Pathology and Epidemics

As physicians, the Russell brothers were frequently exposed to epidemic diseases.1 Fevers, of great interest to eighteenth-century physicians, were thought to be diseases rather than symptoms of diseases. “The common epidemic diseases at Aleppo are Continual, Intermittent, Remittent fevers, Malignant Remittents,2 and regular and anomalous Erratic fevers to which children are liable,3 Diarrhoea, Dysentery, Pleurisy, Peripneumony,4 Quinsy,5 Rheumatism6 and Ophthalmia,7 common in Aleppo, which all return as regularly as the seasons”,8 as well as the plague – and smallpox that was “sometimes very fatal”.9 Other endemic diseases,10 many that targeted children, included measles, Chincough,11 Putrid Fevers, Petechial,12 and Scarlet Fevers. It is not surprising that the Russells focused on the prognosis, signs, symptoms and treatment of various diseases, including Cutaneous leishmaniasis, smallpox and the plague.

1 Hawgood, “Alexander Russell”, pp. 1–6; Starkey, “Contagion followed”; Aleppo Observed, pp. 164–178. 2 Aleppo2 ii: 300. i.e. typhoid. 3 SP 110/74. In a letter to a patient in Cyprus, Patrick recommended cold baths be taken in the cool of the morning, 11 October 1760. Laidlaw, British in the Levant, p. 145. 4 Respiratory diseases and pneumonia. 5 Peritonsillar abscess. 6 Alexander’s work is cited by Henry William Fuller, On rheumatism, rheumatic gout, and sciatica (London: J. Churchill, 1860), p. 419. 7 Aleppo2 ii: 299, 322. On ophthalmia, see Aleppo2 ii: 299–300. 8 Boott, John Armstrong, vol. 1, p. 114. 9 Volney, Voyage en Syrie, vol. 1, p. 362. 10 Davis, Aleppo, p. 75. 11 Whooping cough. 12 Petechial fever: A malignant fever, accompanied with livid spots on the skin.

Epidemic Diseases: Three Different Research Paths

Rather than providing a comprehensive survey of all medical topics covered in Aleppo, the focus here is on three serious infectious diseases.

1) Embellishing Alexander’s original research on Cutaneous leishmaniasis. 2) Cooperation between brothers as they explored local variolation as pre- judarī), “an acute ج��د ر �ي� .vention for smallpox (Latin: Variola major; Ar contagious disease, with fever and pustules that usually leave permanent scars” (OED). In the eighteenth century, “variolation” was the cutaneous inoculation of material from smallpox pustules, variously named small- ن .pox inoculation, insertion, engrafting or transplantation ,(ṭāʿūn ط�ا �عو� .Development of research13 on the plague (Latin pestis; Ar (3 “a contagious bacterial disease characterized by a fever and delirium, typically with the formation of buboes and sometimes infection of the lungs”; by extension, “any contagious disease that spreads rapidly and kills many people.”14

Oca

Most visitors to Aleppo mentioned the plague and the virulent flesh-eating disease known as the “Aleppo Boil” (Cutaneous leishmaniasis).15 These erup- tions, known then as Mal d’Aleppo, Herpes Aleppina, Oca and many other names, are chronic sores that heal slowly and are spread by sand-flies that flourish in waste and sewage. Volney described Mal d’Aleppo as endemic in the region.16 Alexander has been credited with the first clinical account in English of Mal d’Aleppo:

13 Research continues: for example, Marc Galimand, Elisabeth Carniel and Patrice Courvalin, “Resistance of Yersinia pestis to Antimicrobial Agents”, Antimicrobial Agents and Chemotherapy 50:10 (2006), pp. 3233–3236. 14 Starkey, “Contagion followed”. 15 Aleppo1, 262–265, Aleppo2 ii: 307–314. A. P. Gelpi, “Alexander Russell and the Aleppo ulcer”, International Journal of Dermatology 26:2 (1987), pp. 131–134. 16 Volney, Voyage en Syrie, vol. 1, p. 231. Until 1960, the disease was restricted to Aleppo and Damascus. By 2016, Syria’s civil war had triggered an epidemic in the refugee camps and across the region.