‘Direful Attendants’: The Great Pox and Shame

‘The pestilent infection of filthy lust’  – William Clowes, A … treatise touching the cure of the disease called (morbus gallicus) (London, 1579).

‘[the great pox] has the direful Attendants of Shame, Reproach and Ridicule.’  – John Profily, An easy and exact method of curing the venereal disease (London, 1748).

A woman representing syphilis; advertising Dr Abreu’s sanatorium for syphilitics in Barcelona. Colour lithograph by R. Casas (1900). Source: Wellcome Library, London.

From the sixteenth century until today there have been those who have strongly associated the pox, syphilis, and other sexually transmitted diseases with shame and who have stigmatised those who contract these infections.

During the eighteenth century some people argued that medical practitioners ought not to cure those who contracted the pox. It was, they contended, a disease spread through sinfulness, and therefore a just punishment for any who contracted it. They argued that the potential to readily obtain a cure encouraged those who contracted the disease to persist in their debauched lives, thus infecting British society with an epidemic of immorality.

However, not everyone agreed with this line of thinking. The London-based John Marten wrote:

But I must declare, I cannot be of their Opinion, because it seems to shut out Charity, which at least however ought to be afforded to our Fellow-Creatures in Misery; And besides we are all frail, the same Flesh and Blood as others all subject to the same Venereal Pleasures. (From: John Marten, Treatise of all degrees and symptoms of the venereal disease.)

Indeed Marten’s treatise is one which treats some pox victims in a very sympathetic manner, showing us that the reaction to the pox was not uniformly negative. He emphasises that there were numerous victims of the disease who contracted it through no fault of their own – citing many cases wherein an adulterous husband (and occasionally wife) gave the disease to their faithful and unsuspecting spouse. In these cases he is always very much at pains to emphasise the innocence of the faithful party.

Nevertheless, single women who contracted the disease were in particular danger of stigmatisation. Eighteenth-century ideals of femininity idolised faithful wives and pure virgins. Some writers warned that women were especially deceitful and would use makeup and cosmetic strategies to trick men for financial gain, infecting them with the pox in the process.

Whilst Marten believed that a few innocent female virgins were infected through violence or seduction, he strongly condemned the many women whom he perceived as lacking sexual morals (i.e. those who had sex outside of marriage). In his Treatise he included some advice for his male readers. He urged them to find a pocket-sized portrait of a beautiful woman, and then to diligently deface it, erasing the nose, giving it rotten teeth, etc. They were to carry this image about with them and to look upon it when they had ‘a fancy for a woman’ to remind themselves of the sin and disease that apparent beauty could conceal.

Syphilis remains very present in global society. In England the diagnosis of syphilis has increased by 76% since 2012 (rising from 3,001 diagnoses in 2012 to 5,228 in 2015) and in the US rates have also been increasing. When reading about the stigmatisation of pox victims in the eighteenth-century, it is very easy for us to shake our heads, to say ‘wasn’t that awful, well things are better now’. But are they? Whilst more effective care is more readily available in some areas of the world, have societies’ attitudes progressed toward STDs, women’s and non-hetrosexual sexualities?

‘Interviewer: And what comes into your head when I say sexually transmitted infection, or STI to you?

Participant: You shouldn’t really say it ‘cos anyone can get them but kind of, more it’s perceived as slightly, not dirty people but kind of more promiscuous, stuff like that…(i24, man, aged 16–19)’

    – From Fiona Mapp, ‘Reflections on Using a Flash Card Activity for Studying Social Representations of Sexually Transmitted Infections‘ (2017).

An unexpectedly fashionable career

If asked today to list fashionable careers, it is highly unlikely that any of us would include ‘syphilis specialist’ in our list. During the eighteenth and nineteenth centuries the prevalence of the disease in British society and the ongoing debates surrounding its nature and cure provided many medical men with the opportunity to carve out very fashionable, and indeed lucrative, careers.

Medical instruments in A complete treatise on the virulent gonorrhoea, by Jacques Daran (London, 1766), University of Glasgow Library, Sp Coll NH.6.24; with permission of University of Glasgow Special Collections.

Among those who became famous for their work on the disease were two Scottish surgeons – John Hunter and Benjamin Bell. Hunter and Bell were particularly important and noted because they debated whether gonorrhea and syphilis were caused by the same pathogen.  Hunter argued for the same pathogen, whilst Bell took the position that they were separate diseases. Their work on the diseases was widely read and debated in the medical community, for instance Solomon Sawrey, a surgeon, published a book on An inquiry into some of the effects of the venereal poison on the human body; with… observations on some of the opinions of Mr. John Hunger and Mr. Benjamin Bell (1802).

John Hunter (portrait on left-hand page),  A Treatise on the Venereal Disease (London, 1810), University of Glasgow Library, Sp Coll 84.b.12; with permission of University of Glasgow Special Collections.

The London-based surgeon John Marten also appears to have carved out a successful career as a pox practitioner (despite some accusations of quackery from contemporaries!). Marten published a very popular Treatise on all degrees and symptoms of the venereal disease. The book was clearly successful, running to seven editions. However, Marten did not just seek fame and fortune through his published endeavors. He also sought these through treating the upper circles of London society for the disease. The service that he offered was clearly tailored to meet the desires of an elite clientele; he offered to meet patients in clandestine locations away from their homes and his surgery and would send letters and remedies anonymously and to alternative collection addresses rather than directly to people’s homes. This was all to help fashionable Londoners maintain a respectable facade, free from association with a disease considered immoral and associated with horrific physical suffering and disfigurement. Moreover, all of these services were mentioned in Marten’s book, thus making it a sort of extended advertisement; a way to win him more wealthy patients!

John Marten (portrait on the left-hand page), A Treatise of all the Degrees and Symptoms of the Venereal Disease (London, 1708), University of Glasgow Library, Sp Coll Hunterian Ab.6.11; with permission of University of Glasgow Special Collections.

Today we sometimes say that something is ‘to die for’, well during the eighteenth century, a successful career as a practitioner treating the pox was just that. Self-experimentation was common among medical men during this period, and some injected themselves with material extracted from the sores of venereal patients. This was undoubtedly risky, it could result in the need for months of mercury treatment, and had the potential to prove fatal. There is at least one known case of a student, who was preparing a thesis on venereal disease, dying from injecting himself with material from a pox sore.

Thus, whilst the great pox was not a fashionable disease to suffer from during the eighteenth and nineteenth centuries, it provided many medical men with the opportunity to obtain fame and fortune. To be a pox practitioner, surgeon or doctor, was so desirable that it was literally seen as a career worth dying for.

Medical Fascinations, Human Lives: Hunter’s Syphilis Specimens

Should you visit The Hunterian Museum you can come face to face with victims of the great pox (syphilis). As you enter the main museum from the staircase, to the left hand side, on the topmost shelf of a cabinet containing a series of human specimens there is a set of skulls showing the ravages of what is now known as tertiary syphilis, the disease’s most aggressive phase.

LHS: Syphilis of the Skull, Hunterian Museum & Art Gallery collections, catalogue number GLAHM 122592. RHS: Syphilis of the Skull, Hunterian Museum & Art Gallery collections, catalogue number GLAHM 122590.

William Hunter, as is evident from the collection that he bequeathed to the University of Glasgow, was a voracious collector with incredibly diverse interests. But why did he collect these specimens?

Well, it seems these bones were principally objects of medical-scientific interest for Hunter. Perhaps he even used them in some of his teaching. In any case, neither these skulls nor the disease that they illustrate were Hunter’s primary interest. This is reflected in his catalogue of anatomical preparations. Some of the entries in this manuscript carefully document the origins (and sometimes even synopsise the life-stories) of human and animal specimens. However, no record is made of where the pox specimens were acquired from, and no clue is given to the victims’ identities.

We know very little of Hunter’s own perspective on the disease and its victims. In 1775 he gave a paper to the Royal Society in London, discussing the geographical origins of the disease. During this paper he suggested the pox was associated with ‘immorality’ and ‘disgrace’. However, it is unclear whether Hunter shared this opinion or was merely acknowledging contemporary attitudes.

But these skulls are not just ‘specimens’, they are human remains. They lived lives as vivid as our own. The holes in some of the skulls can look like the accident of a careless archaeologist. It is easy to forget when browsing in the museum, that these people watched, and likely suffered unimaginable pain, as the pox ate away their bones. These painful and emotional experiences cannot be captured by museum labels or catalogue descriptions.

One of the aims of this project, particularly through the Insight Talks I have delivered in The Hunterian, has been to ask museum visitors to consider how they view the objects and specimens on display. To acknowledge the scientific and medical importance of items like these skulls, but also to encourage viewers to consider these as emotional objects, which suggest a past that we cannot fully access. Ultimately, without documentation we cannot hope to discover the stories of these individuals, but through combining our knowledge of medical history, the attitudes towards and treatment of the pox, alongside our own emotional experiences of illness, we can give some flesh to these bones and see them not only as specimens, but as people.

A preserved skull of a woman who had been suffering from syphilis and encountered her ‘long wished for death’ on 28 August 1796. Credit: Wellcome Library, London.

‘Hypochondriacal People’: Lives Haunted by the Pox

These dreadful Apprehensions have frequently possesst the Imaginations of some People that had taken the way to get the Pox, so, as to be soon perswaded they have it, whether it be so or no.
John Marten, A Treatise of all the Degrees and Symptoms of the Venereal  Disease in Both Sexes (London, 1708), p.43.

In the Treatise of all the Degrees and Symptoms of the Venereal Disease by the London-based surgeon John Marten there is an intriguing and disturbing discussion of ‘hypochondriacal’ patients. These ‘hypochondriacal’ men and women were, firstly, those who although they were cured of the pox according to their doctors, believed that they were still afflicted with the disease. Secondly, this group included those who had never had the pox, but had read and heard about it, and had usually participated in behaviours (such as sexual intercouse with a prostitute) that were believed to pose a high risk of contracting the disease, that had become (wrongly) convinced that they were labouring under the disease’s symptoms.

Syphilis of the Skull, Hunterian Museum & Art Gallery collections, catalogue number GLAHM 122592.

The few pages on pox-related hypochondria in Marten’s book provide a sharp insight into the terror that this disease provoked in eighteenth-century British society. The picture of the skull from The Hunterian’s collection (above) very clearly demonstrates the impact the pox could have on the body in its most severe form. Perhaps some of the ‘hypochondriacal’ had witnessed others with this form of advanced pox, where the bones of the living victim begin to rot away. They may have seen such cases whilst they themselves were undergoing treatment, or possibly they had seen them on the streets or in the illustrations in the numerous books on the subject. The disease and its treatment were synonymous with suffering and loss of respectability (because of its association with immoral sexual behaviours). In other words, it could bring both literal (physical) and social death. For some, it appears that the threat of the disease or a relapse, were sufficient to cause severe anxiety which consumed their lives.

Marten’s book shows the pity he felt for these fear-ridden hypochondriacs, but it also reveals a sense of annoyance. His sympathy was driven by his intimate knowledge of the disease, having treated seemingly innumerable patients for the pox, some of whom died from the disease. He also recognised that the cures were often ‘desperate’, extremely painful and occasionally, when badly administered, fatal. To be afflicted with the pox was terrifying, and to undergo treatment was no less so.

Modern readers might compare these eighteenth-century pox patients with twenty-first century cancer patients, who suffer with their disease and often face courses of treatment which take a huge toll on the body and mind. Today, many of us will know someone who has undergone treatment for cancer, and the fear that lingers with many former patients and their families that the disease may one day return.

John Marten (pictured on the left-hand page), A Treatise of all the Degrees and Symptoms of the Venereal Disease (London, 1708), University of Glasgow Library, Sp Coll Hunterian Ab.6.11., with permission of University of Glasgow Special Collections.

Sympathy, however, is not the only emotion that we encounter in Marten’s text. There is also a strong sense of frustration with the unwillingness or inability of the ‘hypochondriacal’ poxed to take his word, or that of other reputable medical practitioners, that their illness is cured or non-existent. That said, Marten’s exasperation seems to be primarily driven by the frustration of seeing patients leading themselves into ruination. Faced with a rejection of his professional experience and medical logic, Marten was rendered powerless, and could find no way to sooth the worries of his anxious patients.

Phobia of the pox led men and women to seek out the opinions of multiple medical practitioners, until they could find one that diagnosed them with the pox. But, according to Marten, ‘no fair skilful Practiser, will Administer any further than the Distemper truly requires, it being mercenary to make a Prey of those unfortunate Discontents’. Thus, their fear made them vulnerable to unscrupulous doctors, or worse still, quacks, men who pretended to have medical knowledge and/or qualifications and sold useless prescriptions or aped the cures of professionals as a money-making scam. Throughout the eighteenth-century quack remedies for all manner of illnesses often proved at best useless and, at worst, seriously harmful or fatal. Moreover, even where a proper cure for the pox (usually mercury) was administered, Marten warned that it damaged the patient’s health because it was unnecessary.

Moreover, once the hypochondriacs found a practitioner who agreed they were suffering with the pox their fear was also likely to intensify. Marten described how they became plagued with doubts surrounding the capability of the doctor or surgeon (quack or not) who had diagnosed and begun to treat them. The concern that ‘they were not in Hands skilful enough’ led them to seek out more medical men to treat them, and they bounced from one to the other with growing fear that they might never be cured. This erratic and self-destructive path, driven by intense fear, did not end Marten stated, ‘’til they had ruin’d both their Bodies and their Purses’ through the costly and unnecessary treatments. Not only was the pox potentially fatal, according to Marten the sheer fear of the disease could also ruin lives.

Whilst Marten mostly despairs at the illogical nature of the ‘hypochondriacal’ patients, their persistent intense fear and willingness to undergo huge financial and physical stresses to be rid of the disease they believed they had demonstrates just how great the fear surrounding the pox was in eighteenth-century Britain.

A (Very) Brief History of the Pox

In 1495 Europeans began to remark on the appearance of a new ‘terrifying, troublesome, and painful sickness’. Those afflicted suffered from aching bodies covered with ulcerations, and pustules which could ooze and stink. In its most horrific form the disease rotted the bones of its living victims, and one contemporary described how those afflicted wished ‘to die as soon as possible’.

Many thought that the disease had begun its spread in the wake of the siege of Naples by King Charles VIII of France. They believed the disease had spread northwards through Italy and beyond as his soldiers and mercenaries had returned home to France, Germany and Switzerland. Thus it became known as the ‘French disease’ and the ‘Sickness of Naples’, although it quickly gained other names too, including the ‘great pox’ and the ‘Plague of Job’. Today archaeologists and historians are still debating the origins of the disease. Some contend that it was brought back from the New World by Christopher Columbus’ men, but others argue that it developed from diseases already present in Europe. Whatever its origins, the disease spread with incredible speed reaching Scotland by 1497 and Russia by 1499.

The opening image from, Tractatus de pestilentiali scorra, Joseph Grünpeck (Augsburg, 1496), University of Glasgow Library, Hunterian Bx.3.38, with permission of University of Glasgow Special Collections.

The great pox struck fear into the hearts of Europeans whose doctors struggled to identify, let alone cure this new pandemic. Heated arguments about its causes emerged. Some believed that it was spreading through the air, or through sharing cutlery and clothes. Others emphasised its sexual nature, noting that the first ulcerations usually appeared on the genitals. Whilst physicians argued about its earthly causes, many believed that ultimately the disease was a punishment from God. For example, on 7 August 1495 the Holy Roman Emperor, Maximilian I, issued his Blasphemy Edict, which claimed that sins such as lust, swearing and intoxication had angered God and caused him to send the new disease. By the eigtheenth-century, the sexual transmission of the disease was agreed by most doctors, with very few still adhering to non-venereal theories of transmission. And although doctors were more focused on its earthly causes, its associations with sin, especially immoral sexual practices, remained strong.

Even more worryingly, it was not only the causes of the pox which posed a problem. Initially many doctors believed the disease to be incurable. Various remedies were attempted, including herbal mixtures and bloodletting. However, by the mid-sixteenth century doctor’s felt the disease was curable after all. By this time two preferred treatments had also emerged: guaiacum and mercury, and the use of these remedies persisted through the eighteenth-century.

Drug jar for mercury pills, Faenza, Italy, c.1731-1770 (Library Reference No.: Science Museum A42768), Wellcome Library, London.

Guaiacum was a bark imported from the Americas, and was usually consumed as a drink or decoction, made into a sort of tea, sometimes with the addition of other medicinal herbs. However, this imported cure could be expensive or difficult to obtain. Some physicians also argued that it was ineffective. Therefore, mercury became the most common treatment for the disease. It could be administered internally, swallowed as pills, or externally, as a lotion rubbed onto the body with the patient then often being wrapped in blankets or being left by a hot stove to sweat (see image below). Today we know that mercury is highly poisonous to the human body and many early modern physicians recognised that the treatment was excruciating and harmful to the body. Yet they saw it as their best hope against the disease. One eighteenth-century surgeon, John Marten, commented that ‘a desperate Cause must have a desperate Cure’.

A patient undergoing sweating treatment: first they sit wrapped in blankets on a chair, beneath which is a flaming spirit stove (Fig.1) and then get into bed (Fig. 2) staying wrapped up. Sweating Treatment for Syphilis, engraving by  J. Harrewijns, from: Venus belegert en ontset by Stephen Blankaart (1685), Wellcome Library, London.

However, these treatments were not always successful, and indeed the mercury must have poisoned some patients. Moreover, today it is recognised that syphilis (believed to be the same or highly similar to the pox suffered in the eighteenth century) can enter a dormant phase wherein it appears to have disappeared, although it can later re-emerge. The disappearance of the symptoms would likely have led some early modern medical practitioners and patients to believe that the disease was cured. A failure to recover or a relapse of the disease (usually interpreted as a new infection) were often blamed on the patient, who could be accused of failing to follow doctor’s orders or for having an immoral lifestyle that led to reinfection. These moral judgements persisted into the eighteenth-century and are something that I will be exploring in more detail in an upcoming post.

Indeed, despite being present in Britain for around 200 years, interest in the pox had not diminished by the eighteenth century. It was during this period that William Hunter collected a number of human skulls disfigured by the disease, one of which is shown in the image below. These skulls illustrate the devastating impact of the pox; the deformation and disintegration of the bones seen in the image below would have taken place during the victims lives. The pain and suffering caused by the disease which was first remarked on in 1495 was far from over. Marten recorded the extreme fear that the disease caused amongs his patients, and an upcoming post will explore how the spectre of the disease haunted their lives.

Syphilis of the Skull, Hunterian Museum & Art Gallery collections, catalogue number GLAHM 122590.

Of the 242 printed medical texts on the pox (dating from 1496-1820) in the university’s Syphilis Collection, 84 were published in Britain during the eighteenth-century. Clearly, the pox remained a central issue in medicine. However, it also provoked moral and emotional questions and responses. Marten remarked that there were those who caught the disease both ‘deservingly’, such as those who slept with prostitutes, and ‘undeservingly’, often through infected spouses. The next posts in this blog will therefore explore how these distinctions between deserving and undeserving victims arose, alongside the variations in responses from reproach to sympathy that we find embodied in the collection’s texts.

 

Syphilis: The disease that came to stay

In 1495 a new pandemic swept across Europe; echoing his contemporaries’ fears Joseph Grünpeck, a German secretary, described it as a ‘terrifying, troublesome, and painful sickness’. Today identified as syphilis, this disease had come to stay. It reached Britain by 1497, and in the eighteenth century it continued to trouble all levels of society.

Syphilis and its victims provoked a huge range of emotions; they were stigmatised and satirised, but also the objects of pity and sympathy. Many sufferers lived in great pain and shame, yet for some men syphilis was a badge of honour recalling their success in the battlefield of romance.

Syphilis was known by many names, including the ‘French Disease’, the ‘Great Pox’ or simply ‘the Pox’, and it fascinated medical men.  William Hunter collected a number of skulls from syphilitics for his anatomical collection, whilst his brother, John, wrote one of the many medical treatises on the disease.

Working with the Syphilis Collection in the University of Glasgow Library’s Special Collections alongside the syphilis skulls in the Hunterian Museum, this project investigates the emotional history of syphilis in eighteenth-century Britain. It explores how the disease’s victims were perceived and how they perceived themselves. The collection’s texts provide a unique insight into the opinions of contemporary medical practitioners, whose works are laced with both medical and moral opinions. The skulls meanwhile raise important questions about the afterlives of syphilitics. Why did Hunter have these skulls? Did they simply represent useful teaching objects? Or did they provoke a fascination similar to that experienced toward the diseases’ living victims?

A medical treatment for the pox (syphilis) from ‘Erster [-der dritte] theil der grossen wundartzney‘ (Frankfurt, 1562) by Paracelsus, University of Glasgow Library, Sp Coll Ferguson Ap-d.51, with permission of University of Glasgow Special Collections.