Smallpox, here is only the history of this strange disease, that is now widespread across the known world, and that sooner or later seizes all sorts of people, without regard to climate, age, sex or temperament of the patient. Whether the ravages of this illness are a product of its own violence, or the flawed methods which we use to treat it, smallpox no longer concedes to the plague in the disasters it causes.

There is every reason to presume that smallpox was unknown to the Greeks and Romans since no doctor of that time left us a description of it. Authors such as Hippocrates, Aretaeus, Celsus, Caelius Africanus, and Soranus of Ephesus, who were so successful in the descriptions of diseases that we can look at them rather as finished paintings than stories, as the ancients excelled no less in these descriptions than in poetry, sculpture, or painting, would not have neglected to tell us of smallpox if it had existed in their time. It could be however that it was known in some other parts of the world and appeared in the Indies and was brought to Arabia.

We know only that the Arabs brought it into Egypt when they conquered it under Caliph Omar; that [smallpox] spread with them through all the places where they bore their arms, religion, and commerce, namely to Egypt, Syria, Palestine, Persia, Lycia, the length of Africa’s coasts, and from there into Spain, where [smallpox] spread with Europeans into all the other parts of the known world. Rhazes, a Syrian by birth, Arab by origin, and Muslim by religion, who lived in the ninth century, was the first of all the authors who remain to us, who treated the disease with accuracy. One must read the excerpt done by the illustrious Friend to be convinced of it, and from which it suffices to give the most abbreviated synopsis.

Rhazes, who wrote in the blazing climate of Persia, observes that smallpox there is more epidemic in the springtime than in the fall. Children and adults there are the most susceptible; the elderly are rarely attacked, as long as the season is not very contagious. The bodies which abound in humors easily catch the infection and dry temperaments are attacked the most violently. Rhazes names small-pox chaspé in Syrian; the word caphe or capheph in Arabic means an eruption of pustules .

The symptoms which precede this illness are, according to the Arab physician: an acute fever, a violent headache, pains in the loins, dryness of the skin, difficulty breathing; the eyes become red; one feels pricking all over the body; is disturbed by awful dreams during sleep; finally one has chest pains with nausea. Rhazes calls the pustules which raise to a point sublimia [high], and lata [wide] those that are wide and flat, like in confluent smallpox.

Rhazes expands a lot on the prognoses for smallpox. If, he says, the eruption develops easily, the pustules come properly to maturity and the fever ceases, there is no longer any danger; it is the same when the pustules are large, distinct, small in number, ripen well, and cause the patient neither oppression, nor excessive warmth.

But if the pustules are compact, uniform, spread all over like herpes, erode the skin, and no longer contain any matter, it is a type of smallpox very malignant, especially if the fever increases after the eruption, and then new pustules begin again to emerge.

If the eruption, he continues, develops the first day of the illness, this indicates too much impetuosity in the humors; if it comes on the third day, it is a better sign; and if it is the seventh day, the disease is still more fortunate.

When the pustules are very small, hard, a color of purple, green, or a blackish red, it is a bad omen. If the pustules continue in this state, the fever does not diminish, and it is accompanied by fainting or palpitations, one should only wait for a speedy death.

The method of treatment comes next. Rhazes advises to bleed first or to apply the cupping glasses. The room must be kept cool and the whole regimen consists of a cooling and acidic diet. The herbal teas of barley should be the food. The refreshing remedies and acids will be proportionate to the vitality more or less of the patient. If the belly is taut, one should get release with some laxative teas, taken two times per day. When the pustules have all come out, have the patient take steam. He will use it to dilute barley water, pomegranate juice, and other broths similarly watered down. If the oppression is not very great, Rhazes advises a bath of warm water in order to bring about the eruption. He prescribes opiates when the patient cannot sleep or when he is attacked by diarrhea at the end of the illness. He also counsels to have recourse to calming remedies when some terrible symptoms which prevent the pustules from coming to suppuration appear.

On the decline of the illness, when nature was ready to succumb under the weight of the morbific matter, he made use in this urgent case of bloodletting and purging in order to help the patient.

We must admit that this description is so faithful that since the time of Rhazes just to our own we have discovered practically nothing new to add to the good practices of the Arabs. We have at least a thousand authors who have published works on this disease without any utility for the public, or rather were of great detriment to the public, for we cannot say how many ill individuals were killed by the cordials and irritants which were used, either to accelerate the eruption, or to bring the eruption to suppuration after it was done.

Finally Sydenham took nature for his guide and destroyed by this conduct the duration of such great errors. His description of the illness is of an accuracy and elegance that cannot be admired too much. He predicted the dangers that he was incapable of avoiding and indicated the pitfalls where he and others had failed.

We can compare in this respect Sydenham with Lord Verulam, one of the most exact observers of nature that there ever was; not content with the surprising discoveries that he had made, he wrote down the plan that those who would come after him were to follow, in order to continue successfully natural history, being impossible for one man in view of the brevity of life to gather all the materials that nature provides in making up a body of history. The famous Boyle began where the other had finished and came to execute the plan that the first philosopher had left.

Sydenham who had already made so many discoveries about smallpox regarded this disease as a true inflammatory fever and each pustule as a phlegmon; he took very good care of his patient until the approach of the secondary fever; but when this began to increase so that the matter was badly dispatched, the face became less swollen, the sputum thickened and stops, then seeming like a prophet, he announced the danger which threatened the patient without the power to prevent it despite all the range of his knowledge in this part.

Helvetius next introduced purging during the last stage of smallpox, which is, in my opinion, one of the best methods that we can use in order to alleviate the fever. It is true that this doctor accepts purgation without knowing why, but Friend would demonstrate the reasons behind this method and established its necessity by theory and experience.

Lastly Boerhaave explicitly wrote on this disease with his standard wisdom; he developed the nature and treatment which suits it. What he adds to this treatment is quite noteworthy, vulgata quippè methodo [the common method], he says, nullus nisi spontè emergit [only emerges spontaneously]: if someone escapes by the method that is usually followed, it is rather to nature that he is indebted than to the efforts of those who treat him. This judgment appears to me to be so true, that I no longer doubt that Physicians who wish to speak in good faith, would agree with candor.