1.1 Introduction

This passage from the History of Bologna by the haberdasher Friano degli Ubaldini is one of the more detailed descriptions of the Mal Francese written by a non-medical author. He wrote this passage some six years after the appearance of the disease, with more perspective on its impact than shorter chronicler accounts from the beginning of the epidemic.

Ubaldini outlines the themes mentioned by many of his contemporaries when recording the advent of the French Disease. It began in 1494, coinciding with the arrival of the French troops in Italy, hence the name French Disease. Ubaldini also emphasised that it was an unknown, strange and horrible sickness, which was characterised by boils and pains, and that it lasted a long time, leading to the afflicted becoming crippled with very few recovering. He recorded that citizens of Bologna had clubbed together and raised enough money to convert the existing hospital of S. Lorenzo de’ Guarini into a centre for treating this sickness and other incurable diseases.

A wide range of Italian chroniclers recorded the arrival and the initial impact of the French Disease (cf. AHF, ch. 2; Foa, Reference Foa1990; Tognotti, Reference Tognotti2006, ch. 1). Many were compiled and published in 1884 by Alfonso Corradi, a tireless physician turned medical historian (AHF, ch. 1; Zanobio and Armocida, Reference Zanobio, Armocida and Italiana1983). Almost all his sources were from the area between Milan and Venice in the north and Florence and Rome in the centre. Most of these chroniclers came from major cities, as did most of the archivists and librarians that Corradi had approached for information. The geographical distribution also reflects the concentration of large and medium sized cities in the Italian north and centre, to which Corradi added Naples and Palermo. In these urban conurbations, universities had been founded and doctors published treatises on the Pox, while in two cities, Bologna and Ferrara, public debates took place in the 1490s, specifically about whether the French Disease was a new disease or had been described by classical medical writers such as Galen and Hippocrates.

The chroniclers came were from a wide variety of professional backgrounds that often resist precise categorisation, ranging from papal secretary to tanner, and including priests, historians and politicians. For example, Bartolomeo Senarega, an official chronicler, who wrote the Commentaries on the Events of the City of Genoa from 1488 to 1514, worked as a notary, ambassador and civic administrator. By definition, chroniclers, both ecclesiastical and lay, were literate, whose livelihoods depended on expressing themselves orally and in writing. Three worked at the papal court, where cases had been identified. Two chroniclers were associated closely with Pope Julius II: the humanist and historian Raffaello Maffei da Volterra, who mentioned the Mal Francese under 1496 in his Commentarium Urbanorum (1506), and the papal secretary Sigismondo dei Conti da Foligno. Sigismondo’s chronicle was almost co-terminus with the years of Julius’s papacy, 1503–12, and the French Disease is mentioned in 1503. Later in the century, the protonotary and papal secretary, Cirillo Bernardino Aquilano (1500–75), described the advent and impact of Mal Francese in his Annali of Aquilea, which he finished in 1540, thus providing a longer perspective on the unfolding of the disease. This brief survey shows how the growing familiarity of urban literate classes with the Great Pox was reflected in the greater detail of chroniclers’ descriptions of its nature, symptoms and mode of transmission.

The majority of these chroniclers were from cities where specialised hospitals for incurables, the Incurabili, had been established. The problem had been spelled out in Leo X’s Bull Salvatoris Nostri Domini Jesu Christi in 1515 (AHF, 155):

The Bull underlines, as had Friano degli Ubaldini, that patients with incurable diseases such as lepra and plague were excluded from general medical hospitals. The Bull also expressed a wider concern, the threat posed by the sick through their smell and bad breath, which were seen as corrupting the air and potentially infecting those with whom they came into contact, a theme underlined by medical and lay commentators.

If Leo X was largely responsible for repurposing the hospital of San Giacomo in Rome, the majority of the Italian Incurabili had been founded through the influence of the Companies of Divine Love, whose members included some of the leading lights of the Catholic reform movement from Caterina Fieschi and Ettore Vernazza in Genoa to Filippo Neri and Gaetano Thiene in Rome. Their proselytising activities in promoting lay religious devotion and active charity inspired local secular and ecclesiastical authorities to help finance some of the largest of this type of hospital in early modern Europe. By 1530 some ten new Incurabili had been founded in Italy as well as specialised wards in existing hospitals, a pattern repeated, though often on a smaller scale in countries such as Germany, France and England (AHF, ch. 7; Quétel, Reference Quétel1990, 64–5; Siena, Reference Siena and Siena2005; Stein, Reference Stein2009, 1; Falcucci, Reference Falcucci2020). It was no accident these chroniclers mentioned the Incurabili, as they reflected policies towards those sick from the French Disease and boosted the charitable reputation of their cities.

1.2 Names and Origins

Most chroniclers, like Friano degli Ubaldini’s account of the beginning of the epidemic, used a version of the phrase ‘the French Disease’. In Florence the apothecary Luca Landucci called it ‘French boils’, and the patrician Piero di Marco Parenti referred to it as ‘French scab’. Most writers attributed its rapid spread to Charles VIII’s troops travelling throughout Italy, and the local women with whom they had sex, both willingly and unwillingly. Understandably, the French shifted the blame elsewhere, using ‘Mal de Naples’, claiming their troops contracted the disease in that city. Chroniclers across Europe blamed Mal Francese on mercenaries returning home from the Italian campaign, as mentioned, for example, by the Burgundian chronicler Jean Molinet and the Strasbourg chronicler (Quétel, Reference Quétel1990, 11–13; Stein, Reference Stein2009, 1–2; Cohn, Reference Cohn2018, ch. 5).

Italian writers also knew of its Neapolitan origins, as recorded by Landucci: ‘And on 11 January 1496/7, Monsignore Begni [d’Aubigny] came from Naples, with perhaps fifty horses, and he was sick. He had the French boils. He arrived in a basket. He was lodged in the house of Jacopo de’ Pazzi, where he was accorded great honour’ (Landucci, Reference Landucci1985 ed., 143). D’Aubigny, Lord Bernard Stuart, was a commander of the French army in Charles VIIII’s invasion and led the French retreat. He contracted the French Disease in Naples, and had to be carried in a basket, rather than sitting astride one of his fifty horses. Significantly, in contrast to plague, which was also current in Florence in this decade, D’Aubigny’s Pox was not regarded as a being threat to the health of others. As a French general, he was received by the Florentines with honours and stayed with the Pazzi, one of the leading patrician families in the city. He was next recorded in Ferrara, where he stayed with Duke Ercole d’Este. Ferrara’s anonymous chronicler was particularly struck by D’Aubigny’s condition; he described him as ‘being ill from a certain disease called the French Disease, which causes very severe pains and hard buboes all over the body’ (AHF, 44–5).

The name Mal Francese or Morbus Gallicus became the most common label not just in Italy but also in many countries in western Europe, including England and Germany (Foa, Reference Foa1990; Quétel, Reference Quétel1990, 16; Cohn, Reference Cohn2018, ch. 8). Most of the first generation of Italian chroniclers were content to refer to the French as the originators of the disease, backed up by Spanish doctors working at the papal court, such as Gaspar Torrella (Arrizabalaga, Reference Arrizabalaga and Siena2005). Then gradually the perceived geographical origins widened; the Sicilian chronicler recorded that in 1498 the Spanish had brought it to the Kingdom of Naples from Spain, where it had in turn arrived from the New World following Columbus’s return from the ‘Indies’ (Corradi, Reference Corradi1884, 347; Cohn, Reference Cohn2018, ch. 5; Falcucci, Reference Falcucci2020).

The New World origins of the French Disease became more widely accepted by the second generation of Italian chroniclers. Both the protonotary and papal secretary, Cirillo Bernardino Aquilano writing in about 1540, and the historian Francesco Guicciardini writing in the late 1530s, repeated the story. The latter wrote that

(Guicciardini, Reference Guicciardini and Menchi1971 ed., 234). Other chronicles in Italy and elsewhere linked the Pox to specific social groups, such as Jews, Moriscoes, the poor and prostitutes, although it seems that Pox, in contrast to plague, did not lead to their persecution (Cohn, Reference Cohn2018, 97–106; cf. Foa, Reference Foa1990; Quétel, Reference Quétel1990, 16). Sigismondo dei Conti recounted that the Pox arrived from Spain when the Jews were expelled, providing a Biblical parallel for the spread of ‘lepra’ after the Jews were driven out of Egypt (Corradi, Reference Corradi1884, 365–6). Later in the sixteenth century, the surgeon and empiric Leonardo Fioravanti, ever keen to reject medical orthodoxy, dismissed the New World origins of the disease and its novelty by championing the idea of cannibalism, suggesting the Pox derived from soldiers during the Italian wars, who had been driven by starvation to eat the bodies of the dead, a theme taken up in sixteenth-century France (Eamon Reference Eamon1998, 10–12; Losse, Reference Losse2015, ch. 3).

The attribution of labels to diseases has always been an important way of attempting to understand and control them. The Papal secretary Raffaello Maffei da Volterra reported in 1496 that it was said that the disease was either ‘elephantiasis’ or ‘satyriasis’ (Corradi, Reference Corradi1884, 359). Contemporaries also drew an association between the French Disease and ‘lepra’, one of the most common epidemic diseases in the Middle Ages, and images discussed in following sections reflect this conflation or overlap between the two diseases in the 1490s. The chronicler of Cremona even recorded that everybody who saw a person with the Great Pox thought they were lepers (Corradi, Reference Corradi1884, 361). Lepra also affected the skin through the eruption of ulcerated spots and lesions, and lepers had long been highly visible in medieval cities, where they were housed and treated in leprosaria. In 1496, Fileno delle Tuatte had labelled the new disease the ‘lepra of Saint Job’, reflecting Job’s position as its patron saint, while others in Ferrara and Venice (Marin Sanudo) called it the ‘sickness of San Job’ (Corradi, Reference Corradi1884, 346). This period coincided with the continued decline of this disease, leaving the field open to the growing association of Job with the French Disease, a topic examined in Section 5 (AHF, 52–54).

1.3 Symptoms

Chroniclers across Italy and Europe presented similar descriptions of the horrifying symptoms of the French Disease. Many of the earliest chroniclers discussed the appearance of the Great Pox in more generalised terms, as when the apothecary Luca Landucci first mentioned it in his diary on 28 May 1496: ‘there began a certain sickness that was called the French boils like a large pock’; and by 5 December he recorded its spread: ‘And in this time, Florence and its countryside were full of French boils, as was every city in Italy, and they lasted for a long while’ (Landucci, Reference Landucci1985 ed., 132, 141). Landucci mentioned one of the main external symptoms, the boils (bolle), which he likened to a ‘Great Pox’ (‘vagiuolo grosso’), though he did not suggest it led to death, in contrast to when another disease broke out the following May: ‘in this time people died of fever in this area and in the hospitals; this fever made people rant and almost lose their minds and [led to] … their death within two or three days’ (Landucci, Reference Landucci1985 ed., 150). He recorded disease incidents throughout his diary to 1516, whereas only four entries mentioned the French Disease between May 1496 and January 1497. This reflects the nature of the Pox, which became a serious chronic ailment rather than a dramatic episode of acute epidemic disease, which killed rapidly. Landucci was typical of many chroniclers who recorded Mal Francese at the time it appeared. It was worthy of note when it was new, but less as it became an established part of everyday life, except when a famous person was afflicted severely or a city celebrated the foundation of an Incurabili hospital for the treatment of Mal Franciosati.

The first generation of chroniclers shared a broadly similar vocabulary when describing the symptoms, with ‘boils’ as the most common term used, and other local variations, including ‘brozzole’ and ‘rogna grossa’. Many mentioned severe pains and swollen joints. As Fileno dalle Tuatte wrote, patients ‘could not move from bed’ (Corradi, Reference Corradi1884, 346), while Sigismondo dei Conti da Foligno wrote, probably based on his own observation at the papal court, that this led them ‘to scream out day and night without ceasing’ (Corradi, Reference Corradi1884, 363). The Perugian chronicler Francesco Maturanzio recorded that some suffered so much that in desperation they threw themselves into the river (Matarazzo, Reference Bonaini and Polidori1851 ed., 33).

An unusually detailed description of the symptoms of Mal Francese appears in the diary of the Venetian patrician Marin Sanudo (Sanudo, Reference Stefani1879 ed., I, 137):

Sanudo mentions the most obvious signs of the disease, the pustules and blisters all over the body, but he also emphasises their particular visibility on the face ‘up to the eyes’, and the pains in limbs, leading to patients wishing to die rather than to suffer any more. He links the disease to ‘the modest parts’, asserting that it was spread through coitus, and that it could be contracted by infants. Some idea of the impact of the disease on the body and face can be appreciated from the seventh Perugian watercolour (Figure 2), which shows a nude man half-turned away from the viewer. He is covered in red sores, as well as some more serious black lesions. He holds out his arms crossed in front of him with his hands extended as though in agony, illustrating Sanudo’s comment ‘such patients cry out for death’.

Figure 2 Pox patient with red sores and black lesions (late sixteenth century):

(BCAP, MS G61, c. 21r)

1.4 Transmission

The question of how the French Disease was transmitted was clearly of vital importance to medical practitioners in advising people how to avoid contracting this ‘horrible disease’. Section 2 will examine in more detail medical theories of transmission, but chroniclers in the early stages of the epidemic recorded a variety of explanations. Friano mentioned the risks of ‘eating and drinking and carnal relations’, while Elia Cavriolo recounts that the Pox could be caught through close proximity or even by sleeping in the same bed (Corradi, Reference Corradi1884, 345; Cavriolo, Reference Cavriolo1585, 214). In Florence, in 1504, deliberations of the cathedral board of works revealed the canons’ fear of contracting the French Disease from the public. They asked for a new wooden cupboard to be constructed so that they could keep separate ‘the chasuble, chalices and liturgical vestments’ used during communion (Puccinotti, Reference Puccinotti1850–66, ii/2, 505).

It is no surprise that there should have been a wide variety of explanations of how Mal Francese was spread in its early stages, given the continued debates about how even plague was transmitted 150 years after the Black Death. But a certain delicacy was also required, for ecclesiastical figures were listed among those who had caught the disease, as noted by the lawyer Francesco Muralti in his chronicle of Como: ‘popes, kings, princes, marchionesses, dukes, soldiers, nearly all the nobility, merchants, and all who are lustful, and secular and regular clergy’ (Corradi, Reference Corradi1884, 362). Even so, many chroniclers from across Italy agreed that sexual transmission was one of its main causes, whether they were from Venice, Ferrara, Bologna, Siena and Rome. For example, the Bolognese chronicler, the Anonymous Bianchina, wrote in 1496 that ‘this disease affected both women and men, and the majority caught it through coitus’ (Corradi, Reference Corradi1884, 344). The Genoese chronicler, Agostino Giustiniano, the Dominican Bishop of Nebio, recorded that the Mal Francese ‘began in the genital members for both men and women’ (Corradi, Reference Corradi1884, 343).

Increased observation and experience of the Great Pox led chroniclers to understand better its nature and methods of transmission. Greater onus was now placed on women as the transmitters. Fileno delle Tuatte of Bologna declared that ‘women have it in their nature’, as did Portoveneri of Pisa: ‘it’s caught by frequenting women who have these diseases’ (Corradi, Reference Corradi1884, 346; Portoveneri, Reference Bonaini1845 ed., 338: 1502). Similarly, Francesco Murlati wrote: ‘The beginning of this disease was detected from the woman’s vulva, for a man who had intercourse with a woman suffering from that disease first felt an itch on the rod’ (Corradi, Reference Corradi1884, 361). Delle Tuatte emphasised that prostitutes and courtesans were most likely to pass on the sickness, which he remarked led to their ejection from Bologna and Ferrara (Corradi, Reference Corradi1884, 346). In other places such as in London in 1506, brothels were closed briefly. It is difficult to say whether these measures were more generally linked to the threat of the Pox or whether they were part of broader policies against beggars and the poor at times of crisis (Pelling, Reference Pelling, Beier and Finlay1986, 87; Quétel, Reference Quétel1990, 66–7; Schleiner, Reference Schleiner1993; Fabricius, Reference Fabricius1994, 61–2; Siena, Reference Siena1998, 559). In any event, they were only temporary expedients, since it was seen as better to control prostitutes than to leave them unregulated, and some cities regarded prostitutes as preferable to sodomy (Hewlett, Reference Hewlett and Siena2005, 256; Cohn, Reference Cohn2018, 120–1).

The theme of sexual transmission remained common to the second and third generations of Italian chroniclers. Cirillo Bernardino (1500–75), protonotary and papal secretary, who finished writing his Annali of Aquila in 1540, declared that the French ‘infected the women of the region with the contagion, and these infected women infected those with whom they came into contact’ (Corradi, Reference Corradi1884, 365). Writing in the late 1530s, Guicciardini agreed, but also described changes in the nature of the disease; initially it ‘killed many people of both sexes and of all ages, and many became very deformed, rendering them useless and subject to continuous torments. The majority of those who got better, returned after a short time to the same miserable state’. He also recorded that the disease was not static (Guicciardini, Reference Guicciardini and Menchi1971 ed., 233):

In acknowledging the expertise of astrologers and medical practitioners, Guicciardini recognises that diseases, like humans, have life cycles, which cause them to grow stronger and to weaken. He then dismisses those who claimed that they had contracted it as one might catch influenza through the air: ‘This calamity is certainly one which men of our time might justly complain about, if they caught it through no fault of their own: but all those who have diligently observed the nature of this illness agree that never, or very rarely, can anyone catch it except by contagion during coitus’ (Guicciardini, Reference Guicciardini and Menchi1971 ed., 234).

1.5 Conclusion

It has been argued that Italian chroniclers reflected more generally how contemporaries understood and reacted to what they saw as a ‘new disease which arrived in Italy in these times’ from the New World (Piero di Marco Parenti in: Corradi, Reference Corradi1884, 342). Initially across Europe a range of explanations was provided about its origins from the Moriscoes to prostitutes to more general factors, such as God’s punishment for individual and society’s sins, and astrological influence. However, in Italy chroniclers, unlike early medical writers, rarely cited planetary conjunction as a contributory cause for the epidemic of Mal Francese. This was in contrast to initial explanations for the Black Death, which was seen as God’s punishment for the sins of mankind. But the two epidemics had significant differences. Plague killed indiscriminately large numbers of people within a few days, and the poor were blamed for fomenting and spreading the disease. For the Great Pox, which typically led to years of very painful sickness, commentators came to make connections between contracting the disease and physical contact and the blaming of women in particular as the main vehicles of contagion (Henderson, Reference Henderson, Clark and Rawcliffe2013). While Section 4 examines how this theme was developed in popular literature by linking disease, prostitution and immorality, the next section shows how a more morally neutral stance was adopted in the writings of many medical practitioners.

2.1 Introduction

The eighteenth watercolour of the Perugian album (Figure 3) shows a young man sitting patiently on a stool, while a surgeon opens and cleanses an ulcer on his right arm; the tourniquet suggests that he may also have been bled. Despite his rather blank expression, the patient is clearly in a distressed state with red spots visible on his chest and on his legs and feet, while his left arm is in a sling; his legs are bandaged, probably covering ulcers treated with a mercury ointment. His head is covered loosely with another bandage, which may indicate he is suffering from further lesions or already losing hair, another symptom of the Great Pox.

Figure 3 Surgeon treating a Pox patient (late sixteenth century),

(BCAP, MS G61, c. 50r)

Surgeons were central to treating the Pox, since many symptoms were external, though physicians were heavily invested in establishing its exact nature and recommending treatments. Chroniclers noted that the disease was unknown to doctors, and the emergence of a disease not described in the medical canon could potentially cast doubt on the whole edifice on which Renaissance medicine was based. This led to public debates in the 1490s concerning the nature of the French Disease, at the Ferrarese court, the University of Bologna, and later the University of Leipzig. Initially there were attempts to claim that it corresponded to diseases described by classical physicians, Galen (elephantiasis) and Hippocrates (‘diseases of the summer’), but ultimately its novelty was recognised. Physicians then took ownership of it by Latinising the popular term to Morbus Gallicus, a first step in inspiring confidence in their ability to provide efficacious treatment (AHF, ch. 4, cf. Carmichael, Reference Carmichael, Marques and Cule1990; Ciccarella, Reference Ciccarella2018–19, 1.3).

This section will begin by examining contemporary medical understanding of the Great Pox by comparing a selection of treatises by physicians and surgeons across the sixteenth century. The first is Antonio Benivieni, the Florentine physician to the Medici family, whose casebook De Abditis Nollibus was published posthumously in 1507. He reveals how a practising physician understood the nature of the disease within less than a decade of its first outbreak. The second and third physicians, Niccolò Massa (1485–1569) and Girolamo Fracastoro (c. 1478–1553), were from the following generation when the disease had begun to evolve. A briefer consideration will be given to the treatises of two surgeons, Giovanni Andrea della Croce (1583) and Leonardo Fioravanti (Reference Fioravanti1561).

The writings of these five practitioners reflect how ideas of physicians and surgeons about the nature of the disease evolved over the sixteenth century. This will provide the background for discussion of the treatment of a range of practitioners both in private practice and within specialised Incurabili hospitals. But first, in order to understand the medical concepts of these authors, it is necessary to provide a brief outline of contemporary Galenic theory. Galenism, named after Galen of Pergamon in Asia, who flourished in the second century CE under the Roman Empire, informed university medical education and thus the practice of physicians and surgeons, and the basic ideas were shared by practitioners of empirical and domestic medicine. Galenic theory held that the human body was made up of four humours: blood, phlegm, choler, equivalent to red or yellow bile, and melancholy (black bile), and each was viewed as equivalent to four actual bodily fluids. Having said this, almost all internal illnesses were regarded as due to the complexional imbalance of an individual’s humours according to their four main qualities: hot, cold, dry or moist. Furthermore, much of the explanation for the causes of the Great Pox was due to the influence of corrupt and potentially contagious matter, which derived from outside the body and led to the corruption of humours and putrefaction (Siraisi, Reference Siraisi1990, 104–6; Wear, Reference Wear2000). Initially, while some of the early medical writers in the 1490s, such as the Spanish doctors Per Pintor and Gaspar Torrella, who worked at the papal court in Rome, also alluded to divine and astrological primary causes of the epidemic, in time these ideas became less central (AHF, 110–111, 120–121; Cohn, Reference Cohn2018, ch. 5).

Treatment began with diagnosis; physicians examined excreta (and urine in particular), and took the pulse (Nutton, Reference Nutton2004, ch. 16). The aim was to re-establish the proper balance of health through the administration of simple and compound medicine, linked to an individual’s complexional make-up. Doctors recommended internal interventions from purging and balancing humours through the administration of pills and electuaries to rid the body of the putrefaction associated with the disease. Surgeons undertook external treatment, including letting blood to purge the body of corruption, applying ointments and cauterisation to treat swellings, sores and lesions, and ultimately surgery for the removal of damaged or diseased limbs.

2.2 Physicians and Mal Francese

Benivieni began by describing the pustules, ulcers and pains in the joints mentioned by chroniclers, but was more specific in distinguishing different types and their effects (Benivieni, Reference Benivieni1954 ed., 13). The first pustules he observed began near or on the genitals; as they spread they corroded the flesh and gave off a fetid and foul discharge, as did both pimples and larger pustules. When the scales associated with pustules fell off, they led to scarring and bleeding. This is reflected in the second Perugian watercolour (Figure 4), showing a fashionably dressed young man in doublet, ruff and hose with a hat decorated with two large feathers. He is obviously in some pain since in addition to a red rash on his neck and upper nose, his hands around his genitals hold his penis, with red streaks suggesting a stream of blood.

Figure 4 Young man with diseased genitals (late sixteenth century),

(BCAP, MS G61, c. 12r)

Benivieni then went on to describe the symptoms and the causes of the disease (Benivieni, Reference Benivieni1954 ed., 13):

Symptoms, ranging from different sizes and types of pustules to scales of skin to a corrosive discharge were interpreted as being caused by the corruption of the humour of black bile. Thus, for Benvieni black bile took on a pathological character and became a physical agent, which corroded the flesh, as did the dried discharges. Having determined the diagnosis, Benivieni emphasised that a trained physician must provide treatment, warning against unskilled practitioners, whose use of certain ointments had led to patients developing into an incurable state and dying prematurely. Instead, Benivieni stresses the need to rid the body of the corrupt humours, especially black bile, either through blood-letting, leeches or cupping glasses, followed by taking medicines to loosen the bowels and hence ‘to draw off the humour you seek to evacuate … since the moisture cannot be drawn off by one evacuation only, it will be necessary to repeat the dose frequently’ (Benivieni, 19).

Massa developed the explanation further in his Book of the French Disease, published in Latin in 1524, twenty-two years after Benivieni’s death (Massa, Reference Massa1566, 14: Italian ed.). Based on a wealth of clinical knowledge of patients with Mal Francese and dissections of their bodies, Massa interpreted the cause of the disease as the liver becoming frigid and dry, reflecting its complexional quality. This led corrupt humours to spread through the body via a patient’s veins, and in turn to pustules breaking out all over the skin. Following Galen and the Arabic physician Avicenna, Massa argued that while it was rare a single humour caused disease, nevertheless one humour was often dominant, as we have seen in the case of black bile, and it caused specific symptoms on the surface of the body (Massa, Reference Massa1566, 14: Italian ed.):

Benefitting from more experience of the disease, Massa is more specific than Benivieni in his differentiation between different types of pustules, likening some to an oyster shell. The third physician, Fracastoro, gradually evolved his ideas about the Great Pox from the 1520s. His first publication on the subject was the Latin poem, Syphilis or the French Disease (1530), followed by a short unpublished treatise of 1533, though his ideas were most developed in a substantial section of his 1546 Latin treatise, On Contagion (De contagione). If it had a much less wide circulation than treatises written in the vernacular, he provides a very useful and detailed guide to contemporary ideas of the nature of the disease (Pellegrini, Reference Pellegrini1939; Peruzzi, Reference Peruzzi and Italiana1997; Henderson, Reference Henderson, Pastore and Peruzzi2006; Ciccarella, Reference Ciccarella2018–19, 1.5).

Fracastoro placed Mal Francese within a wider context than Benivieni or Massa. He saw it as part of a family of contagious diseases, which attacked the exterior rather than the interior parts of the body (Fracastoro, Reference Fracastoro and Wright1930 ed., 149):

In contrast to earlier authors, Fracastoro saw the causative agent as deriving from outside the body, and in particular from putrefaction of the air, mirroring explanations provided in many plague tracts from the time of the Black Death onwards. For Fracastoro, contagion and putrefaction were spread by ‘seeds of disease’, which, through their viscous quality, could attach themselves to clothes and be absorbed through breath and the pores: ‘We must therefore suppose that … there had stolen into the air a certain foul putrefaction which later proved to be analogous with the thick, foul phlegm in our bodies’ (Fracastoro, Reference Fracastoro and Wright1930 ed., 149; Nutton, Reference Nutton1983).

Fracastoro shared the observation of other writers, such as Massa and Guicciardini, that the disease had evolved over time. He distinguished between the first thirty years from its initial appearance in 1494, from the following twenty years. In this initial phase, the major symptoms lay dormant for up to four months, but the individual became melancholic, lacking in energy and had a pallid complexion (Fracastoro, Reference Fracastoro and Wright1930 ed., 139). When the symptoms broke out, there was a preponderance of pustules with fewer of the larger gummata Benivieni had observed. Fracastoro regarded the later phase as characterised by drier pustules, more acute pains, and, from about 1540, loss of hair and teeth (Fracastoro, Reference Fracastoro and Wright1930 ed., 141). In the following decade, Pietro Rostinio, in his Italian treatise (1556) based on Musa Brasavola’s Latin treatise (1553), confirmed that the disease had changed since the 1490s with the emergence of three different types, reflecting its decline (Rostinio, Reference Rostinio1565 ed., 2–4; McGough, Reference McGough2011, 65–6).

Fracastoro also observed that the main method of transmission had changed: ‘since the original disposing cause which had been in the air had now ceased to exist, the disease had no other means of propagating itself than by contagion from one person to another’ (Fracastoro, Reference Fracastoro and Wright1930 ed., 156–7). This occurred ‘only when two bodies in close contact with one another became extremely heated. Now this happened in sexual intercourse especially, and it was by this means that the great majority of persons were infected’ (Fracastoro, Reference Fracastoro and Wright1930 ed., 135). The transition to direct physical contact as the main cause of infection suggested to Fracastoro that the disease would ultimately disappear, for it was now in its old age and, like the humours of the elderly, ‘the substance becomes colder and colder every day’ (Fracastoro, Reference Fracastoro and Wright1930 ed., 157).

This discussion of the nature of the disease has shown that for contemporaries the essence of Mal Francese was phlegm, putrefaction and corruption of the humours, and the main aim of treatment was their elimination through the use of internal and external medicines. Sweating was an important evacuative method, and among the most popular sudorific was China root imported from South America, which had an important drying quality, essential when dealing with phlegm caused by putrefaction (Quétel, Reference Quétel1990, 63; Winterbottom, Reference Winterbottom2015). The use of heat is reflected in Figure 1; a male patient with bare feet is seated on a stool in front of a fire and wears a turban to avoid heat loss and hide loss of hair.

Fear of the dangerous effects of traditional, more drastic treatments involving mercury sublimates, often administered by surgeons and empirics, led Fracastoro and other contemporaries to recommend what was to become a specific against the French Disease, Guaiac wood. First mentioned in 1516, this hard and resinous wood was imported from the West Indies (Hispaniola). Its virtues were described by Fracastoro in his poem Syphilis (1984 ed., 87–9):

Holy Wood was very expensive since it was imported from ‘the Indies’ and could only be afforded by the affluent and be administered by a physician (Shaw and Welch, Reference Shaw and Welch2011, 298–9). Poorer patients could gain access to this miraculous drug through Incurabili hospitals, as they did in other European cities, such as the Pox hospitals of Augsburg and London (AHF, ch. 8; Siena, Reference Siena and Siena2005, 209; Stein, Reference Stein2009, 147–52). When Holy Wood and physicians’ treatment failed, private patients resorted to surgeons and empirics who treated symptoms on the visible body parts, especially the face, torso and limbs, as reflected in the Perugian watercolours.

2.3 Surgeons

Surgeons rarely wrote entire treatises on the French Disease, discussing it within more general works, such as in Giovanni Della Croce’s Cirurgia universale (De Ferrari, Reference De Ferrari and Italiana1988; Latin ed.: 1573; Italian ed.: 1583). The section in Book 5 on Mal Francese consists of a dialogue between a father and son about the nature of the disease and available treatments. The discussion is heavily dependent on the medical classics and echoes Massa’s discussion: ‘The French Disease is a certain type of poison, which does not travel immediately to the heart, but because of its properties goes to the liver, and corrupts it together with the blood, from whence various affections arise’ (Della Croce, Reference Croce and Andrea1583, c. 33 r).Footnote ⁵ Della Croce mentions symptoms familiar from other contemporary descriptions, such as genital buboes, and burning sensation during urinating, as well as common treatments to remove the cause of the disease through evacuation and purging by administering Holy Wood, sarsaparilla and China root. He does not rule out the application of mercury sublimates by a surgeon, who is an expert in using potentially dangerous treatments for; he argues that sometimes it is better to use a violent remedy than let a patient die (Della Croce, Reference Croce and Andrea1583, c. 53 r).

Many of these treatments, even when recommended by physicians, were the province of a surgeon. Della Croce has separate chapters on how to deal with the different types and sizes of pustules. In Chapter VII, he recommended unguents to wash and treat ulcers or brosole on the genital area (Della Croce, Reference Croce and Andrea1583, c. 44 r). He also discusses the opening and draining of the larger swellings, known as ‘buboes, tumours and gummata’, which appear after the genital ulcers as the disease develops. These symptoms reflect the changes in the nature of disease with larger gummata and buboes in the groins, also one of the classic features of plague, from which he died in 1575.

Symptoms of genital disease are clearly represented in two of the initial watercolours in the Perugian album (Figures 5–6). The first shows a well-dressed young man about town, with ruff, doublet, trunk hose, cloak and sword, who supports his penis in his right hand from which flows a stream of black urine, which Fracastoro listed as one of the symptoms of Mal Francese, while his left arm is flung out as in pain. In the second watercolour he holds his penis to facilitate the treatment of a surgeon, who is probing a deep ulcerated sore on his inner thigh, reflecting Della Croce’s treatment to open and drain the larger gummata. Both images show the man with red marks on his face, and the first shows brighter red marks over his left eye, nose and mouth, and a red rash on his lower face and neck.

Figure 5 Young nobleman with black urine (late sixteenth century),

(BCAP, MS G61, c. 7r)

Figure 6 Surgeon treating ulcerated sore on right thigh (late sixteenth century),

(BCAP, MS G61, c. 9r)

When none of these treatments worked, the surgeon resorted to cauterisation of ulcers and of festering wounds, as in the case of a young man in Figure 7. A military surgeon applies a red-hot cautery iron to the right-hand sole foot of a young man, dressed in doublet and shirt, who is yelling in agony. A small brazier fire and bellows indicate the source of the heat. The patient is clearly in a more advanced stage of his disease. The legs and feet are covered with red lesions, as is his left hand, and whether the symptoms shown here were the gummata of Mal Francese or battle wounds as a result of explosion of firearms, the principle of treatment remained the same.

Figure 7 Military surgeon cauterising Pox ulcers (late sixteenth century),

(BCAP, MS G61, c. 47r)

Della Croce was part of the medical establishment, and he contrasts the potentially harmful effects of treatment provided by empirics with the beneficial effects of formal medicine based on ‘the three famous instruments: Diet, Pharmacy and Surgery’ (Della Croce, Reference Croce and Andrea1583, c. 41 r). Leonardo Fioravanti, by contrast, challenges this learned tradition in fascinating ways. Trained as a surgeon, he argued that the effectiveness of treatments should be grounded in experience rather than theory, rejecting so-called scientific medicine based on the ancient Greek and Roman tradition (Eamon, Reference Eamon1998, 7–16). The Great Pox provided Fioravanti with the perfect vehicle for advancing his claims and at first this led to personal success. In Palermo he cured a Spanish noble and was subsequently appointed to direct the Incurabili hospital, followed by the grant of a licence to administer guaiacum by the Roman College of Physicians. However, his irascible character and personal attacks on members of the medical establishment led him to being banned from practising in both Rome and Venice.

Many of Fioravanti’s ideas and recommended treatments, including for Mal Francese, were described in his Capricci medicinali (1561), which reached a wide readership, going through fifteen editions in Italian, and was translated into French and German (Eamon, Reference Eamon1998, 9). His notion of the nature and causes of Mal Francese was not new; for example, he explained the malady was caused by corrupt and putrid humours linked to the malfunction of the liver, and nor was his description of pains, boils, pustules, ulcers and smell (Fioravanti, Reference Fioravanti1561, 23–6, 189–90). More controversial was his discussion of the impact of the disease on both internal and external body parts, eschewing the traditional distinction of the medical profession. He also criticised physicians’ over-reliance on diet and ‘weak’ medicines as ineffective, instead advocating heroic treatments based on strong emetics and purgatives, including ‘evacuating the stomach from a certain viscous putrefaction, which is generated by the corruption of the disease’ (Fioravanti, Reference Fioravanti1561, 189). Pills of hellebore, senna and crocus were administered to the patient to create a great vomit, followed by the administration of mercury. The principles underlying Fioravanti’s treatment of Mal Francese differed little from those of physicians; it was his cantankerous character and above all the assumption that he could administer internal medicines that aroused opposition. Fioravanti claimed his success was based on his experience in treatment. However, historians of Mal Francese in Italy have tended to concentrate on treatises than practice, so we shall examine briefly the treatment provided by physicians and surgeons within Incurabili hospitals, and then the role of empirics and non-licensed practitioners.

2.4 Incurabili Hospitals and the Poor

Incurabili hospitals were founded in the sixteenth century in many cities across Italy from Venice to Palermo, specifically in response to the problems caused for poorer members of society by the explosion of Mal Francese. One of the significant features of these new institutions was their size, building on the tradition of large-scale Italian medical hospitals. One particularly well-documented example was San Giacomo in Rome, which developed from an existing hospital for the poor sick to the south of Piazza del Popolo, with the façade of the church fronting onto Via del Corso. There were three main periods of expansion, the first under Leo X (1519–26), when the original male ward was enlarged, as was the female ward in the following two decades. The most significant development, under the patronage of Cardinal Antonio Maria Salviati, led to building a new male ward and a new elliptical-shaped church behind the façade designed by Carlo Maderno and completed by Francesco da Volterra; the façade can be seen in Giovan Battista Falda’s view of 1676 (Figure 8). We can see the scale of the male ward, the Corsia Salviati (now called Corsia Genga) from an early twentieth-century photograph when the hospital was still in use (Figure 9). When built it was 100 metres in length, 10 metres wide and had 263 beds over two floors. By 1581, San Giacomo treated annually some 2,200 male and female patients in two vast wards, even as it turned away many more seeking admission (De Angelis, Reference De Angelis1955, 7, 9–14, AHF, ch. 8).

Figure 8 Giovan Battista Falda, Church and hospital of San Giacomo degli Incurabili, Via del Corso, Rome (1676). (Creative Commons Attribution-ShareAlike 3.0 license )

Figure 9 Corsia Salviati, early twentieth-century view, Hospital of San Giacomo degli Incurabili

(Photo: Marco Ciaramella: Creative Commons Attribution-Share Alike 4.0 International license)

San Giacomo, as at the other Italian Incurabili, employed a large administrative and nursing staff, who provided the food and medicines to enable the physicians and surgeons to put into operation the forty-day regime of treatment of Holy Wood. Preparations were made well before the doors were opened. Carpenters were employed to make further beds to be placed between the existing rows, as well as to seal the windows to keep in the warm air from the fires lit to heat the ward. Sweating in a well-heated ward and purging were an essential part of treatment along with a light diet and the administration of medicines prepared in the apothecary’s shop. These included aloe pills, hellebore, with strong, simple medicines, such as China root, to evacuate putrefied humours and morbid matter. Large quantities of Guaiacum were prepared in three different stages, each with a different but related purpose. The wood, first cut up into small pieces and soaked in water, was boiled until reduced to half its original volume. The foam produced was dried and used as a drying powder on sores; a concentrated solution was drunk regularly; and a weaker solution, obtained by re-boiling the wood, was drunk during meals. While this treatment followed the recommendations of the medical treatises examined above, none of the doctors give a hint of what the sensory experience of the administration of a full course of Guaiacum would have been like. Although large and airy, the wards would have been insufferably hot, particularly in the summer months, and full of the smells associated with evacuation of bodily liquids and the cries of severely sick men and women (Henderson, Reference Henderson, Pastore and Peruzzi2006).

2.5 Empirics

While Incurabili hospitals did treat the poorer members of society, few had access to their services if they lived in remote areas. Instead, they could turn to empirics, whose petitions to medical colleges for licences provide evidence of their treatment of Mal Francese. Protectionism, whether protecting the role of official practitioners from the incursion of unlicensed interlopers or patients from possible harm, remained a feature of medical colleges across Europe (Pomata, Reference Pomata1998; Pelling, Reference Pelling and White2003; Gentilcore, Reference Gentilcore and Siena2005). Many of their existing archives contain references to the French Disease, especially as it proved to be such a challenge to the medical profession. Some examples were published by Alfonso Corradi from the Roman College, which received petitions from practitioners claiming to specialise in the Pox, including twelve from 1559 to 1566. Seven petitioners were surgeons, including one, Dominus Jacobo Longo, from Messina, who, ‘notwithstanding his clerical status’, was permitted to treat Mal Francese, as well as ‘pains and other infirmities’, using Holy Wood (Corradi, Reference Corradi1884, 350–2). A surgeon from Padua, called Bernardo Vittorio, provided a detailed description of his skills in 1559 (Corradi, Reference Corradi1884, 352–3):

This long list of specialities secured the College’s approval, for Vittorio was given a licence in perpetuity to practise many of a surgeon’s normal duties, including the use of his special Balzarine oil. Other surgeons were granted licences for more specific activities, as with Benedetto di Girolamo from Parma, who specialised in venereal afflictions among other skin diseases, ‘to be able to treat and draw out [infections of] the skin and flesh of the rod, and the French disease and scrofula and other things pertaining to surgery’ (Corradi, Reference Corradi1884, 354). For some practitioners, especially those who were not trained surgeons, the College restricted the medicines they could use, including mercurial ointments.

The archive of the College of Physicians of Florence, which covered grand ducal Tuscany, also contains even more petitions for licences to treat the French Disease, as well as pleas from patients asking the College to permit certain treatments, and prosecutions of practitioners discovered using prohibited methods and medicines.Footnote ⁶ Seven of the ten cases associated with the French Disease between September 1560 and March 1564 were petitions from medical practitioners. Four were registered as surgeons, but used treatments prohibited by the College. Two used heat from a dry stove, ‘stufa secca’, to sweat out the disease. Maestro Benedetto Petrini was forbidden to employ this treatment because it was regarded as ‘too audacious’; probably it involved the use of mercury sublimate, but he was still allowed to continue with weaker treatments. In his petition, Petrini countered that he would like to resume his previous practice, but with the advice of a physician, thus cleverly bowing to the authority of the medical profession.Footnote ⁷

Two petitions in 1562 from patients pleaded that a Castelfiorentino surgeon be allowed to treat their Mal Francese. Both were evidently suffering from the extreme symptoms, with Bernardo di Simone Gazzetti declaring that ‘it prevents him from speaking, as he attests, and devours his face’.Footnote ⁸

His state is shown in the eleventh Perugian watercolour of a man reduced to begging in the final stages of his illness (Figure 10). He is shown with torn clothes, wild hair, corroded nose and a body covered with red sores and the more serious black pustules.

Figure 10 Beggar with diseased body and face (late sixteenth century),

(BCAP, MS G61, c. 31r)

Evidently, the Castelfiorentino surgeon had gained a reputation for success, since Bernardo declared that he ‘relies on the practices which he had seen him undertake’.Footnote ⁹ The problem was that the surgeon’s licence had been revoked because he had used ‘violent stoves for the French Disease, without the physician’s orders’.Footnote ¹⁰ In the event the College permitted the surgeon to use these treatments, though only for these patients and only if both took responsibility for the effects: ‘If he wants him to kill him, let him do it’ and ‘if he wants to choke himself, let it be restricted to him.’Footnote ¹¹

Patients were not the only people to respect the expertise of a wide range of practitioners to treat the disease. In August 1561, the physician Maestro Cristiano Pagni petitioned the grand duke on behalf of Pellegrino da Casabasciana of the Lucchese contado, who wished ‘to treat Mal Franzese, gouts and other incurable conditions’ in the Tuscan state, especially in the Valdinievole. Pagni asked the College to relax its own regulations and allow Pellegrino to practise without being obliged to be examined. Unsurprisingly, the College replied that ‘[t]he law prohibits anyone to offer medical treatment, who has not been approved by this office’.Footnote ¹² Maestro Cristiano’s interest in this matter had been provoked by the claim that Pellegrino had cured a patient with Mal Francese, and had offered to cure within fifteen days somebody from Pescia, who had gout and could only walk with the help of crutches (croccie). Cristiano petitioned that Pellegrino should be allowed to continue with his treatment, so that he could observe how it worked and that he himself could experiment with the ‘secret of the doctor’. The grand duke had given his permission for this to go ahead, so the College had to agree, even though ‘we don’t believe in it’! It stipulated, however, that Maestro Cristiano should supervise the cura and that Pellegrino could only undertake this treatment; for anything else he would need to be examined by the College.

This case involves a series of participants: Pellegrino, who was described as ‘a doctor’; the petitioning physician Maestro Cristiano; the grand duke, who was able to override the College’s privileges; and the College, which was forced to make an exception. The College also maintained its authority, limiting Cristiano’s permission to practise without proper authorisation, and placed this ‘experiment’ under the supervision of the physician. It also involved the local secular authority, stipulating that the Vicar, the local administrative representative of the Florentine government, should carefully observe its success.

A broadly similar story emerges from the cases of three women who treated Mal Francese. Women were excluded from the privileged circle of those who could belong to the medical guild – physicians, surgeons and apothecaries – but, nonetheless, played a valuable role as healers within society. The College had granted licences to each of these women at some stage in their careers, but these licences were limited and when the women did not follow the restrictions, they incurred the College’s displeasure. Monna Agnola di Agnolo da Cannaia had come to the College’s notice three times over a two-year period from September 1560.Footnote ¹³ She declared that she had worked for many years treating those with Mal Francese, using ‘certain stoves’ to make the patient sweat. Monna Agnola also specialised in treating poor women with the disease and that they preferred her over male practitioners. Finally, while admitting that she had given medicine through the mouth, she claimed this was only as an assistant to a physician. It was during the questioning of Monna Agnola that they discovered that she had used ‘cinnabar and other violent things, inimical to nature’.Footnote ¹⁴ The College had heard that Monna Agnola’s treatment had led to deaths, and people becoming crippled. A year later she returned to ask for the reversal of her sentence, supported by evidence from a series of patients whom she had cured.Footnote ¹⁵ Clearly, the College was not impressed since it reiterated its decision, declaring that treatment using the stoves was too violent, especially leaving them in the hands of a woman without knowledge of medicines.Footnote ¹⁶ In October 1562, Monna Agnola managed to get the decision reversed, following the intervention of the grand duke, who employed her husband as a coachman. However, the College stipulated that she was only allowed to practise on those patients whom physicians ‘themselves did not want to lay on their hand, and especially poor people’.Footnote ¹⁷

The second woman was Monna Lena detta la Biancha, who described herself as a ‘very poor widow, with six little nephews, four female and two male’.Footnote ¹⁸ She petitioned for a reversal of the decision prohibiting her from her practice, even though she had followed their stipulations ‘not to give anything by mouth and not to use arsenic, neither solimate nor mercury, and always to take advice from other doctors and to use all modesty and ensure that no one will be able to complain about her’.Footnote ¹⁹ Evidently, the petition carried some weight as it was presented by Maestro Tommaso de’ Medici on behalf of the grand duchess, who had said she wanted Monna Lena to be allowed to continue to practise, as long as she abided by the restrictions listed in the petition. These were to be enforced by the duchess’s own doctor, the surgeon Maestro Lorenzo Venturini, or, failing him, the physician Maestro Pietro da Perugia. With the grand duchess’s support, everything should have gone smoothly for Monna Lena. However, the College discovered that Monna Lena had used the hot stove treatment on a certain prostitute with Mal Francese, without the permission of either Maestro Lorenzo or Maestro Pietro. The College fined her twenty-five scudi, which she then petitioned to be rescinded since she could not afford it – it was equivalent to about 150 days’ wages for an unskilled worker! – and had said that she was unable to obtain the license from the doctors, since one was sick and the other absent.

2.6 Conclusion

These cases reveal that while official treatment was supplied by physicians and surgeons, patients also resorted to empirics, especially as there was no guarantee that College members were more successful (Pelling, Reference Pelling and White2003). Empirics also had the advantage of charging much lower fees than the privileged cartel of College practitioners. In Italy, as elsewhere, this privileged cartel sought to control the medical marketplace, to defend their own privileges, earn revenues from fines and to guarantee quality. Colleges were part of a wider governmental structure, and direct appeals to higher authority in the shape of the ruler might lead to intervention. Even if this resulted in clemency and the reversal of an earlier decision, the College still forbade outsiders to go beyond the terms stipulated. The granting of licences to non-members, including empirics and women, suggests a slightly more flexible approach to treatment than reflected in official regulations or in the treatises of physicians and surgeons, though this flexibility varied across societies. The success of a practitioner depended on their reputation and consumer demand, but also on the constraints and costs imposed by medical guilds and Colleges. Patients themselves often had their own ideas and relied on practitioners from a wide variety of backgrounds to provide them with treatment, as we shall see in the following section.

3.1 Introduction

Ser Tommaso di Silvestro, a canon of Orvieto cathedral, provides one of the first, most detailed accounts of the personal experience of Mal Francese. In 1497, he had contracted the disease, but then recovered. His description survives in his chronicle of Orvieto, which records numerous public natural disasters, including plague and famine (Diario, 69):

A year later, on 26 April 1498, his symptoms returned with greater ferocity (Diario, 101):

These passages give a vivid description of the symptoms of the French Disease within the first few years of the beginning of the epidemic. They coincide in broad terms with those discussed by medical writers, though without any allusion to theories of disease. Ser Tommaso was fortunate since he survived for another two decades, but he recorded the names of various compatriots, who died of the disease over the next few years. Ser Tommaso’s discussion of his symptoms is unusually detailed, since it was based on personal experience. In his first attack, he suffered from pains, on his left shoulder, kidneys and buttocks. In the second episode pains spread to his arms and knee and mouth, and then to his genitalia, and scabs developed on his head and boils on his torso. The first round of treatment consisted of a five-syrup electuary and pills, and later he was prescribed blood-letting and a soothing ointment and a hot fomentation of herbs. Significantly, he chose to be treated by a friar rather than by a licensed practitioner, who did have medical knowledge and used herbal remedies, thus avoiding the more violent treatments involving mercury.

In common with many contemporaries during the early stages of this ‘new disease’, Ser Tommaso recorded his own sufferings as uncomfortable, but does not mention how it was contracted, even if he suffered from pain in his ‘rod’. In the 1490s, there was no automatic assumption of a close link between the sickness and sexual transmission and the two prostitutes whom he recorded as dying in Perugia in these years allegedly perished from other diseases. His coyness in not mentioning how he had his illness may arise from a desire to maintain his reputation as a public figure and cathedral canon, but also reflects the theory of transmission widespread at this early stage of the epidemic, that the malady ‘is passed on … through eating and through drinking and through sexual relations’ (Friano degli Ubaldini: Corradi, Reference Corradi1884, 345).

The contemporary accounts by non-medical men examined in this section differ from the chroniclers and medical men examined in previous sections since they are based, either directly or indirectly, on personal experience of the French Disease. They range from the correspondence of the ruling Este family in Ferrara to burlesque poetry and plays and the autobiography of Benvenuto Cellini. Even if some accounts reflect literary tropes rather than based on direct experience, they nevertheless are based on contemporary lay knowledge of the disease. Interleaved with this discussion will be an analysis of the Perugian watercolours, which present a nuanced and vivid picture of the impact of the Pox on the human body, depicting a wide range of individuals of different ages. The album also traces the evolution of the disease through a series of images of a specific patient, whose decadence emerges from his increasingly ravaged appearance, shabby dress and final destitution.

Figure 11 is one of three watercolours of a young man dressed in a green-buttoned tunic, seated on a tree-stump, with one hand holding a hat or turban on his head, to hide his hair loss. His face is covered with marked red raised lesions, and the visible parts of his legs that are around the knee also have red ulcers, and the right leg is bandaged. Most importantly, the watercolours focus on the sufferings of the patient, unusual for medical illustrations in this period, where patients are normally shown with little expression, even when undergoing surgery.

Figure 11 Young man in a turban with red lesions (late sixteenth century),

(BCAP, MS G61, c. 9r)

The album also includes two watercolours surrounded by a cornice showing two elegantly dressed young men (Plates 5–6). These images could illustrate Christian Berco’s observation that a common contemporary perception in early modern Toledo was the close link between the disease with young male libertines, typified by Don Juan, who suffered well-deserved retribution for their sins (Berco, Reference Berco2016, 23–9).

The association between Mal Francese and nobility is well-documented in the correspondence of members of the court of the Este Dukes of Ferrara. The jurist Bernardino Zambotti recorded its presence in the city in 1496: ‘this disease seems to be incurable, since it is the disease of St Job; and it springs from men who do it with women in their vulva. As a result of it, most of these men die; they suffer from pains in bones and nerves, and very big pustules all over the body’ (Zambotti, 267; AHF, 44). Among the first to be affected were members of the Este family from Isabella’s husband, Francesco Gonzaga, Marquis of Mantua, to the three sons of Duke Ercole I d’Este, including his heir, Alfonso (AHF, 45–50; Bourne, Reference Bourne2008; James, Reference James2020, 134–8, 169, 172–173). Ercole’s concern, as we have seen, led to the promotion a public debate in Ferrara concerning the nature of the disease, helping to inform both Bernardino Zambotti’s knowledge and that of his cousin Zaccharia, Ercole’s favoured court physician (AHF, 46–48).

The correspondence of the Estense family and that between Duke Francesco Gonzaga and his wife Isabella reveals a striking absence of references to the term ‘Mal Francese’, though the disease was widespread in Ferrara. Moreover, there was a close resemblance between contemporary descriptions of its symptoms and treatment and those recorded in these letters. In Alfonso’s letters to his father and his brother Ippolito, Cardinal of Milan, his language is evidently informed by the ducal physician, Ludovico Carri, who treated him, to which he added his own observations. In 1497, Alfonso reported that Carri had provided reassurance, that he was not very sick, and that his indisposition was due to having slept without bedcovers during a very hot night. However, by August 1499 he was seeking alternative remedies, asking Ercole to send oil of turpentine, cloves and storax to calm ‘a certain pain … under my left knee that does not let me rest a moment all day and night’ (AHF, 48–9, n. 64; Tosti, Reference Tosti1992, 56–60).

When Francesco’s sickness returned after 1508, it is significant that the term Mal Francese is still avoided. Mario Equicola, humanist and courtier, sent a report in late April from Mantua to Ippolito in Milan describing Francesco’s health in the following terms: ‘Truly he does not feel very well. I do not know precisely what his ailment is, although I recall that in the beginning of March his genital member caused him great pain, and that later, in Gonzaga, he suffered from fevers. I am not sure what is afflicting him at present’ (Bourne, Reference Bourne2008, 469–70; James, Reference James2020, 134–5). Francesco, writing to Isabella a month earlier, recounted that, although he was afflicted by a severe fever and vomiting, the doctors had concluded that it was ‘neither grave nor dangerous’ (James, Reference James2020, 134, n.1). The following April when on a military campaign against Venice, he wrote that his sleep was interrupted because he had a ‘tremendous catarrh’ and the following month he complained of appalling pains in his thighs (James, Reference James2020, 138, n.15, 140 n.21, 141).

The repeated pains and sleeplessness with fevers and catarrh should have convinced Isabella that Francesco had Mal Francese, given that the symptoms were very well-known at the time, and her brothers suffered from the disease. In April 1508, Francesco came closer to admitting the cause of his condition in a message, which he asked to be forwarded to Louis XIII: ‘tell the King it was probably caused by “love”’ (James, Reference James2020, 137 and n. 12). Although Francesco was careful not to mention the true cause of his condition to his wife, his symptoms coincide with contemporary descriptions, both of chroniclers and medical writers examined in Sections 1 and 2. It is telling of his attitude to his personal doctors to whom he had submitted himself for years to regimes of blood-letting and purging, that latterly he claimed greater relief from the ministrations of empirics. In 1514, he was treated by an empiric from Genoa, who gave him a ‘certain drink and a certain water to bathe his infected eyes (ochi offesi)’ (James, Reference James2020, 169 n. 34). Later that year he had three days’ treatment from a Franciscan, which he claimed had had miraculous effects, recalling Ser Tommaso’s ministrations by a friar (James, Reference James2020, 172).

Alfonso and Francesco’s faith in their doctors lasted as long as they were successful and reassuring, and, in time, like Ser Tommaso, they turned to treatments they had heard were more efficacious and to practitioners outside the immediate court circle. These sources suggest that educated lay men and women had their own ideas about their illness and the most appropriate treatments.

3.2 Pox and Literary Autobiography

From personal letters, we turn to literary autobiography in renaissance Italy, and although many are relatively well-known, here they will be analysed to draw out their medical content, in particular authors’ descriptions of Mal Francese and its symptoms. They are a very different type of source and have to be examined within the tradition of burlesque poetry (cf. Ciccarella, Reference Ciccarella2018–19, ch. 2). The authors were associated closely with some of the main literary academies in the sixteenth century, typified by a relaxed ribald atmosphere, reflected in their titles such as the Roman Accademia della Vigna, whose members were known as ‘Vintners’, the probably fictitious Accademia de’ Balordi (hare-brained), and the Accademia degli Umidi (damp or humid), a satirical suggestion that its members had wet or humid humours leading to weak brains (Zanrè, Reference Zanré and Siena2005, 189, 192). The satirical nature of the genre leads one to be cautious when assessing the reliability of the poems and plays recited and performed in the literary academies. They were not transparent accounts, but rather literary topoi, and at times it is hard to work out how far they really did record personal experience. Even so, we shall argue that they do reflect general knowledge among the literate laity about the nature and symptoms of the French Disease.

Some ten years after Ser Tommaso’s account, the Sienese poet and actor Niccolò Campani wrote The Lament of Strascino (Lamento di quel tribolato di Strascino), an allegedly autobiographical verse narrative account of his long eight-year battle with Mal Francese between 1503 and 1511. The work was divided into two parts. The first was written between 1509 and 1511 during the latter stages of the disease, and the second ten years later when he had recovered and was working at the papal court in Rome. Assuming he really did have the disease, it is doubtful that he truly recovered, since he died in 1523 at the relatively young age of forty-five, two years after his work had appeared in print (Alonge, Reference Alonge1974; Pieri, Reference Pieri2010; Ciccarella, Reference Ciccarella2018–19, 2.3; Gagné, Reference Gagnéforthcoming).

Ser Tommaso’s chronicle and Campani’s poem belong to different genres with very different conventions. While Ser Tommaso’s is very evidently a personal account, albeit within a history of Orvieto, Campani’s shares the form and function of the satirical poems and plays about the lives of prostitutes we shall examine in Section 4. Campani was well-known for his comedies and performances at Italian courts, including those of Mantua and Rome, where Mal Francese was rife.

The title of The Lament derives from a biblical model, most famously the Old Testament books of Jeremiah and Job. The relevance of the subtitle, ‘patience and impatience’, becomes clear when one recalls that the root of ‘patience’ (patior) means to suffer. The rich and powerful king of the land of Uz had a series of personal tragedies visited upon him, including skin disease, as a test of his faith. In the long run he was restored by God to his former state, but along the way he suffered the indignity of being wrongly accused by his wife and friends for being punished for his sins. The visual representation of Job is the subject of Section 5, for as patron saint of the Great Pox he was shown covered with spots and lying on a stinking dunghill, reflecting the association between corrupt air and disease.

The woodcut print on the title page of the 1564 edition of The Lament (Figure 12) shows the patient lying on a bed, with medical attendants replacing Job’s wife and friends. Campani believed that the saint had more hope than him since his afflictions did not match the excruciating pains of Mal Francese (Campani, Reference Campani1523, verses 50–3). The religious theme is emphasised by the devil flying above the patient, showering him with the disease, a diabolical reinterpretation of the Angel arriving with the palm of martyrdom. Behind the bed is an image of Christ, who had the power not just to inflict disease as punishment but also to take it away as the divine physician. These contradictory themes of ‘patience and impatience’ are at play throughout the poem. Campani’s hope was that through patience and saying prayers and litanies, God would pardon him and the disease would pass. At times impatience took over and during his ‘war of torments’ he was moved to blasphemy, deciding it was better to invoke hell and demons. Finally, he reverted to his belief in divine punishment as the cause and believed that on recovery his tremendous suffering would purge him of all his sins (Campani, Reference Campani1523, verses 10–21).

Figure 12 Niccolò Campani, The Lament of Strascino, frontispiece (Venice, Reference Niccolò.1564), (internet archive, Creative Commons, Public Domain Mark 1.0)

The image of the sick room strikingly underlines the themes of physical disease and medical treatment (cf. Gagné, Reference Gagnéforthcoming). The patient’s whole body is covered with dark blotches representing the horrendous sores, pustules and ulcers generated by the Mal Francese. He is shown leaning back on his pillow and gazing at the medical practitioner, who takes his pulse from the left arm. The physician carries around his waist a scroll, probably a urine chart, to aid diagnosis of the patient’s condition, while the attendant holds a urine flask. The doctor and his attendants stand close to the bed, while behind them is an open window to cleanse the air of the smell produced by suppurating sores.

The poem traces the development of the author’s illness, emphasising what life was like before he became sick, when he was ‘cheerful and playful’ as actor, poet and playwright at noble courts, while now ‘my cheerfulness and sounds are converted into cries of pain’, especially at night (Campani, Reference Campani1523, verse 3). On the frontispiece of the Lamento, the patient expresses his emotions through his exclamation ‘Alas the pains’ (‘Hoimè le doglie’), written on a scroll emerging from his mouth. As the poem progresses, his suffering worsened, moving from simply ‘pain’ to ‘extreme pain’, which makes him envy the dead and wish to die (Campani, Reference Campani1523, verses 73–6). Dominique Brancher in her analysis of pox and pain in French literature at the time suggests that this genre represented a form of poetic therapy, in which the patient confronted and tamed the illness (Brancher, Reference Brancher, Gygaz and Locher2015, 55–6).

In addition to pain, Campani mentions that the disease remained hidden for four to six months before the familiar signs began to appear (Campani, Reference Campani1523, verse 38). At that point, perhaps fearing the worst, but not yet suffering the full impact of the disease, he distances himself from his own experience and describes the torments suffered by those in the advanced stages (Campani, Reference Campani1523, verse 42):

Here Campani emphasised the external signs most visible to an outside observer, but in his own case, he emphasises internal symptoms, as when he mentions the great heat caused by the disease, the pain in his mouth and the stink of disease on his breath. His throat was also affected, leaving him with a hoarse voice, and gave him no peace, being unable to eat or sleep, but only to cry aloud (Campani, Reference Campani1523, verse 84). Campani does not go into detail concerning other more specific physical symptoms, particularly in relation to the impact on his limbs and parts of his body hidden from view, except to mention that he was afflicted by ‘boils, sores, gummata, and pains’ (Campani, Reference Campani1523, verse 124). When he begins to recover, he is able to think in a more objective way, considering Mal Francese within a wider context, comparing his own disease with both podagra and gout. He concludes with an ironical comment that the major difference is that while gout is more selective, Mal Francese ‘benefits’ everybody (Campani, Reference Campani1523, verse 132):

Campani sought medical help to alleviate, if not cure, his symptoms. He recounts he wasted large sums on doctors’ useless treatment, including sweating in a hot dry stove and mercurial ointments (Campani, Reference Campani1523, verses 24, 27). Instead, he adopted his own remedies, despite the disagreement of medical professionals. He found temporary ways to ‘comfort’ or relieve the symptoms, including taking young garlic, modifying his diet and sitting in front of a roaring fire, drinking a lot of wine and mixing with lively companions (Campani, Reference Campani1523, verses 28–32). All the latter expedients coincided with gentler preventative measures that were part of the six ‘non-naturals’, recommended by Galenic medicine to adjust the environmental conditions which affected a patient’s body, such as heat and humidity, and their internal complexional balance which determined health. Ultimately, Campani did not lose faith in doctors, for he attributed his cure to Maestro Simone da Ronciglioni. He claims he had been cured by the application of mercury unguents to his sores and pustules. Such was his belief in Maestro Simone that he undertook seven courses of painful treatment, which he had earlier rejected, as well as ‘Holy Wood’, which he maintained helped prevent the disease from returning (Campani, Reference Campani1523, verse 126).

He gives considerable detail about the development of the illness and treatment over the course of eight years. His account makes a telling comparison with Ser Tommaso di Silvestro’s. With the benefit of twenty-five years, Campani knew what to expect in terms of the development of the sickness; Ser Tommaso instead had encountered an unknown disease without an established prognosis, which must have been bewildering. This development of knowledge was also true of the first medical writers examined in Section 2; for while Benivini had yet to develop a detailed description of the disease, by the time that Niccolò Massa was writing in the 1520s, a clearer idea had emerged of the symptoms similar to those recounted by Campani. However, neither Campani nor Ser Silvestro provides any idea of how they contracted it. This is in contrast to the putatively autobiographical pamphlet from the early 1520s, The Seven Pains of the French Disease (Li sette dolori del Mal Francese), possibly by the poet and actor Maestro Andrea Veneziano, whom we meet in Section 4, as author of The Purgatory of the Courtesans. He attributes the source of the disease to prostitutes, and ends with the admonition (Sette dolori, 1580 ed., verse 17):Footnote ²⁰

This pamphlet was also part of the tradition of burlesque poetry and was designed to be recited publicly in Rome in Piazza de’ Sciarra, explaining the words above the image, ‘a very enjoyable thing’. This type of pamphlet circulated widely and was printed cheaply in multiple copies; Campani’s pamphlet went through fifty-seven editions before 1600 (Ciccarella, Reference Ciccarella2018–19, 307; Sampson, forthcoming).

The frontispiece of some editions of The Seven Pains (Venice, 1555) contains a woodcut showing a bearded male sufferer, whose nude body is covered with pustules and sores (Figure 13). He reclines on a bed, reflecting both Job on his dunghill and the figure shown on the frontispiece of Campani’s Lament. The patient holds a fan in his left hand with which he attempts to assuage the heat of his pains and disperse the smell of decay. From the late sixteenth century, such images of Pox sufferers were reproduced on fans, thus acting as another medium through which knowledge of the disease was further popularised; it has been suggested they were also part of a broader movement emphasising the benefits of avoiding contagious diseases and adopting a healthy way of life (Strocchia and Kelly, Reference Strocchia and Kelly2022).

Figure 13 Andrea Veneziano (attrib.), The Seven Pains of the French Disease, Frontispiece (Venice, 1555),

(Ministero della Cultura/Biblioteca Nazionale Marciana, Venice. All rights reserved)

The theme of pain runs through this pamphlet. It outlines in detail the different stages of the disease, which first affected the brain to ‘demonstrate its power and valour, and made lord of the fortress’ (Sette dolori, 1580, verses 3–4). This ‘cruel passion’, the ‘cruel and little mean pain’, was felt all day and night in both the head and temples. The second phase of the disease moved from internal to external symptoms affecting the face (Sette dolori, 1580, verse 7):Footnote ²¹

The poor patient is teased about his appearance. He compares his hairless face to a frowning falcon, or a featherless starling or an ape, since there was not a hair left on his face, although he jokes that on the positive side, he will save money on barbers. On the negative side, he has to spend a lot on medicines, including oils and syrups or waters to bathe in, though none of this did anything to prevent the development of the third main source of pain (Sette dolori, 1580, verses 7–10), loss of teeth and sense of taste, returning the sufferer to being like a puttino or baby, who can only eat soups. But this is not all, for the fourth stage led to the development of ‘delightful’ boils: ‘On your face they flower like roses, and make you into a beautiful person’ (Sette dolori, 1580, verse 12).Footnote ²² In the next phase, the disease entered the bones and led to a ‘cruel pain’, leading the patient to yell and cry aloud, as gummata ate away the flesh, even on the soles of the feet, making it incredibly difficult to walk. Finally, the pains became ‘atrocious’, caused by the ‘cursed sore from hell’, which led to death (Sette dolori, 1580, verses 14–16). Some idea of his appearance can be gained from the only too graphic image in the twelfth watercolour of the Perugian manuscript (Figure 14).

Figure 14 Bald man holding his hair which has fallen out (late sixteenth century),

(BCAP, MS G61, c. 33r)

This ‘featherless starling’ certainly looks bemused as he stares at lengths of his own brown hair in his right hand, and his illness is reflected in the red discolourations and ulcers on his neck, face and arms, as well as bloody bandages on his right arm to cover his sores.

The poem describes the seven stages in the development of Mal Francese in unflinching detail, dwelling on the growing levels of pain from being ‘wretched and cruel’ as it enters the head and temples to ‘torments’ as it removes facial hair to that associated with the decay and falling out of teeth to the rose-like boils and ‘cruel pains’ as the disease enters the bones and finally to ‘atrocious pain’ and death. Although the intent was a cruel ridicule of the disease, the author was careful in his use of terminology, reflecting how the symptoms were described by other contemporaries, including doctors. His precise account of the malady’s development suggests that even if the writer had not experienced it himself, he was an attentive observer of the suffering of others. He reflects, moreover, the accounts of the medical writers already examined, from Massa to Fracastoro, who emphasised the intolerable pains, pustules and loss of hair.

The French Disease remained a constant theme of the circle of burlesque poets associated with the relaxed atmosphere of the literary academies (Ciccarella, Reference Ciccarella2018–19, ch. 3). Giovan Francesco Bini, for example, who was a member of the society of the Intronati in Siena, published his Chapter on the French Disease (Capitolo sopra il Mal Francese), in 1530–32.Footnote ²³ Antonfrancesco Grazzini, best known as ‘Il Lasca’, was known for his many ribald songs, particularly about his associations with courtesans, as he recorded in a letter to Lionardo Della Fonte where he mentioned ‘mal francioso’: as a result of ‘playing around and whoring’, he ‘discovered two small boils at the end of his penis’. The moral of the story was: ‘How much passion I seemed to have, how much pain I feel’ (Grazzini, Reference Grazzini and Verzone1882 ed., 143–4; Zanrè, Reference Zanré and Siena2005).

This section concludes by examining another literary source, the lively and often scurrilous autobiography of the celebrated sculptor and goldsmith, Benvenuto Cellini, which he wrote in 1558. He, like the members of the literary academies, wrote a short account of his experience of Mal Francese, from which he had allegedly suffered some thirty years earlier, by which time the disease was well established and treatments had evolved from mercury to fumigation to guaiacum (Cellini, 1971 ed.,117–118).

This description reflects the tone of much of Benvenuto’s Vita, emphasising his sense of being a victim of circumstances. His brief sketch of the course of the disease reflected observations of doctors at the time, with a four-month period of dormancy (Fracastoro, Reference Fracastoro and Wright1930 ed., 237, 137). His claim that these swellings were not the same as those he had seen in other cases suggests a familiarity with the symptoms, which convinced him that he, as the patient, knew better than the doctors, for they had disputed his diagnosis of the Great Pox. Then Cellini, though initially adopting the treatment they prescribed, rapidly rejected it, instead taking a course of Guaiacum, which supposedly cured him.

By rejecting the medical experts’ diagnosis and treatment, he emphasised his own expertise and experience, which is also reflected in the seriousness with which he followed the regime during the Holy Wood cure, ‘with scrupulous discipline and rules of abstinence’. His critical attitude to doctors is also revealed in an earlier passage where he describes the role of Jacopo Berengario da Carpi (Cellini, 1971, 17–118):

Berengario was a renowned physician and anatomist who had taught at Bologna University and had been invited to treat the Pope, an honour which belies Cellini’s claim the Roman clergy considered him a charlatan (French, Reference French, Wear, French and Lonie1985). This account, apart from making a good story supporting Cellini’s suspicion of physicians, reflects his dislike of the mercurial fumigations favoured by Berengario, which by the 1530s had already gone out of fashion and their place taken by Holy Wood. The extent to which we can take Cellini’s account at face value needs to be questioned, given that the Vita was written with the benefit of thirty years’ hindsight. This episode serves as another dramatic narrative device representing the many challenges of his life, including treachery, imprisonment and accusations of murder. If escaping the clutches of the Great Pox can be seen as equivalent to escaping from prison, nonetheless his account does reflect knowledge of the disease, its symptoms and treatment.

3.3 Conclusion

While the authors of this range of sources wrote from different standpoints, whether genuinely reflecting their own experience, as with Ser Tommaso or members of the Ferrarese court, or allegedly autobiographical accounts by satirical writers or Cellini, what emerges above all is a vivid recreation of the physical suffering of patients with Mal Francese. The descriptions are considerably more detailed than those of chronicles examined in Section 1, which reflected only a very general knowledge of the disease among a wider public. The vocabulary of the later writers reflected more closely that of medical treatises (Section 2), though lacking their detailed explanatory theoretical framework. The Perugian watercolours, on the other hand, provide a visual counterpart to these descriptions, showing the effects of the disease on the human body and the emotional and facial reactions of the patient, most of whom were young men. The next section turns to examine the impact of the disease on women, and in particular courtesans and prostitutes, through the lens of another genre of popular burlesque and satirical narrative, to explore further how they reflected lay understanding of medical ideas and the wider social and moralistic implications of contracting the Pox.

4.1 Introduction

The previous section examined the real and imagined impact of the Great Pox on male sufferers. One of the striking features of these accounts is that authors often avoided stating how they had contracted the disease or their culpability, unless, as with Cellini, it served his narrative. By contrast, the satirical poems and plays about the lives of prostitutes, which became increasingly popular from the 1520s, contained a central message of moral and physical decline.

As we have seen in previous sections, early accounts of the epidemic, whether lay or medical, tended to provide a range of explanations for the origins and transmission of the disease, from astrological to corrupt air. However, some also add sexual transmission as a cause, specifically making the connection between Pox, prostitution and women more broadly. One wrote ‘women have it in their nature’, another that ‘[t]he beginning of this disease was detected from the woman’s vulva’, and another: ‘it’s caught by frequenting women who have these diseases’ (Section 1; Corradi, Reference Corradi1884, 346, 361). This association is not surprising given the long-standing belief in the relationship between women and disease in contemporary medical theory. While men’s humoural make-up was hot and dry and therefore more resistant to disease, a woman was seen as damp and cool making her more susceptible to infection (Schleiner, Reference Schleiner1994, 500–6). As the influential medieval text, Trotula’s Book on the Diseases of Women, had it: ‘Because women are by nature weaker than men … diseases very often abound in them especially around the organs devoted to Nature’ (Green, Reference Green2001, 65).

These medical explanations ran parallel to medieval theological views of women as the heirs of Eve in her role as temptress of Adam and responsible for the Fall, lending a moral dimension to her role as an agent of contagion, and in particular in the transmission of venereal disease, as was clear from ideas concerning the nature of medieval lepra. In fact, within two years of the beginning of the initial outbreak of the Pox, Fileno delle Tuatte of Bologna labelled the new disease as the ‘lepra of Saint Job’, alluding to their shared symptoms of spots, ulcers and disfigurement. There was, moreover, a belief shared by doctors that lepra was caused by coitus with leprous women or intercourse during menstruation (Jacquart and Thomasset, Reference Jacquart and Thomasset1985, 177–88; Rawcliffe, Reference Rawcliffe2006, 48–56, 78–89). Lepra, then, lent a model for contemporaries to understand the nature of the Great Pox and it helped to shape attitudes towards those who caught and suffered from it. But there were also considerable differences, not least the scale and rapidity of spread of the Great Pox, compared with lepra, and the fact that the latter was seen as transmitted in a variety of ways, while the former was increasingly seen as a sexually contagious disease.

Ideas and explanations about the nature of the Great Pox built on these medical and theological ideas about women and played a decisive role in a shift in attitudes and policies towards prostitution in the sixteenth century along with broader social and theological changes. There was a long tradition in the Catholic Church of toleration of prostitution as a necessary evil, reflected in Thomas Aquinas’s statement in his On the Government of Rulers, that if one removes the cesspit, the palace will become an unclean and evil-smelling place. However, the increase of physically decayed Pox patients added to the large number of diseased and disabled beggars on the streets of renaissance Europe; this led to growing intolerance and increased emphasis on the links between moral and physical decline. Luther’s characterisation of the papacy as a sink of iniquity and vice following his 1510–11 visit to Rome was given extra force by the topos of the Pox-ridden prostitute. This image was popularised by Erasmus in his Colloquies (1518), where he developed the analogy between the corrupt diseased body of the priest and the decay of church and society, taken further by his friend, the humanist knight Ulrich von Hutten in his well-known 1519 treatise on the Pox and guaiacum (Munger, Reference Munger1949; Healy, Reference Healy2001, 139–143; Stein, Reference Stein2006, 629).

In Italy, changing attitudes towards prostitution, immorality and disease were reflected in satirical plays and poems. As Tessa Storey has pointed out, three different types of narratives evolved across the century (Storey, Reference Storey2008, ch. 1). The first took the form of a small booklet in verse, describing the rise and fall of a courtesan, sometimes prefaced by frontispieces of crude woodcuts illustrating her physical decline. Secondly, broadsheets appeared from the later sixteenth century with a single image showing the life cycle of a courtesan, as they were punished for immorality by falling ill. A third phase came with a series of images narrating a moral story, warning courtesans or their clients not to trust each other. At the same time, and following the Counter-Reformation, the church placed renewed emphasis on the role and sanctity of the family and mounted a crusade to rescue fallen women and to protect vulnerable girls from a life of sin (Rosenthal, Reference Rosenthal1992, ch. 1; McGough, Reference McGough2011; Pullan, Reference Pullan2016). This section, then, revisits key aspects of this narrative literature through the lens of contemporary medical understanding of the Great Pox.

4.2 Pox and Prostitution in Renaissance Rome

One of the earliest and best-known poems in this genre was the Purgatory of the courtesans of Rome (Purgatorio delle cortigiane di Roma, 1529). The poem was by Maestro Andrea Veneziano, a painter and poet at the papal court, and was followed by a short sequel, The Lament (Il Lamento), probably by Andrea’s friend, Pietro Aretino. Both were well-known for satirical verse, building on the tradition of songs performed during carnival, the festival of public enjoyment before Lent. In these carnival songs (canti carnascialeschi) courtesans were portrayed either very positively or very negatively. The two authors shared a mixture of cruelty, moralising and the burlesque (Kurz, Reference Kurz1952, 137–9; Kunzle, Reference Kunzle1973; Shemek, Reference Shemek, Ferrara, Giusti and Tylus2004, 50; Geschwind, Reference Rachel., Erhardt and Morris2010, 125–7; Storey, Reference Storey2008, 25–7; Ugolini, Reference Ugolini2009, 4; Ciccarella, Reference Ciccarella2018–19, ch. 4; Strocchia and Kelly, Reference Strocchia and Kelly2022, 10–12). These pamphlets are part of the explosion of cheap printed works that circulated from the late fifteenth century, enabling the popular poems, plays and prophecies recited in the open air and in literary academies to reach a much wider audience. Related woodcuts were often displayed in taverns and were increasingly available as single sheet broadsheets from the second half of the sixteenth century (Niccoli, Reference Niccoli1990; Salzberg, Reference Salzberg2010).

Although the Purgatorio was a satire, it also hid a more serious warning to prostitutes and prospective clients of the dangers to their health and fortune. The courtesan was warned ‘not to trust in your beauty, that is brief and fragile like smoke and wind’, for if now ‘you are young, beautiful and clean’, in old age you will be ‘dressed in every misery’, ending up sick in the ‘new Purgatory’ of the hospital of San Giacomo for incurables in Rome. The title is apt since it references that state after death of suffering, where people purified their souls by doing penance for their sins to make them worthy of entering heaven (Ugolini, Reference Ugolini2009, 18).

Andrea recited the text during Carnival on 10 February 1525, and according to the title of the mid sixteenth-century Sienese edition of the pamphlet, the author ‘was dressed as a beggar supported by a crutch and carrying a bell’. In a woodcut illustration on the frontispiece of a 1529 Bolognese edition (Figure 15), Andrea rests in the countryside, surrounded by flowers, while he leans on a large staff, wearing little except a wreath of laurel leaves around his midriff.

Figure 15 Andrea Veneziano, Purgatory of the courtesans of Rome, frontispiece (Bologna, 1529), (BNCF, Palatino, E.6.6.153.II.8), (Ministero della Cultura/Biblioteca Nazionale Centrale Firenze)

The event was staged in front of a large crowd near the River Tiber in the presence of Andrea’s patron, Pope Clement VII, and his court. One of the more dramatic features of the occasion was described in an anonymous letter written to the Florentine politician, Paolo Vettori, the Admiral of the papal fleet, who was based at Civitavecchia on the coast north of Rome (Graf, Reference Graf1888, 256):

Although there was no more detail concerning the appearance of the effigies, they probably mirrored the description in the poem of the effects of poverty and disease on the appearance of older prostitutes, and identifying the labels on the effigies would have further damaged their reputation. This episode underlines the agency of the courtesans themselves, as emphasised in recent literature on prostitutes in this period, for they were not powerless to demonstrate their outrage. One should also remember that all these events took place during carnival, which traditionally provided a brief period when people could protest within the safety valve of the world turned upside down.

The representation of the aged courtesans as effigies and the oral recitation was designed as a warning of the ultimate fate of any woman who became a prostitute, but significantly the poem focussed on the Ospedale di San Giacomo, which was described as a living purgatory. Here patients were described as doing penance for their sins through the sufferings of their diseased bodies; their sicknesses and symptoms are described in excruciating detail. What then does the Purgatorio add to our knowledge of the hospital as discussed in Section 2.4 and of their patients? In his satirical poem, Andrea began by contrasting the hospital’s ‘beautiful cloisters’ with the physical condition of the sick, who suffered from ‘pain exceeding any torment and infernal plague’ (Purgatorio, 1529, lines 16–21: Ugolini, Reference Ugolini2009, 17–18). He also portrayed the hospital as overcrowded and insufficient for the demand of potential patients, since, as emphasised in Leo X’s papal Bull of fourteen years earlier, Rome had become full of incurables. Beds in the wards were packed closely side by side, and the beautiful cloisters had become the place where the most seriously ill were abandoned.

Given the intention to emphasise the purgatorial nature of San Giacomo, Andrea described the nature of patients’ symptoms in detail. This was the place to see ‘scary monsters’, destroyed by their illnesses, which included lepra, cancers and ‘universal sicknesses’, ‘that destroy the flesh down to the bone’ (Purgatorio, 1529, lines 16–21: Ugolini, Reference Ugolini2009, 17–18). But Andrea concentrated mainly on Mal Francese, given its association with courtesans. The symptoms correspond quite closely to those described by medical writers, reflecting the diffusion of knowledge of the details of the disease beyond the world of practitioners. Patients suffered from pains, boils and sores, which spread from head to foot, and led to the flesh of limbs being eaten away and to losing features on their faces, including eyes, making them no longer recognisable. Then, as mentioned in Section 2.4, Leo X’s Bull of 1515 underlines the bodily decay of the sick beggars, which generated pus and stench, leading to the corruption of the air associated with the spread of disease (Purgatorio, 1529, lines 50–5: Ugolini, Reference Ugolini2009, 18):

This satirical poem also had a serious intent, to warn women of the perils of prostitution, and to deter potentially vulnerable girls from entering the profession (Matthews Grieco, Reference Grieco, Sara, Johnson and Matthews Grieco1997, 78–86; McGough, Reference McGough2011, ch. 4; Geschwind, 2012, 107–33). These themes related to a longer theological tradition, which viewed women’s bodies as the primary agent of original sin, leading to both physical and moral sickness (Green Reference Green2001; Ugolini, Reference Ugolini2009, 5–12; Ciccarella, Reference Ciccarella2018–19, ch. 4; Gagné, Reference Gagnéforthcoming). In both literary and visual portrayals, the female body disfigured by disease was contrasted with the beauty of the ideal Renaissance body, as underlined here: ‘And such a one who had high and divine features now is incurably ill, like a monster’ (Purgatorio, 1529, lines 46–7: Ugolini, Reference Ugolini2009, 18). More specifically, some scholars suggest that this was a way of representing the lack of male responsibility for the transmission of the Great Pox (Shemek, Reference Shemek, Ferrara, Giusti and Tylus2004, 55–7; Zanrè, Reference Zanré and Siena2005, 189–91). Paola Ugolini offers a more nuanced interpretation, arguing that ‘the text seems to establish a double satirical focus that does not only aim at courtesans, but at male suiters too’ (Ugolini, Reference Ugolini2009, 13–14). The fact that Andrea presented himself as a beggar with a crutch reflects the common image of those suffering from the Great Pox, whether male or female.

A further graphic representation of the later stages of the disease is shown in the crude woodcut on the title page of the edition of c. 1560 (Figure 16). A courtesan is wheeled along on a handcart, after her limbs had been attacked and weakened by the disease. Her legs are badly ulcerated, and the abscesses smelt, since they attracted flies, which she attempts to whisk away with a twig. These handcarts were a common contrivance to enable a crippled man or woman to travel around the city, as reflected in an incised marble plaque on the wall beside the entrance door to the hospital church of Santa Maria in Porta Paradisi (Figure 17). He is scantily dressed and, like the courtesan, his head is covered to hide his baldness, while his right-hand foot was probably reduced to a stump. He is sitting in his cart with his hands joined in supplication begging for himself and to raise funds for the hospital behind him.

Figure 16 Andrea Veneziano, Purgatory of the courtesans of Rome (Rome, c. 1560),

(British Library Board, shelfmark:11427.b.61: frontispiece).

Figure 17 A beggar with the Great Pox seated on a handcart, incised marble plaque, Church of S. Maria in Porta Paradisi porch, Hospital of S. Giacomo degli Incurabili, Rome

(Photo: author)

This text, the Lamento, probably by Aretino, was recited immediately after Andrea’s Purgatorio, highlighted the evils associated with the social-climbing of courtesans, reflected in the topsy-turvy world of Carnival. While Andrea emphasised the role of San Giacomo as the purgatory for those sick with Mal Francese, Aretino dwelt on the telling contrast between the glamorous life of beautiful young courtesans and the poverty and ill health of their old age after they had been afflicted with the Great Pox; this was given greater veracity as the poem is allegedly narrated in the first person by the anti-heroine herself (Shemek, Reference Shemek, Ferrara, Giusti and Tylus2004, 51–5). To underline the moral of his message, the gradual decline of a courtesan is described, beginning with sartorial and gastronomic contrasts between past and present (Lamento, in Purgatorio, c. 1560, ed., lines 10–18: Kurz, Reference Kurz1952, 164):

Unlike the happy days when she wore gold, she now wears clothes made of sacking, and while in the past she smelt of expensive perfumes, now she smells of sulphur and mercury to treat the ‘boils, gummata and pains’. Later Aretino is even more precise about the symptoms, which include first loss of eyebrows, and eventually the hair on the head, forcing her to disguise her baldness and sores with an old sheet, while her beautifully made-up face has now terrible scabs and flesh eaten-away by disease. While written in emotive language, this description reflects knowledge of the treatment of medical practitioners and their descriptions of the later stages of the disease as it disfigured the face and body (Section 2).

Decline in her health inevitably led to a gradual decline in the courtesan’s standard of living, as she was forced to part with her servants, her clothes and jewellery, and her grand rooms. She is reduced to live outside in all weathers under benches, and to beg for her living on Ponte Sisto, often left without bread or warmth, until she enters the hospital of San Giacomo, where she contemplates buying poison to end her miserable existence (Lamento, in Purgatorio, c. 1560 ed., line 112).

Though satirical, and presented through the male gaze as a warning to courtesans and their clients, both poems point to the sad reality of the lives of prostitutes as they became sick with the French Disease. Andrea’s image of the ‘fearful monsters’ must have resonated with all who had seen diseased beggars on Ponte Sisto and in other public places, and for visitors to San Giacomo and Incurabili hospitals throughout Italy. If their presence on public highways and Piazze moved some to compassion, it made others fear infection from the smell of suppurating wounds and the stinking breath which infected the air, as mentioned in a Venetian law of 1522: ‘giving forth a terrible stench and infecting their neighbours and those with whom they live’ (Chambers and Pullan, Reference Chambers and Pullan1992, 308–9).

The Purgatorio and Lamento continued to be influential as models in tone and contents for the satirical and moralistic literature about the life cycle of courtesans. This can be seen in the pamphlet published some ten years later by the Florentine poet and bookseller Gianbattista Verini, The Pride and Lament of the Ferrarese Courtesan (Il Vanto e Lamento della Cortegiana Ferrarese), which places greater emphasis on her previous luxurious way of life. It enumerates the numerous attributes of her beauty, including her ‘two eyes more black than crows that those who look at them are astonished’, ‘the lips of coral’, ‘the nose outlined between two roses’ and ‘the throat of alabaster’ (Il Vanto, Reference Verini1540, lines 13–14. 17, 20, 28).Footnote ²⁴ She is represented as profiting from her beautiful appearance, with princes and lords paying court to her, an opulent lifestyle in a grand house, with beautiful clothes and food and wine fit for kings. After fifteen years, she began to suffer from great pains and became a ‘dried leaf’, leading to a bitter death (Il Vanto,Reference Verini1540, line 123). Though more emphasis is placed on what she lost than the disease, recognisable symptoms are mentioned, including severe pains and stench, so that ‘thinking of it cracks my heart’, ‘so nobody will love me anymore’ (Il Vanto, Reference Verini1540, lines 125–6, 146–7).Footnote ²⁵

The two-part structure of the Lamento echoes other similar poems and plays written in Italy in the sixteenth and seventeenth centuries, contrasting the courtesan’s luxurious lifestyle, with her decline and ‘bitter death’. Her symptoms of pain and smell are also familiar from other contemporary descriptions, reflected in the crude print on the pamphlet’s frontispiece (Figure 18). Like the woodcut accompanying the Purgatorio, the Ferrarese courtesan is wheeled along in a handcart, suggesting her difficulty in walking; but reflecting the pride of the title of the poem, she imperiously points out directions to her helper with a long, distorted finger.

Figure 18 Gianbattista Verini, The pride and lament of the Ferrarese courtesan (Siena, Reference Verini1540), BNCF, Landau Finaly 535/7, frontispiece (Ministero della Cultura/Biblioteca Nazionale Centrale Firenze)

4.3 The Reformation of Morals in Word and Image

Over the sixteenth century there was a general increase in intolerance towards prostitutes. Towns and cities attracted growing numbers of the marginalised poor, which included women forced into selling their bodies to survive (Storey, Reference Storey2008). In Italy, the post-Tridentine Church mounted a campaign to save souls, by converting non-Christians, such as Jews and Muslims, and preventing potentially vulnerable women from becoming prostitutes. These themes were reflected in the satirical literature produced for the delectation of members of literary academies, and popularised through the explosion of print as chapbooks and broadsheets and even the text and image shown on fans. These were deliberately didactic tales, imbued with a Counter-Reformation morality (Matthews Grieco, Reference Grieco, Sara, Johnson and Matthews Grieco1997, 78–86; Storey, Reference Storey2008; Geschwind, Reference Rachel., Erhardt and Morris2012; McGough, Reference McGough2011, ch. 4; Strocchia, Kelly, Reference Strocchia and Kelly2022). In addition to the more traditional emphasis on the moral and physical dangers for men in associating with prostitutes, increasingly they levelled stark warnings to women of this way of life. This theme was concretely reflected in the later sixteenth-century foundation of Convertite convents to house repentant prostitutes. Although this was part of a longer tradition, the Counter-Reformation gave an extra impetus to this type of institution, as it did to those such as the Zitelle in Venice, which provided shelter to poor young women, who might otherwise, through poverty, be induced into the world of prostitution. Laura McGough has argued that the establishment of Convertite convents paralleled the foundation of Incurabili hospitals, which treated those women who had not heeded the warnings of moralists (McGough, Reference McGough2011).

The admonitory message to young women of the link between prostitution, immorality and the Great Pox underlay the multiplication of popular pamphlets from the mid sixteenth century onwards with titles underlining the inevitable downward spiral of their misfortune. These included Valentino Detio il Colloredo’s The tearful and lamentable case of Cecilia Bruni from Murano (Caso lacrimoso e lamentevole di Cecilia Bruni Muranese, Cortegiana in Venetia a San Paterniano), (Ronciglione, Reference Detio and Colloredo1621), Gasparre Angeli’s discourse about the courtesan Lena (Viterbo, Reference Angeli1622) and ‘the little girl who became a courtesan through being poorly looked after by her mother’ (La putta che diventa corteggiana, Per il mal governo di sua Madre, composta da un Capriccio bizaro, Venice, 1668). By the early seventeenth century, many texts have a different tone. They portray prostitutes as victims of their circumstances rather than as sources of moral and physical infection. Lena, for example, appears to have been fated for a misfortunate life from a young age. She was maltreated by her father, Chiappino, a cobbler on Ponte Sisto. He was murdered when Lena was nine, whereupon she was looked after by her mother, who stole from shops, though her real profession was ‘to give kisses, and she provided this service to everybody’ (La putta, 1668, lines 59–68). Lena’s mother also met a grim end, being beaten so severely that she was taken to the hospital of San Giacomo, where she died two years later, after probably contracting the Great Pox. Lena, orphaned at the tender age of eleven, had little alternative but to follow the example of her mother. She shared her experience of violence and being abandoned by men with whom she had fallen in love, although the story ended happily with marriage to Zan Scarsella.

The emphasis in these stories is on a cycle of misfortune caused through no fault of the courtesan herself, but rather by the conditions in which she grew up, followed by her association with her customers who infected her with Mal Francese. This is rather a different narrative than that presented in earlier texts, such as the Purgatorio, where the courtesan was blamed for overweening ambition and pride, which led to her moral and physical decline.

Despite the introduction of this new more nuanced attitude, the highly moralistic genre remained strong, and the figure of the prostitute was depicted visually in a series of broadsheets, beginning with single sheets illustrating her life cycle, before developing into more complex narrative structures illustrating warnings to both prostitutes and clients of the dangers to each other.

A representative single sheet narrative is Paolo Tozzi’s print dating from c. 1600, This is the least of the sufferings of us prostitutes, dying in a hospital, with verses adapted from a longer poem by the Venetian poet Bartolomeo Bonfante (Figure 19).

Figure 19 Paolo Tozzi, This is the least of the sufferings of us prostitutes, dying in a hospital (verses by Bartolomeo Bonfante, c. 1600),

(Civica Raccolta Stampe Achille Bertarelli, Castello Sforzesco, Milan; © Comune di Milano, all rights reserved)

This shows the sad story of a courtesan, who, in the ‘flower of my life’, had been courted by gentlemen on bended knees, who sang her ballads and songs, caressed her and gave her splendid food to eat, but which all ended in tears and laments. The series of scenes reflects the remorseless turning of the wheel of fortune, as she accepts gifts and flowers from her lovers, who, though smiling, are carrying the Mal Francese. After succumbing to the embraces of one of her lovers as they lie together in the sand dunes, she begins a downward spiral, her life reduced to misery and beggary, as she is depicted with the ulcers of the Pox, while her ex-lover walks past her, holding his nose to block the smell of her disease. Intentionally or not, the posture of the courtesan echoes that of Job on the dunghill, as she is shown semi-recumbent on a sand dune (see Section 5). She ends up sick in hospital (Ospeal), surrounded by chamber-pots and urinals, where she eventually dies. Then, as if the punishment of the pains of Mal Francese were not bad enough, the text ends with: ‘After your death, you will go to the burning fire, where you will remain in perpetuity, buried in that hell.’

The complete version of Bonfante’s poem is printed under a new image of c. 1620 Signora Anzola sick in hospital (Figure 20), thus returning to the topos of 100 years earlier, of the prostitute ending up in the purgatory of San Giacomo degli Incurabili in Rome. Tended by a nun, she is shown lying on a bed with her semi-nude body covered with the spots of the French Disease, reminding the viewer of the perils of the life of a prostitute. As if her suffering was not bad enough, she awaits the painful treatment of the surgeon on the left of the picture (Bonfante, 1620, verses 10–11; Kurz, 165–6):

Anzola addresses the viewer with a direct glance from her sickbed, inviting us to share in her suffering, as in a later stanza she describes her painful symptoms. She is subjected to humiliating treatment by the barber, who cleans the sores all over body, presumably including her genital area, and administers ointment made from mercury sublimate, designed to eat away the sores and ulcers (Kunzle, Reference Kunzle1973, 127–8; Storey, Reference Storey2008, 28–9; Strocchia, Kelly, Reference Strocchia and Kelly2022, 15).

Figure 20 This is the miserable end of Signora Anzola (Civica Raccolta Stampe Achille Bertarelli, Castello Sforzesco, Milan;

© Comune di Milano, all rights reserved)

In the same way that satirical literature 100 years earlier had fallen into two distinct categories, the decline of courtesans and the sickness of men with Mal Francese, so these more complex narrative broadsheets can be divided into those depicting the decline of a prostitute and analogous stories of a rake. The latter emerged slightly later, but many of the textual descriptions, such as Bonfante’s, and their visual counterparts had much in common, relying on one another as models. It has been argued that the Bolognese Giuseppe Maria Mitelli’s 1692 etching, La vita infelice della meretrice (The unhappy life of the prostitute), may reflect an engraving by Andrea and Michelangelo Vaccari in early seventeenth-century Rome (Kurz, Reference Kurz1952, 145). The scenes of the prostitute’s life are divided into twelve months. In January, she blithely dances away with her noble lover, accompanied by musicians, little aware of what her future has in store for her as the year progresses. The final two scenes show her decline and demise; while reflecting themes of Paolo Tozzi’s print of 1600, they are transformed through a much more fluid and sophisticated rendition (Figure 21).

Figure 21 Giuseppe Maria Mitelli, The unhappy life of the prostitute (etching, 1692),

(Civica Raccolta Stampe Achille Bertarelli, Castello Sforzesco, Milan; © Comune di Milano, all rights reserved)

In November, we see the familiar image of the sick prostitute reduced to begging on the street, half-lying and supported by a crutch. A young man wearing a hat, short cloak and sword, to denote his social status, points with horror at the recumbent figure, whose fate is mirrored by the accompanying beggar, who points at his head and disfigured face to emphasise the misery of the disease. The moral of the story is stated in the text underneath: ‘The poor afflicted woman, oppressed by diseases, which cause her to be a beggar on the public streets, curses the lovers, hates herself.’ Significantly for our theme, disease is represented through the disability of lameness, rather than a visual description of her body covered with ulcers and gummata, as it had earlier. The same remains true of the final scene, ‘December and the end of the work’, where she appears in her last hours lying in a hospital bed suffering ‘hardships and woes’ associated with the Great Pox. Her unmarked face is drawn and gaunt, and she is comforted by the crucifix at the foot of her bed and a well-dressed lady lamenting her fate.

The broadsheets and poems of narratives about the decline of both prostitutes and rakes led to the production of elaborate and multi-episode broadsheets. While the reasons that girls became courtesans had more to do with escaping poverty, for men the stories usually involved more affluent individuals, who had lost honour and riches due to their immoral activities and Mal Francese often played an important role in their downfall.

These themes sounded familiar to English and French audiences, because the topic of the connection between the French Disease and immorality was a popular theme of literature well beyond early modern Italy. Catholic corruption was echoed in Measure for Measure, where Shakespeare likened society to a diseased body polluting the way England was governed. In contemporary French literature, as in the writings of Rabelais, the country was portrayed as a metaphorical patient ravaged by the wars of religion (Healy, Reference Healy2001, ch. 4; Losse, Reference Losse2015). Italian broadsheets also inspired iconographic representations of these themes in England, most famously in William Hogarth’s A Harlot’s Progress and A Rake’s Progress, a series of paintings and prints from the 1730s (Kurtz, Reference Kurz1952; Bindman, Reference Bindman1981, Reference Bindman2021).

4.4 Conclusion

The popularity and constant reprinting of these pamphlets and broadsheets points to their hold on the popular imagination. Not only were they distributed widely by travelling vendors and charlatans and displayed in taverns but also scenes came to be popularised further by being reproduced on fans. Close examination of these texts and images shows that the same themes and even the same words were repeated from one pamphlet or broadsheet to another, reinforcing the underlying moral of the Catholic Church’s campaign to reform morals and to remedy social and sexual failings. They also carried a warning about avoiding contact with locations of infection, whether brothels or diseased bodies.

The textual descriptions of Mal Francese, whether in the allegedly autobiographical verses of male patients or the anti-courtesan literature, provided a detailed guide to the signs and symptoms of the Great Pox, which mirrored accounts in medical treatises. The more general public was made aware of the suffering of patients through the mouths of travelling performers, while the visual images of victims added another dimension to their understanding. The boils and ulcerated pustules shown in popular prints reflected the basic symptoms of the disease, especially when linked to disfigurement of the face and limbs, as reflected in the frontispiece of the Purgatory of Courtesans. Emphasis is placed on the sickness of women rather than on their male clients, and while their symptoms were often represented schematically, there were clearly those of the Great Pox described in verse in the texts. The final section will return to examine the visual representation of the Pox on the male body through images of St Job, also often shown schematically, appropriate to the genre. Altarpieces and frescoes of Job reflected and diffused the moral message of the church and at the same time knowledge of the effects of the disease.

5.1 Introduction: Lepra and the French Disease

The image of St Job most familiar in the Middle Ages was as patron saint of ‘lepra’, when he was often shown covered with small spots, reflecting the description in the Book of Job 2:7 as suffering from ulcers, ‘from the soles of his feet to the top of his head’. Like St Sebastian, the patron of plague, who recovered from his first martyrdom, Job offered hope to victims, since he had survived and been cured through God’s grace. Many of these depictions of Job’s disease were very schematic, as in Bartolo di Fredi’s fresco of Job and His Friends (c. 1370), in the Collegiata of San Gimignano in Tuscany (Figure 22). This detail shows his almost naked body and face decorated with small brown boils, with no reference to the more developed symptoms when the disease attacked the soft tissue and bones (Terrrien, Reference Terrien1996; Rawcliffe, Reference Rawcliffe2006; Carnevale, Reference Carnevale2010, Reference Carnevale2015; Boeckl, Reference Boeckl2011, 83–5; Argenziano, 2012; Helas, Reference Helas, Labbé and Schenk2018; Presciutti, Reference Presciutti, Henderson, Jacobs and Nelson2021).

Figure 22 Bartolo di Fredi, Job and his friends (detail), Collegiata of San Gimignano (c. 1370),

(Wikipedia Commons)

This section will examine the ways in which Job was depicted, and whether his iconography changed when he became patron saint of the Great Pox, a disease also typified by lesions (cf. Argenziano, Reference Argenziano, Gasperini and Rossi2013, 79–95). While in early printed books in northern Europe Job appeared in scenes showing God’s punishment for sexual misdemeanours, some of the earliest Italian iconography linking Job with Mal Francese concentrated instead on illustrating themes of his life, a theme which gradually gave way to representation alongside other saints associated with disease (Schleiner, Reference Schleiner1994). We shall trace the growing popularity of his image above all in northern and central Italy, and it will be argued that his increased visibility was at least in part a response to the demand from hospitals and confraternities associated with the campaign to treat the Great Pox (see Section 2).Footnote ²⁶ In the process we shall examine more broadly how representations of Job related to that of ‘lepra’ and plague; although there are many studies of the imagery of these two disease, there is no overall survey of the visual representation of the Great Pox in renaissance Italy (Lodone, Reference Lodone2015, 41; Boekl, Reference Boeckl2011; Bailey et al., Reference Bailey, Jones, Mormando and Worcester2005). Part of the explanation may be that an epidemic of plague was an inherently more dramatic event than the Pox, killing large numbers of people in a short time, with the resulting need to bury thousands, while the Pox was a chronic disease and its victims suffered a long-drawn-out death (Henderson, Reference Henderson, Clark and Rawcliffe2013). The outward signs of the plague, with the large buboes under the armpits or on the thigh, were also more instantly recognisable than the generalised spread of pustules over the body.

We have met Job as patron saint of the Great Pox through references in both chronicles and the Lament of Strascino (Sections 1 and 3), but a brief examination of his life helps to clarify his appeal. The story of Job was familiar in the Middle Ages from The Golden Legend, the popular collection of saints’ lives by the thirteenth-century Dominican, Jacopo da Voragine, and from visual representations usually in ecclesiastical contexts. The basic story addressed the question of why God permits evil in the world, and involved the central character, Job, whose personal tragedies were visited upon him by the devil as a test of his faith, including loss of worldly goods, death of offspring and skin diseases. Job’s faith ultimately triumphed when he was once again returned by God to his former state. The Golden Legend introduces four more characters to tease out some of the themes of the topic: Job’s wife berates him for not actively cursing God for causing his suffering, while his friends, Eliphas, Bildad and Zophar, assert he is being punished for his sins.

Job personifies patience in the face of adversity, and as an exemplar for those suffering from long-drawn-out chronic diseases. The New Testament inspiration for the iconography of ‘lepra’ lay in the episodes when Christ healed a leper and raised Lazarus from the dead (Boeckl, Reference Boeckl2011, ch. 4).

From the later fourteenth century onwards, depictions of the symptoms of ‘lepra’ became more graphic, showing deeper ulcers and distorted limbs and noses (Boeckl, 68–9). This change is largely attributed to the resurgence of its religious importance under the influence of the Observant Franciscans, building on the legend of Francis’s visit to tend patients in a leper hospital. More generally, the Observants emphasised the importance of engagement with the community through charitable works, leading the friars to inspire the foundation or re-foundation of substantial hospitals to treat the sick. These two themes are brought together in an illustration to the Perugian manuscript La Franceschina, a 1474 chronicle of the Order by the Franciscan Jacopo Oddi (Figure 23). In this image Francis and his companions nurse lepers, whose lesions are shown in horrific detail; green and red paints are used to depict the raised nodules and bruised skin, and the sick men have distorted bodies and faces (Presciutti, Reference Presciutti, Henderson, Jacobs and Nelson2021, 92–5, 97).

Figure 23 St Francis and companions tending to lepers in a leprosarium, Jacopo Oddi, La Franceschina (1474),

BCAP, MS 1238 f.223r (Wikipedia Commons)

Even with the Observant Franciscans’ increased interest in lepra, visual representations of it in Italy became much more sporadic, reflecting the disease’s overall decline. At the same time, Job took on his new role as patron saint of the Great Pox, and came to be known, among other names, as ‘the disease of St Job’. Another epithet used by early Italian chronicles was the ‘lepra of St. Job’, which reflects the lack of certainty about the identity of the disease at the beginning of the epidemic. This was in turn translated into uncertainty about its visual representation, and particularly whether symptoms depicted within the first decade referred to lepra or the French Disease, or even both. This was particularly true of early narrative of Job’s life; one of the most complete cycles was by Pseudo-Bartolommeo di Giovanni. He was active in late fifteenth-century Florence and associated with Domenico Ghirlandaio, whose busy workshop produced paintings for charitable institutions, such as the foundling hospital of the Innocenti and the confraternity of the Buonomini di S. Martino (Zeri and Gardner, Reference Gardner and Zeri1971, 140–1).

Figures 24–26 reproduce three of the five scenes. The first shows the destruction of Job’s house and the death of his children, while the second and third emphasise Job’s interaction with his wife and friends. In Figures 25 and 26 there is a striking contrast between his richly dressed friends and Job’s almost nude body covered with a series of brown spots on his face, torso and legs. The dependence of the iconographic tradition of Job as leper can be seen clearly in the near contemporary fresco by Cosimo Rosselli in the Sistine Chapel, Christ Healing a Leper, which forms part of The Sermon on the Mount (Boeckl, 132–36), (Figure 27).

Figure 24 Pseudo-Bartolommeo di Giovanni, ‘The destruction of Job’s house and the death of his children’, detail of The story of Job (late fifteenth century),

State Museums in Berlin, Picture Gallery (Jörg P. Anders. Public Domain Mark 1.0)

Figure 25 Pseudo-Bartolommeo di Giovanni, ‘Job visited by his friends in the wilderness’ (late fifteenth century),

State Museums in Berlin, Picture Gallery

Figure 26 Pseudo-Bartolommeo di Giovanni, ‘Job on his sickbed’ (late fifteenth century),

State Museums in Berlin, Picture Gallery

Figure 27 Cosimo Rosselli, Christ healing a leper, detail of: The sermon on the mount (1481–82) Sistine Chapel, Vatican City (Wikipedia Commons)

Figure 26 shows Job in bed, his condition having worsened with the pustules now depicted more realistically, larger, redder and more prominent, similar to the lepers in La Franceschina. In this panel, the configuration is slightly different; two men are accompanied by Job’s wife and a female servant. His wife, identified by a crown, is remonstrating with Job, who holds out his hand to ward off her injudicious advice to reject God for his unjust punishment. The identity of the two men is not clear, though the one wearing a red head covering was probably a physician discussing Job’s condition and treatment with his colleague. The empty bowl brought by the servant, who is looking at the physician, may indicate imminent blood-letting, part of the therapy recommended by doctors for both lepra and the Great Pox. The body language is similar to the depiction of physician and apothecary in Domenico di Bartolo’s fresco of the scene in the hospital ward of Santa Maria della Scala in Siena painted in the 1440 (Bell, Reference Margaret., Henderson, Jacobs and Nelson2021). The physician holds his nose indicating the smell given off by Job’s suppurating pustules, though his richly dressed companion stands on the platform surrounding the bed, reflecting the physical relationship between patients and practitioners in the woodcut on the frontispiece of the Lament of Strascino (Figure 12).

5.2 Job in the Sixteenth century

From the early sixteenth century Job usually appears as a free-standing figure, not part of a narrative, and with other saints, usually Sebastian and Rocco, patrons of plague victims. In this new iconography, more emphasis is placed on the pronounced signs of disease on his pock-marked body (Lodone, Reference Lodone2015, 35–43). Job’s representation makes an instructive comparison with his frequent companions, Sebastian and Rocco. In common with Sebastian, he is shown as semi-nude, but they differ in age and attributes. Sebastian is portrayed as a youth with an unblemished idealised body pierced by arrows to represent his first martyrdom and the arrows of disease. Though Job also appears semi-nude, he is typically depicted as an older man covered with ulcers and sporting a long white beard. Rocco, whose cult also developed later in the fifteenth century, is shown as a young nobleman pointing to a plague bubo prominently displayed on his upper thigh. While depictions of the attributes of these plague saints remained quite standard, from the latter half of the sixteenth century there was an increasing tendency to include scenes showing the impact of epidemics on the population of cities. Dramatic images of sick and dying men, women and children appeared either in predellas of altarpieces of holy figures or as an integral part of scenes of saints, such as S. Carlo Borromeo tending to the sick (Bailey et al., Reference Bailey, Jones, Mormando and Worcester2005; Barker, Reference Barker and Lynteris2021).

One of the earliest representations of St Job to be securely linked to Mal Francese is an altarpiece by Domenico Panetti including St Job, commissioned by a confraternity in Ferrara dedicated to St Giobbe. It had been founded in 1499 and was granted a patent by Duke Ercole d’Este to collect funds through the state to establish a hospital for incurables, reflecting that the sickness was widespread in the city and among members of the Este family (Section 3; AHF, 47, 151–2). The confraternity commissioned a series of images of the saint, the earliest of which was Panetti’s Virgin and Child with Saints Job, Antonio Abbate, Vito and Pietro Martire (1503) designed for the high altar of the chapel, complementing a fresco-cycle of scenes from Job’s life commissioned at the same time from the local artist Zohaine dall’Agnolo, (Figure 28), (Lodone, Reference Lodone2015, 36, 47–9, 151–2, 319, n. 32).

Figure 28 Domenico Panetti, Virgin and child with saints (1503), Pinacoteca Nazionale, Ferrara

(Creative Commons: CC-BY-4.0. https://catalogo.beniculturali.it/detail/HistoricOrArtisticProperty/0800046616)

Panetti shows Job with joined hands in supplication on behalf of those sufferings from the French Disease, with pustules and boils on his torso, feet and lower legs. The marks are sufficiently pronounced to indicate Job’s association with Pox, and may reflect an early stage of the disease, with small, dry ulcers which developed into pustules, as described by Fracastoro. Towards the end of the century, the confraternity commissioned the Ferrarese painter Ippolito Scarsellino to produce a set of eight panels illustrating The History of Job to replace the earlier fresco-cycle (now in the Landesmuseum, Hannover; Novelli, Reference Novelli2008, 112–5, 304).

Incurable hospitals and confraternities continued to commission works to adorn their churches, oratories and ward chapels, many appearing in the first quarter of the sixteenth century. Like many incurable hospitals, Santa Maria dei Guarini in Bologna, adapted a pre-existing institution, which they re-dedicated to Job.

In the case of Bologna, two strikingly different images of Job were commissioned in this period, one for the main altar of the oratory, and the other for their statutes. The first was painted in 1510 by Francesco de’ Giacomo Raibolini the Bolognese artist known as il Francia, showing the crucifixion framed by the two standing figures of the Madonna and St John the Evangelist (Figure 29). Both are fully dressed, in stark contrast to the virtually nude Job on the ground in front of the cross, reflecting his traditional stance, lying on a dunghill. He points to a banner above him on which is written ‘Maiora. Sustinuit. Ipse’. The message is clear: that by carrying his cross of suffering, his faith will win in the end (Lodone, Reference Lodone2015, 47–8).

Figure 29 Il Francia, Crucifixion with St Job (1510),

Musée du Louvre, Paris (Wikimedia Commons: Sailko)

Though the Incurable hospital is dedicated to the treatment of Mal Francese, Job’s body appears free of blemish, a stylistic decision in line with Il Francia’s highly idealised figures. This is in strong contrast with how Job was depicted in the illumination to the papal privilege to the hospital in 1535. The detail depicted in Figure 30 shows Job to the left side of Mary, the Madonna of Mercy, who spreads out her blue cloak to protect the members of the flagellant confraternity. Job wears a red mantle and extends his left hand towards the flagellants, recommending them to Mary for her protection. The red sores which cover his entire body, including his face, arms and legs, are particularly striking, and remind one of some of the red lesions of patients illustrated in the Perugian album. The lesions correspond to contemporary lay and medical descriptions of the symptoms in the later stages of the French Disease, but without the distorted limbs, which would probably have been considered inappropriate for the context of this image.

Figure 30 St Job, the Madonna della Misericordia and three confraternity members (Archivio di Stato di Bologna, Privilegio di papa Paolo III, anno 1535, in Ospedali, S. Maria dei Guerini, poi S. Giobbe, serie IV, Miscellanea, b. 2. N.8; Protocollo n. 4303 del 20/07/2023)

The iconography of both images indicates the importance of function and setting. The altarpiece, which emphasised Job’s penitential role and the acceptance of suffering in the path towards physical and spiritual health, was designed for a more public audience, while the statutes would have been viewed only by members of the hospital community. The contrast between an image for a more private as opposed to a public audience was also mirrored in the vivid depiction of lepra in the Franceschina manuscript in comparison with the vast majority of altarpieces and frescoes of Job in the Middle Ages.

The cult of Job in the sixteenth century enjoyed extraordinary popularity, as reflected in the many images of the saint in northern and central Italy; an initial survey reveals over fifty paintings, including frescoes. These commissions were driven initially by hospitals and confraternities, which inspired their multiplication in conventual and parish churches. They were not just in major cities, but also in small provincial towns and remote country areas.

The new and important association of Job with Sebastian and Rocco underlines his role in protecting the sick, as reflected in the fresco-cycle commissioned by the confraternity administering a hospital, S. Antonio Abate in San Daniele dei Friuli. In 1513–22, Martino da Udine, or Pellegrino da S Daniele, and his workshop painted the church interior. The panel showing the three saints together is of particular interest because of the contrast between the way their bodies were represented, given that each was linked to a major disease (Figure 31). On our right a well-dressed Rocco gazes at the viewer with his left leg exposed to show a significant raised brown bubo to which he points with his left hand, underlining its importance as a well-known symptom of plague. On the left, the pale-skinned and virtually unblemished youthful body of Sebastian is pierced by a single arrow. In stark contrast, the older Job with a white beard has a much darker skin tone. He is semi-dressed, revealing a scattering of brown lesions on his arms and legs, distinct from Rocco’s bubo (Bergamini and Barattini, Reference Bergamini and Barattini2000, 83, 86–7).

Figure 31 Pellegrino da S Daniele, workshop, Sts Job, Sebastian and Rocco, fresco, St Antonio Abate, San Daniele dei Friuli (1513-1522),

(Photo: Kunsthistorisches Institut in Florenz – Max-Planck-Institut, detail)

Job also appears with other holy figures associated with disease, as with a commission by the confraternity of bombardiers of St Barbara in the Carmelite Church of Santa Croce in Vicenza (Figure 32).

Figure 32 Marcello Fogolino, Madonna and child with Sts Job and Gottard (1505–08): Pinacoteca di Brera, Milan

(Creative Commons: CC-BY-4.0) (https://catalogo.beniculturali.it/detail/HistoricOrArtisticProperty/00180074)

In 1505–08, Marcello Fogolino painted this altarpiece for the Chapel of Santa Barbara, the patron saint of soldiers. It shows the enthroned Virgin and Child; St Job stands semi-nude to the Virgin’s right in contrast to the richly apparelled St Gottardo. Though Gottardo was the patron saint of illnesses, such as fevers and podagra, his face and hands are unblemished, while Job’s body is covered with clearly portrayed red lesions and boils. This graphic depiction of a disease well-known to its intended audience, for soldiers initially spread it through Italy, recalls the Perugian watercolour of the army surgeon treating a man with severe red lesions (Figure 7). The altarpiece also underlined Job’s patience in the face of suffering as he prays to the Virgin and Christchild (Lucco, Reference Lucco and Zeri1990, 309–311; Lodone, Reference Lodone2015, 51).

We began this section by asking how far the representation of the French Disease in relation to Job differed from the iconography of lepra on his body and that of Lazarus. While the more decorative presentation had much more in common with the traditional representation of Job’s ‘lepra’, ulcers and pustules of the Great Pox were more distinctive.

Interpreting the representation of disease in the visual arts is no more straightforward than in the literary context, discussed in Sections 3 and 4. Fortunately, an altarpiece by Francesco Pagani for the convent of San Francesco in Conegliano in the northern Veneto in the 1520s offers a comparison between Job and Lazarus (Figure 33). Both men appear semi-nude, but Job’s body, discretely covered with a branch and leaves, has a scattering of brown ulcers. The only indication of Lazarus’s sickness is the dog licking his sore ankle. Of course, the main purpose of the altarpiece was not medical illustration, even though sickness is represented, but religious and is reflected in the moving and intense Franciscan piety, with the dead Christ supported by Mary’s arms and the two saints.

Figure 33 Francesco Pagani detto da Milano, The descent from the cross with the Virgin, and Sts Job and Lazarus (1520s), Gallerie dell’Accademia, Venice (BCS: LICENCE CC-BY 4.0)

We have seen that the first forty years of the sixteenth century often saw greater attention paid to depiction of the symptoms of the Great Pox, reflecting wider knowledge of the disease not only among those who commissioned images, including confraternities, hospitals and the Franciscans, but also among members of the wider public. Another temporal change from the later sixteenth century was a return to narrative scenes. The importance of narrative was reflected in Gregory Martin’s 1581 guidebook Roma Sancta, describing a scene in front of the Roman Incurabili hospital of San Giacomo on their main feastday: ‘Upon St James day in Julie, when al the citie visiteth this Hospital, there are set forth in lively purtraicts Job with his sores upon the dunghill, his wife holding her nose for niceness not abiding her husband’s stinche, his three frenddes weeping and lamenting his case’ (Martin, Reference Martin and Parker1969 ed., 187; AHF, ch. 8).

The display of these images was intended to solicit both compassion for the sufferings of the poor incurables and financial support for the hospital. Figure 34, a later print of a 1622 altarpiece, summarises many of the themes discussed in Section 3.2. It is by the Sienese painter Raffaello Vanni and is a dramatic transposition of the traditional scene of Job being mocked by his wife into the battle between good and evil, reflecting the woodcut on the title page of the Lament of Strascino (Figure 12). The semi-clad Job is shown seated on the base of a neo-classical column. Though his wife urges him to abandon God, as indicated by Job’s glowing halo, his battle against temptation is nearly over. Evil has been overcome, as one can see from the devil’s upended body with taloned legs and feet at the very centre of the composition, while Job glances towards the heavens and God reaches out to save him. This picture, then, paints a strong moral and theological message, underlined by the important, if subtle, role of the depiction of disease. If not as dramatic as some of the earlier sixteenth-century images of the saint, nevertheless his body was marked by a series of lesions, which would have been recognisable, in conjunction with this narrative, as representing the French Disease. There may be a number of reasons to explain this iconographic shift to moralising themes. It may reflect changing priorities and tastes following the Counter-Reformation. As we have seen in Section 4, less emphasis was placed on the close connection between disease and sin and more on redeeming fallen women and discouraging young women becoming involved in prostitution. Literary texts came to place more emphasis on immorality with less discussion of the detailed symptoms of disease. In the cheap woodcuts and prints detailing the remorseless wheel of fortune associated with the decline of women who sold their bodies, the French Disease became a symbol of wider social and moral malaise.

Figure 34 Raffaello Vanni, St Job mocked by his wife (late eighteenth-century print of 1622 altarpiece),

(Wellcome Collection: Public Domain)

5.3 Conclusion

This section has underlined the growing popularity of the cult of Job in sixteenth-century Italy, as images of the saint in altarpieces and fresco-cycles penetrated major cities and towns and smaller and more isolated rural areas. Many images of Job were commissioned for chapels and churches belonging to hospitals and confraternities associated with the treatment of the French Disease, but they also spread out to parish churches and religious Orders, particularly Franciscans.

Broadly, the way that the French Disease was represented grew out of Job’s earlier role as patron of ‘lepra’, and while there were many similarities, particularly in the rather schematic representation of symptoms, some distinct traits of ulcers and pustules did emerge, which reflected descriptions of the Great Pox by medical and lay writers. There was also much variation in how the disease was shown according to the context of a commission. Patrons might wish the artist to stress Job’s role as a penitential saint who was to be emulated, but with less stress on symptoms and more on suffering to be emulated, while in others, such as in hospital contexts, ulcers and pustules were shown in greater detail to emphasise how a patient needed faith to recover. The return to more narrative scenes in the later sixteenth century, reflecting wider shifts in religious and moral discourse, meant that Job’s symptoms remained an integral if more subtle part of his iconography.