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Jon Arrizabalaga, John Henderson and Roger French

The Great Pox

The French Disease in Renaissance Europe

Yale University Press

New Haven and London
 >997 by Jon Arrizabalaga, John Henderson and Roger French

All rights reserved. This book may not be reproduced in whole or in part, in any form
(beyond that copying permitted by Sections 107 and 108 of the U.S. Copyright Law
and except by reviewers for the public press) without written permission from the
publishers.

Set in Bembo by Best-set Typesetter Ltd, Hong Kong

Library of Congress Cataloging-in-Publication Data

Arrizabalaga, Jon.
The great pox: the French disease in Renaissance Europe/Jon
Arrizabalaga, John Henderson, and Roger French.
Includes bibliographical references and index.
ISBN 978-0-300-21317-1
1. Syphilis—Europe—History—16th century. I. Henderson, John,
> 949“ IL French, R. K. (Roger Kenneth) III. Tide.
RC201.6.A1A77 1997
614.5'472'09409031—dczo 96-23453
CIP

A catalogue record for this book is available from the British Library.

10 987654321
 Contents

List of Plates, Figures, Tables ix

Acknowledgements xi
Preface xiii
I Syphilis and the French Disease i
Introduction: medicine andhistory I
Laboratory Medicine and theNew Ontology of Infectious Disease I
The Historiography of the Pox 3
The Textual Tradition 4
The Biographical and Bibliographical Traditions 8
The Historical Tradition IO
The Columbian Question 16
Conclusion 16
2 The Arrival of the French Disease in Renaissance
Italy: initial impact and lay reactions 20
Introduction 20
Chronicles and Mal Francese in the 1490s 21
Mal Francese as a New Disease 24
Symptoms 2$
Curable or Incurable? 27
Treatment of Mal Francese 28
Mortality 32
Conclusion: the lack of an official response 34
3 God’s Punishment: lay perceptions of the French
Disease in Ferrara 38
Introduction 38
Ercole d'Este and Girolamo Savonarola 3P
Mal Francese Overtakes Ferrara 44
The Ailments of the Este Family 47
A Significant Silence 50

v
vi Contents

God’s punishment for the sins of mankind-Mal Francese

and sinful sexual activity-The disease of St Job
Conclusion $
4 The Medical Dispute at the Court of Ferrara 56
Disputations and Disputes $$
The Circumstances of the Dispute
Die Basics of Medicine ^8
Die Disputants 59
Nicolo Leoniceno-Sebastiano dall’Aquila -Coradino Gilino
Die Substance of the Dispute 70
Leoniceno and Hippocrates’ diseases of summer-Dall’Aquila and
Galen’s elephantiasis• Gilino and the ignis sacer or persicus
Controversial Issues 84
Conclusion 87
5 The French Disease in Northern Europe: the case
of Germany 88
Introduction 88
Disputation 90
Humanism 93
Pox and Literature 97
Reform 99
Astrology 107
6 The French Disease and the Papal Court 113
Introduction 113
Die Problem with the Pox 113
Resources 114
Strategies 116
Astrology 119
Causes and Contagion 121
Diseases, Signs and Symptoms 126
Practice 129
Prevention • Treatment
Treatment with Heat 135
Two Controversial Remedies 137
Die ‘dry stove’• Mercury
Die Cardinal of Segorbe: a case study 142
7 The French Disease and the Hospitals for Incurables
in Italy until 1530 145
Introduction 145
Phase One: the Company of Divine Love and Mal Francese
in Genoa, 1496-1504 145
Bologna and Ferrara 149
 Contents vn

Phase Tu>o: Incurabili hospitals and Mal Francese, 1515-153° D2

Incurabili Hospitals in South and Central Italy D4
Rome-Naples and Florence
Incurabili Hospitals in Northern Italy and the Catholic Reform
Movement 162
Conclusion 168
8 The French Disease and the Incurabili Hospitals,
1530-1600: thecaseofRome 171
Introduction: developing reactions to Mal Francese and the poor 171
The New Orders and theIncurabiliHospitals 171
The Construction Programmes
Rome’ Venice• Florence
Size and Treatment 185
The Patients at San Giacomo, 1550-1600 190
Admissions • Mortality • Length of stay
San Giacomo Admissions and PatientSymptoms 201
Symptoms • Diseased body parts
Social Status of Applicants 212
Patients and their clothes 214
Geographical Origins of Patients at SanGiacomo 224
Conclusion 230
9 Catching the Pox: contagion 234
Introduction 234
Complexional Medicine 235
Sympathies and Subtleties 236
Contagion and Seeds 244
Contagion and Sympathy 246
Conclusion 251
10 The French Disease Grows Old 252
Introduction 252
Epidemics and Empirics 252
PWidf Is Disease? 258
The Galenic model-Names, essences and quiddities
Is the Pox a Disease at All? 262
Classification of Disease 262
A New Disease? 264
The French Disease Changes 266
The Material Basis of Disease 269
Sennert 272
Conclusion 278
Notes 283
Index 341
 Plates, Figures, Tables

Plates

2.1 ‘The letting of blood during the treatment of Mal Francese’ in

mid-sixteenth-century Italy (Biblioteca Comunale Augusta, Perugia [cited as
BCAP|, MS 472 [G 61]). 3°
2.2 ‘The removal of a Mal Francese sore through cauterisation’ (BCAP, MS 472
[G 6i|). 31
2.3 ‘The sweating of a Mal Francese patient' (BCAP, MS 472 [G 61]). 3>
3.1 The Flood, school of Ercole de’ Roberti, Ferrara (Rijksmuseum, Amsterdam). 43
3.2 ‘The sick Job tempted by the Devil and annoyed by two musicians’, woodcut
from Fur die platem Malafrantzosa, printed c. 1500 (Staatsbibhothek, Munich;
taken from K. Sudhoff, Archiv far Geschichte der Medizin, i [1907-8), pl. vii). 53
5.1 ‘The Virgin Mary with the Christ Child punishing people affected with the Pox’,
from J. Griinpeck, Tractatus de pestilentiali seorra sive Mala de Franzos, Augsburg,
1496, p. 25 (Wellcome Institute Library, London). 89
5.2 ‘The planets at the Creation’, from Griinpeck, Tractatus, p. 26 (Wellcome Institute
Library, London). 108
5.3 ‘Saturn and Jupiter in their chariots’, from Griinpeck, Tractatus, p. 66 (Wellcome
Institute Library, London). til
6.1 ‘Dry-stove treatment’, from L’Espagnol afflige du Mal de Naples, a satirical illustration
that appeared after the 1647 Neapolitan revolt against Spanish domination.
(Bibliotheque Nationale, Paris). 138
7.1 ‘Mary, St Job and members of the flagellant confraternity of S. Giobbe in
Bologna’, from an indulgence to the Hospital dei Guarini e di S. Giobbe, 1525.
(Archivio di Stato di Bologna, Archivio degli Ospedali, S. Maria dei Guarini e
di S. Giobbe, ser. IV, Mise, 2.8). 150
7.2 San Ciobbe, by Domenico Panetti (Indianapolis Museum of Art, James E. Roberts
Fund). 151
7.3 Incised marble plaque showing a beggar with Mal Francese seated on a cart, from
outside the Church of S. Maria in Porta Paradisi, Spedale di S. Giacomo, Rome. 156
8.t ‘The history of a Prostitute’ (Archivio Fotografico, Castello Sforzesco,
Milan). 174
8.2 Ordini del dare acqua del legno at the Spedale di San Giacomo, Rome (Archivio di
Stato di Roma, Ospedale di S. Giacomo 854.42). 175
8.3 ‘The Spedale di San Giacomo’, detail from a map of Rome by Stefano de Perac,
printed by Antonio Lafrery, 1577. 180
8.4 ‘The Spedale di San Giacomo’, detail from a map of Rome by Antonio Tempesta,
1593- 180
8.5 ‘The Spedale di San Giacomo', detail from a map of Rome by Giovanni Battista
Falda, 1676. 181

ix
X Plates, Figures, Tables

8.6 View of the Spcdale di San Giacomo along Via del Corso, by Giovanni Battista Falda,
1676 (Biblioteca Hcrziana, Rome). 181
8-7 The upper male ward of San Giacomo, from a late nineteenth-century print
(Biblioteca Hcrziana, Rome). 182
8.8 The upper male ward of San Giacomo, from an early twentieth-century photograph
(Direzione Sanitaria. Ospedale di S. Giacomo, Rome). ■83
8-9 Spedale degli Incurabili, Venice: facade on the Zattcre. From Luca Carlevaris. 184
8.io Spedale dcgli Incurabili, Venice: eighteenth-century ground plan by Cesare
Fustinelli (Biblioteca del Museo Civico Correr, Venice, MSS I’D, c. 818/31). 184
8.11 Spedale degli Incurabili, Venice: ground-floor ward from a photograph ofc. 1930
(Centro Giusdzia Minorite, Venice). 186
8.12 Spedale di S. Trinita. Florence: early eighteenth-century ground plan (Archivio
di Stato di Firenze. Ospedale di S. Mana Nuova 24). 186
8.13 Patient register, male admissions, May 1561, Spedale di San Giacomo, Rome
(Archivio di Stato di Roma, Ospedale di S. Giacomo 386. f. 79r). 191
8.14 Cnppled male Mal Francese patients (BCAP, MS 472 (G 61]). 221
8.15 Male Mal Francese patients (BCAP. MS 472 [G 61 ]). 222
8.16 Affluent male Mal Francese patients (BCAP. MS 472 [G 61]). 223
8.17 Female Mal Francese patients (BCAP. MS 472 (G 61]). 224
9-1 ‘A Man in Bed Suffering from the French Disease’, line engraving showing stages
of guaiacum-wood treatment’, by P. Galle after Jan van der Straet known as
’Stradanus', 1580s (Wellcome Institute Library. London). 241

Figures
8.1 San Giacomo degli Incurabili: Male and female admissions, 1554-1599 193
8.2 San Giacomo degli Incurabili: Male admissions, 1561-1562 194
8-3 San Giacomo degli Incurabili: Male and female admissions. 1569-1570 194
84 San Giacomo degli Incurabili: Percentage mortality of admissions, 1554-1599 195
8-5 San Giacomo degli Incurabili: Percentage mortality of total admissions, 1569-1570 198
8.6 San Giacomo degli Incurabili: Mortality of Holy Wood admissions cf. normal
admissions, 1569-1570 199
8.7 San Giacomo degli Incurabili: Frequencies of lengths of stay, male and female,
1561-1562 and 1569-1570 201
8.8 San Giacomo degli Incurabili: Mortality compared with length of stay (days),
1569-1570 202
8-9 San Giacomo degli Incurabili: Symptoms of male patients (excluding those with
Mal Francese) admitted 1561-1562 209
8.10 San Giacomo degli Incurabili: Symptoms and social status, males, 1561 217
8.11 San Giacomo degli Incurabili: Symptoms and social status: males, 1562 217

Tables
8.1 San Giacomo degli Incurabili: Symptoms of male patients identified with Mal
Francese, 1561-1562, 1569-1570 206
8.2 San Giacomo degli Incurabili: Symptoms of male patients not identified with
Mal Francese, 1561-1562, 1569-1570 206
8.3 San Giacomo degli Incurabili: Symptoms and illnesses of female patients, 1569-1570 207
8.4 San Giacomo degli Incurabili: Symptoms and known body parts of male patients
admitted, 1561-1562 and 1569-1570 210
8.5 San Giacomo degli Incurabili: Selected items of clothing worn by patients
admitted 1561-1562 and 1569-1570
219
8.6 San Giacomo degli Incurabili: Known geographical ongins of discharged patients
from Italy (including Sicily), 1561-1562 and 1569-1570 226
8.7 Known geographical origins of patients of San Giacomo degli Incurabili, 1561—1562
and 1569-1570, and household heads from Census of City of Rome, 1527 229
 Acknowledgements

During the long gestation of this book the authors have incurred a debt of
gratitude to a number of individuals and institutions. In the first place our
colleagues in Italian universities, libraries and archives have proved very
generous in their willingness to help well beyond their normal call of duty.
This was particularly the case in Rome, where the research on the records of
the Spedale di San Giacomo in Augusta could not have been completed by
John Henderson in the short time at his disposal. In this respect two people
should be especially mentioned, Claudio Schiavone and Vittorio Malvagna, as
well as the staff of the Archivio di Stato di Roma. We should also like to
thank the archivists of the Archivio di Stato in Bologna, Ferrara, Florence,
Modena and Siena as well as of the Archivio Diocesano in Ferrara and the
Archivio Segreto Vaticano. We are also grateful to Professor Alessandro
Pastore of the University of Verona, who expedited a number of matters in
relation to the records of the Incurabili hospital in Bologna. We are also
grateful to the staff of a number of libraries. In Florence: Villa ‘I Tatti’, The
Harvard University Italian Center for Italian Renaissance Studies, Biblioteca
Nazionale Centrale, Kunsthistorisches Institut; in Rome: Biblioteca
Apostolica Vaticana, Institut Fran^ais; Biblioteca Civica di Ferrara; Barcelona:
Biblioteca de Catalunya, Institucion Mila i Fontanals (CSIC); Madrid:
Biblioteca Nacional; London: British Library, Warburg Institute, Wellcome
Institute Library; Cambridge: University Library, Whipple Library.
We are also grateful for financial support from a number of institutions.
The support of the University of Cantabria (Santander) and of the Basque
Government made it possible for Jon Arrizabalaga to stay for twenty months
in Cambridge and four months in Florence between 1985 and 1987. For
further shorter periods he has been subsidised by the DGICYT (Spanish
Ministry of Education and Science) and the British Council, the British
Academy and the CSIC. From 1987 his research for this book has been partly
funded by the research fellowships PB86-0639, PB89-0066, and PB92-0910-
C03-03 of the Spanish DGICYT.
John Henderson’s research in Italian state archives (Ferrara, Florence and

xi
xii A cknowledgemcn ts

Rome) was funded first by a Wellcome Trust Research Fellowship and then
by a British Academy Travel Grant; further periods of research have been
financed by the Wellcome Trust. John Henderson is also grateful to the
American Academy in Rome for the privilege of staying there as a Visiting
Scholar.
Thanks are also due to a number of scholars who provided invaluable
suggestions on reading all or part of the manuscript: above all to the anony­
mous reader of Yale University Press, but also to Jane Bridgeman (for her
guidance on the history of sixteenth-century Italian dress), Andrew
Cunningham, Luis Garcia-Ballester and Juan A. Paniagua. We also owe a
considerable debt to Dr John Dawson and the staff of the Literary and
Linguistic Computing Centre of the University of Cambridge for all their
help in the processing, preparation and analysis of the patient records of the
Spedale di San Giacomo in Rome. We are also grateful to the librarians and
archivists who have granted us permission to reproduce the photographs listed
on pages ix and x, and to Deborah Howard for her helpful advice. Especial
thanks are due to the staff of the following institutions for their help: Archivio
Fotografico, Castello Sforzesco, Milan; Biblioteca Comunale Augusta,
Perugia; and the Centro Minorile, Venice. Finally we should like to thank
our families who have given us support during the long gestation of this
book.
 Preface

This book is about the appearance of the French Disease in renaissance

Europe and the reactions of the docton and other people to what was
perceived by the majority as a new disease. Inevitably, given that research on
the subject is still in its infancy in many countries, we have had to restrict our
coverage to a series of interrelated case studies. Our main emphasis is on
renaissance Italy, but detailed comparisons with other parts of Europe have
helped to show what was common and what special to the reaction of several
of the countries of the Old World. The main historical argument of this book
rests on the surviving written evidence about what people thought and did
when the disease arrived and during the subsequent hundred years. Their
thoughts and actions often had enough in common for us to see groups of
people with some characteristic reaction to the disease. These groups and
their reactions raised a number of questions which we have tried to answer in
this book. These questions derive essentially from a single query: what made
a particular reaction characteristic of the group that displayed it?
Of course, these groups were not mutually exclusive, for a doctor was a
citizen of this or that town and may have belonged to a religious
confraternity, but as a medical man, as a citizen and as a member of a pious
association he had purposes, interests and beliefs in common with other
members of those groups. The purposes, interests and beliefs of groups had
some bearing on how they reacted to the French Disease; and within a group
the reactions of the individual reflected his other allegiances.
In the first place, what were the concerns of the learned doctors in the
society of the time that made them agree on aspects of the French Disease,
and what led them to disagree? However much they disagreed among
themselves, they agreed in disagreeing totally with the other kinds of practi­
tioners. Did the other practitioners have a characteristic response that derived
from their position? Since the doctors were learned and rational, their char­
acteristic action was to try to understand the French Disease. Undoubtedly
they believed that understanding the disease was the surest way to treating and
preventing it. But equally clearly it gave them a competitive edge in the

xiii
 xiv Preface

medical marketplace: what relationship was there between the commercially

useful image of the learned doctor and the content of his theoretical medi­
cine?
Similar problems arose with men and women without medical training.
Religious confraternities were clearly defined groups; they thought charitable
thoughts and acted in charitable ways, including building hospitals. But were
these the only reasons that hospitals for poxed patients were built? (And how
charitable was compulsory admission to a hospital?) Did the perception of the
pox by laymen who were responsible for public health differ from that of the
learned doctors? Centrally, to what extent did they agree on how a person
contracted the disease and how therefore it was transmitted? How character­
istic of them as a whole was the reaction of the city authorities?
The confraternity, the hospital, the urban administration, the medical
faculty were all in some sense institutions. The biggest institution of the time
was of course the Church, and we explore in the following pages how the
Church as a spiritual, political and very strong social force tackled the
problems generated by the new disease. As an institution the Church was
composed of smaller groups. One important charitable arm consisted of the
religious orders. How, then, did the newer orders such as the Jesuits or the
Capucin fathers take on and develop the example of the Observants in caring
for the poor in general and the sick poor in particular?
Indeed, the biggest social group to be affected was the urban poor, if only
because there were more of them. It had been the same in the Black Death,
a century and a half before, and in the epidemics of ‘plague’ which afflicted
Europe every ten to fifteen years thereafter. The poor were noticeable in
urban centres, and it was here that public health measures first evolved and
also where civic authorities turned to the university physicians for advice. But
the medicine of the university-trained physicians was not designed to cope
with epidemics that were sudden, widespread, acute and fatal in the case of
the plague, or chronic, disabling and disgusting, as with the French Disease.
It was based on Greek and Arabic sources and was geared towards the long­
term care of the class of citizen who could pay a physician’s fees. We explore
contemporary perceptions of how the pox affected the different social classes
and what kind of medical help was available for them. Directly related is the
question of how far experience of two great epidemics changed the attitudes
and actions of the city authorities, towards public health in general and
towards that of the poor in particular. Furthermore, how did plague and pox
ultimately change European medicine as a whole?
As for cultural groupings, a doctor in a papal or princely court or a medical
faculty might give his primary allegiance to Greek or to Arabic authors and
so think and behave differently. Despite being dispersed across several Euro­
pean countries, the hellenists were very conscious of being a group with
common aims. They therefore had a characteristic reaction to the French
Disease. How did this reaction work out in the practice of medicine? To
 Preface xv

what extent were the humanists a coherent group throughout Europe with
common ideals that might influence the way they perceived the pox?
Few would have disagreed that the arrival of the French Disease was an act
of God. This was thus part of the nature of the disease and part of its
contemporary perception. To invoke the image of St Job and to exercise
piety and charity might seem the characteristic reaction of a major group, the
whole of Christendom. But northern Europe practised a different religion
after the Reformation. Did these changed affiliations of the new group affect
its perceptions of the French Disease?
These issues are studied in the following chapters. Disputations in a faculty
and a princely court make the allegiances of the disputants clear. When
learned physicians are competing for the favours of a pope or ducal patron,
their strategies are revealed. The death of a cardinal at the hands of his doctors
highlights the dangers of administering mercury. The administration of a large
hospital generates paperwork that reveals a great deal about the patients. All
this accumulated experience formed contemporary perceptions of the disease,
the answer to our quaestiones disputatae: what did people think and do about
the disease?

Since the manuscript of this book went to press the following works have
appeared which we have been unable to incorporate in our discussion: W.
Schleiner, Medical Ethics in the Renaissance, Washington DC, 1995, esp. ch. 6;
and D. W. Amundsen, Medicine, Society, and Faith in the Ancient and Medieval
Worlds, Baltimore and London, 1996, esp. ch. 11.
 Chapter One

Syphilis and the French Disease

Introduction: medicine and history

This is a history of the French Disease; or, in the English vernacular, the pox.
It is not a history of syphilis. The difference is an important one and is
reflected in the kind of historical analysis we have adopted in writing this
book. This is not the only kind of way to write about the history of a disease,
but the nature of the pox makes the issues involved in investigating the
history of diseases particularly clear.
By 1905-6, when the venereal syphilis treponeme1 was isolated and the first
serological procedure (the Wassermann reaction) for the diagnosis of syphilis
was invented, a great change had overtaken Western medicine. It was a
change doubly important for the theme of this book. First, and simplest, the
means of overcoming a great scourge were potentially at hand. The causal
organism of other dangerous diseases, cholera, tuberculosis and plague, had
already been discovered. From 1909 to 1912 venereal syphilis became the
target of the first successful aetiological drug ever developed against a bacterial
disease.
Second, medicine’s success against bacteria changed medicine and medi­
cine’s perception of itself. It may not be an exaggeration to say that for the
first time in its history Western medicine supported its reputation by obvious
success in the process of cure. A powerful new tool was now added to the
other strategies the doctor had long employed to generate authority for
himself and his profession. When the doctor came to look at the history of
medicine, his view was coloured not only by his professional authority but by
the nature of the new medicine.

Laboratory Medicine and the New Ontology of Infectious Disease

In earlier periods, before the laboratory and the germ theory, the relationship
between cause, disease, symptom and sign had been different in different

1
2 The Great Pox

systems of medicine, as we shall see in the course of this book. Often the
nature of the relationship was discussed in learned and theoretical treatments,
and often in practice the doctor found it unnecessary or undesirable to
‘diagnose’ a specific disease. Causal systems generally agreed that there was a
hierarchy of causes ramifying through a world where macrocosm was closely
related to microcosm. There was a ‘first cause’, perhaps celestial, and a chain
of secondary causes down to the ‘immediate cause’. A single cause might lead
to a number of different diseases and a single disease might arise from a
number of different causes. It was widely agreed that there were ‘mixed’
diseases and that one disease could change into another. The nosologists
constructed schemes of classification that subdivided groups of diseases into
genera and species, and quarrelled with each other over the details.2
During the nineteenth century most diseases that modem medicine recog­
nises ‘crystallised in the form of specific entities’.' Central to this event was
the development of a new medicine based in the laboratory.4 It was here that
complex doctrines of causality whose origins were ultimately Greek and
ancient were abandoned in the construction of a wholly new pattern of
causality.5 We will focus on infectious diseases, the group to which syphilis
belongs. When it was understood that the infective micro-organism was the
cause of the disease, a new ontology arose. By 1910 it was clear that the
essence of these infectious diseases was always an external pathogen or
causative agent. This was a natural species, was alive and reproduced its kind.
In all the shifting picture of symptoms and clinical descriptions the one
constant was the pathogen. Only when, in the laboratory, the pathogen was
identified in the tissues or fluids of the patient was a diagnosis confirmed.
Variable (and therefore unreliable) symptoms became secondary in the proc­
esses of explanation and diagnosis. Although some specific diseases had had
names and had prompted discussion about disease entities in the Latin tradi­
tion, particularly from the sixteenth century onwards, the germ theory of
infectious diseases in the nineteenth century transformed the way in which
people thought about them.
But all this did not represent confusion, for confusion is a muddling of
extant categories, and our categories did not then exist. In solving their own
problems in their own ways these doctors serve to highlight the great change
that came over medicine after the laboratory and the germ theory. Their
perceptions were so different that we cannot insist on the identity of diseases
before and after. ‘We are simply unable to say whether they were the same,
since the criteria of “sameness” have been changed’.6 Yet the new authority
of the doctor and his technical expertise in knowing about pathogenic
organisms made it natural that he should be thought of as the best qualified
to look at the history of medicine. The new ontology of disease seemed to
provide a scientific yardstick to measure the attempts of people in the past to
understand and treat diseases.
Doctors knowledgeable about the germ theory did in fact begin to write
 Syphilis and the French Disease 3

histories of infectious diseases in the last decades of the nineteenth century.

They believed that the germ theory had provided ‘the first successful under­
standing of these diseases’ and had ‘replaced the old, unsuccessful and mis­
guided attempts’7 at achieving this aim. One of the purposes of writing about
the past is to win present battles, and the medical bacteriologists faced a good
deal of opposition at first.8 But they won their battle and the history they
wrote was rapidly and widely diffused. It was a constructed history, legiti­
mating the position of its authors by selecting and championing men
like Fracastoro, Leeuwenhoek, Redi, Spallanzani and Semmelweis as
microbiologists and bacteriologists avant la lettre. And they introduced them­
selves as products of their own history, ‘successors to those far-sighted
men whose fate had inevitably been not to have been appreciated in their
own day’.9
In other words, we can see elements of construction in historical accounts,
both after and before the germ theory. Our own attempt to write a history
of the pox will be seen in clearer perspective if we examine in more detail
how others have done so.

The Historiography of the Pox

It is recognised that physicians from the Greeks to the Enlightenment turned

to the medical past for three major reasons. One was to enhance the dignity
of their profession by giving it a distinguished ancestry. A second, related
tactic was to seek credibility for novel systems by claiming that the ancients
knew something of them. The third reason was to improve directly their own
knowledge of medicine and therefore its practice. While introductions to
medical works often reflected (and sometimes still do) the first of these reasons
for looking at medical history - giving it the dignity of age — the technical
stuff of medicine was drawn from the old authorities, which gave medicine
epistemological support. Up into the nineteenth century, large editions of the
old authorities were intended for medical rather than historical use.
In parallel, the ever more rapid accumulation of European medical litera­
ture in early modem times added substantially to the problems of handling
large amounts of technical literature. Two techniques for coping with this
were biography and bibliography prompted by humanist scholarship and
changes in historiographical practice outside medicine. Broadly, they formed
new genres of literature, but within medicine served the subsidiary purpose of
categorising and analysing the technical literature. Because the major ancient
authors did not date, and indeed attracted much new scholarship, the ancient
literature added to these problems.
A determined attempt to solve these problems was made in the Enlighten­
ment. Separate intellectual concerns from the fields of history and textual
criticism were drawn together to produce medical historiography in the strict
4 The Great Pox

sense. The result was that simple chronology ceased to be the main criterion
for the arrangement of the medical past. While the ancient authors were still
consulted for the technical content of medicine, there could be no strict
distinction between historical and technical texts; but the new historical
awareness gave rise to the first historico-critical reconstructions of the medical
past. This in turn influenced the textual, biographical and bibliographical
traditions and began to make new distinctions. By the mid-nineteenth cen­
tury these had come to follow wo alternative patterns, medical documenta­
tion and medical history."’
The French Disease was being studied while these changes were going on.
We can see in what was written about it the changes that were occurring in
medical historiography as a whole. The three traditional patterns that we in
fact see in it can be called the textual, the bio-bibliographical and the
historical. These three traditions changed over time and (as we shall see) were
often combined. No exhaustive analysis is in order here, but a brief glimpse
at these traditions will help to locate both the customary account of ‘syphilis’
in the past and our own treatment of the pox.

77ie Textual Tradition

The textual tradition was dominant until well into the eighteenth century and
was maintained for direct medical purposes at least until the end of the
century. Thereafter it was slowly transformed, but kept vigorous for the
purposes of medical history. Very many of the studies that have fuelled this
tradition have actually focused on works from the late fifteenth and early
sixteenth centuries, when the French Disease attracted most attention. Thus
for nearly five centuries the pox itself has been a centre of attention from both
historians and medical men, for different reasons.
From the second decade of the sixteenth century, the European printing
presses began to issue a series of collections of medical works (up to six
authors) dedicated to the French Disease. Many went into subsequent edi­
tions, and the individual works themselves appeared many times. Among the
most popular of the collections were those published in Pavia and Venice
in 1516, another of unknown origin in 1532, one more from Venice in 1535
and a collection published in Basel and Lyon in 1536." They centred on
a core collection of works by Joan Almenar, Nicolo Leoniceno and
Angelo Bolognini, to which different editors added according to preference
from a looser group of tracts by Sebastiano dall’Aquila, Antonio Scanaroli,
Nicolo Massa, Ulrich von Hutten, Pietro Andrea Mattioli, Lorenz Friese and
Nicolaus Pol.
This tradition culminated in the collection made by Luigi Luigini (b. 1526),
who in 1566-7 gathered together the works of no less than fifty-nine
authors.1- As the lengthy title of the collection itself proclaims, Luigini’s aim
 Syphilis and the French Disease 5

was to be exhaustive and to collect every extant work, whether already in

print or not. For him his final published collection was a documentary corpus
that would help the medical men of his time to fight what they saw as a new
scourge more ferocious than any faced by their predecessors. It attacked the
main organs of the body, they said, the heart, liver and brain; it corrupted the
blood and putrefied the spirits, crippling the vital actions; it demanded
the most powerful remedies the doctors could secure in their attempts to cure
it. Luigini’s purpose was less to allow his readers to compare these texts by
reason of their proximity than to make it possible to learn from them the true
nature of the disease, ‘To discern silently all that is valuable to contemplate
upon’.13 In other words he was acting as an ‘aggregator’ who collected the
views of authors and authorities following the epistemological tradition that
held medical knowledge to be cumulative, collaborative and progressive. The
publisher, Jordanus Zilettus, thought so too, and in his brief foreword claimed
that the collection was ‘the best way of making it possible for every scholar
to read so many authors and achieve knowledge of, and the cure of, the
French Disease’.14 While the technique of ‘aggregation’ was well established
in medical circles in the middle ages, Luigini treated it in a humanist way,
editing out the ‘numerous and abominable’ errors introduced by printers into
earlier editions of the various tracts.15 What he did not say was that he
suppressed sentences and even paragraphs which he considered irrelevant.
Luigini’s collection retained its utility down to the eighteenth century,
when it was re-edited (1728) by the ‘teacher of Europe’, the Leiden professor
Herman Boerhaave.16 His purpose, like that of Luigini, was medical. The
cumulative knowledge that the collection contained was for him a
perfectissimam historiam, a ‘complete description’, where historia means a sort of
generalised case history of the disease, with overtones of empirical description
of the Hippocratic kind. Boerhaave’s editorial improvements on the collec­
tion consisted of marking the references off from the text by the use of italics,
inserting medical receipts and textual references and reordering the sequence
of texts. This and his alleged correction of dangerous errors was for the
medical use of the ‘cultivators of medicine’ whom he addresses in his
preface.17 The disease by now had a new technical name - lues venerea. The
accumulated lore within the collection could be seen to support Boerhaave’s
own notion of a radicalis curatio: cure by the mercury method.18 Inevitably
there is a chronological component to Boerhaave’s historia. It was not only
that support for the mercury treatment was to be derived from a practice that
was now over two centuries old, but that the old accounts of its beginning
and the symptoms showed that in the intervening period the disease itself had
changed. Consequently, its treatment had to be different: history was of direct
medical use.
Despite the changes in the disease, no one doubted that the old Morbus
Callicus was the same as the eighteenth-century lues venerea. To trace its
origins and changes was to discover the natural history of the disease, and a
6 The Great Pox

knowledge of its natural history was preliminary to a knowledge of its cure.

So thought Christian Gottfried Gruner (1744-1815), who in 1789 published
a new collection of texts, which he introduced as additional to those of
Luigini’s collection in Boerhaave’s edition. It was bigger - sixty-four authors
from 1495 to 1556 - and included material on the disease from non-medical
sources. To this he added 'vestiges’ of the disease from a further seventy-two
authors from the ancient period (Greek, Latin and Hebrew) and the middle
ages (Arabs and their Latin followers).19 His scholarly apparatus is more
elaborate than Boerhaave's, as Boerhaave’s had been more so than Luigini’s.
His additional historical information and bibliography, together with the new
rare or unknown texts, were designed to recover the fullest possible memory
of the human experience with the disease: ‘Only by the means of the guide
and teaching of history can one dispel the darkness and illuminate with its
light anything dubious, uncertain and obscure. Who follows it without anger
or bias can scarcely deceive or be deceived.’2"
But in fact Gruner’s techniques of presentation were also designed to
support his own rather peculiar ideas about the origin of the disease, for he
maintained that it had first appeared among the Marrani, a term he used to
cover both Jews and the Arabs who had been expelled from Spain in 1492.
With this in mind Gruner continued his programme of work and four years
later published another volume with twenty-seven more early works, medical
and non-medical, on the French Disease.21 The same instinct that made
sixteenth-century Italians call the disease French and citizens of France call it
Neapolitan, now made Gruner elaborate on the alien origin of the disease
among the Marrani. He claimed that his new collections of texts supplied a
complete natural history of the disease in which its origins, mode of transmis­
sion and changes all pointed to a Marranic source. Gruner also had in mind
that a historical treatment of the disease as detailed as his not only would
direcdy improve the medicine of the learned practitioner, but also would
enhance his reputation as learned, an image so useful in the traditional
competitive batde with the unlettered practitioner.22
Gruner’s was the last attempt to provide a general history of the disease
within the textual tradition that saw history of direct use to practice. Later
studies were more narrowly conceived. In 1843 the professor of pathology
Conrad Heinrich Fuchs (1803-55) Put together a collection of thirteen Latin
and German medical works on the Lustseuche, the pox in Germany. He
focused on the first fifteen years of the disease, beginning in 1495, and on
German writers. The collection was intended to be of service to German
readers and it rested on the assumption that the disease had been epidemic
during its first fifteen years, thereafter changing its nature.23 Indeed, he held
that the pox had changed in that time more than any other disease, and in
that sense he was reporting historically rather than medically. This is why
he excluded non-German and later authors from his account, for the disease
they handled in their patients was different. Surely Fuchs had taken some
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harmless

für Neptuni

erexere

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modo sit memoranda

possit omnium

obruerunt

Grasleitenhütte adjiciebant aut

manu Spartæ

eine leichtbeschwingten Apollinis

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donate

hoc zufügen illud

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armen XIV

his

vocata

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ex Eleam Echemo

VII XIX

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fabula Lacedæmoniorum Alma

mentionem iram
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ja Olympiæ fugientem

congressis ad das

X Athenienses

zufügt

hunc vates et

keine Spartani illa

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Macedonibus

testatus

perfectly

bewundern in Messeniis

antiquitatis der
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Cabiris est

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ex

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16 est agreement

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earlier

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im

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acceperit

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1 Lacedæmoniorum

die vel jener

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urbe VIII

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