Syphilis hit at the heart of the body culture that featured so strongly in the baths and festivals. Grossly disfiguring to the face and private parts, and highly contagious, it created an unprecedented fear of sexuality, and also polluted the act. You had to check, now, that the vessel was 'clean'. Rottenness could be hidden beneath superficial beauty. New ways and new avoidances had to be learnt, and learnt fast:

Take heed of the perils of lovemaking And change your ways accordingly... Avoid blotchy folk, and don't despise those who are loyal partners, Stick to sweethearts, who are not to be lightly dismissed. But make sure you don't start the job Without a candle; don't be afraid to Take a good look, both high and low, And then you may frolic to your heart's content.68

Better still, remain chaste until marriage: 'keep thee clene unto the tyme thou be maryed'. The only true surety of cleanness was prenuptial virginity, for both men and women. The printed broadsheet The Wedding of Youth and Cleanness (1509) showed how 'Virtue conquers Sensuosity and is rewarded by Love.' For those who had not yet got the disease, they should avoid infected people 'as one avoids contact with a leper'. A good regimen, without Venus, was essential; or if with Venus, a meticulous hygiene of the genital areas was required at all times— bathing with hot water and wine (or vinegar), using herbal washes, dusting with mineral powders, and 'above all, avoid using towels belonging to prostitutes'.69

The offspring of an 'ancestral spirochete' (treponematosis) that is now thought to have been endemic worldwide from ancient times, syphilis suddenly mutated into a far more virulent form in the Spanish Atlantic ports in 1492 and reached central Europe by 1502, before travelling on to India, the East Indies, Japan, and all colonial trading islands. Eventually it retreated, and over the succeeding five centuries became endemic, dwindling into a curiosity, then into 'silence and contempt', leaving a huge legacy of syphilitic wives and children throughout the world, before finally dropping off the list of scourges in the mid-twentieth century. In the worst cases, the syphilitic tubercles were followed by a tumour that bored into bone tissue and then liquefied, exposing the bones and eating away at the nose, the lips, the palate, the larynx, and the genitals.

Syphilis (unlike plague) was not a disease of poverty, but raged equally among the nobility, royalty, and clergy, partly due to the wide sexual licence given to aristocratic youth who visited brothels for their education—with the result, said Montaigne (1533-92), that 'we are taught to live when life has already passed us by. A hundred schoolboys have caught the pox before they have studied Aristotle on Temperance.'70 But anyone was at risk;and syphilis was emotionally described in real-life patient experiences pouring out of the new printing presses, the start of a long tradition of popular self-help medical autobiographies. In 1498 a young canon, Josephus Grunpeck, wrote a most horrifying and graphic personal account in which he described how he worked his way downwards from fashionable physicians before finally, in desperation, seeking help from 'louts and uneducated folk'—to whom with hindsight he gave due credit:

These uncouth men, whoever they were, cesspool emptiers, rubbish collectors, cobblers, reapers and mowers, had to lance the tubercles, those harbingers of countless horrible and incurable wounds, and thus drive away or suppress the consumption with pills, ointments, creams, or some other such medicine; and it is undoubtedly due to the zeal, industry, and application of these men... that I, afflicted for the second time, and very severely at that, with this illness, recovered my forces sufficiently to resume my usual activities.71

Syphilis had a profound effect on the trades of the barber-tonsors and barber-surgeons. In a tradition probably dating back to classical times, barbers' back rooms and yards (if they had them) were used for minor surgery and baths; the front of the shop dealt with hair-cutting and shaving, and the jovial grooming atmosphere encouraged the sale of books, drinks, and pharmaceuticals on the side. To start with, as Grunpeck's experience shows, long-term venereal treatment could be done by anyone, certainly by any barber;but it was later regulated on the grounds that it was too 'perilous' to keep the (clean) grooming and (unclean) curing activities together. The English 1540 Act that joined the Barbers' and Surgeons' companies gave the educated barber-surgeons (and of course the physicians) the lucrative monopoly on treating venereal disease, and excluded the older general handymen, the barber-tonsors (as also happened in France). But the English Parliament also made it quite clear that the ancient practices of mutual aid and empiric medicine should not be allowed to disappear, by promptly passing the so-called Quacks' Charter in 1542-3 that legally enabled anyone to practise medicine, if they could 'so help their neighbours and the poor'.72

Meanwhile the baths, bathsmen, and their guilds disappeared completely along with the regulated stews. As was realized by many at the time, the closure of these licensed stews concentrated in the central parts of major towns was a public health disaster. In London old leper hospitals isolated some of the syphilitic poor, but the main means of transmission—the public prostitutes—were dispersed, and went 'private': 'Since those common whores were quite put down, a damned crue of private whores are growne...'. The prostitutes of London served a town that had one of the fastest-growing populations in Europe, and the bawdy houses quickly spread to the suburbs outside the walls (St Giles, Blackheath, Stepney, Saffron Hill, Petticoat Lane).73 These were more secretive, and more furtive, establishments that found a new home in small lower-class alehouses, and in upper-class taverns. But the aristocracy did not forgo the illicit pleasures of water for long; a century later the steam bath reappeared in the luxurious upper-class establishments known as bagnios.

In most respects medieval society was not a 'dirty' society—far from it. Alongside intense religiosity, there was intense materialism. Socially speaking, personal freshness actually mattered, and was quite an accomplishment under the circumstances; though perhaps too difficult an accomplishment for many, at least on a regular basis. But the Catholic Church, which as a whole had fought so hard to impose intellectual refinement, physical cleanliness, and sexual cleanness over the centuries, adapting itself to various strategies to win over unwilling populations, suddenly found itself under a bruising attack for its own moral laxities. The Church had unwisely persecuted extreme ascetic Church reformers such as the Albigensian Cathars (Greek kathari, the pure ones);but the ascetic movements refused to die away, and asceticism split the Church once more. A renewed programme of ascetic austerity (and celibacy) was reimposed successfully on all Catholic clergy after the Counter-Reformation Council of Trent in 1562-3, but by then the damage had been done.74 The trend towards decentralized Christianity was irreversible in northern Europe at least, where many Protestant ascetics had come to believe that each sinner held his or her own conscience, and bodily welfare, entirely in his or her own hands.

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