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The Wages of Sin

University of Chicago Press

Chapter One

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 ulcersthat 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 Hotel-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 Hotel-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, Bicetre
and the Salpetriere, 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.

The Source of This Distemper

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.

* * *

Worse than the Disease

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.

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.

These Bitter Pains and Evils

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.

Continues...

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Excerpted from The Wages of Sin
by Peter Lewis Allen
Copyright © 2003
by University of Chicago.
Excerpted by permission.
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