SMALLPOX AND MEASLES.
With our modern habit of seeking out the matter of fact, of going back to the reality and of reconstructing the theory, it is not easy for us to understand how completely the medieval world of medicine was enslaved to authority and tradition even in matters that were directly under their eyes. It was thought a great thing that Linacre, of Oxford, in the first years of the 16th century, and Caius, of Cambridge, some fifty years later, should have gone back to Galen for their authority, passing over the Arabians who had been the interpreters of classical medicine all through the Middle Ages. Their editions of forgotten medical works of the Graeco-Roman school were a step forward in scholarship, and they opened the way to the first-hand observations of disease which really began some hundred years after with the writings of Willis, Sydenham and Morton. But smallpox and measles were not Galenist themes, they were peculiarly Arabian; and the very moderate share that England took in the medical Revival of Learning made no difference to the paragraphs or chapters on those diseases that were circulating in the medieval compends. While the Arabian or Arabistic writers of Spain, of Salerno, and of Montpellier were the depositaries and interpreters of the Galenic teaching, they were also the first-hand authorities upon some matters of specially Arabian experience, of which smallpox and measles were the chief. Whatever was said of those two epidemic maladies abroad, in the systematic works of Gordonio and Gilbert, and in the later compilation of Gaddesden in England, was not only of Arabian origin, but it was all that was known of them. Rhazes, the original Arabic writer on smallpox and measles about the beginning of the 11th century, supplied both the doctrine and the experience. His observations and reasonings, altered or added to by his later countrymen, passed bodily into the medical text-books of all Europe. The interest in the treatise of Rhazes was so great that it was printed in 1766 by Channing, of Oxford, in Arabic with a Latin translation, and in an English translation from the original by Greenhill, of Oxford, in 1847.
In the literature we took over smallpox from the Arabians; but had we no native experiences of the disease itself, and, if so, when did it first appear in this country? One can hardly attempt an answer to these questions even now without stirring up prejudice and embittered memories. It has been the fate of smallpox, as an epidemological subject, to be invested with bigotry and intolerance. Whoever has maintained that it is not as old as creation has been suspected in his motives; anyone who shows himself inclined to put limits to its historical duration and its former extent in Britain is clearly seeking to belittle the advantages that have been derived during the present century from vaccination.
The wish to establish the antiquity of the smallpox in Europe has been as strong as the wish to overthrow the antiquity of the great pox. While undoubted traces of the latter in early times have been covered over with the generic name of leprosy, the vaguest reference to “pustules” or spots on the skin have been turned by verbalist ingenuity to mean devastating epidemics of smallpox. I am here concerned only with Britain, and must pass over the much-debated reference by Gregory of Tours to epidemics in the 6th century, the period of the Justinian plague. But in England the epidemic which stands nearest in our annals to the great plague of the 6th century, the widespread infection described by Beda as having begun in 664 and as having continued in monasteries and elsewhere for years after, has been claimed by Willan as an epidemic of smallpox[870]. Willan, with all his erudition, was a dermatologist, and acted on the maxim that there is nothing like leather. His contention in favour of smallpox has been referred to in the first chapter, dealing with the plague described by Beda, and need not farther concern us. It is not in England that we find evidence of smallpox in those remote times but in Arabia.
Smallpox in the Arabic Annals.
For our purpose the evidence on the antiquity of smallpox in China and India may be accepted, and for the rest left out of account. The Arabian influence is nearer to us, and is the only one that practically concerns us. Coming, then, to the history of smallpox in its prevalence nearest to Europe, we find a definite statement of the disease appearing first among the Abyssinian army of Abraha at the siege of Mecca in what was known as the Elephant War of A.D. 569 or 571. The best of the Arabic historians, Tabari[871], writes: “It has been told to us by Ibn Humaid, after Salima, after Ibn Ischâg, to whom Ja‘gûb b. Otha b. Mughira b. Achnas related that one had said to him, that in that year the smallpox appeared for the first time in Arabia, and also the bitter herbs,—rue, colocynth [and another].” The tradition is by word of mouth through several, after the Semitic manner, but it need not on that account be set aside as worthless. So far as concerns the bitter herbs, it is said to be against probability; but as regards the new form of epidemic sickness, there is no such objection to it.
The Arabic legend, as given by Tabari is as follows: “Thereupon came the birds from the sea in flocks, every one with three stones, in the claws two and in the beak one, and threw the stones upon them. Wherever one of these stones struck, there arose an evil wound, and pustules all over. At that time the smallpox first appeared, and the bitter trees. The stones undid them wholly. Thereafter God sent a torrent which carried them away and swept them into the sea. But Abraha and the remnant of his men fled: he himself lost one member after another.” In a former passage, the calamity of Abraha is thus given: “But Abraha was smitten with a heavy stroke; as they brought him along in the retreat, his limbs fell off piece by piece, and as often as a piece fell off, matter and blood came forth.” To illustrate this account by Tabari, his recent editor, Nöldeke, cites the following from an anti-Mohammedan poem: “Sixty thousand returned not to their homes, nor did their sick continue in life after their return.” One of the elephants which dared to enter the sacred region is said to have been also wounded and afflicted by the smallpox.
In this narrative of Abraha’s disaster, says Nöldeke, there is a mixture of natural causation and of purely fabulous miracle; a real and sufficient account of the cause of the Abyssinian leader’s discomfiture, namely, an outbreak of smallpox, had been blended with legendary tales. That the disease was smallpox is made probable by the continuity of the Arabic name; under the same name Rhazes, the earliest systematic writer, describes the symptoms, pathology and treatment of what was unquestionably the smallpox afterwards familiar in Western Europe. Why it should have originated on Arabian soil in an invading army from Africa, is a question that would require much knowledge, now beyond our reach, to answer conclusively.
Theory of the nature of Smallpox.
The nature of the disease should, however, be borne in mind always in the front of every speculation as to the origin of its contagious and epidemic properties. It involves no speculative considerations to pronounce smallpox a skin-disease, of the nature of lichen turned pustular. It is a skin-disease first, and a contagious or epidemic malady afterwards; its place among diseases of the skin is indeed fully acknowledged by dermatologists. Apart from its contagiousness it conforms to the characters of other cutaneous eruptions: its outbreak is preceded by disturbed health, including fever; when the eruption comes out the fever is so far relieved; and as in some other eruptions which are not contagious the constitutional disturbance is in proportion to the area of the skin involved. Even the peculiar scars or pits which it leaves behind in skins of a certain texture or in the more vascular regions, such as the face, are not unknown in non-contagious skin-diseases; nor does its other peculiarity, the offensive odour of many pustules, seem unaccountable in a skin-disease native to tropical countries.