In describing the character of the eruption and its transformations, Galen[112] certainly seems to have small-pox in mind. At a certain stage the eruption broke out all over the body in the form of ἐξανθήματα μέλανα (a dark efflorescence), probably of haemorrhagic type. When it ulcerated, a crust (ἐφελκίς) formed on the surface, which became detached, and then everything proceeded to a cure. A scar remained after the separation of the crust, comparable to the ‘pitting’ of small-pox. In some cases ulceration did not occur, but the exanthem was rough and scaly and became detached like a skin: in this condition all got well. Galen gives some indication of the course of the disease in one who recovered. ‘A young man on the ninth day had his whole body covered with ulcers, as had most of those who recovered. Then he was seized with a cough, and three days after the ninth he was in a condition to go into the country for convalescence.’ The day after the cough set in, he expelled during a paroxysm of coughing a crust just like those of the cutaneous ulcers. Galen had previously examined his mouth and fauces, and had detected no signs of ulceration. He could also swallow both liquids and solids without any difficulty. To determine whether the crust came from his gullet or no, Galen administered a draught of vinegar and mustard; and from the absence of pain attending this drastic procedure he concluded that it must have come from the larynx and not from the gullet. Destructive ulcerations of the larynx have been recorded in rare instances in the course of small-pox, but such a condition would certainly preclude a journey to the country after the lapse of two days. It would be less impossible after the expulsion of a diphtheritic membrane.
It would be unprofitable to follow Galen further into the features of the pestilential fever he details, for, as we have said, it is quite uncertain that these are the features of a single disease. Indeed, apart from the evidence of Galen’s writings, it would be reasonable to presume the reverse from such knowledge as we have of other prolonged periods of pestilence.
Before leaving Galen we may say that he postulates a dual causation of pestilence: on the one hand, great irregularity of the seasons inducing a pestilential state of the atmosphere: on the other, a vitiated condition of the human body, due to contaminated food, rendering it liable to fever from very slight causes. The atmospheric factor, no doubt, would seem to be confirmed by the universality of the disease, while the greater severity of the disease and perhaps its special incidence as well among the ill-fed and destitute would seem to incriminate the resisting power of the individual.
The plague of a.d. 252, during the joint imperialty of Gallus and Hostilian, rivalled the Antonine pestilence both in virulence and duration. Hostilian was one of the first victims, though his death was commonly ascribed to the hand of Gallus. Eusebius[113] says that the disease had already worked havoc in Alexandria and Egypt, before it reached Rome. In some cities of Rome and Greece the daily mortality rose as high as 5,000,[114] and with greater or less virulence the disease spread over the whole known world.[115] Eusebius attributes the pestilence to moulds deposited from the air, a belief that we shall meet again in the course of the Great Plague of London.
Cyprian, the Christian bishop of Carthage, has left us some details of the symptoms in his eloquent homily ‘De Mortalitate’, which St. Augustine admired so greatly. Eusebius and Cyprian are both intent on extolling the self-sacrificing zeal with which the Christians laid down their lives in the service of the sick. Their writings help us to appreciate the contempt of suffering generated in the mind of the early enthusiasts of Christianity by living perpetually in the presence of persecution and in the fear of death. We know from the manner in which Cyprian[116] yielded himself to the sword of the executioner that the spirit of the ‘Sermo de Mortalitate’ permeated his whole being. In this sermon we may still read the glowing appeal of Cyprian to his hearers to seek courage and consolation in repentance for their sins.
Cedrenus[117] was so impressed with the infectiveness of the disease that he believed it might be communicated by a look, as Plato had conceived to be true of ophthalmia. Trebellius Pollio[118] recounts the association of terrestrial and other portents. Volcanoes awoke to fresh activity: earthquakes occurred and rumblings of the earth were heard: the sky was darkened for days: chasms yawned in the ground: great tidal waves overwhelmed many cities. It seemed as though the end of the world, foretold by the Christians, was at hand. In Rome the Sibylline books were consulted, and they prescribed the easy atonement of a sacrifice to Jupiter Salutaris.
Eusebius[119] is the chief authority for the pestilence of a.d. 302, during the reign of Maximian. It was accompanied by famine, so that the people were reduced to eating grass, and as many died of starvation as of disease. The famished dogs fought over the corpses of the dead, and the people slaughtered them wholesale, lest they should go mad and attack the living.