The French pox.

Aetiology and epidemiology Syphilis (also known as ‘The French Pox’) landed on England’s shores in about 1493. The term ‘French Pox’ was derived from the belief that the disease originally travelled from the New World and through France before arriving in England’s green and pleasant land. Controversially, it was believed to be Christopher Columbus’ own ship that brought such misery but this was not suggested until several decades after the event. Smallpox and plague exacted a much higher toll on human life and a lot more quickly than syphilis, yet it still became one of the most prolific and feared fatal diseases for over 450 years. The causative agent for syphilis is a spirochaete bacterium, Treponema pallidum, which is carried through the mucous membranes of the mouth, anus or genitals. The early Tudors had no understanding of bacteria or viruses. They believed, as did the ancient Greeks, in humoral medicine, whereby illness was lodged with the individual who was out of ‘balance’ in some way. It was also thought possible to become ill from bad smells or poisons lodged in foods. The Tudors did understand, however, that plagues came in waves. The Black Death killed 30–50% of the population. These were the massive medical dramas; lower-ranking illnesses tended not to be well recorded. It is therefore interesting for modern-day scholars to find actual reference to both the first known cases of a disease and also some logging from notes, fairly early on, of the development and spread of the epidemic. As early as 1505, clusters of cases began to be recorded. Twelve years after the first notes of the disease may not be considered especially rapid by modern standards but by Tudor standards this was fast. Numerous doctors were discussing cases of syphilis in the last decade of the 15th century, especially in the Italian city-states. Somewhere, out there in the medical community, were individuals who registered the movement of the disease and the nature of the symptoms. The natural scientists of common sense were reacting and asking the right questions such as ‘How?’ and ‘Why?’. The reader must appreciate that in Tudor England there were no esteemed professional publications, such as this one, in which information might be shared and disseminated. Medical schools (as we know them) did not exist. A doctor or surgeon learned their profession as an apprentice to a licensed medical practitioner or, for a rich individual, there was university first to study medicine followed by an apprenticeship. The university did provide a forum for philosophy, including debate. Unfortunately, most of the content of the studies was based on the beliefs of medical philosophers who lived centuries before the birth of Christ. It is important to distinguish between physicians and surgeons. Physicians would have been what we would generally regard as general practitioners, and would have been university trained. Surgeons, who were of a lower social status, would have been ‘knife men’; it was the barber surgeons who would be more likely to have done an apprenticeship. By the mid 1500s, rich and poor alike were being infected by the Pox and a wide range of names for the disease appears in the literature and doctors’ notes of the period: Hot Piss, The Clap, Winchester Goose (the Bishops of Winchester held the taxation on whore houses), the French Disease, the French Embrace, the Infinite Malady and Syphilis. Syphilis is an interesting disease to track since it seems to have gone through some changes or mutation in terms of how symptoms were presented. Indeed, the great challenge is to ascertain whether this is the disease the contemporary doctors’ notes say it is! A further complicating factor is that syphilis modified its behaviour faster than any other disease ever known. There does not seem to be (as we know it) at the beginning of the disease a small hard chancre; instead the body was rapidly covered in pus-filled lesions that seem to correspond to the secondary stage, usually appearing several weeks after the first stage comprising just a small ulcer. The secondary stage was highly infectious. There was confusion, understandably, that this might be a form of leprosy or scabies. This presentation seems to have lasted from a matter of months to just over a year before subsiding, whereupon a cure seemed apparent. In fact, the disease was usually lying dormant and would reappear some years later as tertiary syphilis. Naturally, medical practitioners thought reoccurrences represented reinfection. All this discussion would have been of little concern to the Tudor physician. He would be convinced that sexual contact and the stars had resulted in the body’s humors being thrown out of balance in a hot, dry state (Table 1). The pus-filled blisters were seen as vents for the yellow bile humor. Like bubbling porridge, the heat was so great the skin was boiling. The hot urine further convinced medical practitioners of the extreme heat and fire elements of the Pox. God, in this governance of the stars, would also play His part in this illness as divine retribution for the “licentious and beastly disorder” of the morally degenerate. For it was very early on in the passage of the disease that poxing of the genitals could be seen and it was but a short journey to lay the blame firmly at the whorehouse doors. The Tudors regarded God as a Michelangelo figure who could stretch out His arm and move the planets about like billiard balls, with the resultant effect on air, tides and the humors of man. The astrological sign of Ares (the Greek god of war), which is hot and dry, would be seen as controlling some of the heavens when syphilis was rampant. The French Pox