Britannica,” adding the remark that here concerns us:--“and sethence [since then], with many pestilential agues, and, lastly of all, with the pestilential boche [botch or plague rightly termed].” These continued fevers, pestilential agues, or hot rotten agues, Jones distinguishes from quotidians, tertians and quartans. Of the last he says: “and when quartans reign everywhere, as they did of no long years past; of the which then I tasted part, besides my experience had of others,”--probably the fevers of 1558, elsewhere called by him the sweating sickness, and by Stow called “quartan agues.” He mentions also quintains, which he had never seen in England, “but yet in Ireland, at a place called Carlow, I was informed by Mr Brian Jones, then there captain, of a kerne or gentleman there that had the quintain long.”

Not only the term “ague,” but also the terms “intermittent,” “tertian,” and more especially “quartan,” can hardly be taken in their modern sense as restricted to malarial or climatic fevers. An intermittent or paroxysmal character of fevers was made out on various grounds, to suit the traditional Galenic or Greek teaching; but the paroxysms and intermissions were not associated specially with rise and fall of the body-temperature. The curious history of agues, and of the specialist ague-curers, properly belongs to the time of the Restoration, when Peruvian bark came into vogue, and will be fully dealt with in the first chapter of another volume.

The last years in the Tudor period that stand out conspicuously in the parish registers for a high mortality, not due to plague, are 1597-8. The year 1597 was a season of influenza in Italy, and perhaps elsewhere in Europe; so that the epidemic in England that year may have been the same, but more probably was famine-fever. In the parish register of Cranbrooke the deaths for the year are 222, against 56 births; and 181 of the deaths are marked with the mark which is supposed to mean plague proper. The register of Tiverton has 277 deaths, against 66 births, but it is almost certain that the cause of the excess was not plague, of which the nearest epidemic in that town was in 1591. In a country parish of Hampshire, with a population of some 2700, the deaths in 1597 were 117, against 48 births, the mortality being about twice as great as in any year from the commencement of the register in 1569, and after until 1612[822]. In the north of England the type of disease in 1597-8 was plague proper.

The parish register of Finchley has a remarkable entry under the year 1596 which introduces us to other considerations: “Hoc anno moriebantur de dysenteria xix,” the whole number of burials for the year having been 28. Next year, 1597, there are 23 deaths from dysentery, the burials in all having been 48--an enormous mortality compared with the average of the parish. The year 1597, if not also 1596, was a year of great scarcity, apparently all over England; in Northumberland, Durham, and Cumberland, the scarcity was attended by plague proper; but in other parts of England, it would seem, by other types of sickness, of which dysentery was one.

One of the 16th century English names used for flux was the obsolete word lask, which occurs often enough in writings of the period to suggest that the malady was common; it is sometimes called a choleric lask (cholera morbus), or a vehement lask, as in Elyot’s Castel of Health and in Cogan’s Haven of Health. Lasks, or lienteries, or dysenteries have not been dealt with in a chapter by themselves because the records of them are too few and meagre, so far as we have gone in the history; but it may be convenient to bring together here the better known instances. In the period of famine-sicknesses, dysentery and lientery must have been common types, the latter being specially mentioned by Rishanger of St Albans for the year 1294. Trokelowe, another St Albans chronicler, writing of the famine-sickness of 1315-16, uses the singular phrase “morbus enim dysentericus ex corruptis cibis fere omnes maculavit” and says it was followed by “acuta febris vel pestis gutturuosa.” Dysentery from corrupt food is again specially named for the year 1391. The “wame-ill” was the prevalent type of sickness in the great Scots famine of 1439, a year of famine in England and France. When we next hear of it in English history it is among the troops of the marquis of Dorset in Gascony and Biscay in 1512, some 1800 of them having died of “the flix.” Then comes the “great lask throughout the realm” in 1540, associated with “strange fevers.” The sickly years 1557-58 and 1580-82 had probably some dysentery, or lientery, either as primary maladies or as complications of the fevers: Cogan’s generalities imply as much for 1580-82, and we know that the corresponding sickly period a century after (1657-59) was so characterised in the description by Willis. The fatal infection in the fleet after the defeat of the Spanish Armada, in August, 1588, was probably dysentery and ship-fever. Many other instances of the kind remain to be given in the chapter on the sicknesses of voyages and colonial settlements.

Dysentery begins to be heard of more frequently in the Stuart period, as a malady of London. It is a prominent item, along with summer diarrhoea, in the London bills of mortality from the year 1658, under the name “griping of the guts,” and is occasionally mentioned in letters from London about the same years. The dysentery of London in 1669 was the subject of Sydenham’s observations, who says that it had been rarely seen in the preceding ten years[823]. On the other hand he speaks of “the endemic dysentery of Ireland,” although he is not sure as to its type or species[824]. Statements as to the Irish “country disease,” are as old as Giraldus Cambrensis[825]; but as the whole question of dysentery is intimately bound up with that of typhus-fever, I shall reserve consideration of its prevalence in Ireland on the great scale, as well as of the annual mortality from it in the London bills of the 17th century, until that section of the work in which fevers and the maladies akin to them come into the first rank as if in lieu of the plague.

* * * * *

NOTE. A sweating character in the “hot agues” or fevers of the Elizabethan period, in those of 1580-82 as well as in those of 1557-58, is asserted in several passages in the text. It is noteworthy that in Measure for Measure, one of Shakespeare’s early comedies, the bawd says: “Thus, what with the war, what with the sweat, what with the gallows, and what with poverty, I am custom-shrunk” (Act I. Scene 2).

VIII. THE FRENCH POX

One great epidemic disease of the first Tudor reigns, which brought consternation and distress to multitudes, makes hardly any appearance in the English records of the time, and no appearance at all in the writings of the English profession. Long after, in 1576, William Clowes, surgeon to St Bartholomew’s Hospital, first broke the professional silence about lues venerea in England, and in his larger work of 1579 he gave a number of startling facts and figures of its then prevalence in London. But the great epidemic outburst of that disease in Europe began in the last years of the 15th century; its ravages on the epidemic scale are supposed to have lasted for twenty or thirty years from 1494; and its subsequent prevalence is assumed, not without reason, to have been of a milder type and within narrower limits. We hear of it, in England, from the political side, at the time when popular arguments were wanted against the Romish mass-priests and against the monasteries and the orders of friars. In the practical reasoning of Englishmen the scandalous lives of priests, monks and friars made the strongest argument for the policy which the king had adopted towards Rome; and it so happened in those very years that a scandalous life was betrayed, and made odious in more than sentiment, by bearing an outward and visible sign. The epidemic of morbus Gallicus arose at an unfortunate time for the pretensions of Rome, or, perhaps, it was itself part of the march of events. In Simon Fish’s Supplication of Beggars, which was compiled in 1524 and was read to Henry VIII. shortly after, the weightiest plea is the charge of scandalous conduct resting upon the priests. In the inquisitions which preceded the suppression of the monasteries, the same plea is, justly or unjustly, brought to the front in the case of one abbey after another. So close did the association of a scandalous vice and its attendant disease become with the priesthood that James I., writing long after concerning the sentiments of his mother, Mary the queen of Scots, represents her as forbidding the archbishop “to use the spittle” in his own baptism, for the reason that she would not have “a pokie priest to spet in her child’s mouth[826].” These, says king James, were “her owne very words;” at all events, “a pocky priest” may be accepted as a phrase of the time. The fact that the epidemic of syphilis in England was used to discredit Romish priests is one of the few indications that we have of its existence in this country. Wide and deep as the commotion must have been which it caused, it found hardly any more permanent expression than the private talk of the men of those days. It was otherwise on the Continent. There, indeed, a copious literature sprang up, of which some thirty works remain, from the essay of Conrad Schellig of Heidelberg, printed without date or place, but ascribed to the year 1494 or 1495, down to the elaborate survey of the disease by Nicolas Massa of Venice in 1532. The single work extant in England from that, the earliest and greatest, period of the disease, is a poor piece of manuscript in the Sloane collection, translated from some foreign author, and entitled, “The tretese of the pokkis: and the cure by the nobull counsell of parris[827].” One of its cases is that of a man, aged forty, with two broad and deep, corroding and painful sores on his leg; another is of a bishop of Toledo, who had “pustules” and nocturnal pains “as if the bones would part from the flesh.” The vague meaning of the term pox is shown in one phrase, “paynes, viz. aches and pokkis.”

It was nothing unusual abroad to give cases, and to authenticate them with the names of the sufferers. Thus Peter Pinctor, physician to the pope Alexander Borgia, in a notorious but exceedingly scarce work published in 1500, enters fully into the truly piteous case of the cardinal bishop of Segovia, major-domo of the Vatican, “qui hunc morbum patiebatur cum terribilibus et fortissimis doloribus, qui die ac nocte, praecipue in lecto, quiescere nec dormire poterat,” as well as into the case of Peter Borgia, the pope’s nephew, “in quo virulentia materiae pustularum capitis corrosionem in pellicaneo [pericranio] et in craneo capitis sui manifeste fecit[828].”

Contrasted with the copious writing and recording of cases abroad, the English silence is remarkable. The origin of our first printed book on the subject is characteristic. A literary hack of the time, one Paynel, a canon of Merton Abbey, had translated, among other things, the Regimen Salernitanum, a popular guide to health several hundred years old. Going one day into the city to see the printer about a new edition, he was asked by the latter to translate the essay on the cure of the French pox by means of guaiacum (or the West-Indian wood) “written by that great clerke of Almayne, Ulrich Hütten, knyght.” For, said the printer, “almost into every part of this realme this most foul and peynfull disease is crept, and many soore infected therewith.” Ulrich von Hütten’s personal experience of the guaiacum cure was accordingly translated from the Latin, in 1533, and proved a good venture for the printer, several editions having been called for[829]. The translation has no notes, and throws no light on English experience. It is not until 1579, when Clowes published his essay on the morbus Gallicus, that we obtain any light from the faculty upon the prevalence of the malady in England. Meanwhile it remains for us to collect what scraps of evidence may exist, in one place or another, of this country’s share in the original epidemic invasion during the last years of the 15th century.

Earliest Notices of the French Pox in Scotland and England.

The first authentic news of it comes from the Council Register of the borough of Aberdeen under the date 21st April, 1497[830]:--

“The said day, it was statut and ordanit be the alderman and consale for the eschevin of the infirmitey cumm out of Franche and strang partis, that all licht weman be chargit and ordaint to decist fra thar vicis and syne of venerie, and all thair buthis and houssis skalit, and thai to pas and wirk for thar sustentacioun, under the payne of ane key of het yrne one thar chekis, and banysene of the towne.”

The next news of it is also from Scotland, from the minutes of the town council of Edinburgh, wherein is entered a proclamation of James IV., dated 22 September, 1497[831]:--

“It is our Soverane Lords Will and the Command of the Lordis of his Counsale send to the Provest and Baillies within this bur{t} that this Proclamation followand be put till execution for the eschewing of the greit appearand danger of the Infection of his Leiges fra this contagious sickness callit the Grandgor and the greit uther Skayth that may occur to his Leiges and Inhabitans within this bur{t}; that is to say, we charge straitly and commands be the Authority above writtin, that all manner of personis being within the freedom of this bur{t} quilks are infectit, or hes been infectit, uncurit, with this said contagious plage callit the Grandgor, devoyd, red and pass fur{t} of this Town, and compeir upon the sandis of Leith at ten hours before none, and their sall thai have and fynd Botis reddie in the havin ordanit to them be the Officeris of this bur{t}, reddely furneist with victuals, to have thame to the Inche [the island of Inch Keith in the Firth of Forth], and thair to remane quhill God proviyd for thair Health: And that all uther personis the quilks taks upon thame to hale the said contagious infirmitie and taks the cure thairof, that they devoyd and pass with thame, sua that nane of thair personis quhilks taks sic cure upon thame use the samyn cure within this bur{t} in pns nor peirt any manner of way. And wha sa be is foundin infectit and not passand to the Inche, as said is, be Mononday at the Sone ganging to, and in lykways the said personis that takis the sd Cure of sanitie upon thame gif they will use the samyn, thai and ilk ane of thame salle be brynt on the cheik with the marking Irne that thai may be kennit in tym to cum, and thairafter gif any of tham remains, that thai sall be banist but favors[832].”

Sir James Simpson, with his indefatigable research over antiquarian points[833], has brought together evidence of payments from the king’s purse to persons infected with the “Grantgore” at Dalry, Ayrshire, in September, 1497, at Linlithgow on 2nd October, 1497, at Stirling on the 21st February, 1498 (“at the tounne end of Strivelin to the seke folk in the grantgore”), at Glasgow (also “at the tounn end”) on 22nd February, 1498, and again at Linlithgow, 11th April, 1498. He quotes also from a poem of William Dunbar, written soon after 1500, on the conduct of the Queen’s men on Fastern’s e’en, the terms “pockis” and “Spanyie pockis.” From Sir David Lyndsay’s poems, of much later date, and from other references, he makes out that “grandgore” or “glengore” was the usual name in Scotland down to the 17th century. Grandgore means à la grande gorre, which is the same as à la grande mode. This name was given for a time in France to the great disease of the day, but it was soon superseded by vérole. Scotland is the only country where “grandgore” became established as the common name of the pox.

Before leaving the Scots evidence, two other ordinances may be quoted from the town council records of Aberdeen. In a long list of regulations under date the 8th October, 1507, there occur these two[834]:--

“Item, that diligent inquisitioun be takin of all infect personis with this strange seiknes of Nappillis, for the sauetie of the town; and the personis beand infectit therwith be chargit to keip thame in ther howssis and uther places, fra the haile folkis.”

“Item, that nayne infectit folkis with the seiknes of Napillis be haldin at the common fleschouss, or with the fleschouris, baxteris, brousteris, ladinaris, for sauete of the toun, and the personis infectit sall keip thame quyat in thar housis, zhardis, or uther comat placis, quhill thai be haill for the infectioun of the nichtbouris.”

“Sickness of Naples” is a reference to the well-known diffusion of the disease all over Europe by the mercenaries of Charles VIII. of France, dispersing after the Italian war and the occupation of Naples.

For England the first known mention of the pox is several years later than the Scots references, although that proves nothing as to its actual beginning in epidemic form. In the book of the Privy Purse Expenses of Elizabeth of York, queen of Henry VII., there is an entry under the date of March 15, 1503, of a sum of forty shillings paid on behalf of John Pertriche “oon of the sonnes of mad Beale;” which sum appears to have been what the youth cost her majesty for board, clothes, education, and incidental expenses, during the year past. The various items making up the sum of forty shillings are: his diets “for a year ending Christmas last past,” a cloth gown, a fustian coat, shirts, shoes and hose, “item, for his learning, 20_d._ item for a prymer and saulter 20_d._ And payed to a surgeon which heled him of the Frenche pox 20_s._ Sm̅{a.} 40_s._” It will be observed that the surgeon’s bill was as much as all his other expenses for the year together[835].

The London chronicler of the time is alderman Robert Fabyan; but although Fabyan, writing in the first years of the 16th century, uses the word “pockys” to designate an illness of Edward IV. during a military excursion to the Scots Marches in 1463, or long before the epidemic invasion from the south of Europe, he says nothing of that great event itself. There is a record, however, of one significant measure taken in the year 1506, the suppression of the stews on the Bankside in Southwark. These resorts were of ancient date, and for long paid toll to the bishop of Winchester. In 1506 there were eighteen of them in a row along the Surrey side of the river, a little above London Bridge; they were wooden erections, each with a stair down to the water, and each with its river front painted with a sign like a tavern, such as the Boar’s Head, the Cross Keys, the Gun, the Castle, the Crane, the Cardinal’s Hat, the Bell, the Swan, etc. These houses, says Stow, were inhibited in the year 1506, and the doors closed up; but it was not long ere they were set open again, the number being at the same time restricted to twelve[836]. They had been suppressed once before, at the earnest demand of the citizens, in the reign of Henry IV., and it appears from a sermon of Latimer’s that they were again suppressed about the year 1546. Thus Shakespeare had several precedents in London for the situation which he creates in a foreign city, in Measure for Measure.

The next reference that I find to it is an oblique one, by Bernard André in his Annals of Henry VII. On the occasion of mentioning the sweating sickness of 1508, he says the latter disease occurred first in England about four-and-twenty years before, and that it was “followed by a far more detestable malady, to be abhorred as much as leprosy, a wasting pox which still vexes many eminent men” (“multos adhuc vexat egregios alioquin viros tabifica lues[837]”). Bernard André’s association of the pox with the sweating sickness, as of one new disease following another, is in the same manner as the reference to it by Erasmus. In a letter from Basle, in August, 1525, to Schiedlowitz, chancellor of Poland, he discourses upon the sickliness of seasons and the mutations of diseases[838]: Until thirty years ago England was unacquainted with the sweat, nor did that malady go beyond the bounds of the island. In their own experience they had seen mutations:--“nunc pestilentiae, nunc anginae, nunc tusses; sed morbum morbus, velut ansam ansa trahit; nec facilé cedunt ubi semel incubuere.” He then proceeds:

“But if one were to seek among the diseases of the body for that which ought to be awarded the first place, it seems to my judgment that it is due to that evil, of uncertain origin, which has now been for so many years raging with impunity in all countries of the world, but has not yet found a definite name. Most persons call it the French pox (Poscas Galleas), some the Spanish. What sickness has ever traversed every part of Europe, Africa and Asia with equal speed? What clings more tenaciously, what repels more vigorously the art and care of physicians? What passes more easily by contagion to another? What brings more cruel tortures? Vitiligo and lichens are deformities of the skin, but they are curable. This lues, however, is a foul, cruel, contagious disease, dangerous to life, apt to remain in the system and to break out anew not otherwise than the gout.”

Whether it was from some mistaken theory of contagiousness or for other reasons, a fellow of Merton was ordered to leave in 1511 because he had the French pox[839]. In the English history nothing appears above the surface until the beginning of the movement against the papal supremacy and in favour of Reformation. That was a time of public accusations of all kinds, and among the rest of opprobrious references to the pox. In Simon Fish’s Supplication of Beggars[840], which was written in 1524, certain priests are thus hyperbolically spoken of:

“These be they that have made an hundred thousande ydel hores in your realme, which wold have gotten theyr lyvinge honestly in the swete of their faces had not there superfluous riches illected them to uncleane lust and ydelnesse. These be they that corrupte the hole generation of mankynd in your realme, that catch the pockes of one woman and beare it to another, ye some one of them will boste amonge his felowes that he hath medled with an hundreth wymen.”

In the year 1529, there is a more painful and most undignified charge. In the Articles of Arraignment of Wolsey in the House of Peers, the sixth charge is:

“The same Lord Cardinall, knowing himself to have the foul and contagious disease of the great pox, broken out upon him in divers places of his body, came daily to your Grace [the King], rowning in your ear, and blowing upon your most noble Grace with his perilous and infective breath, to the marvellous danger of your Highness, if God of his infinite goodness had not better provided for your Highness. And when he was once healed of them, he made your Grace believe that his disease was an impostume in his head, and of none other thing[841].”

Among the glimpses of contemporary manners in Bullein’s Dialogue of the Fever Pestilence (1564), there is one referring to the pox; Roger, the groom, soliloquizes thus: “her first husband was prentice with James Elles, and of him learned to play at the short-knife and the horn thimble. But these dog-tricks will bring one to the poxe, the gallows, or to the devil[842].” Bullein, in his more systematic handbook to health, promises to treat of the pox fully, but omits to do so. In one place he refers to the wounds of a young man who fell into a deep coal-pit at Newcastle as having been healed “by an auncient practisour called Mighel, a Frencheman, whiche also is cunnynge to helpe his owne countrey disease that now is to commonly knowen here in England, the more to be lamented: But yet dayly increased, whereof I entinde to speake in the place of the Poxe.” But the only other reference is (in the section on the “Use of Sicke Men and Medicine,”) to certain drugs “which have vertue to cleanse scabbes, iche, pox. I saie the pox, as by experience we se there is no better remedy than sweatyng and the drinkyng of guaiacum,” etc[843].

A good instance of the oblique mode of reference to the malady occurs in another dialogue by a surgeon, Thomas Gale[844]. The pupil who is being instructed tables the subject of “the morbus,” which he farther speaks of as “a great scabbe;” whereupon Gale pointedly takes him to task for the affectation of “the morbus;” any disease, he says, is the morbus; what you mean is the morbus Gallicus.

About the same date, 1563, a casual reference is made to the wide prevalence of the pox by John Jones in his Dyall of Agues. In illustration of the fact that various countries originate different forms of pestilence, as the Egyptians the leprosy, the Attics the joint-ache, the Arabians swellings of the throat and flanks, and the English the sweating sickness, he instances farther, “the Neapolitans, or rather the besiegers of Naples, with the pockes, spread hence to far abroad through all the parts of Europe, no kingdom that I have been in free--the more pity[845].”

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.

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.

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.

Smallpox in the Arabic Annals.

For our purpose the evidence on the antiquity of smallpox in China and India may be accepted, and for the rest left out of account. The Arabian influence is nearer to us, and is the only one that practically concerns us. Coming, then, to the history of smallpox in its prevalence nearest to Europe, we find a definite statement of the disease appearing first among the Abyssinian army of Abraha at the siege of Mecca in what was known as the Elephant War of A.D. 569 or 571. The best of the Arabic historians, Tabari[871], writes: “It has been told to us by Ibn Humaid, after Salima, after Ibn Ischâg, to whom Ja‘gûb b. Otha b. Mughira b. Achnas related that one had said to him, that in that year the smallpox appeared for the first time in Arabia, and also the bitter herbs,--rue, colocynth [and another].” The tradition is by word of mouth through several, after the Semitic manner, but it need not on that account be set aside as worthless. So far as concerns the bitter herbs, it is said to be against probability; but as regards the new form of epidemic sickness, there is no such objection to it.

The Arabic legend, as given by Tabari is as follows: “Thereupon came the birds from the sea in flocks, every one with three stones, in the claws two and in the beak one, and threw the stones upon them. Wherever one of these stones struck, there arose an evil wound, and pustules all over. At that time the smallpox first appeared, and the bitter trees. The stones undid them wholly. Thereafter God sent a torrent which carried them away and swept them into the sea. But Abraha and the remnant of his men fled: he himself lost one member after another.” In a former passage, the calamity of Abraha is thus given: “But Abraha was smitten with a heavy stroke; as they brought him along in the retreat, his limbs fell off piece by piece, and as often as a piece fell off, matter and blood came forth.” To illustrate this account by Tabari, his recent editor, Nöldeke, cites the following from an anti-Mohammedan poem: “Sixty thousand returned not to their homes, nor did their sick continue in life after their return.” One of the elephants which dared to enter the sacred region is said to have been also wounded and afflicted by the smallpox.

In this narrative of Abraha’s disaster, says Nöldeke, there is a mixture of natural causation and of purely fabulous miracle; a real and sufficient account of the cause of the Abyssinian leader’s discomfiture, namely, an outbreak of smallpox, had been blended with legendary tales. That the disease was smallpox is made probable by the continuity of the Arabic name; under the same name Rhazes, the earliest systematic writer, describes the symptoms, pathology and treatment of what was unquestionably the smallpox afterwards familiar in Western Europe. Why it should have originated on Arabian soil in an invading army from Africa, is a question that would require much knowledge, now beyond our reach, to answer conclusively.

Theory of the nature of Smallpox.

The nature of the disease should, however, be borne in mind always in the front of every speculation as to the origin of its contagious and epidemic properties. It involves no speculative considerations to pronounce smallpox a skin-disease, of the nature of lichen turned pustular. It is a skin-disease first, and a contagious or epidemic malady afterwards; its place among diseases of the skin is indeed fully acknowledged by dermatologists. Apart from its contagiousness it conforms to the characters of other cutaneous eruptions: its outbreak is preceded by disturbed health, including fever; when the eruption comes out the fever is so far relieved; and as in some other eruptions which are not contagious the constitutional disturbance is in proportion to the area of the skin involved. Even the peculiar scars or pits which it leaves behind in skins of a certain texture or in the more vascular regions, such as the face, are not unknown in non-contagious skin-diseases; nor does its other peculiarity, the offensive odour of many pustules, seem unaccountable in a skin-disease native to tropical countries.

Eruptions on the skin are in many cases the outcome of constitutional ill-health; for example, the eczema of gout. Also where the whole body is infected, as in syphilis, there are skin-eruptions, which may be pimples (lichenous) or scales, or rashes, or, as in the first great outburst of syphilis, “pustules” so general over the body that those who were casting about for the nosological affinities of the new malady, saw no better place for it than Avicenna’s group of alhumata, which included smallpox and measles. That a skin-eruption of the nature of smallpox should have come out as a constitutional manifestation, and that a number of persons should have exhibited it together for the same internal reason, are both credible suppositions, although necessarily unsupported by historic evidence. Let us suppose that the Abyssinian army before Mecca endured some ordinary discomfort of campaigning, that, in the uniformity of their life, numbers together had fallen into the same constitutional ill-health just as numbers together have often fallen into scurvy, and that an eruption of the skin, proper to the tropics, was part of it. What we have farther to suppose is that the constitutional eruption became catching from the skin outwards, so to speak,--that it could be detached from its antecedents in the body, and could exist as an autonomous thing, so that it would break out upon those who had none of its underlying constitutional conditions, but had been merely in contact with such as had developed it constitutionally or from within. Such detachment of a constitutional eruption from its primary conditions is little more than constantly happens when a skin-disease like eczema, or acne, persists long after its provocation, or the disordered health which called it forth, is removed. The inveteracy or chronicity of some skin-diseases is itself a form of autonomy, but a form of it which does not transcend the individual, just as, among infections themselves, cancer does not transcend the individual or propagate itself by contagion[872]. But there exists a closer probable analogy for a secondary eruption becoming a self-existent or independent infective disease. The instance in view is no more than probable, and may easily be disputed by those who have sufficient prepossessions the other way; but there is no theory that suits so well the negro disease of yaws as that it is a somewhat peculiar secondary of syphilis, which is now able to be communicated as an exanthem detached from the primary lesions on which it had depended originally for its existence.

All the evidence, historical and geographical, points to the several varieties of the black skin (or yellow skin) as the native tissues of smallpox. It is not without significance that a disease of the negroes which was observed by English doctors not long ago in the mining districts of South Africa led to a sharp controversy whether it was smallpox or not: according to some, it was a constitutional eruption; according to others it was a contagious infection. Such phenomena are not likely to be seen in our latitudes; but the original smallpox itself was not a disease of the temperate zone[873].

I shall not carry farther this line of remark as to the probable circumstances in which a pustular eruption, among the Abyssinians before Mecca, or among other Africans or other dark-skinned races in other places and at other times, had become epidemically contagious in the familiar way of smallpox. One has to learn by experience that there is at present no hearing for such inquiries, because a certain dominant fashion in medicine prefers to relegate all those origins to the remotest parts of the earth and to the earliest ages (practically ab aeterno), and there to leave them with a complacent sense that they have been so disposed of. That is not the way in which the study of origins is carried out for all other matters of human interest. Yet diseases are recent as compared with the species of living things; some of them are recent even as compared with civilized societies. Epidemical and constitutional maladies touch at many points, and depend upon, the circumstances of time and locality, and upon racial or national characters. Perhaps their origins will one day be made a branch of historical or archaeological research.

European Smallpox in the Middle Ages.

The present extensive prevalence of smallpox among the Arabs may or may not date from the Elephant War of A.D. 569. Its prevalence also in Abyssinia, so widely in modern times that almost everyone bears the marks of it, may have no continuous history from the return of Abraha’s expedition. But the history of smallpox in the West comes to us through the Saracens, and there can be no question that the disease is at the present day peculiarly at home in all African countries, and most of all in the upper basin of the Nile, where, as Pruner says, “it appears as the one great sickness[874].” It is a remark of Freind, whose erudition and judgment should carry weight, that “the Saracens first brought in this distemper, and wherever their arms prevailed, this spread itself with the same fury in Africa, in Europe, and through the greatest part of Asia, the eastern part especially[875].” Our inquiry here does not extend beyond England, so that the extremely disputable question of the amount and frequency of smallpox in the European countries conquered or invaded by the Saracens in the Middle Ages need not be raised[876].

So far as concerns England, smallpox was first brought to it, not by the Saracen arms, but by Saracen pens. The earliest English treatise on medicine, the Rosa Anglica of Gaddesden, has the same chapter “De Variolis [et Morbillis]” as all the other medieval compends--in substance the same as in the earlier work of Gilbert, and in all the other Arabistic writings earlier or later. The Rosa Anglica was a success in its day, partly, no doubt, by reason of its style being more boisterous than that of Gilbert’s or Gordonio’s treatises, partly, also, on account of its blunt indecency in certain passages. Guy de Chauliac, of Avignon, one of the few original observers of the time, had heard of the Rosa Anglica, and was curious to see it; but he found in it “only the fables of Hispanus, of Gilbert, and of Theodoric,” and he rather unkindly fixed upon it the epithet of “fatuous.” What de Chauliac had probably heard of was Gaddesden’s occasional claims to originality; and these we shall now examine so far as they concern smallpox.

One of Gaddesden’s variations from the stock remarks on smallpox is his explanation of why the disease was called variola: it is called variola, says he, because it occurs in diverse parts of the skin (quia in cute diversas partes occupant). This is an ingenious improvement upon Gilbert, who says that it is called variola from the variety of colours (et dicitur variola a varietate coloris)--sometimes red, sometimes white, or yellow, or green, or violet, or black. Another remark attributed (by Häser at least) to Gaddesden as original, is that a person may have smallpox twice; but Gaddesden, in a later paragraph, shows where he got that from: “And thus says Avicenna (quarto Canonis), that sometimes a man has smallpox twice--once properly, and a second time improperly.” The most famous of Gaddesden’s originalities is his treatment by wrapping the patient in red cloth; for that also Häser ascribes to him. But Peter the Spaniard, the Hispanus of de Chauliac’s reference given above, is before him with the red-cloth treatment also, while he is candid enough to quote Gilbert: “Any cloth dyed in purple,” says Hispanus, “has the property of attracting the matter to the outside.”

Gilbert’s reference is as follows: “Old women in the country give burnt purple in the drink, for it has an occult property of curing smallpox. Let a cloth be taken, dyed de grano.” Bernard Gordonio, also, says: “Thereafter let the whole body be wrapped in red cloth.” There was probably Arabic authority for that widely diffused prescription, as for all the rest of the teaching about smallpox. But Gaddesden does improve upon his predecessors in boldly appealing to his own favourable experience of red cloth:--“Then let a red cloth be taken, and the variolous patient be wrapped in it completely, as I did with the son of the most noble king of England when he suffered those diseases (istos morbos); I made everything about his bed red, and it is a good cure, and I cured him in the end without marks of smallpox.”

With reference to this cure, it has to be said, in the first place, that the object of the red cloth was to draw the matter to the surface[877], and that it had nothing to do with the prevention of pitting. The means to prevent pitting was usually to open the pustules with a golden needle; that is the Arabian advice, and all the Arabists copy it. Gaddesden among the rest copies it, but he does not say that he practised it on the king’s son. If he had said so, we might have believed that the disease was actually one bearing pustules which could be opened by a needle. What he says, in the earliest printed text (Pavia, 1492) is that, while the king’s son was “suffering from those diseases,” he caused him to be wrapped in red cloth, and the bed to be hung with the same, and that he cured him without the marks of smallpox. Gaddesden was not altogether an honest practitioner; on the contrary he was an early specimen of the quack in excelsis. According to the learned and judicious Dr Freind, “his practice, I doubt, was not formed upon any extraordinary knowledge of his faculty;” and again, “He was, as it appears from his own writings, sagacious enough to see through the foibles of human nature; he could form a good judgment how far mankind could be imposed upon; and never failed to make his advantage of their credulity[878].” The opportunity of diagnosing variola in the king’s son, and of curing it by red cloth, so as to leave no pits, was one that such a person was not likely to let slip. “It is a good cure,” he says; and we may go so far with him as to admit that it must have been impressive to the royal household to have heard some sharp sickness of the nursery called by the formidable name of variola, and to have seen it cured “sine vestigiis.”

Measles in Medieval Writings.

In the writings of the Arabians and of their imitators, the so-called Arabists, measles and smallpox are always taken together. The usual distinction made between them is that morbilli, or measles, come from the bile, whereas variolae, or smallpox, come from the blood, that the former are small, and that they are less apt to attack the eyes. The reference in Gaddesden is of the usual kind, but it is complicated by the introduction of a third term, punctilli, which Gruner, however, takes to be merely a synonym for morbilli. As Gaddesden’s passage is of some importance for the history of the familiar name of the disease in England, I shall translate it at length, so far as it can be made into sense:--

“Variolae are so called, as if variously choosing the skin itself, because in the skin they occupy divers parts, by apostematising and infecting; they are caused by corruption of blood, and therein they differ from morbilli and punctilli.

Morbilli are small apostemata in the skin generated of bile; and they are a diminutive of apostematous diseases because they occupy less space by reason of the sharpness of choleric matter. They are in fact variolae of choleric matter, and the smallest of pustules. But punctilli are infections commonly sanguineous, as if they had arisen from a fleabite, only they remain continually. And punctilli are of two kinds, large and small. Of the small I have already spoken [under the name of morbilli?]. But the large are broad, red and opaque infections in the legs of poor and wasting persons, (pauperum et consumptuorum), who sit as if continually at the fire without boots; and they are called in English mesles[879].”

The rest of Gaddesden’s chapter on smallpox and measles contains nothing that is not to be found in Avicenna or in any medieval compend on medicine. But the passage quoted is of interest as using the old word “mesles” to mean one of the two forms of morbilli or punctilli. We are here enabled to see a little way into the confusion of mind which attended the medievalists in their verbalist dealing with disease. The syntax of Gaddesden’s sentence implies that the broad, red and opaque infections on the legs of poor and wasted persons were called in English mesles. In other writers, both before and after his date, the name of mesles or mesels or meseals was given, not to a form of disease, but to a class of sufferers from disease. It is the name applied to the inmates of leper-houses by Matthew Paris (circa 1250)--miselli and misellae, being diminutives of miser[880]. It is the word used for the same class in the Norman-French entries in the Rolls of Parliament in the reign of Edward I. fixing the taxation of leper-houses: if the head of the house was himself a meseal, the hospital was to pay nothing, but if the head were a whole man, the hospital had to pay[881]. The same use of mesles, as meaning the leprous, in the generic sense, occurs several times in the 14th century poem, ‘The Vision of Piers the Ploughman[882].’ Thus, Christ in His ministrations,

“Sought out the sick and sinful both, And salved sick and sinful, both blind and crooked; And comune women converted, and to good turned. Both meseles and mute, and in the menysoun bloody, Oft he heled such. He ne held it for no mystery, Save tho he leched Lazar that had ylain into grave.”

Or again:

“Ac old men and hore that helpless ben of strength, And women with child that worche ne mowe, Blind and bedred and broken their members, That taketh their mischief mekely, as meseles and other.”

It is this old English word “mesles,” meaning the leprous in the generic sense, that Gaddesden brings into his Latin text in connexion with morbilli (or punctilli). It is useless to look for precision in such a writer; but if his introduction of “mesles” in the particular context mean anything at all, it means that the English word represented a variety of morbilli,--the large, broad and opaque variety. That it should have occurred to him to bring these blotches or spots on the legs of poor people even remotely into relation with the morbilli of the Arabians, probably means that Gaddesden had a merely verbal acquaintance with the latter, or that he knew them only in books. It is certainly improbable that anyone, even in the Middle Ages, who had ever seen a case of measles should bracket that transitory and insubstantial mottling of the skin, with the large, broad and “obscure” spots (or nodules, or what else) on the legs of poor and wasted persons, which were called, in the vernacular, mesles. But Gaddesden, though a verbalist and a plagiary, was a great name in medicine, a name usually joined (as in Chaucer) with more solid reputations than his own. If he identified “mesles” with a variety of morbilli (which variety no one but himself seems to have heard of), it was an easy transition for the name in English usage to become what it now is, measles meaning morbilli, in the correct and only real sense of the latter[883].

History of the name “Pocks” in English.

Gaddesden’s case of variola which he cured without pitting by means of red cloth stands alone in English records until the 16th century; probably he was as little able to diagnose variola as morbilli, and it is more than probable that he would not have scrupled to call some infantile malady by the book-name variola, on the principle of “omne ignotum pro terribili,” when there was anything to be gained by so doing. There is no independent evidence that smallpox or measles existed in England in the 14th and 15th centuries. There are extant various medieval prescription-books, in which remedies are given for all the usual diseases. If the name of variola, or any English form of it, occur therein, we should draw the same inference as from the prescriptions for maladies of children such as “the kernels,” and “the kink” (or whooping-cough)[884]. In the Anglo-Saxon “leechdoms,” which have been collected in three volumes, the word poc occurs once in the singular in the phrase “a poc of the eye” (probably a hordeum or sty of the eyelid), and once in the plural (poccan) without reference to any part of the body and with no indication that a general eruption was meant. Willan, indeed, has found in a manuscript of uncertain date a Latin incantation against disease, in which the words lues, pestis, pestilentia, and variola occur; at the end of it is written in Anglo-Saxon an invocation of certain saints to “shield me from the lathan poccas and from all evil[885].” This looks as if poccas had been the Anglo-Saxon translation of variola. But it remains to be seen in what sense the word “pokkes” was used in the earliest English writings.

In the ‘Vision of Piers the Ploughman’ (passus XX) the retribution of Nature or “Kynde” upon the wickedness of the times is thus mentioned:

“Kynde came after with many keen sores, As pokkes and pestilences, and much people shent; So kynde through corruptions killed full many.”

In the lines immediately preceding there occur some other names, equally generic:

“Byles and boches and brennyng agues Frensyes and foul evils, foragers of kynde.”

“Boche” is botch,--the name given to the plague as late as the Stuart period, from its chief external sign, the bubo; and “byles” is merely the Latin bilis = ulcus. “Pokkes” may be the Anglo-Saxon word; but it is known that many of Langland’s colloquialisms are of Norman or French origin, and in that language there is a term poche, which is not far from the English “boche.” Whether “poche” be the same as “boche” or not, “pokkes and pestilences” may be taken to be synonyms for “byles and boches.” The generic or elastic use of such terms received a striking illustration in 1528, when spotted fever (typhus), perhaps mixed with plague, became exceedingly common among French and Spanish troops. Among the French the disease was called les poches and among the Spaniards las bubas[886], although both names had been assigned to syphilis at the time of its epidemic outburst in the end of the 15th century. In those times diseases were called by their external marks; so that diseases essentially most unlike, but having certain spots, or blemishes, or botches, or pustules of the skin in common, were called by a common name. The plague itself was known by certain spots on the breast or back called tokens: hence the figure of John Stow and others that “many died of God’s tokens.”

There was certainly laxity of naming to that extent in the case of modern languages. As to Willan’s inference from the medieval incantation, it is by no means clear that variola in medieval Latin may not have been used generically also; although, in the school of Salerno it appears to have had its meaning fixed, in the Arabic sense of smallpox, from the time of Constantinus Africanus, who introduced the teaching of Bagdad into that school about the year 1060.

The next use of “pokkes” that I have found is in a manuscript chronicle of England down to the year 1419[887], one of the series known as the chronicle of the Brute (from its commencing with the mythical landing of Brutus in England after the siege of Troy); this manuscript, known as the “Fruit of Times,” was afterwards printed at the St Albans press about 1484[888], the history being carried down to Edward IV., and the passage in question reproduced exactly as it stands in the handwriting. Under the 40th year of Edward III. (1366) there is the following entry:

“Ther fell also such a pestalence that never none such was seen in no man’s tyme or lyf, for many men as they were gone to bede hole and in gude poynte sodanly thei diede. Also that tyme fell a seknes that men call ye pokkes, slogh both men and women thorgh ther enfectyne.”

It is clearly the same passage that occurs condensed in the chronicle of William Gregory, mayor of London, which was written probably in 1451-52[889]. Under the 40th of Edward III., after referring to a “grete batille of sparows” just as the earlier chronicle does, he proceeds: “Also the same yere men and bestys were grettely infectyd with pockys, wherfore they dyde, bothe men and bestys.” The variation of “men and beasts,” instead of men and women, is curious, and suggests that there may have been a common source for the story. The chronicle contemporary with 1366, which is of best authority, was that kept at St Albans Abbey; but it gives nothing under that year. Shortly after 1361, however, and probably about 1362 or 1363 it has a singular entry, which may have been the source of these references to “pockys.” The Latin may be translated thus: “Numbers died of the disease of lethargy prophesying troubles to many; many women also died of the flux; and there was a general murrain of cattle[890].” Here we have men, women, and cattle; also lethargy, flux, and murrain; and it is conceivable that later compilers of English chronicles may each have used this contemporary Latin entry of composite events to put their own gloss upon it, or to amplify the history into what each conceived to be the probable meaning. But the most singular enlargement was that made by Holinshed in his chronicle of 1577. Having copied word for word, sparrows and all, the entry under the year 1366 in the “Fruit of Times” (as printed at St Albans about 1484), he takes leave to amend the sense in the part that chiefly concerns us--he changes “pockys” into “smallpocks,” and “men and women” into “men, women, and children[891].” Holinshed was dealing with an event two hundred years before his own time, and had no more first-hand knowledge of it than we have; but his authority has been accepted for the fatal prevalence of smallpox in 1366 by modern writers on the history of that disease, such as James Moore[892], who have not sought for the contemporary authority nor exercised a critical judgment upon the lax ways of verbalist compilers. Thus is history made--but not so easily unmade.

One other reference to “pockys” has to be noticed before we leave the philological part of the subject and come to the unambiguous history of the realities. Fabyan, in his Chronicle written not long before his death in 1512, says that Edward IV. during an expedition to the Scots Marches “was then vysyted with the syknesse of pockys[893].” It is futile to conjecture what the king’s illness may really have been. The word in Fabyan’s time had already acquired a technical sense, which it has ever since retained; but that well-understood meaning was some twenty years later than the year 1474 (although the disease itself doubtless existed all through the Middle Ages); while, in its earlier generic sense, as in the ‘Vision of Piers the Ploughman,’ it seems to have meant botches or other tokens of pestilential disease. In a Latin glossary of English words, published a hundred years after[894], “a pocke” is still defined as phagedaena, and “the French pocke” as morbus Gallicus, while “smallpox” is not given at all.

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.

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.