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Downloaded from Brill.Com09/28/2021 03:19:41AM Via Free Access 242 Chapter 8 Chapter 8 Pathology and Epidemics As physicians, the Russell brothers were frequently exposed to epidemic dis- eases.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. © koninklijke brill nv, leiden, 2018 | doi 10.1163/9789004362130_014 Janet Starkey - 9789004362130 Downloaded from Brill.com09/28/2021 03:19:41AM via free access 242 Chapter 8 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- ج .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. Janet Starkey - 9789004362130 Downloaded from Brill.com09/28/2021 03:19:41AM via free access Pathology and Epidemics 243 Eruption … is named by the Natives Hebt al Sinne*, or Botch of a year; but by the Europeans and Turks, as if it were peculiar to that place, Il Mal d’Aleppo, the Aleppo Evil, and Haleb Chiban3, the Aleppo Ulcer. It is not however confined to that city; being common almost in the same degree at Aintab, and the villages situated on the banks of the rivers Sejour and Kowick: whence the vulgar opinion of its being produced by the water.17 ج [sic] �ح� ج� �ه�ا �ل�����س���ه Heb al Sinne * � ج ���ل� ج� چح ج���ا �ي� Haleb Chibani 3 After it is cicatrised, it leaves an ugly scar, which remains through life, and for many months has a livid colour. When they are not irritated, they seldom give much pain … It affects the natives when they are children and generally appears in the face, though they also have some on their extremities … In strangers, it commonly appears some months after their arrival. Very few escape having them, but they seldom affect the same person above more than once.18 These pimples remain for a year and then disappear, leaving a permanent mark. Avicenna and Richard Pococke19 may have mentioned this exotic dis- ease but Patrick provided one of the earliest detailed clinical descriptions – its signs, symptoms and possible treatment, and local distributions – after exam- ining a Turkish patient.20 In 1801, Adam Freer, by then in India, continued to develop his mentor Patrick’s research and published a paper about possible cures of cutaneous disease:21 Dr Adam Freer has communicated an account of the Indian Method of curing the Ring worm viz by a decoction of the fresh bark roots tops or flowers of the cassunda cassia sophera of Linnaeus.22 This remedy is also said to be useful in the herpes miliaris of Sauvages and perhaps, as 17 Aleppo2 ii: 308. 18 Aleppo1, 263. 19 Pococke. Description, vol. 2, pp. 26–28. 20 Aleppo2 ii: 263, 312–314. Gelpi, “Aleppo ulcer”. World Health Organisation, “Control of the leishmaniases”, Technical Report Series 793 (Geneva: WHO, 1990); P. Desjeux. The Leishmaniases Report (Geneva: WHO, 1993), pp. 1–6. Aleppo Observed, p. 155. 21 Adam Freer, “Account of the method employed in Bengal for the cure of the cutaneous disease, commonly known by the name of Ring Worm, the Harpes Serpigo of Sauvages, by means of cassanda vinegar, communicated to Dr Duncan senior”, Annals of Medicine 5 (1800), pp. 371–372; summarized in The Monthly Magazine 37 (1814), p. 321. 22 cassunda (Cassia sophera Lin. Sp. Pl. 542): A purgative, Senna sophera L. Roxb. Janet Starkey - 9789004362130 Downloaded from Brill.com09/28/2021 03:19:41AM via free access 244 Chapter 8 Dr Freer observes, may be advantageously extended to other cachexies and discolourations.23 Local physicians had many different therapies, but knew nothing about “mod- ern discoveries” such as “the use of mercury, ipecacuanha, the Peruvian bark, or the preparations of antimony”.24 Some misdiagnosed the condition and ap- plied different painful caustic remedies including alum, Verdigris, and caustic soda, to remove any encrustations and to extirpate the roots of the tumour.25 Others thought it was caused by a mosquito with a hundred spiky legs, prob- ably a centipede.26 Alexander recounted that “the natives reckon but two spe- cies of this disorder, and distinguish them by the names of male and female; but there is a third kind of Cutaneous distemper, that, though it is commonly ascribed to the bite of a common millipede, or wood louse, seems to me to be altogether of the same nature though milder in degree.” He went on to describe the signs and symptoms of the various types.27 Patrick treated Mal d’Aleppo with mercury. It was not until 1903 that scientists discovered that Oca is caused by an infec- tion by parasitic flagellates of the genus Leishmania and transmitted via spe- cies of sand-flies (Phlebotomus) from animal reservoirs, especially rodents and canines.28 Scientific research came somehow full-circle in 1930, for, curiously is was on the Golden Hamster, a small rodent in Aleppo that was first identified by Patrick Russell, that tests were then made by parasitologist Saul Adler to discover how the disease spread. The Russells suggested the best treatment for Cutaneous leishmaniasis was the external application of a mercurial plaster or Red Precipitate,29 al- though most patients preferred local remedies. Mercurial plaster (Emplastrum Hydrargyri) was made of olive oil, resin, quicksilver and oxide of lead.30 Red 23 The Critical Review (1801), p. 188. Herpes miliaris: Herpes or Shingles; Cachexia (Cachexies): a wasting syndrome due to a severe chronic illness such as cancer or anorexia. 24 Aleppo2 ii: 132. Antimony: Sb. Ar. ithmīd. 25 Aleppo2 ii: 306–314. 26 Aleppo2 ii: 309. 27 Aleppo1, 262–264. 28 Oumeish Youssef Oumeish, “Cutaneous leishmaniasis”, Clinics in Dermatology 17:3 (1999), pp. 249–254. 29 “Mercuric oxide (HgO), a heavy red crystalline powder obtained by heating mercuric ni- trate, or by heating mercury in the air” (Online Dictionary). 30 John Murray, A system of materia medica and pharmacy (Edinburgh: W. Laing et al., 1810), vol. 2, pp. 412–413. Aleppo1, 262–265; Aleppo2 ii: 311–314. Janet Starkey - 9789004362130 Downloaded from Brill.com09/28/2021 03:19:41AM via free access Pathology and Epidemics 245 Precipitate is Mercuric oxide and is now classified as “very toxic” and banned as a pesticide as “dangerous for the environment” by the European Union.31 In Aleppo Patrick prescribed washing the tumour with milk and water, adminis- tering mercury – and waiting – for he claimed that the best treatment was to leave well alone, as such infections usually heal spontaneously.
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