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.