Appendix to the Commentary on Book Second.
ON SMALLPOX AND MEASLES.
The reader, we are sure, would be disappointed, if we were to quit the subject of Fever without touching upon the history of Smallpox and Measles. We will, therefore, conformably with our general plan, give a brief abstract of the descriptions of these diseases which we meet with in the works of the ancient physicians. In the first place, then, we may mention that, after having read, we may say, every word of every ancient writer on medicine that has come down to us, we can confidently affirm that the Greeks and Romans are altogether silent on the subject, and that we are indebted to the Arabians for the earliest accounts which we have of these diseases. Rhases, indeed, pretends (provided the Introduction to his ‘Treatise on Smallpox’ be not spurious) that Galen had delivered some imperfect descriptions of smallpox; but he would appear to have been led into this mistake by following some inaccurate translation of the works of Galen into the Syriac language; for no passages which would justify the interpretation which Rhases puts upon them are now to be found in the original. Lately, Dr. Bateman attempted to show that allusions to measles and smallpox are to be met with in the works of several of the Greek authors; but we entirely agree with Drs. Mead and Freind, who maintain the contrary. In an Arabian MS. preserved in the University of Leyden, it is stated that the smallpox and measles first appeared in Arabia about the year 572, P.C. See Reiske (Opuscula Medica, p. 10.)
Although Rhases be the most ancient writer whose account of smallpox and measles has come down to us, he does not pretend to have been the first of his countrymen who had noticed them, but gives extracts from the works of the elder Mesue, the elder Serapion and Aaron, wherein mention is made of them. According to Rhases, the common cause of smallpox is a fermentation in the blood; and hence the disease is most apt to seize children, whose blood is hotter than that of other persons. He was well aware, however, that the disease is capable of being propagated by contagion, for he ranks the pestilential fever or smallpox among the diseases “qui transeunt ab uno ad alios.” The symptoms, as described by him, are, continued fever, pain in the back, itching at the nose, disturbed sleep, and afterwards redness and fulness of the face, pain of the throat, difficulty of breathing, dryness of the mouth, thick spittle, hoarseness, headach, inquietude; and these symptoms are followed by the characteristic eruption of the smallpox or measles; but in the case of the latter there is more anxiety of mind, sick qualms, and heaviness of heart; and in that of the former there is more pain in the back, heat, and inflammation of the whole body, especially in the throat, with a shining redness. He then lays down the rules of treatment. He directs us to bleed from the arm at the commencement, provided the patient be more than fourteen years old, but by a cupping instrument if he be younger. He forbids us, however, to abstract blood after the eruption is come out. He allows light kinds of animal food, with acids; and for drink he recommends water cooled with snow, or cold spring water, or some diluent and acid draught, such as barley-water acidulated with pomegranate juice. Aaron, one of his authorities, forbids, however, the administration of cold water when the eruption is coming out. He directs the chamber to be sprinkled with cold water, and even at a certain stage permits the patient to go into the cold bath. He recommends abstinence from new milk, wine, dates, honey, mutton, beef, shell-fish, and all high-seasoned and heating things. The rest of his general treatment we need not give in detail. Suffice it to say, that the medicines recommended by him are, for the most part, vegetable acids and astringents. Upon the whole, the earlier part of his treatment consists of bleeding, cold drinks, and acid draughts. For hastening the eruption, when that is desirable, he directs us to wrap up the patient closely in clothes; to rub his body all over; to keep him in a room not very cold; to give him some cold water to drink; to put on a double shirt; and to place near him two small basins of very hot water, one before and the other behind him, so that the vapour may be diffused all over his body, except the face; but he prudently directs us not to allow the moisture to cool upon the body, but to get it carefully wiped off. All furnaces and hot baths he condemns, as overheating and weakening. He very much commends figs for promoting the eruption. He afterwards gives very minute directions about the treatment of particular parts, such as the eyes, the throat, and the nose. For the eyes, he recommends various astringent lotions or collyria, such as galls and rose-water, sumach, pomegranate rind, &c. The care of the throat he justly holds to be a very important consideration, and recommends bleeding when there is acute pain, and gargling with cold water, or with astringent decoctions, such as those of acid pomegranates, sumach, and the juice of mulberries. When the pustules on the limbs are large, he directs us to open them; and when there is great pain in the soles, he recommends them to be rubbed with warm oil, or the feet to be put into hot water. When the pustules seem to stand in need of ripening, he directs the body to be fomented with the steam arising from a hot decoction of chamomile, violets, and the like; and, when too humid, the patient is to be laid on pounded roses, rice-meal, or millet seed. For removing the scabs and eschars, he recommends us to rub them with the warm oil of sesame, or oil of pistaches; but the larger are to be cut off carefully without any application of oil. For removing the specks on the eye he recommends many stimulant collyria, containing antimony, verdigris, sal ammoniac, tutty, camphor, &c. For removing cicatrices or marks on other parts of the body, he mentions various applications, containing litharge, bastard spurge, &c. When the belly is loose, either in smallpox or measles, which, as he remarks, is commonly the case on the decline of the fever, he recommends abstinence from all laxative things, and commends barley-gruel, to which the meal of pomegranate seeds may be added; or, if the looseness increase, gum arabic, &c. may be added to the drink. He adds, that it sometimes happens that the bowels require to be opened, and he directs this to be done by means of myrobalans, prunes, and the like. When in measles there is much appearance of vitiated bile, he directs the discharge of it to be promoted. He points out the difference between distinct and confluent smallpox; and remarks that the latter is far more dangerous than the other. He also correctly states that when, in measles or smallpox, the eruption is suddenly determined inwardly, it is a fatal symptom. He all along inculcates that measles and smallpox are nearly allied to each other.
Georgius, one of the authorities quoted in his ‘Continens,’ says that measles arise from blood mixed with much bile, and smallpox from gross blood mixed with much humidity. He states that the danger is proportionate to the pain in the throat and difficulty of breathing. The elder Serapion, as quoted by him in the same work, directs, if it is the winter season, the wood of tamarisk, &c. to be burned beside the patient.
In his work ‘Ad Mansorem,’ he recommends nearly the same treatment as that which we have been detailing from his Tractatus on Smallpox; but does not speak so decidedly in favour of cold drink.
Avicenna’s description of smallpox and measles is very similar to that of Rhases. He confidently pronounces them to be contagious diseases. He states correctly, that when smallpox proves fatal, it is usually from the affection of the throat, or from the bowels becoming ulcerated. Sometimes, he adds, the disease superinduces bloody urine. He agrees with Rhases that measles is a bilious affection, and that it differs from smallpox only in this, that in the former the morbific matter is in smaller quantity, and does not pass the cuticle. His treatment also is little different. At any period during the first four days he approves of venesection, but forbids it afterwards. He recommends cooling and diluent draughts prepared from tamarinds and the like. He prescribes figs to facilitate the eruption of the pustules, and forbids cold drink after they begin to come out. When the pustules are large and fully formed, he approves of letting out their contents with a gold needle. His treatment of the throat, eyes, belly, and hands is nearly the same as that recommended by Rhases. When ulcers are formed after the falling off of the eschars, he directs them to be dressed with the white ointment, composed of ceruse and litharge. (iii, 1, 4.)
Serapion’s account of smallpox and measles, as is remarked by Haly Abbas, is very defective. He treats of them along with apostemes, and his description of the symptoms is far from being accurate.
Avenzoar, in his Treatise on Epidemical Diseases, treats incidentally of measles and smallpox, for the cure of which he recommends principally gentle purgatives, such as tamarinds, with cooling and acid drinks. (iii, 3, 4.)
Alsaharavius also mentions them briefly among the pestilential diseases; but his description of them is not to be compared with that of Rhases.
According to Haly Abbas, variola is produced either by external causes, such as a pestilential state of the atmosphere, or from respiring the air of a place which has been tainted with the effluvia from the pustules of persons affected with the disease; or it may arise from an ebullition of the blood when it is loaded with gross humours which nature endeavours to cast outwards. He then briefly describes several varieties of the disease, differing from one another in degrees of malignity; and among them he ranks rubeola, which is occasioned, he says, by a hot thin blood, and is not of a bad nature. In it, he says, the eruption, when at its height, resembles millet seeds, or is somewhat larger, the colour is red, and the pustules discharge nothing. The precursory symptoms of smallpox are fever, swelling of the face, itching of the nose, inflammation and redness in the face and other members, heaviness of the head, and roughness of the throat. (Theor. viii, 14.) With regard to the treatment of variola and rubeola, he recommends venesection during any of the first three days; or, if the patient be a child, he directs us to apply a cupping instrument to the back. The patient is then to be made to drink barley-water in which jujubes and sebesten plums have been boiled; syrup of poppies is to be added, if the cough be troublesome, or the pain of the throat severe; and spoon-meats prepared with spinage, orach, and the like, are to be given. When the eruption does not come properly out, he recommends a decoction of fennel, lentils, figs, &c. to be taken cold.—By the way, this practice is favorably mentioned by Fracastorius, a writer of the 16th century (De Morb. Cont.) For asperity in the chest he recommends the mucilage of fleawort, linseed, and the like, and forbids all heating things. The patient is to be kept upon a low diet, as in other fevers; and his apartment is to be fumigated with aromatics, such as sandal-wood, myrtles, and roses. When the belly is constipated, he directs barley-water with manna, prunes, and the like; or, if loose, barley-water with myrtle seeds, gum Arabic, Armenian, or Cretan earth (chalk?). He forbids purgatives after the seventh day, especially in rubeola, as there is danger of diarrhœa or dysentery being superinduced; and, if these affections should come on, he directs them to be stopped with astringents. He recommends particular attention to the eyes at the commencement, and with this intention directs them to be bathed with an astringent decoction. No animal food is to be allowed until the eruption and heat are gone.