Satan’s Harvest Home, an anonymous pamphlet published in London in 1749, offers a copious accounting of contemporary vices, with special attention to “the Present State of Whorecraft, Adultery, Fornication, Procuring, Pimping, Sodomy, And the Game at Flatts.” That state was strong, the pamphlet found, throughout “this good Protestant kingdom” and especially in the capital city of London: brothels bustling, coffeehouses, taverns, and gin shops overflowing, homosexuality on the rise, and the streets filled with a “vast Body of Courtezans, which stands ready, on small Purchase, to obey the Laws of Nature, and gratify the Lust of every drunken Rake-hell.” The unhappy results were, likewise, everywhere to be discerned: livelihoods, marriages, and reputations lost; illegitimate children gotten. Worst of all was “the Propagation of that infectious Disease call’d the French Pox, which in two Centuries has made such incredible Havock all over Europe.” Soldiers, university students, and dissolute aristocrats were notoriously prone to it—as, of course, was the vast body of courtesans—but no one was immune: “Men give it to their Wives; Women to their Husbands, or perhaps their Children; they to their Nurses, and the Nurses again to other Children; so that no Age, Sex or Condition, can be entirely free from the Infection.”

The pamphlet’s rhetoric was sensational but as the historian Olivia Weisser’s new book suggests, its epidemiology was sound. The disease we call syphilis did, in fact, become endemic in Europe at the end of the fifteenth century and menaced the continent for centuries after. Where syphilis came from—whether it was carried north by mercenaries in the army of Charles VIII, was brought from the New World on ships, or evolved domestically from an existing strain of disease—is still unclear. Whatever its origin, the disease’s impact was enormous: the first documented outbreak occurred in Naples in 1495; by the start of the sixteenth century “the dreaded pox”—to quote Weisser’s title—had spread across the continent of Europe and was making inroads in Asia. With its rapidly swelling, close-quartered, highly transient population, the city of London was an ideal breeding ground for venereal disease; by the late eighteenth century roughly one in five city dwellers under the age of thirty-five had been infected, “well over twice as high” as in less crowded regions of the country.

The author of Satan’s Harvest Home was right on another point, too, Weisser suggests: the pox plagued everyone in eighteenth-century London. For those infected with the disease, it meant years of terror and an intermittent, ever-worsening array of symptoms, from skin lesions and genital secretions to bone loss, organ damage, and madness. For the rest of the population, it meant existing in a constant state of low-level anxiety about the possibility of infection. “The disease walked the streets in the form of pocked faces, wigs, patches, and bleached skin,” Weisser writes.

Advertisements for cures adorned the walls of shops and peppered the pages of newspapers. The disease was the subject of drinking songs and the centerpiece of court cases. Antivenereal pills and potions were concocted in home kitchens and stocked in cabinets, while ready-made cures were sold out of grocers’ stalls, markets, bakeries, and cheese shops. City dwellers saw, read, sang, and spoke about venereal disease. To traverse London was to glimpse a kind of long-running public morality play in which the wages of sexual sin were made manifest in the flesh of passersby. But it was also to witness the birth of a new era of medical diagnosis and legal evidence in which the old social currencies of guilt and shame were put to novel uses.

The cloud of infamy surrounding the pox informed the way the disease was treated, both by those afflicted with suspicious symptoms and by those promising to cure them. Indeed, earlier than most histories of medicine suppose, Weisser argues, the pox shifted the understanding of disease itself from the dysregulation of an individual body—a complex ecology of nerves and humors subject to environmental influences and its own peculiar internal weather systems—to the operation of a distinct and recognizable agent of infection. That theoretical shift, which was accompanied in practice by a turn from self-reported symptoms to clinical observation and targeted diagnosis, is typically traced to the urban hospital wards of the nineteenth century, where physicians treating large numbers of patients suffering similar courses of disease started to extrapolate from common symptoms to shared underlying afflictions, and from shared afflictions to standardized regimes of treatment.

The doctors, apothecaries, and unlicensed healers who treated sexually transmitted diseases in eighteenth-century London were not, Weisser emphasizes, thinking in such abstract terms; rather they were confronting an impasse in communication. “Venereal healers relied on sensory observations and manual manipulations to evaluate the sick people in front of them…not because they could envision the disease’s trajectory and knew how to interpret signs with certainty” but because they assumed their patients were lying to them—about what they were feeling, how long they had been suffering, and what actions or events had preceded the onset of their affliction. By the same token, patients themselves sought out ready-made drugs and standardized courses of treatment not because they understood them to be pharmacological specifics for a given pathogen but because they craved anonymity. Old-fashioned morality begot newfangled medical practices.

As a result, Weisser argues, sexually transmitted infections were the first ailments recognized as belonging to their own distinct category of disease, though eighteenth-century diagnostics were far less precise than our own. What we would now regard as different pathogens—chlamydia, gonorrhea, syphilis—were all simply known as “venereal disease” or, more euphemistically, “the secret disease,” “the French disease,” “the Neapolitan disease,” and “the pox.” (People in France and Naples “preferred other names.”) The disease was understood to manifest on a spectrum of affliction: “a clap” was a mild or early case—the sort of thing a rakish young man might boast about to his friends—while a “true pox” was a serious case, attributed either to repeated acts of sexual excess or to prolonged neglect. (As Alexander Pope said of an acquaintance whose offensive manners had worsened with age, “Time…at last matures a clap to pox.”)

Symptoms varied: in the early stages of a clap, painful urination and genital discharges (“gleets”) were common, as were swellings or eruptions on the skin—“pustules, ulcers, itching, and scabs.” Patients afflicted with the pox might also complain of sore throats and sore eyes, headaches and fevers, symptoms hard to distinguish from those of other ailments (and increasing the temptation, no doubt, to pretend that one merely had a hangover or a cold). In the most advanced cases, however, the signs were unmistakable—and appalling. Sufferers presented with fallen palates, sunken noses, necrotizing sores, mental disturbances, and full bodily paralysis: “a dismal Scene,” in the words of one expert.

The pervasiveness of such dismal scenes in eighteenth-century medical literature and popular culture has led some historians to identify it as a time of unprecedented sexual license. But caution is advisable: “It is impossible to say what individual patients ‘actually’ suffered from,” the historian Kevin Siena observes in Venereal Disease, Hospitals and the Urban Poor (2004), and unwise in any case to link the spread of venereal disease to changes in sexual norms and behaviors.¹ What demonstrably did change between the late fifteenth century and the eighteenth was syphilis itself. Records of early outbreaks suggest a nightmarishly swift and vicious disease, as Jared Diamond notes in Guns, Germs, and Steel (1997): “Its pustules often covered the body from the head to the knees, caused flesh to fall off people’s faces, and led to death within a few months.” Within fifty years, however, the spiral-shaped syphilis bacterium had evolved into the agent of a still-nightmarish but far less deadly infection, long incubating and intermittently surfacing. For the bacterium itself, Diamond notes, this was all to the good: “Syphilis spirochetes that evolved so as to keep their victims alive for longer were thereby able to transmit their spirochete offspring into more victims.” For people, however, it meant that dying from the pox was now only half the problem; first, one had to figure out how to live with it.

And that, Weisser argues, is what eighteenth-century Londoners became extraordinarily practiced at doing. Keeping an infection secret wasn’t easy. Beauty patches and thickly applied cosmetics could mask facial lesions and scars, but the wide-stance gait of an individual with an active case of genital sores was harder to dissemble. One man caught running down the street with a stolen silver tankard stuffed down his pants was described in court as “straddling as if he had got the Pox.” In advanced cases—often exacerbated by treatment with toxic mercury-based remedies—ulcers on the throat and palate caused a distinctive speech impediment one healer described as “snuffling.” Snuffling and straddling, the victims of venereal disease were desperate for relief—and for secrecy, which made them easy marks for the purveyors of ready-made cures.

The pox, as the medical historian William F. Bynum puts it, was a “quack’s paradise.” A less censorious name for such practitioners—the one they themselves embraced—is “empirics.” Unlike surgeons and apothecaries, empirics had no formal medical training, no system of apprenticeship or credentialing. Their cures—powders, oils and potions, balms and salves, poultices, pumices, and fumigations—were based not on academic theory but on experience: their own, and the ones they provided to customers, which tended to be dramatically purgative. “As patients retched, defecated, and spat,” Weisser writes, “the pestilence was expelled from their bodies [in] a healthful and observable elimination of excessive, clogged, or corrupt matter.” Feeling awful was proof that the treatment was working. So was paying through the nose: a basic powder could be had for a half-shilling a dose, but a glass-bottled elixir might cost twenty-one shillings—“eleven days’ wages for a skilled tradesperson.” One enterprising healer offered remedies on a sliding scale: “five shillings for a mild clap and up to ten for a severe case.”

Coffeehouse walls were pasted thickly with advertisements for exotic-sounding cures—“Paris pills,” “Greek Water,” “the Herculean Antidote,” the “Italian bolus”—highlighting their provenance and efficacy (“Ancient & Excellent”) and their palatability (“more like a Pomander than a Pill”). The cures themselves could be found for sale at apothecaries and surgeries but also in bookstalls, toy shops, taverns, and private homes. Some pox remedies, conveniently, doubled as treatments for inoffensive ailments: those in need of a discreet cure were urged to go to Mr. Haines on the Strand and “ask for the Three chemical Indian Beads for the Rheumatism.”

Privacy was essential to patients, but for those treating venereal disease, publicity was king. John Case (“your old Friend Dr. Case, who faithfully Cures the Grand P—”) was one big name in the business; John Marten, author of a number of best-selling books on the subject, was another. Dr. William Cockburn—the ad copy writes itself—specialized in “looseness” but had a lucrative sideline in an antivenereal drink “popular among Dutch physicians.” All insisted that they were reputable and trustworthy professionals while their colleagues were rapacious frauds: a substantial chunk of Marten’s A Treatise of All the Degrees and Symptoms of the Venereal Disease, in Both Sexes (1708) is devoted to the “Mischiefs caus’d by Ignorant Pretenders.”

In another book, Marten impugned one rival, John Spinke, by name, calling him a “Country-barber” and his remedies a “meer Sham to get Mony.” Spinke retaliated with a self-published volume titled Quackery Unmask’d (1711), in which he charged Marten—“Venus’s Botcher” and “Quack of Quacks”—with faking his learning, juking his book sales, and “talking like a tampering Old Woman.” A century earlier, in the records he kept of his busy medical practice in Stratford-upon-Avon, Shakespeare’s son-in-law John Hall complained that a man with “virulent gonorrhea” had wasted a month seeking remedies from a surgeon before coming to him to be “suitably and correctly purged.”²

Anonymized accounts of successful treatments were a crucial marketing device for healers, and these supply Weisser with some of her most detailed evidence of how venereal disease reshaped doctor–patient relations. Practitioners called in to consult on possible cases of the pox took for granted that their patients would obfuscate, prevaricate, and hedge, and so they paid close attention both to their outward symptoms and to their “Habit and State of Life.” In an elderly spinster a recurring sore throat might be a “common Catarrh or Cold,” but in a known denizen of brothels and bathhouses, it was probably a clap. One patient first attributed his swollen testicle to having slept cross-legged, but when the physician Daniel Turner—who had obtained a medical degree from Yale in exchange for a donation of books to the college’s fledgling library—noticed stains on his bedsheets, the man burst into tears, “admitting that he was poxed and begging Turner to protect his reputation.”

In the encounter between Turner and his patient, Weisser sees an anticipation of the moralizing logic of the nineteenth-century penitentiary, Magdalen hospitals, and other “reform-minded institutions,” although, as she acknowledges, pox treatment also had the aura of the pre-Reformation Church. The box constructed to shield customers from public view while they paid for pills handed through a tavern window strongly resembled a confessional, and even when a healer was sure of his diagnosis the patient’s admission of sexual impropriety was regarded as salutary. But savvy practitioners understood that it behooved them not to insist on a full confession, much less perfect contrition, before proceeding to absolution in pill or powder form. “I never differ with patients about names,” the physician John Douglas explained, “but leave them always to call their disease what they please.”

Of course, plenty of sufferers sought to cure themselves—the most private method of all. Weisser notes that early modern recipe books are a valuable but “elusive” resource for tracking trends in the treatment of venereal disease, since few recipes are baldly titled “for the pox.” But home remedies for dropsy, scurvy, and bone ache often contain knowing allusions to what the compiler of one recipe book called “diseases in the secret parts”; references to warts, sores, or “runnings,” “pain and rawness of the privities,” and “swellings in the yard” supplied broad hints to those in need. Ingredients gave hints, too: plantain water, chinaroot, guaiacum seeds, and sarsaparilla were known specifics for venereal disease; so were breast milk and liquid or powdered mercury. One Sussex man “made himself a mercurial girdle”—flannel coated in ointment made of mercury, turpentine, and pig fat—and wore it for a month to treat an itch he attributed to “lying on dirty bedsheets.”

The most inventive and inveterate self-treater of venereal disease Weisser finds is Thomas Thistlewood, a Lincolnshire man who moved to Jamaica in 1750, serving first as an overseer and then as the owner of a sugar plantation. Thistlewood was a horror of a human being, an appallingly cruel and violent man whose sadistic instincts were licensed and supercharged by the system of slavery.³ He was also a diligent diarist who kept careful track of the progress of the venereal disease he had brought with him from England and of his yearslong quest for a cure. The list of Thistlewood’s recurring symptoms is, frankly, a joy to contemplate: “sores and swellings on his groin, a burning sensation while urinating, involuntary erections, small fleshy growths on his genitals, and continued discharges”; muscle aches, headaches, and fevers; a “sort of tickling in the urethra,” bouts of “searing pain,” and a “weeping” penis. The hellish remedies he endured also make for pleasant reading: mercury pills and turpentine enemas, regular bloodletting and gallons of home-brewed herbal emetics, self-administered exams with a metal probe, injections of “cleansing water” into the urethra with an ivory syringe, poultices made of nettles and “cow itch.” It isn’t clear from the diary whether Thistlewood ever attempted a cure involving the application of powdered quicklime dissolved in boiling water, “as hot as y[o]u can endure it,” to genital sores—but one can hope.

What is hard to bear is the knowledge that Thistlewood was spreading his disease to the victims of his relentless sexual predation. In his diary he routinely mentions forcible encounters with enslaved women—at least 138 of them, by his own account. Plantation records reveal that twenty-eight of those women suffered subsequent venereal infections. Predictably, Thistlewood blamed the women. “Head ach[e], feverish feel oddly: a small running,” he writes in one entry, adding, “suspect Fanny.”

Despite its title, the early chapters of The Dreaded Pox are strikingly buoyant in tone, leavened by the Entrepreneurial Anticks of quacks and the follies and foibles of their customers. Eighteenth-century English folk also thought venereal disease was funny: in ballads, jest books, and plays, the tricksy, poxy whore and her hapless (or hard-bitten) john were recurring comic types. Real-life accounts of affliction sold even better: as one critic of John Marten’s medical treatises shrewdly observed, he wrote to “amuse the World and gain Patients.” The first aim was, potentially, every bit as lucrative as the second, and the cheerfully lurid cover of The Dreaded Pox suggests that Weisser’s own publisher is well aware of it.

But Weisser herself remains attuned to the grim realities of her subject. The pox ruined lives, and as the later chapters in her book remind us, not everyone had a rollicking good time on the way to getting it. Popular imagination associated the pox with prostitutes, but as the author of Satan’s Harvest Home lamented, mothers and nursemaids also sometimes transmitted the disease to children. Indeed, many female sufferers of venereal disease were married women infected by their husbands; others, like the enslaved women of the Thistlewood plantation, were victims of rape. And in both cases, the outward manifestations of the pox, however painful and unwelcome, were also a rare form of legal currency: backed by the validation of a professional diagnosis, they were tangible proofs of harms society otherwise tended to ignore.

Take the case of Lady Frances Hanbury Williams, whose husband, Charles, regularly visited the spa town of Bath, seeking relief from what he described as a stubborn case of colic. In fact, it was a venereal disease—as Lady Frances realized in late August 1742, when she found herself in “misserable condition” back in London, suffering from painful genital ulcers and a persistent vaginal discharge. When she recovered sufficiently to do so, Lady Frances filed for a legal separation and custody of the couple’s two young daughters. Absent “undue cruelty,” a husband’s adultery was not grounds for such a separation, and in letters to her lawyers, Lady Frances never openly accused Lord Charles of infidelity. Instead, she charged him with the “infamous Crime” of lying to her about the nature of his own affliction. The court awarded her the separation, and in 1762, when Lord Charles died, an Act of Parliament gave her the right to revert to her maiden name. A decade later she died under the care of a physician from St. Luke’s Hospital for Lunaticks.

Weisser finds records of seventeen trials in which a wife’s unwitting infection with venereal disease was advanced as legal cause for separation from her husband. Men no doubt found themselves in similar predicaments, infected by their adulterous wives, but they might not have needed to out themselves in court, since a wife’s infidelity was sufficient cause for separation if her husband wanted it. For women, however, venereal disease provided “a language for expressing the grave implications” of sexual betrayal—and a language for expressing the devastation of rape. Unlike firsthand testimony, which was regarded as untrustworthy, and unlike bruises, scrapes, and broken bones, which healed in time, the marks of venereal disease were “long-enduring, debilitating, and visible.”

The qualities that made infection so publicly shameful were singularly useful as evidence: awkward gaits, persistent sores, stained linens, and foul secretions “did the work of proving rape.” The method wasn’t infallible, of course, and establishing that sex has occurred isn’t the same as establishing that it was nonconsensual. But the presence of an affliction no one wanted seems to have made it significantly easier for a judge and jury to grant that the sex had also been unwanted: around 11 percent of early modern rape trials ended in a conviction, but the conviction rate for trials involving venereal disease was 34 percent.

Stigma, then, was the most complicated and unpredictable side effect of all. It added greatly to the suffering and anxiety of many eighteenth-century patients, but it gave others a medically authorized, legally consequential vocabulary for naming sexual harms. For those desperate to avoid it, stigma created huge incentives to disguise or falsify the nature of their affliction. For those eager to capitalize on it, it created a booming trade in quick cures and ready-made remedies—the beginnings, Weisser suggests, of the commercial pharmaceutical industry. And for medical professionals of all stripes, it shifted the burden of attention and care from the individual subjective experience of illness to the underlying causes and recognizable patterns of disease, even as it also recast treatment as a confessional rite. When it came to venereal disease, Weisser’s book persuasively suggests, stigma was both an atavistic force and a cultural accelerant. It was part of what made the pox dreaded, and medicine modern.