PART II.

CRITICAL ANALYSIS.

I.

The History of the Small-Pox. By JAMES MOORE, Member of the Royal College of Surgeons in London, Surgeon of the Second Regiment of Life-Guards, and Director of the National Vaccine Establishment. 8vo, pp. 312. Longman & Co. London, 1815.

THIS HIS is a curious and a very amusing volume;-a sort of commendation, by the way, which we have not often occasion to bestow upon the subjects of our critical examination in this Journal. Mirth and medicine, indeed, are not very necessarily combined; but the author would have degenerated, and been unworthy of his name and parentage, if he had given us nothing, in such a history, but a sombre detail of pestilence and physic. His little work (little in point of size, but not in point of labour), bears internal evidence of extensive and varied research, in the minute details of medical biography, and the cu rious historical anecdotes, with which it abounds, and which are pointed by not a little shrewd criticism, medical, moral, and political, and by a considerable portion of satirical humour. The work is dedicated to Dr Jenner, and is said to have been com→ posed, together with a history of cow-pox, hereafter to appear, with the view of aiding that enlightened benefactor of mankind in the extermination of the variolous pestilence, by convincing the public of the baneful effects of the one and the benign influence of the other, by thus contrasting their portraits. The opposition which vaccination has experienced renders such aid, he avers, necessary; for,' as he quaintly expresses it,' among the practitioners of the healing arts, Hygeia found enemies and Disease and Death, friends.'

In the first chapter, he treats briefly of various opinions on the origin of the small-pox,' and settles very expeditiously the question of the existence of the disease in the time of the Greeks and Romans, which he determines in the negative, principally upon the score of the accuracy of those writers in describing diseases with which we are still familiar, and of the impossibility of supposing them capable of overlooking the striking characteristics of small-pox, which were so minutely described by far inferior writers, the Arabians. We shall not set up any formal defence of the opposite doctrine, in favour of which, however, we think there are many circumstances of considerable weight; and we should have been glad if the author had not presumed upon the refutation by other writers, but had attempted to satisfy us himself. With all due veneration for the ancients, at least of that small number who were original observers, we think those sweeping assertions of their unvarying accuracy in the diagnosis of diseases, which preclude all idea of their having seen a formidable disease, without distinguishing it from all similar maladies, are the effusions of pedantry, and not justified by actual observation, or by the history of medicine. Have not these writers generally classed all violent and fatal diseases under the term pestilential? Have they anywhere given any thing like such an account of the common plague, as an ordinary ship's-surgeon would now give us from the Mediterranean? It appears, indeed, that they were generally too much afraid of encountering pestilence, to be able to give us very accurate histories of the symptoms, and too often fled from the cities where it prevailed. They were also blinded, long before the time of Galen, by their hypotheses of the humours, and were content to determine whether an ulceration or eruption was the discharge of a bilious or phlegmatic humour, without attending to the history of symptoms. We must acknowledge, that the chapter, which Aetius has preserved from the works of Herodotus, a Roman physician (which are unfortunately lost), appears to us a body of positive evidence, which strongly opposes all such negative evidence, as the mere silence of other writers from Galen to Actuarius. Mr Moore notices this singular chapter very slightly, by naming it only in the margin: We think it merited more of his attention; and that it is impossible to settle the question without a thorough explanation of it. There is nowhere, perhaps, a more distinct statement of nettle-rash,-of the little herpetic eruption about the mouth and alæ nasi at the decline of slight fevers, of the petechiae in fevers of a more typhoid character, à pravis humoribus, '-and of the ulceration and carbuncles of malignant and pestilential' fevers, than in this chap

ter; and at the same time the symptoms of small-pox appear to be mentioned with no small accuracy, and many of the prognostics and diagnostics pointed out. * What other eruptions, the most malignant when ulcerating the face, and when most numerous rather than when few,' &c. accompany pestilential fevers, save small-pox? But yet so much under the influence of prevailing hypotheses was this discriminating writer, that he considers all these eruptions only as signs of an abundance of corrupt humour, corroding the body.' It is some impeachment of the accuracy of the other Greek writers at Rome, after Herodotus, that they have omitted to describe distinctly those eruptive fevers with which he was obviously familiar. There is some reason for supposing that the great pestilence at Athens, the effects of which have been so well described by Thucydides, was small-pox. It was obviously not the plague; (for neither buboes nor carbuncles are mentioned); but a disease in which the skin was extensively affected, being red or livid, with an eruption of small pustules and ulcerations.' It might, indeed, have been that epidemic, of which we happily know little in modern times, and which was the frequent result of famine, so admirably described by Lucretius under the appellation of Ignis sacer. But the very obscurity of these accounts is a proof, that neither physicians nor philosophers were very accurate in their discrimination of the various species of pestilential fevers, all of which they deemed but modifications of the same thing; and it renders every inference from their silence on any particular pestilence nugatory.

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Having settled the dispute respecting the ancients, Mr Moore refutes very satisfactorily the statement of Dr Paulet respecting an epidemic in France in 580, of which Queen Anstrigild, wife of Guntram king of Burgundy, and the two sons of Chilperic and the dreadful Fredegonde,' died. This was called variola, and affords the first instance, he says, of the use of this word. But upon the authority of Gregory of Tours and of the Herman chronicle, Mr Moore shows that this epidemic was the common plague, conjoined with dysentery. The story of the princess Fredegonde has nothing to do with the author's history; but it is too good a story not to be told; as it would have produced from Shakespeare a drama, equal to that of Lady Macbeth; and it occupies three or four pages in Latin and English, and

6

See Aëtius, Tetrab. II. Serm. I. cap. 129.

† Φλυκταίναις μικραῖς καὶ ἕλκεσιν ἐξηνθηκος. Thucyd. Lib. VI. § 49. ‡ Lib. VI.

affords scope for one or two satirical squibs. His next source of authority was that ponderous collection of lies and absurdity, the Lives of the Saints, compiled in about forty folio volumes, (which constitute but three-fourths of the intended work) by the Bollandists. As these lucubrations relate the proceedings of the early Christians, who were much concerned in attending the sick, it might be expected that they would afford some information respecting the prevalent diseases, at a period not much later than the era of Galen and his successors, or at least some centuries before that of the Arabians. We have heard, indeed, that the late Dr Willan believed that he discovered in this work, some evidence of the existence of small-pox in the second and third centuries: but Mr Moore does not appear to have found at least the word variola, before the thirteenth century. He admits, however, that he did not labour much in the perusal of this ponderous work; and surely the non-occurrence of the term, by which this disease has been designated in modern times, is no proof whatever of the non-existence of the malady, which might have been described, among other severe maladies, before any specific name was assigned to it. But while he contends that there is no evidence of the prevalence of small-pox in Europe so early as the sixth century, the author believes, that the opposite opinion, adopted by Mead, Dimsdale, and others, that it was not introduced till the return of the crusaders, about the end of the eleventh or beginning of the twelfth century, is equally erroneous.

In chapter II. he proceeds to trace the earliest accounts of the disease in Asia and Africa, whence it is commonly believed to have been imported to the western kingdoms; and begins with the records of China, one of the earliest inhabited countries in the world. For our knowledge of these, we are indebted to the Catholic missionaries, who, by their address and influence, gained access to these documents. Mr Moore details some evidence from the works of the missionaries, extracted from authentic Chinese publications, from which it appears, that not only the small-pox, but even some modes of inoculation, were familiarly known at a very remote period, probably long before the commencement of the Christian era. At the end of the seventh century, it is mentioned familiarly as an epidemic, in the chronicles of Japan, among the ordinary incidents of the time. And in Hindostan, according to the traditions of the Bramins, the small-pox is of immense antiquity. It has several names in the ancient Sanscrit language; and its very early existence in that country is proved by their sacred books, and by the mythology of the Hindus.' The author collects from M. Sonnerat,

the genealogy and attributes of the goddess who presided over the small-pox, and relates also another account of the same deity from Baldæus. The existence of this superstition, and of various idols, as well as the practice of inoculation among the Bramins from very ancient times, prove the antiquity of the disease in India: and from a collection of original Hindoo drawings, Mr Moore has engraven a representation of a procession, exhibiting the actions and attributes of this terrible goddess. These religious rites, Mr Moore observes, are decisive proofs of the dread in which small-pox was held, when human power was deemed inadequate to resist the calamity; and travellers in later times. have been struck with the dreadful alarm which its occurrence excites in China, India, Tartary, &c. In the latter country and Thibet, it is deemed a plague; and the patients are not only left to chance, but shut up from all communication. These circumstances, and the want of free communication in those countries, are considered by Mr Moore as affording an explanation of the non-extension of the disease to Persia and Greece, long before the time of Hippocrates; and he attempts to account for the non-importation of the infection by the armies of Darius and of Alexander, in their respective invasions of India, by the long time which elapsed in so distant a warfare, the numbers of men who perished, and the extent of the deserts which were recrossed, which would give time to purify the troops from infection. Something like the small-pox, indeed, seems to have occurred near the mouth of the Indus, before the embarkation of Nearchus, according to the account of Quintus Curtius; but it is probable, as the author suggests, that the sick would not survive the hardships which the army was obliged to endure. Mr Moore then briefly traces the progress of ancient commerce with India, and shows that the length of the voyage, as well as of the overland journey, was too long to admit of a probable communication of small-pox, even after Hyppolus had shortened the course, by trusting to the western monsoon, and stretching across the Erithrean sea, without compass, from the mouth of the Arabian gulf to Musiris. Even this was a voyage of a year. But towards the close of the sixth century, the spirit of commerce spread among the Persians, who brought from India the commodities which were wanted in the west; for their vicinity to India gave them great advantages over the Egyptian merchants.-

But,' the author adds, it also augmented the danger of transporting the variolous contagion. Indeed, whatever attention might have been paid by the commanders of these merchant-vessels, it was