The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter
of Naples’, but rapidly became the ‘French Pox’ and other terms accusing this or that nation: the Spanish disease in Holland, the Polish disease in Russia, the Russian disease in Siberia, the Christian disease in Turkey and the Portuguese disease in India and Japan. For their part, the Portuguese called it the Castilian disease, and a couple of centuries later Captain Cook (1728–79), exploring the Pacific, rued that the Tahitians ‘call the venereal disease Apa no Britannia – the British disease’ (he thought they’d caught it from the French).
That some of the Spaniards at the siege of Naples had accompanied Columbus suggested an American origin for the pox (or ‘great pox’, to distinguish it from smallpox). It certainly behaved in Europe like a new disease, spreading like wildfire for a couple of decades. ‘In recent times’, reflected one sufferer, Joseph Gruenpeck (c. 1473–c. 1532):
I have seen scourges, horrible sicknesses and many infirmities affect mankind from all corners of the earth. Amongst them has crept in, from the western shores of Gaul, a disease which is so cruel, so distressing, so appalling that until now nothing so horrifying, nothing more terrible or disgusting, has ever been known on this earth.
Syphilis, we now know, is one of several diseases caused by members of the Treponema group of spirochetes, a corkscrew-shaped bacterium.* There are four clinically distinct human treponematoses (the others are pinta, yaws and bejel) and their causative organisms are virtually identical, suggesting all are descendants of an ancestral spirochete which adapted to different climates and human behaviours.
What caused this terrible outbreak? Many epidemiological possibilities have been mooted. It is feasible that some American treponemal infection merged with a similar European one to become syphilis, with both initial infections subsequently disappearing. Others maintain that venereal infections had long been present in Europe but never properly distinguished from leprosy; treponemal infections (pinta, yaws, endemic and venereal syphilis) had, it is suggested, initially presented as mild childhood illnesses, spread by casual contact and producing a measure of immunity. With improved European living standards, treponemes dependent on skin contact had become disadvantaged, being replaced by hardier, sexually transmitted strains. Thus an initially mild disorder grew more serious. A related theory holds that the spirochete had long been present in both the Old World and the New; what would explain the sixteenth-century explosion were the social disruptions of the time, especially warfare.
Like the pox itself, the debate raged – and remains unresolved to this day. But whatever the precise epidemiology, syphilis, like typhus, should be regarded as typical of the new plagues of an age of conquest and turbulence, one spread by international warfare, rising population density, changed lifestyles and sexual behaviour, the migrations of soldiers and traders, and the ebb and flow of refugees and peasants. While Europeans were establishing their empires and exporting death to aboriginal peoples, they were caught in microbial civil wars at home. Bubonic plague bounced from the Balkans to Britain, malaria was on the increase, smallpox grew more virulent, while typhus and the ‘bloody flux’ (dysentery) became camp-followers of every army. Influenza epidemics raged, especially lethal being the ‘English sweat’ (sudor Anglicus) which struck in 1485 (delaying Henry VII’s coronation), 1507, 1528, 1551 and 1578, and was described by Polydore Vergil, an Italian diplomat in London, as ‘a pestilence horrible indeed, and before which no age could endure’. John Caius’s (1510–73) A Boke of Conseill against the Disease Commonly Called the Sweat or Sweating Sickness (1552) noted the copious sweating, shivering, fever, nausea, headache, cramps, back pain, delirium and stupor. It came to crisis within twenty-four hours, with very high mortality. It was thought even worse than the plague, for plague:
commonly giveth three or four, often seven, sometimes nine … sometimes eleven, and sometimes fourteen days’ respect to whom it vexeth. But that [the sweating sickness] immediately killed some in opening their windows, some in playing with children in their street doors, some in one hour, many in two it destroyed, and at the longest, to they that merrily dined, it gave a sorrowful supper.
The ‘English sweat’ remains a riddle. Such calamities form a doleful backdrop to the Renaissance.
THE MEDICAL RENAISSANCE
From the fourteenth century Europe’s cultural and intellectual life was undergoing a mighty rebirth. First in the bustling commercial cities of Italy and later in transalpine courts, the arts and humanities were being restored to a brilliance unknown for centuries. Glory would be achieved, enthusiasts proclaimed, by burying the immediate past and emulating the ancients. New inventions were changing material culture: gunpowder, the compass and Gutenberg’s printing press. Books multiplied, and were cheered on by propagandists and educators.
Among these was the monk who quit his monastery, Desiderius Erasmus (1466–1536), who led European scholarship and culture for more than three decades. A supreme stylist, it was he who established Greek as the basis for literary and theological studies, not least through production of a restored Greek text for the New Testament. His example prompted others to produce the first Greek editions of the ancient medical authors, and he inspired young scholars and physicians to bring out the great Aldine edition of Galen (1525). He also took a keen personal interest in medicine, both as patient (he suffered from gout, kidney stone and hypochondria) and as author. His Latin versions of three of Galen’s works, The Protrepticus, The Best Method of Teaching, and The Best Doctor is also a Philosopher, were the first to be based on the Greek of the Aldine edition, and enjoyed huge success. Yet, if Erasmus promoted medical learning, he was dubious about doctors, echoing that earlier humanist, Petrarch (1304–74), who had written, ‘I have never believed in doctors nor ever will.’
Painters, philosophers and poets commended the beauty of the human form and the nobility of the human spirit, using the emblem of Vitruvian man, in which the idealized naked male human form was superimposed upon the cosmos at large. Above all perhaps, after centuries when the Church had taught mankind to renounce worldly goods for the sake of eternity, Renaissance man showed an insatiable curiosity for the materiality of the here and now, a Faustian itch to explore, know and possess every nook and cranny of creation. No wonder they became inquisitive about human bodies, which were judged to occupy a privileged status. According to the Venetian surgeon Alessandro Benedetti (c. 1450–1512),
The human body was created for the sake of the soul and stands erect among other animals, as established by divine nature and reason so that it might look upward more comfortably.… The heart was first created since it contains the principle of life and sense. Next came the brain and liver. Then nature, performing like a painter, sketched out the other members with a life-giving fluid; they gradually receive their colours from the blood, which is very abundant in man and stirs up very much heat.
Art and nature thus both drew attention to the body, and in an intellectual climate that revered the classics, no wonder there was a revival of ancient medicine. For centuries, of course, Galen had been god: the Arabs had synthesized his works and the medieval West had translated these into Latin. So why was there a need for a Galen revival?
Admiration for all things Greek was in the air. Spurred by the fall of Constantinople in 1453, Greeks like Theodore Gaza (fl. 1430–80) and his student Demetrius Chalcondylas (d. 1511) went to Italy, taking manuscripts with them and passing their knowledge to Italian humanists eager to believe that truth was at its purest in Greek sources: Plato, Aristotle, the poets and orators. These ideas were obviously applicable to medicine too, for were not its first oracles Greek?
‘Back to the sources’ (ad fontes) acquired a further incentive. From 1517 Luther and his fellow Protestants were reforming the Church by returning to the Bible as the well-spring of true religion. Every doctrinal formulation of the Catholic Church was to be rejected unless sanctioned by the Bible, and the study of Greek manuscripts, it was argued, would purify the understanding of scripture. A return to the sources promised the key to progress, and philology (the study of language) was vital to rescue truth before it was engulfed in oblivion and error. This awakening prompted a medical parallel.
The first priority for medical