This enigmatic plot against the life of the citizens

Only in a certain number of patients was vomiting of yellow matter more or less dark; but there was in every one alvine excrement of the same color, which became later blackish by their mixture with the blood. This color never appeared at the invasion or in the period of increase, but always towards the decline or approaches of death; sometimes around the seventh day; most often in the ninth; more rarely to the eleventh . In some cases, these evacuations diarrhea appeared salutary; but generally they were the most annoying omen. They carried off the greatest number of the sick, exhausting their strength.

The occurrence of local gangrenes was also very serious, without, however, prohibiting all hope. Galen had seen the toes ( extremos pedes ) spontaneously separate after their mortification. Several patients, who had survived this mutilation, could, they said, assure their march only with the aid of a stick, on which they were even obliged to lean heavily.

Our author, who had been so busy with the pulse, tells us that he often remained normal during the course of the disease, and that the unfortunates in whom he retained this character all perished. Circumstance done well, he added, to deceive even the most experienced practitioners.

In addition to these facts, those in which he had seen the urine differ slightly from the natural state .

These two congeners did not belong to the Antonine Plague. They possibly attached to it only as a malignant disease which “weakened radical forces stopped the synergies and the most ordinary sympathies organs .” Galen once more verified his master’s famous aphorism: ” Bonus Pulsus, urina bona, æger moritur. ”

Finally, let us note that the disease could be prolonged and take a chronic course. After some alternatives of remission and repetition, the duration of which was very variable according to the individual, the hectic fever was on, and the patient succumbed to the last degree of consumption.

We currently have sufficient data to answer this question: What is the Antonine plague?

By successively adding his symptoms according to the indications of Galen, we have gradually seen a morbid individuality, the complete description of which has ended up reproducing, trait by line, the striking image of the plague of Athens.

That the reader who has been kind enough to follow me, take the trouble to compare the two descriptions, and I hope that he will share my very firm conviction on the identity of the two diseases.

Inflammatory burning of the eyes; redness sui generis of the oral cavity and tongue; aversion to food; unquenchable thirst; normal outside temperature, contrasting with the sensation of an inner fire; coloring of the skin reddish and livid; violent cough and hoarse tone of voice, signs of laryngo-bronchial phlegmasia; horrible fetidity of the breath; general eruption of pustules followed by ulcerations; inflammation intestinal mucosa; vomiting bilious matter; colliquive diarrhea of ​​the same nature exhausting the forces; partial gangrenes and spontaneous separation of mortified organs; various disorders of the intellectual faculties; quiet or furious delirium; fatal termination from the seventh to the ninth day. Finally, in less acute cases, degeneration of the disease into deadly hectic fever, after more or less prolonged oscillations.

All the symptoms which I have just enumerated are found in the picture drawn by Thucydides and in the one we have succeeded in recomposing according to Galen. Two morbid affections which have this common expression can not, of course, be separated from each other.

If Galen, instead of criticizing his illustrious predecessor, had imitated his example, we would have had only to reconcile the two stories so that their legitimate conclusion would arise from itself.

But he preferred to propose to his future readers a kind of nosographic hieroglyph whose signs had to be found, confusedly scattered in his immense work, and as if lost in theoretical digressions, amid which it is not always easy to to recognize. This is how I explain the silence, the indecision, or the laconism of the modern loimographers with regard to the Antonine plague. They found it convenient to repeat, one after the other, that a great epidemic disease had desolated the world under the reign of Marcus Aurelius; that Galen, his contemporary, had witnessed it, and that he had had a great deal of fright. That being said, they think they are quit, in good faith, to their readers, and do not seem to suspect that one can be more demanding.

There was therefore a gap to be filled in the ancient history of the great epidemics. The company tried two German doctors whose erudition and experience were a guarantee of success. I had the advantage of coming after them, and I got hold of some passages of Galen they had not indicated. Whatever may be my deepest esteem for the works of Fodere and Ozanam, I could not fail to recognize that, in the presence of the Antonine plague, they had not kept up with the subject; and I would have no excuse if I left them the last word, when there was so much to say .

As for my conclusion, that of Galen himself, struck by what he saw, formally acknowledged that this pestilential disease had the same appearance as that of which Thucydides had written the relation: “… In magna hac plague cujus eadem facies flee atque ejus qua Thucydidis memoria grassabatur Galen returns to this idea in several places. The doctors of Athens could not conceal their astonishment at this unknown plague which was taking possession of human pathology. It was not the same during the appearance of the Antonine plague. As a man, Galen was terrified; as a doctor, he did not feel the slightest surprise. He had only to re-read Thucydides’s account to make sure he was witnessing the return of an old illness, and that it would probably not be the last.

To complete this study, I think I must examine some peculiarities pointed out by Galen who might to provide material for discussion if I did not put them in their true light.

It will not be disputed that the two descriptions, taken as a whole, differ in certain respects. These discrepancies are inevitable, and one would certainly find them in the accounts of two equally attentive and educated doctors who would have simultaneously observed the same epidemic and recounted what they saw. But it is known that, whatever the protein mobility of the symptomatic picture of an epidemic in progress, the morbid type which represents it retains its personal relief in the midst of the epiphenomena and the complications which are grouped around it. Two diseases bearing this stamp are therefore nosologically identical. In this respect, I believe my conclusion perfectly in accordance with the principles.

I have to answer a more serious argument that requires some explanation.

Galen makes it clear in more than one passage that the eruption was often critical, and fortunately judged the disease . It appeared, in fact, in most of the subjects who cured, while it was wholly absent or incomplete in those who succumbed or whose disease was the most serious. Thucydides makes no reference to this circumstance, which was worth noting.

Between the silence of one and the affirmation of the other, where is the truth? I am swaying without hesitation on Galen’s side, and here are my reasons.

Thucydides was not a doctor, and the firmness of the man of war could not take the place of knowledge indispensable to penetrate the meaning of the morbid phenomena he observed.

Galen, by his practical experience, redeemed his moral weakness; and his favorite theory, of which only exaggeration can be blamed, led him back to the idea of ​​a conservative effort, which might have a happy outcome.

“Nature,” he said, “eliminated by the cutaneous emunctory putrid detritus, produced by fever, whose persistence in the organism would have been inevitably mortal .”

I therefore accept Galen’s interpretation, except for its antiquated formula, because it is the one that best meets the teachings of the clinic, and I believe in the medicinal effectiveness of the eruption, whatever its Moreover, the scarcity of cases in which it has happily been exercised. This remark, to put it in passing, applies to all eruptive fevers without distinction of species.

There is no doctor who doubts the usefulness of variola pustulation. The detractors of the vaccinia make even a great argument. Returning, under the pretext of progress, to the reveries of old humor, they measure the advantages of the suppurative period to the mass of peccary matter which it eliminates; and they refuse the insignificant eruption, caused by the vaccine, of the right to replace the energetic purification of natural smallpox, this ” sublime crisis! As they said in a ridiculous outburst of enthusiasm.

But this operation, whose salutary end is so evident in regular smallpox, undergoes, in time of serious epidemic, deviations which disturb the normal direction. Practitioners are well aware that death almost always occurs during the suppuration period, that is, when the critical elimination is in full activity and seems to promise a favorable termination. Like the archer mentioned by Montaigne, nature often misses the goal, not only because it does not reach it, but because it exceeds it.

In the moral world, every day we see failing, against unexpected obstacles, a company whose wisdom and foresight had matured the plan and secured the chances. Can we be surprised that the blind instinct which directs the hygienic and morbid acts of the organism is dominated by influences which disconcert its fundamentally salutary tendencies? The people of the world, foreign to our art, alone have the right to deny the conservative effort in cases where death has not allowed to reap the benefit. Galen was not mistaken. Between Thucydides and him, the apparent divergence on this fact is reduced to a question of medical competence.

Now I have one last question to be emptied of which I might say is far from recognizing it.

Thucydides bitterly laments, in his account, the absolute impotence of art and the uselessness of remedies tried by physicians.

Galen, on the contrary, exalts with confidence the efficacy of a substance inscribed in the pharmacopoeias of the time under the name of the Armenian bowl . “All who made use of it were,” he says, ” promptly cured. Those who felt no effect died: no other remedy could replace him. “And he concludes, with dubious logic, that the subjects on whom this drug failed, were absolutely incurable .

This is the innocent bowl of Armenia promoted by Galen to the dignity of specific . His refusal to act is the death sentence of the sick.

It is impossible for me to accept the therapeutic question in these terms, and I ask permission to justify my mistrust.

In all epidemics, popular superstition, often encouraged by the complicity of physicians, whose motives are not always to be thoroughly explored, has confided to some peculiar preparations, which may at least be given the advantage of raising morale, capital indication in such a case.

That the bowl of Armenia has produced this last kind of effect, I do not want to deny it; but that he has deserved, as a medicinal agent, the panegyric of Galen, which I can not bring myself to admit.

The post hoc fallacy ergo propter hoc , stands in front of all the questions of applied medical matter, when it comes to judging new remedies or extending the use of certain known substances. I very much suspect Galen’s ardent imagination of not having sufficiently warned him against this bad form of reasoning.

Not that I base my contradiction on the apparent inertia or the pharmaceutical insignificance of the Armenian bowl .

The peculiarity of drug specificity is to act directly on certain affections by an occult virtue, without any appreciable relation to the morbid state she is fighting. Everything is mysterious in the mode of action of the remedy as in the nature of the malady it cures. It is understandable then that the discovery of the specific is a blessing of chance; and we know from the history of the quinquina that they must make a long novitiate before obtaining their right of entry into the therapeutic arsenal. Once their titles are recognized, art has in its hands a heroic resource that is not lacking when it knows how to use it .

At a pinch then, the bowl of Armenia could have been one of these unexpected conquests; but to believe in its marvelous effects, Galen’s self-interest is not enough.

When we want to highlight the real virtues of a new drug, we must gather a number of facts observed without prevention, compare them, rid them of the causes of error or illusion that could alter the meaning. To what extent of activity and frequency did the remedy fulfill the practitioner’s expectation? In what cases did it seem indifferent, harmful or useful? What are the indications and contraindications of his job, etc., etc.?

I do not see in Galen’s work any trace of this work. Endowed medically with all the qualities necessary to carry it out, he lacked coolness and wit. God forbid me to be unjust to him! But one can admire his talents and doubt his courage; there is no solidarity between these two things .

Whatever he said, he had seen only a few scenes detached from the great pathological drama. It is well to believe that he avoided as much as possible any compromising relationship with the sick. We know that the plague still reigned while he composed, in the prudent isolation of his cabinet, some of his most remarkable writings. Is he a practitioner a little widespread to whom an epidemic disease has left these hobbies? How then to believe in the therapeutic exploits of Galen? This example would be unique in the history of major epidemics. Too often, experience has shown how narrowly closed is the action of medicine when it comes into conflict with those implacable enemies of human life. Science must then bow before a kind of fatal law whose peoples are condemned to undergo the inflexible stop in certain moments of crises. The disease treated by Galen was no doubt an exception to the general rule. The proof is that the bowl of Armenia did not survive its ephemeral glory. He has been banished from all the pharmacopoeias, without incurring the reproach of ingratitude. Galen, who believed or pretended to believe in dreams, perhaps owed them the revelation of his specific pretense. I can not decide to give it a more serious origin without incurring the reproach of ingratitude. Galen, who believed or pretended to believe in dreams, perhaps owed them the revelation of his specific pretense. I can not decide to give it a more serious origin without incurring the reproach of ingratitude. Galen, who believed or pretended to believe in dreams, perhaps owed them the revelation of his specific pretense. I can not decide to give it a more serious origin .

One last word. Even if the bowl of Armenia deserved, by its proven services, the honor that Galen did to him, I would have nothing to change in my opinion on the nature of the Antonine disease. It would only prove that art had fortuitously been enriched by a precious resource that was lacking to contemporary Thucydides physicians. Before the discovery of cinchona, intermittent fevers were (it is Sydenham who said it) the disgrace of the therapy. They are today the most beautiful title. This is simply said to be similar. The cinchona has largely proved its worth, while the bowl of Armenia, an exalted moment, has not recovered from the deep oblivion where it has just fallen.

China Rifampicin