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:—

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:

Read gives an account of a travelling mountebank, which is too graphic to be omitted:

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.

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:—

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]:

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]:

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:

The evidence that follows is not so explicit, but it has strong probability. The progress of Charles VIII. from France to Italy in the autumn of 1494 has been told by Philip de Comines in his Cronique du Roy Charles VIII., first printed at Paris in 1528, nineteen years after the author’s death. De Comines accompanied his master, the French king, as far as Asti; he was then sent on a mission to Venice, and rejoined the king at Florence. But De Comines, who was no gossip, omits one interesting fact near the beginning of the journey to Italy, which has been preserved for us in a contemporary work (1503) called La Cronique Martiniane, or chronicle of all the popes down to Alexander Borgia lately deceased[865]. This chronicle relates as follows concerning Charles VIII.’s journey:—“Il se arresta premierement aucuns jours a Lyon, doubteux s’il passeroit les mons, car il y estoit detenu pour les delices et plaisances de la cité et pour les folles amours de aucunes gorrieres lyonnoises. Mais quant l’air devint pestilent, il s’en tyra à Vienne, citè de Daulphinè.” His great army had already passed the Alps and arrived in the country of Asti: it is said to have consisted, in round numbers, of 3600 men-at-arms, 6000 bowmen, 8000 pikemen, and 8000 with arquebuses, halberds, two-handed swords, or other arms, together with a heavy artillery train of 8000 horses. A large part of this force were Swiss; another part were Gascons[866].

Charles VIII. left Vienne on the 23rd of August, and crossed Mont Genèvre on the 2nd September, whence he proceeded direct by Susa and Turin, joining his army at Asti on September 9. At Asti, says De Comines, he had an illness, which caused that minister to delay setting out on his mission to Venice for a few days. The original printed text of De Comines’ Chronique (Paris, 1528), says that the author remained at Asti a few days longer “because the king was ill of the smallpox (de la petite verolle) and in peril of death, for that the fever was mixed therewith; but it lasted only six or seven days, and I set out upon my way.” The next edition has no change but “in great peril of death” (en grant peril de mort), instead of merely “in peril.” Now, where did this diagnosis of petite verolle come from? Nothing is said of smallpox being prevalent at the time among the troops or along their route. The name petite verolle itself did not exist in 1494; it came into existence with grosse verolle, having being made necessary by the latter; and the first that we hear of grosse verolle is when the Italian campaign was over and the pox was raging in Paris, the Parlement of Paris, on the 6th of March, 1497, having made an ordinance against a certain contagious malady “nommée la grosse verole,” which had been in the kingdom and in the city of Paris since two years. Probably Comines deliberately wrote “petite verolle” in his manuscript, having composed the latter subsequent to 1498, or at a time when the terms verolle, or grosse verolle, and petite verolle, were passing current and were known in their respective senses. The causes or circumstances of the king’s malady at Asti are not enlarged upon by De Comines, farther than that he makes a somewhat disjointed remark, that all the Italian wines of that year were sour and that the season was hot, which would have had as little to do with the one kind of pox as with the other. Nor is anything said of smallpox spreading among those near the king[867].

The whole sequence of events, from the “folles amours” of Lyons to the sharp sickness at Asti, has suggested to historians, who have no medical theory to advocate, that it was not really petite vérole that the king suffered from, but grosse vérole. Martin says that Charles VIII. recommenced at Asti his Lyons follies and that he became violently sick, “of the smallpox, says one, or, perhaps, of a new malady which began to show itself in Europe,” meaning syphilis. To show that such infection was already possible, he quotes an ordinance of the provost of Paris April 15, 1488, enjoining “the leprous” to leave the capital. This is very like Edward III.’s order to the London “lepers” a century and a half earlier, in which the reasons given (the frequenting of stews, the pollution of their breath, &c.) point somewhat clearly to the nature of their “leprosy.” An order for the banishment of “lepers” from Paris in 1488 must have been occasioned by some unusual risk of contamination, just as the London order of 1346 would have been. It is in that sense that the French historian regards it; the ordinance, he says, “concernait probablement déjà les syphilitiques confondus avec les lépreux[868].”

De Comines, who is the authority for the diagnosis of smallpox, had inserted the word petite before verolle for reasons best known to himself. I shall show in the next chapter, upon smallpox and measles in England, that the ambiguous teaching of the faculty as to the nature and affinities of the pox proper within the first years of its epidemic appearance gave a ready opportunity of calling the grosse vérole by the name of petite vérole in circumstances where it was polite, or prudent, or convenient so to do. The only importance of a correct diagnosis of the king’s malady is that the case of one would have been the case of many.

The indications all point to a somewhat unusual prevalence of lues venerea previous to the autumn of 1494, in the luxurious provinces of southern France as well as in the capital. Beyond doubt, the malady had already spread by contagion to the great Spanish ports nearest the Gulf of Lyons. The expedition of Charles VIII. passed through that region on its route over the Alps. According to Sebastian Brant, it was the French who brought the disease into Liguria, and, according to Grünbeck, it issued, Gallico tractu, ab occidentali sinu, gathered like a dense cloud super Insubriam (the Milanese), and was thence dispersed, as if by the winds, over the whole province of Liguria.

But for the circumstances of the military expedition of 1494, and the state of war in Italy for two years after, it is conceivable that the unusual prevalence in France of a very ancient malady would have had little interest for Europe at large, although the cities on the nearest coast of Spain appear to have already shared the infection. That unusual prevalence in the south of France has in it nothing of mystery; the period was the end of the Middle Ages, distinguished by a revival of learning, of trade and commerce,—a revival of most things except morals. But, assuming that there was such unusual prevalence above the ancient and medieval level, it may still seem unaccountable that a great European epidemic, of a most disastrous and fatal type, should have been engendered therefrom.

There are, however, many parallel cases, on a minor scale from modern times, of a peculiar severity of type, of inveteracy, and of communicability by unusual ways, having been cultivated from commonplace beginnings, among unsophisticated communities about the Baltic and Adriatic, the people being without resident doctors and unfamiliar with such a disease and its risks. These have been collected and analyzed by Hirsch, whose conclusion is that “the mode of origin, and the character of these endemics of syphilis, appear to me to furnish the key to an understanding of the remarkable episode of the disease in the 15th century,—an episode which entirely resembles them as regards its type, and differs from them only as regards extent[869].”

Referring the reader for farther particulars to the work quoted, I shall leave the antecedents of the epidemic of pox in the end of the 15th century to be judged of according to the probabilities thus far stated.

CHAPTER IX.

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:—