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.