"Marvelous . . . a beautifully wrought and mercifully slim volume. 'Mercifully,' I say, because packed into these 160 pages are enough gruesome tales to last a lifetime."—Margaret Wertheim, LA Weekly

Shortly after Christopher Columbus and his sailors returned from their voyage to the New World, a horrifying new disease began to make its way around the Old. The "pox," as it was often called, erupted with dramatic severity. According to Ulrich von Hutten (1488-1523), a German knight, revolutionary, and author who wrote a popular book about his own trials with syphilis and the treatments he underwent, the first European sufferers were covered with acorn-sized boils that emitted a foul, dark green pus. This secretion was so vile, von Hutten affirmed, that even the burning pains of the boils troubled the sick less than their horror at the sight of their own bodies. Yet this was only the beginning. People's flesh and skin filled with water; their bladders developed sores; their stomachs were eaten away. Girolamo Fracastoro, a professor at the University of Padua, described the onward march of symptoms: syphilis pustules developed into ulcers that dissolved skin, muscle, bone, palate, and tonsils—even lips, noses, eyes, and genital organs. Rubbery tumors, filled with a white, sticky mucus, grew to the size of rolls of bread. Violent pains tormented the afflicted, who were exhausted but could not sleep, and suffered starvation without feeling hunger. Many of them died.

The public was appalled by this scourge. Physicians too, von Hutten reported, were so revolted that they would not even touch their patients. As in the earlier Middle Ages, divines quickly announced that the extraordinary sins of the age were responsible for the new plague; others blamed the stars, miasmas, and various other causes. Barrels of medical ink were spilled on the question of where the disease had come from. Treatments, preventions, and cures were sought. The idea of infection began to be taken far more seriously than it ever had before. Hospitals transformed themselves in response to the new plague—sometimes for the better, but often for the worse, as when, in fear, they cast their ulcerated patients out into the streets. Most of all, people continued to follow their old ways: in the face of this new threat, they castigated and persecuted the sick. As infection spread, so did fear; and where fear went, blame followed close behind.

Perhaps more than any other disease before or since, syphilis in early modern Europe provoked the kind of widespread moral panic that AIDS revived when it struck America in the 1980s. Syphilitics were condemned from pulpits and from chairs in university medical schools. John Calvin (1509-1564) announced that "God has raised up new diseases against debauchery"; medical authorities willingly agreed. The greatest English surgeon of the sixteenth century, William Clowes (1540-1604), who counted Queen Elizabeth among his patients, announced to his colleagues and patients that syphilis was "loathsome and odious, yea troublesome and dangerous, a notable testimony of the just wrath of God." A century later, a French physician, M. Flamand, summed up this point of view concisely by announcing that venereal diseases were "the just rewards of unbridled lust." Disease commonly invited theological speculation, but in the case of syphilis people felt that little speculation was necessary. Just as fornication opened the door to the pox, so the pox opened the door to chastisement and blame.

Motivated by these fears, panicky towns and hospitals barred their gates against syphilitics. Within two years of the first reported cases, cities from Geneva to Aberdeen evicted the pox-ridden. Often, city fathers blamed prostitutes for the disease, and some threatened to brand their cheeks with hot iron if they did not desist from their vices. Sexual morality was becoming stricter, and prostitutes were usually condemned far more savagely than the men who used their services.

What was more extraordinary, however, was that hospitals refused to admit syphilis patients. Hospitals in early modern Europe were charitable institutions, designed to provide care and shelter to the sick poor. The most famous of them, the Paris Hôtel-Dieu prided itself, with one single exception, on the breadth of its generosity. This hospital boasted that it "receives, feeds, and tends all poor sufferers, wherever they come from and whatever ailment they may have, even plague victims—though not if they have the pox." The Hôtel-Dieu expelled its syphilitic patients in 1496, and, after relenting briefly, expelled them again in 1508. Two years after that, another Parisian hospital shunted its pox victims off to the stables, to sleep with the animals. Many cities threw the poxy poor into the leper houses that for years and years had housed only ghostly memories; Toulouse kept its infected prostitutes in a ward that was little more than a high-security prison. Two infamous hospitals in Paris, Bicêtre and the Salpétrière, had patients "piled upon one another," in the words of historian Michel Mollat, "like a cargo of Negroes in an African slave ship." And another, the Petites Maisons, which warehoused syphilitics and the mentally ill from the 1550s until the 1800s, became known as the "pox-victims' Bastille."

Fear of contact was one reason for this behavior. Even more than this, however, the sick—like lepers—were often reviled because people believed that they had brought their torments upon themselves. Some pundits, early on, announced that blasphemy was the vice that had called down this new torment from heaven, but most often syphilis was attributed to the sin of lust. This was certainly a logical assumption: soldiers and prostitutes, traditionally associated with sexual license and moral disorder, were among the first victims, and the connection became even closer when people noticed that the disease's first sores often turned up on the genital organs. The loathsome symptoms were taken as signs that the sick housed debauched and sinful souls. This reasoning stood behind many of the cruelties that individuals, doctors, hospitals, priests, ministers, and even entire towns and cities inflicted on people with the pox, as the stories in this chapter will show.

Horror was the first emotion the pox provoked among the general public, but what the medical community first felt was confusion. Was this an old disease, and, if so, which one? If it was new, what did that say about the state of medical knowledge? And in any case, how could physicians make sense of it?

Medical research in the twentieth century mostly takes place in the lab; in the Renaissance, though, researchers went first and foremost to the library to see what the ancients had said. The problem, however, was that it was not clear that in this case the ancients had anything useful to offer. Nothing the Greek and Arabic authorities had described seemed very similar to the cases turning up in increasing numbers on the physicians' rounds and in the streets, and so it was hard to affirm that the old remedies would do any good.

If the pox was a new disease, how had it arisen? Some cast the blame on supernatural powers—the planets, the stars, God, or even witches. Galenists claimed that the pox came from corrupted air, or even, like lovesickness, from an excess of black bile. Some said the disease was God's punishment for sin; others attributed it to the recent and risky voyages to the New World.

The theories that tied the disease to the Americas were the most innovative, since they focused on the new idea that diseases could travel from one person to another. (They may also have been the most accurate: many scientists today believe that the New World was the source of the syphilis bacterium, or of a new strain or cofactor that triggered the epidemic of the 1490s.) In a quirky 1672 screed entitled Great Venus Unmasked, the English writer Gideon Harvey looked backward to argue that it was Columbus's Neapolitan sailors who had acquired this "new pretty toy." With it, he reasoned, they had infected the prostitutes of their native city, which was under siege by the French in 1494-1495: when provisions in Naples ran out, wrote Harvey, the whores crept over to the besiegers' camp, and offered their services to the French soldiers. If the Neapolitan prostitutes were hungry for food, Harvey explained, the French soldiers were "almost starved for want of women's flesh, which they found so well seasoned, and daubed with mustard, that in a few weeks it took 'em all by the nose."

Other exotic theories abounded. One Leonardo Fioravanti (1518-1588) claimed that the French soldiers became sick because they had devoured the rotten carcasses of their dead enemies. Some said the malady had been bred when a French leper had sex with a Neapolitan whore. Others said soldiers became sick from drinking Greek wine adulterated with lepers' blood; still others blamed the "entailed manginess" of the French, who—as Harvey reminded his English readers—"are slovens in their linen." One anonymous author even suggested that syphilis was spontaneously generated by promiscuous sex.

This wild proliferation of theories showed that nobody really knew where the pox had come from; it also showed that people were deeply troubled by it, and thought that something had gone gravely amiss in the world to provoke such a strange and awful evil. Their confusion and anxiety were also revealed by the names that people gave the new arrival. The name most commonly used today, syphilis, came from an Italian poem, written in 1530, which traced the disease to a punishment inflicted by Jupiter on a fictional character named Syphilus, an impious shepherd. More commonly, however, the pox was called after whichever country people wanted to blame for the disease. To the French, it was the mal de Naples, the sickness from Naples; to many others, it was the morbus gallicus, the French disease. But also accused were the Americans, the Mexicans, the Spanish, the Germans, the Poles, and the Portuguese. Everyone, observed the astute author of A New Method of Curing the French-Pox (1690), "to excuse himself, is forward to ascribe to his neighbors the source and original of this distemper."

Regardless of its geographic origin, people quickly began to notice that the pox traveled from one person to another. They sometimes blamed transmission on common and morally innocuous practices—drinking from a common cup, kissing friends in church, following a syphilitic comrade on the latrine. But from 1495 on, the route of transmission people talked about most was sex. Von Hutten noticed that men in their sexually active years were much more susceptible to the French disease than boys or the elderly; soldiers and prostitutes remained highly suspect. As early as 1504, infection became grounds for breaking off engagements, and even saying that someone was infected was enough to provoke a lawsuit. Syphilis was well on its way to becoming a "venereal" disease, and a public mark of shame.

Treatments for the pox were often more excruciating than the disease's symptoms. According to their place in society, early modern Europeans received varying types of medical care, but all were problematic. The rich were seen by physicians, whose treatments ranged from the useless to the deadly; the middle classes could consult self-help books, or hire barber-surgeons to torture them with knives, drills, and white-hot cautery irons. The poor had to deal with charity hospitals. If admitted to these institutions, they were housed and fed, but they also shared beds and germs with all the other diseased patients in their wards, and often received little medical help; if they were refused admission, they suffered and died in the streets. It was hard to say which was worse—to languish untreated, as syphilis ate its way through one's organs, or to be tortured by poisonous and savage remedies administered by physicians and surgeons who often believed that their job was to punish their patients for their sins. To have syphilis in early modern Europe was a torment and a tragedy for rich and poor alike.

	Trepan (tool for drilling holes in the skull).
	Cautery Irons. Illustrations from The Works of That Famous Chirurgion Ambrose Parey, trans. Thomas Johnson (London, 1649). Courtesy of Archives & Special Collections, Columbia University Health Sciences Division.

Doctors did not use harsh remedies at first, perhaps because the disease had not yet earned real opprobrium, or perhaps because these early cures derived from the Galenic model, which, whatever its limitations, at least employed fairly gentle methods. Physicians who viewed the disease as a humoral imbalance recommended baths, chicken broth, bloodletting, syrups, the milk of a woman who had given birth to a daughter, and even that old standby used for curing lovesickness, sexual intercourse. (This last piece of medical foolishness, fortunately, did not garner many endorsements.) Others warned of the dangers of promiscuous sex, particularly with prostitutes; some even proposed safer sex techniques for preventing the pox, such as washing the genitals, before or after intercourse, in hot vinegar or white wine. It probably took physicians a while to realize that these mild remedies, while doing no harm, did little good, either. Syphilis was new, after all, and nobody knew at first that the disease passed through primary, secondary, and tertiary stages, each with distinct symptoms and with quiescent periods in between. Eventually, though, physicians did realize that they were doing their patients no particular service with remedies of this sort.

Gradually doctors came to understand that, once acquired, syphilis tended to persist, and gradually its severe symptoms and venereal taint attracted much more aggressive medical treatment. Some doctors, for example, injected drugs directly into male patients' infected urethras. A character in the writings of the Dutch humanist scholar Desiderius Erasmus (1469-1536) spoke in favor of binding female syphilitics in chastity belts, and of deporting, castrating, and even burning pox-ridden men alive. Surgeons treated racking syphilis headaches by trepanation, the ancient practice of boring holes into the skull. Oozing ulcers in skin and bone were cauterized with fearsome, white-hot irons. Mild remedies quickly gave way to these treatments, which at least showed that doctors were doing something their patients could feel.

Bleeding, bathing, cautery, and herbs were used now and then, but, most often, physicians fought syphilis with two important drugs: mercury, and the wood of the Central American guaiac, or lignum vitae, tree. Ulrich von Hutten was well acquainted with these, having suffered through the appalling mercury vapor treatment eleven times in nine years. As he explained the process in his book, patients were shut in a "stew," a small steam room, for twenty or thirty days at a time. Seated or lying down, they were spread from head to foot with a mercury-based ointment, swathed in blankets, and left until the sweat poured down; often they fainted from the heat. Disgusting secretions issued from their mouths and noses; sores filled their throats and tongues, their cheeks and lips, and the rooves of their mouths. Their jaws swelled; often their teeth fell out. Everything stank.

Many patients, von Hutten observed, decided they would rather die than undergo this torture. Others went through it, and died as a result. Von Hutten knew of one anointer, for example, who killed three men in a single day by overheating the stew. His patients suffered silently, believing that, the hotter the room, the sooner they would be cured; but though their patience lasted, their hearts gave way under the strain. Others strangled when their throats swelled so much from mercury poisoning that they could not breathe. And others still died of kidney failure when their urination was blocked too long. "Very few there were," von Hutten lamented, "that got their health, if they passed through these jeopardies, these bitter pains and evils."

Stranger methods for applying mercury were dreamed up, too. It could be taken internally, for example: one eighteenth-century recipe called for mixing the liquid metal with hot chocolate, though the author cautioned against this exotic beverage because he felt that the chocolate was too dangerous for those afflicted with the French disease. One entrepreneurial medic marketed underpants coated inside with a mercury ointment. All these remedies were based on the theory that, once inside the body, quicksilver atoms spread through it, eliminating the "pocky miasmas" through sweat and the copious salivation that the heavy metal provoked.

These doctors were not wrong about the virtues of mercury, which Arab physicians had used for centuries to treat diseases of the skin: mercury kills the syphilis bacterium in vitro, and it may also help the body's immune system to attack the microorganism. The problem, however, is that mercury is a deadly poison, particularly in vapor form or when combined with other substances. (Mercuric chloride, for example, commonly prescribed as "corrosive sublimate" in early modern medical handbooks, is fatal in doses as small as a single gram.) Von Hutten correctly noted such symptoms of mercury poisoning as excessive salivation, loosening of the teeth, pain and numbness in the extremities, uremia, and renal damage; other toxic effects include vomiting, dizziness, convulsions, tremors, liver damage, anorexia, severe diarrhea, and mental deterioration. This remedy may have helped cure skin problems, but it also hastened syphilitics to their death.

Doctors warned of these dangers as early as the 1490s. Bishop Torrella, for example, noted that mercury had killed numerous syphilis patients he knew of, including a cardinal and two members of the Borgia family. Others cautioned against excessive and internal use. But despite the suffering it caused—if not because of it—many physicians enthusiastically endorsed mercury in all its forms, and patients continued to seek out and undergo these treatments, at the cost of their financial resources, their remaining health, and, often, their lives.

In 1517 a much-heralded new treatment for syphilis arrived in Europe, championed by many as less deadly and more effective than mercury. Von Hutten was one of these champions: his book about his experiences of syphilis was an enthusiastic testimonial for the new wonder drug, which he also endorsed as a remedy for gallstones, palsy, leprosy, dropsy, epilepsy, and gout. If we ought to give thanks upward to God for all the good and evil in this life, urged von Hutten, how much more grateful we must be for the mercy God had shown in granting us this happy remedy!

Many echoed these sentiments, reasoning that a New World medicine must be sovereign against what was perceived as a New World disease. Guaiac wood and bark were imported into Europe at staggering prices by a monopoly controlled by the House of Fugger, a mining and banking family who were the Rockefellers of their day. The syphilitic rich imbibed guaiac cocktails as often as they could, and the city of Strasbourg even provided these decoctions free of charge to all of its citizens who were afflicted with the pox.

There were, however, two drawbacks to guaiac. One was that, in actuality, it had no effect against syphilis; about all it did was to induce sweating. (The cynical and eccentric physician-alchemist Paracelsus [1493-1541] suggested—cynically but perhaps accurately—that the only people who benefited from the use of guaiac were the Fuggers.) The other problem was that the regimen under which this new drug was administered was almost as harsh as the awful mercury cure. Patients were once again installed in small heated rooms; they were placed on a rigid diet, or even kept from eating anything at all. Purged with powerful laxatives, they drank large doses of the decoction and sweated profusely for thirty or forty days in a row. Von Hutten cautioned that wine and women were to be strictly avoided during this time, lest such moral impurities anger the generous God who had provided this cure. The punitive nature of the remedy was shown even more strongly by a strange book written in 1527 by Dr. Jacques de Béthencourt, The New Lent of Penance. This treatise featured an argument between guaiac and mercury over which one of them cured syphilis more effectively—and which had the dubious merit of making patients suffer more in the process. Syphilitic bodies had to be purified of the disease, but they also needed to be taught a lesson; the harsher that lesson, medics obviously believed, the better.

Copyright notice: Excerpted from pages 143-6 of The Wages of Sin: Sex and Disease, Past and Present by Peter Lewis Allen, published by the University of Chicago Press. ©2000 by the University of Chicago. All rights reserved. This text may be used and shared in accordance with the fair-use provisions of U.S. copyright law, and it may be archived and redistributed in electronic form, provided that this entire notice, including copyright information, is carried and provided that the University of Chicago Press is notified and no fee is charged for access. Archiving, redistribution, or republication of this text on other terms, in any medium, requires the consent of the University of Chicago Press.

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Peter Lewis Allen
The Wages of Sin: Sex and Disease, Past and Present
©2000, 228 pages, 14 halftones
Cloth $25.00 ISBN: 0-226-01460-6
Paper $17.00 ISBN: 0-226-01461-4

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