A Treatise on the Smallpox and Measles

Summary

Al-Razi's treatise, known in Arabic as Kitab al-Judari wa al-Hasba (The Book of Smallpox and Measles), is a short practical monograph in fourteen chapters by the leading physician of the Abbasid world. It is usually described as the earliest surviving work devoted to these diseases and the first to set out clearly how to tell them apart at the bedside. Chapter I opens with a defense of Galen, collecting every passage in which Galen mentions smallpox, while admitting that he gave no complete cause or treatment; al-Razi says he questioned scholars who read Syriac and Greek and found none who could add more. He then gives his own explanation in humoral terms: human life moves from moisture to dryness, the blood of children is like grape must, and smallpox is the fermentation by which it becomes like mature wine. That is why hardly any child escapes it, while young men are seldom attacked and old men only in pestilential air. Chapter II lists the constitutions and seasons most prone to the disease. Chapter III is the most famous. Smallpox is announced by continued fever, pain in the back, itching of the nose and terrors in sleep, with redness of the cheeks and eyes, heaviness, sore throat and cough. Restlessness, nausea and anxiety are more marked in measles, while back pain is more peculiar to smallpox, and measles, al-Razi says, comes from a very bilious blood. Chapter IV outlines the general plan of treatment. The remaining chapters are a manual of care. Chapter V advises preventive bleeding (a vein for those over fourteen, cupping for younger children), cool rooms, cooling acid foods such as lentil soup and pomegranates, and water cooled with snow. Chapter VI deals with bringing out the eruption; Chapter VII with protecting the eyes, throat, ears, joints, and the soles and palms, including rose-water drops for the eyes and opening large pustules. Chapters VIII to XI cover ripening and drying the pustules, removing scabs, and fading the scars. Chapters XII and XIII prescribe diet and the management of the bowels. Chapter XIV gives the prognosis: white, large, distinct pustules that come out easily are the safest, while confluent, hard, green, violet or black ones, sinking of the rash, delirium and fainting are fatal signs. The work closes with praise to God. The treatise circulated in Arabic, in a Byzantine Greek version, and in Latin from the Renaissance onward. The library text is the English translation by William Alexander Greenhill, published by the Sydenham Society in London in 1848, in an OCR transcription.

Top Lessons

• Respect for authority, and its limits

  Al-Razi begins by defending Galen against careless critics, quoting him book by book. Then he says plainly that Galen gave no full account of smallpox and that he must supply what is missing. Real learning honors the masters and still adds what careful observation shows.

• Telling diseases apart

  Chapter III shows a physician sorting overlapping symptoms: fever, redness and cough belong to both diseases, but back pain points toward smallpox and anxiety and nausea toward measles. Careful comparison of signs is the beginning of diagnosis.

• Theory and practice

  Al-Razi's explanation of smallpox as a fermentation of children's blood belongs to humoral medicine and was later abandoned. Yet his bedside observations, his attention to the eyes and his prognostic signs remained useful for centuries. The treatise shows how practical knowledge can be sound even when the theory behind it is not.

• Medicine under Providence

  The treatise begins and ends by acknowledging God: the work is undertaken by God's permission and closes with praise to Him who gave understanding. For al-Razi, careful study of nature and reverence are not in competition.

Verified Quotes

Medical Lens

This is a founding text in the history of infectious disease and clinical diagnosis. Its importance lies in Chapter III, where al-Razi distinguishes smallpox from measles by their prodromes (back pain and terrors in sleep for smallpox; greater restlessness, nausea and anxiety for measles) and in Chapter XIV, which ranks the forms of eruption by prognosis: discrete, large, white pustules that come out easily are mild, while confluent, hard, dark or haemorrhagic-looking eruptions, sudden sinking of the rash, delirium and fainting are fatal. Later clinicians recognized in these descriptions the difference between discrete and confluent or haemorrhagic smallpox, though such equivalences are retrospective readings. The theory is Galenic: smallpox as a fermentation of the moist, hot blood of childhood, with measles from bilious blood and epidemics favored by putrid, hot and moist air; the treatise does not describe contagion between persons. Therapy follows from the theory: preventive venesection or cupping, a cooling regimen of acid foods and snow-cooled water, measures to bring out or dry the pustules, careful timing of purgation, and remedies to remove scabs and fade scars. Al-Razi's attention to the eyes, with rose-water, sumach and pomegranate drops, reflects the frequency of corneal damage and blindness after smallpox. Among his observations is that those who had only a mild childhood pox may be attacked again as young men, an early hint of the question of immunity.

• Chapter I, §§5–8

  The must-and-wine theory of smallpox as fermentation of children's blood, and why young and old are rarely attacked except in putrid air.

• Chapter II

  Constitutions, diets and seasons that dispose to smallpox and to measles.

• Chapter III

  Prodromal symptoms and the differential diagnosis of smallpox and measles.

• Chapter V

  Preventive bloodletting for those over fourteen, cupping for younger children, cool rooms and a cooling diet.

• Chapter VII

  Protection of the eyes, throat, joints, soles and palms; eye-drops of rose-water, sumach and pomegranate; opening of large pustules.

• Chapter XIV

  Prognostic signs: color, size and spacing of pustules, timing of eruption, fever after eruption, delirium and swooning as fatal signs; scarification of a threatened limb.