Medicine in the Middle Ages / Extracts from "Le Moyen Age Medical" by Dr. Edmond Dupouy; translated by T. C. Minor

by Edmond Dupouy

THE ERUPTIVE FEVERS OF THE SIXTH CENTURY —— VARIOLA, MEASLES, SCARLATINA.

Before the sixth century, the terrible period of the plague, one never heard of the eruptive fevers. Small-pox, measles and scarlet fever were unknown to the ancients. Neither Hippocrates nor Galen nor any of the Greek physicians who practiced in Rome make mention of these diseases. The historians and poets of Greece and Italy who have written largely on medical subjects remain mute on these three great questions in pathology. Some authors have endeavored to torture texts for the purpose of throwing light on the contagious exanthemata, but they have not been repaid for their fresh imagination.[17] It is admitted to-day that the eruptive fevers are comparatively new diseases, which made their appearance in the Middle Ages.

The first document that the history of medicine possesses on this point is that left by Marius, Bishop of Aventicum, in Switzerland, who says, in his chronicle, “Anno 570, morbus validus cum profluvio ventris et variola, Italiam Galliamque valde affecit.”[18]

Ten years later, Gregory of Tours described the symptoms of the new disease in the following terms:[19]

“The fifth year of the reign of Childebert, 580, the region of Auvergne was inundated by a flood and numerous weather disasters, which were followed by a terrible epidemic that invaded the whole of Gaul. Those attacked had violent fevers, accompanied by vomiting, great pain in the neighborhood of the kidneys, and a heaviness in the head and neck. Matter rejected by the stomach looked yellowish and even green, many deeming this to be some secret poison. The peasants called the pustules corals.[20] Sometimes, after the application of cups to the shoulders or limbs, blisters were raised, which, when broken, gave issue to sanious matter, which oftentimes saved the patient. Drinks composed of simples to combat the effects of the poison were also very efficacious.

“This disease, which commenced in the month of August, attacked all the very young children and carried them off.

“In those days Chilperic was also seriously afflicted, and as the King commenced to convalesce his youngest son was taken with the malady, and when his extremity was perceived he was given baptism. Shortly afterwards he was better, and his eldest brother, named Chlodobert, was attacked in his turn. They placed the Prince in a litter and carried him to Soissons, in the chapel of Saint Medard; there he was placed in contact with the good Saint’s tomb, and made vows to him for recovery, but, very weak and almost without breath, he rendered his soul to God in the middle of night.

“In those days, Austrechilde, wife of King Gontran, also died of the disease; while Nantin, Count of Angouleme, also succumbed to the same malady, his body becoming so black that it appeared as though calcined charcoal.”

Gregory of Tours, in another chapter, narrates:

“The year of the reign of King Childebert, 582, another epidemic broke out; this was accompanied by blackish spots of a malignant nature, with pustules and vesicles, and carried off many victims.

“Touraine was cruelly devastated by this disease. The patient attacked by fever soon had the surface of his body covered by vesicles and small pustules. The vesicles were white and very hard, presenting no element of softness, and were accompanied by great pain; when they had attained maturity they broke and allowed the humor within to escape. Their sticking to the clothing of the body added considerably to the pain. Medical art was wholly impotent in the presence of this malady, at least when God did not come to the doctor’s aid.

“The wife of Count Eborin, who was attacked by the disease, was so covered by vesicles that neither her hand nor the sole of her foot nor any portion of her body was exempt; even her eyes remained closed. Soon after the fever ceased the fall of the pustules occurred, and the patient recovered without more inconvenience.”

Small-pox came, then, from the Orient—that eternal center of all pestilences and curses. From the seventh century the Saracen armies spread the malady wherever they passed—in Syria, Egypt, and Spain; in their turn, the Crusaders, in returning from the Holy Land, brought the disease into France, England, and Germany. From thence the great epidemics of the twelfth and thirteenth centuries, after which the small-pox became epidemic, appearing and disappearing without causation, but always destroying myriads of victims. “In 1445,” says Sauvel “from the month of August to Saint Andres’ day (November 30), over 6,000 infants died in Paris from small-pox.[21] The physicians knew neither the nature nor the treatment of the new disease.[22]

The measles was first noted at the same time as the small-pox, making its first appearance as an epidemic in the sixth century.

It is more than probable that the measles originated in Egypt, and according to Borsieri, it had such an extension throughout Western Europe that there were but few persons who had not suffered attacks. The history of measles, however, is less clearly defined than that of small-pox, although Anglada says that it figured among the spotted diseases, of which Gregory of Tours speaks.[23] But it was only in the sixteenth century that Prosper Martian exactly describes the disease.

Says Martian, “It is a disease of a special type peculiar to children, who can no more avoid it than small pox. It commences with a violent fever, followed, towards the third day, by an eruption of small red spots, which become elevated by degrees, making the skin feel rough to the touch. The fever lasts until the fifth day, and when it has ceased the papules commence to disappear.”

Measles was designated in the middle ages under the name Morbilli, which signified a petty plague, the same that Morbus meant a special plague. It is then fair to presume that the type of disease was no more serious than it is at the present day.

It is probable that the measles of the sixth century included at the same time small-pox, measles and scarlet fever, of which the ancients made no differential diagnosis. Anglada affirms the co-existence of all forms of eruptive fevers and gives the following reasons:

“The contemporaneous appearance of variola and rubeola represents the first manifestation of an epidemic constitution, resulting from a collection of unknown influences as to their nature, but manifest by their effects. The earth was from thence prepared to receive scarlatina, and it soon came to bear its baleful fruits. We do meet some mention of scarlet fever in the writings of the Arabian School, but it is merely suspected and only vaguely indicated. But when we remember how difficult it often is to diagnose at first between variola and measles, we are not astonished at the indecision manifested in adding another exanthematous affection to the medical incognito. It was only after innumerable observations and the experience of several centuries that the third new disease received its nosological baptism. There is nothing to prove that it did not co-operate with earlier epidemics of variola and rubeola, remaining undistinguished as to type, however.”

What clearly proves that there was confusion between the various fevers of exanthemata is that Ingrassias describes scarlatina in 1510, under the name of rosallia, adding, “Some think the measles and rosallia are the same malady; as for me, I have determined their differences on many occasions. Nonnulli sunt qui morbillos idem cum rossalia esse existimant. Nos autem soepissime distinctos esse affectus, nostrismet oculis, non aliorum duntaxat relationi confidentes inspeximus.”[24]

These facts appear conclusive enough to admit that measles and scarlet fever are, like variola, the products of the epidemic constitution developed during the sixth century, as contemporaries of the bubonic plague, all these maladies representing the medical constitution of the first centuries of the Middle Age.