Thursday, 21 August 2014

The Pox: Syphilis, Stigma & Shame

“A pox on both your houses!” or so goes the popular (mis)quotation from Shakespeare’s Romeo and Juliet.[1]

Whether called the pox, the French disease or morbus gallicus, the Spanish sickness or the Spanish itch, the evil of Naples or the Neapolitan disease, or very simply the venereal infection, syphilis and other sexually transmitted infections plagued the early modern European people.[2]

Indeed, venereal diseases were so widespread, devastating, and stigmatized that people sought to name the disease after enemy countries to which they ascribed the disease’s origins.[3] 

It’s unsurprising then that many English called it the French pox.

Origins

But where did the pox come from?  Tests on medieval bone fragments suggest that it was not a disease that afflicted Europeans before the 15th century.  Though still a somewhat contested idea, the pox was, most likely, brought back from the New World by explorers.[4]

From Marten's A Treatise of Veneral Disease.
Peter Lowe, a 16th century Scottish surgeon, believed that this was the most probable origin of the disease, and cited that even “Spanish Historiographers” and “divers other learned men” held the opinion.[5] 

Gideon Harvey, the 17th century English physician, noted that it was the “Spaniards at Naples, in the year 1494” who first showed symptoms of the disease.  These explorers, he wrote, brought “new pretty curious fangles…[and] this new pock toy” from the West Indies, which they “soon made present of to several of their dearest Julietta’s at Naples.”[6] 

From there, the pox spread to other sexual partners and even to children.    

Both Lowe and Harvey record other opinions of the pox’s origins that help reveal contemporary beliefs and anxieties.

Some, for example, believed the pox was sent from God to punish sin.  Others that it was engendered in French soldiers who turned to cannibalism in times of war, or through sexual intercourse between a French leper and a Neapolitan prostitute who was menstruating at the time, or through the movements of the planets, or even by drinking wine tainted with a leper’s blood.

Symptoms…

Such beliefs reveal much about contemporary anxieties surrounding religion, female sexuality, uncleanliness, and war.

What precisely was the pox, however, is a bit difficult to pin down.  Though primarily referring to syphilis, it seems that early modern medical practitioners used the word “pox” as a catchall that referred to almost all venereal diseases. 

In an effort to better understand this new disease, practitioners drew parallels between its symptoms and those of the ailments with which they were already familiar.  To that end, they noted the similarities between pox and other diseases that manifested externally like smallpox, plague, and leprosy. 

Syphilis is a complicated ailment with many stages of differing symptoms.  First, come the raised sores at site of infection.  Once resolved, the disease begins a second stage that involves rash-like formations of other sores that tend to scab and scar.  This is accompanied by fevers, general feelings of malaise, hair loss, and an attack on the nervous system. 

While the disease may go into a latent stage, the patient is still infectious and women could (and did) give birth to babies already infected with the disease.

18th C skull of woman who suffered from syphilis
The very last stage of syphilis means even larger and more serious sores, further debilitating attacks on the nervous system, and blindness.  If he sores appeared on softer cartilage, perhaps on the nose for example, the patient could in fact lose the whole nose.

Needless to say, it was very difficult to hide the symptoms of the pox.  But it was easy to confuse the symptoms with another disease.  As Harvey wrote, “In short, the Pox is a Monarch, all other Diseases are its subjects, for there is no Disease, but one time or other is noted to accompany it.”[7]

18thC ivory replacement nose
& Stigma

There was pretty wide-spread recognition that syphilis was contracted through sexual activity.  Nevertheless, surgeons like Peter Lowe suggested that patients, such as one “Gentlewoman of a great Family” who he declared a virgin, could contract the disease from an infected toilet.  While yet another patient, a young apprentice of 15, was thought to have been infected by stepping on his master’s spit.[8]

Lowe did, however, recognize that infection also came through sexual activity and noted the case of 35 soldiers who slept with a single infected prostitute.  Of these, he noted, only 7 men were eventually infected – and these men were “weake” and “long in performing the act.”[9]

This association with loose morals, coupled with the disease’s foul symptoms, meant that syphilis was demonized and stigmatized by the early modern English.

Surgeon William Clowes argued that many infected were “rogues and vagabonds” who spread the disease in “lewd alehouses.”  In a short tract on the pox attached to Clowes’s A Prooved Practice, physician John Almenar pointed out that “they which are carefull to escape the French Pockes, let them first eschue sinne.”[10]  As Thomas Rosewell wrote, venereal diseases were a punishment for sin.  The “beastly adulterer, thou filthy fornicator, and unclean liver” needed to change their ways “lest the severity of God take hold of thee” through infection.[11]

Indeed, patients being treated for venereal diseases at St. Thomas Hospital in London were whipped in punishment. 

John Marten, surgeon, wrote a very popular book on venereal diseases where he laid blame on women.  Indeed, many of his case examples highlight women as a source of the disease, spreading it through vengeance, lies, and other behaviours.[12]

Women’s bodies were thought to be especially good breeding ground for the disease and blame for spreading the disease was linked to women of all walks of life – not just prostitutes.  Wet nurses and mothers, for example, were blamed for spreading the disease to children.

From Marten's A Treatise of Veneral Disease
Shame, Privacy, & Treatments

The stigma attached to syphilis meant that patients sought frequently to hide their ailment or how they contracted it.  Marten met frequently with those who sought to hide that they were infected with syphilis or to hide their manner of contracting the disease.  As he wrote, “nothing indeed is more common than that the Patient [lies] to avoid the Shame and Disgrace of having gotten it by Copulation.”[13]

Unsurprising, really!

In addition, this stigma meant that patients demanded privacy and medical practitioners, seeing increased revenue, were happy to comply.

1689 depiction of mercurial salivation.
Medical advertisements and handbills, for example, show that there was patient demand for secrecy:
 
Indeed, some medical practitioners offered secret or back entrances so others could not observe the patient.  Others even offered private lodging where the patient could be confined and cured without others noticing the telltale signs of mercury – the popular pox treatment.

The anonymous author of An Herculean Antidote even offered to send medicines by post for those too “ashamed to come.”  While yet others, likely as a marketing tool, insisted that syphilis could be contracted accidentally through falls, bruises, and heavy labour rather than through sexual impropriety with “foul women.”[14]

As noted earlier, the pox was frequently treated by mercury – it was dabbed onto the sores or ingested.  While this had some effect on syphilis, it was harsh and also had the negative side effect of slowly killing the patient with mercury poisoning.  This was also a treatment that could not be hidden.  When mercury was taken inwardly, patients salivated frequently and had a noticeable odour.

Instead, patients sought less harsh and less noticeable treatments.  To that end, those irregular practitioners who advertised their treatments promised to treat without mercury.[15] 
18th century Italian jar for mercury pills.
Kevin Siena has written and edited some fantastic work on VD, stigma, and shame if you’d like a detailed analysis.[16]

Let me know what you think here or on Twitter – I’m @medhistorian.



[1] Shakespeare wrote “plague” not “pox.”
[2] Girolamo Fracastoro coined the word “syphilis” in his 1530 Syphilis sive Morbus Gallicus.  The word did not come into popular usage until centuries later.
[3] Claude Quétel, History of Syphilis, 16.
[4] A. Carmichael,Syphilis and the Columbian exchange: was the disease really new?” In: Marques MG, Cule J, editors. The great maritime discoveries and world health. Lisbon: Ecola Nacional de Saúde Pública (1991), p 187-200 & Mary Lindemann, Medicine and Society in Early Modern Europe, 69.
[5] Peter Lowe, An Easie Certaine and Perfect Method (1576), Bv.
[6] Gideon Harvey, Little Venus Unmask’d (1670), 4.
[7] Harvey, 28.
[8] Lowe, B2v.
[9] Ibid., B2v.
[10] William Clowes, A Prooved Practice, 111.
[11] Thomas Rosewell, The Causes & Cure (1665), 67.
[12] John Marten, A Treatise of the Veneral Disease, 319.
[13] Ibid., 300-301.
[14] Anon. At the Sign of the Two Faces (17th century).
[15] Anon. At the Boot and Spatterdash (17th century).
[16] Kevin Siena,Venereal Disease Hospitals and the Urban Poor: London's Foul Wards,1600-1800 (Rochester, NY & Suffolk,UK: University of Rochester Press & Boydell and Brewer,2004); Sins of the Flesh: Responding to Sexual Disease in Early Modern Europe (Toronto: Centre for Reformation and Renaissance Studies, 2006); “The “Foul Disease” and Privacy: The Effects of the Venereal Disease and Patient Demand on the Medical Marketplace in Early Modern London,” Bulletin of the History of Medicine 75,2 (2001), 199-224.

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