Leprosy in Medieval Medical Treatises.
The picture given of true leprosy in the medieval treatises on medicine is unmistakeable. There are two systematic writers about the year 1300 who have left a better account of it than the Arabian authors from whom they mostly copied. While the writers in question have transferred whole chapters unaltered from Avicenna, Rhazes and Theodoric, they have improved upon their models in the stock chapter ‘De Lepra.’ It so happens that those two writers, Bernard Gordonio and Gilbertus Anglicus, bear names which have been taken to indicate British nationality, and the picture of leprosy by the latter has actually been adduced as a contemporary account of the disease observed in England[134]. Gordonio was a professor at Montpellier, and his experience and scholarship are purely foreign. The circumstances of Gilbert the Englishman are not so well known; but it is tolerably certain that he was not, as often assumed, the Gilbert Langley, Gilbert de l’Aigle, or Gilbertus de Aquila, who was physician to Hubert, archbishop of Canterbury († 13 July, 1205)[135], having been a pupil at Salerno in the time of Aegidius of Corbeil (about 1180). The treatise of Gilbertus Anglicus bears internal evidence of a later century and school; it is distinguished by method and comprehensiveness, and is almost exactly on the lines of the Lilium Medicinae by Gordonio, whose date at Montpellier is known with some exactness to have been from 1285 to about 1307. Future research may perhaps discover where Gilbert taught or was taught; meanwhile we may safely assume that his scholarship and system were of a foreign colour. The medical writer of that time in England was John of Gaddesden, mentioned in the end of the foregoing chapter; he is the merest plagiary, and the one or two original remarks in his chapter ‘De Lepra’ would almost justify the epithet of “fatuous” which Guy de Chauliac applied to him.
Although we cannot appeal to Gilbertus Anglicus for native English experience any more than we can to his alter ego, Gordonio, yet we may assume that the picture of leprosy which they give might have been sketched in England as well as in Italy or in Provence. The conditions were practically uniform throughout Christendom; the true leprosy of any one part of medieval Europe is the true leprosy of the whole.
Gilbert’s picture[136], as we have said, is unmistakeable, and the same might be said of Bernard’s[137]—the eyebrows falling bare and getting knotted with uneven tuberosities, the nose and other features becoming thick, coarse and lumpy, the face losing its mobility or play of expression, the raucous voice, the loss of sensibility in the hands, and the ultimate break-up or naufragium of the leprous growths into foul running sores. The enumeration of nervous symptoms, which are now recognised to be fundamental in the pathology of leprosy, shows that Gilbert went below the surface. Among the “signa leprae generalia” he mentions such forms of hyperaesthesia as formicatio (the creeping of ants), and the feeling of “needles and pins;” and, in the way of anaesthesia, he speaks of the loss of sensibility from the little finger to the elbow, as well as in the exposed parts where the blanched spots or thickenings come—the forehead, cheeks, eyebrows, to which he adds the tongue. Gilbert’s whole chapter ‘De Lepra’ is an obvious improvement upon the corresponding one in Avicenna, who says that lepra is a cancer of the whole body, cancer being the lepra of a single member, and is probably confusing lupus with leprosy when he describes the cartilages of the nose as corroded in the latter, and the nostrils destroyed by the same kind of naufragium as the fingers and toes. All students of the history or clinical characters of leprosy, from Guy de Chauliac, who wrote about 1350, down to Hensler and Sprengel, have recognised in Gilbert’s and Bernard’s account of it the marks of first-hand observation; so that we may take it, without farther debate, that leprosy, as correctly diagnosed, was a disease of Europe and of Britain in the Middle Ages.
Having got so far, we come next to a region of almost inextricable confusion, a region of secrecy and mystification, as well as of real contemporary ignorance. We may best approach it by one or two passages from Gilbert and Gordonio themselves. The systematic handling of lepra in their writings is one thing, and their more concrete remarks on its conditions of origin, its occasions, or circumstances are another. What are we to make of this kind of leprosy?—“In hoc genere, causa est accessus ad mulierem ad quam accessit prius leprosus; et corrumpit velocius vir sanus quam mulier a leproso.... Et penetrant [venena] in nervos calidos et arterias et venas viriles, et inficiunt spiritus et bubones, et hoc velocius si mulier,” etc. Or to quote Gilbert again: “Ex accessu ad mulieres, diximus superius, lepram in plerisque generari post coitûs leprosos[138].” Or in Gordonio: “Et provenit [lepra] etiam ex nimia confibulatione cum leprosis, et ex coitu cum leprosa, et qui jacuit cum muliere cum qua jacuit leprosus[139].” That these circumstances of contracting lepra were not mere verbal theorizings inspired by the pathology of the day and capable of being now set aside, is obvious from a historia or case which Gordonio introduces into his text. “I shall tell what happened,” he says; and then proceeds to the following relation:[140]
“Quaedam comtissa venit leprosa ad Montem Pessulanum [Montpellier], et erat in fine in cura mea; et quidam Baccalarius in medicina ministrabat ei, et jacuit cum ea, et impregnavit eam, et perfectissime leprosus factus est.” Happy is he therefore, he adds, who learns caution from the risks of others.
Here we have sufficient evidence, from the beginning of the fourteenth century, of a disease being called lepra which does not conform to the conditions of leprosy as we now understand them. The same confusion between leprosy and the lues venerea prevailed through the whole medieval period. Thus, in the single known instance of a severe edict against lepers in England, the order of Edward III. to the mayor and sheriffs of London in 1346[141], the reasons for driving lepers out of the City are given,—among others, because they communicate their disease “by carnal intercourse with women in stews and other secret places,” and by their polluted breath. It was pointed out long ago by Beckett in his paper on the antiquity of the lues venerea[142], that the polluted breath was characteristic of the latter, but not of leprosy. Of course the pollution of their breath might have meant no more than the theoretical reasoning of the books (as in Gilbert, where the breath of lepers, as well as the mere sight of them, is said to give the disease, p. 337), but the breath was probably obnoxious in a more real way, just as we know, from Gordonio’s case at Montpellier, that the other alleged source of “leprous” contagion was no mere theoretical deduction. As the medieval period came to an end the leper-houses (in France) were found to contain a miscellaneous gathering of cases generically called leprous; and about the same time, the year 1488, an edict of the same purport as Edward III.’s London one of 1346, was issued by the provost of Paris against les lépreux of that city. The year 1488 is so near the epidemic outburst of the morbus Gallicus during the French campaigns on Italian soil in 1494-95, that the historian has not hesitated to set down that sudden reappearance of leprous contagion, in a proclamation of the State, to a real prevalence already in Paris of the contagious malady which was to be heard of to the farthest corners of Europe a few years after[143].
There is no difficulty in producing evidence from medieval English records of the prevalence of lues venerea, which was not concealed under the euphemistic or mistaken diagnosis of leprosy. Instances of a very bad kind, authenticated with the names of the individuals, are given in Gascoigne’s Liber Veritatum, under the date of 1433[144].
In the medieval text-books of Avicenna, Gilbert and others, there are invariably paragraphs on pustulae et apostemata virgae. In the only original English medical work of those times, by John Ardern, who was practising at Newark from 1349 to 1370, and came afterwards to London, appearances are described which can mean nothing else than condylomata[145]. From a manuscript prescription-book of the medieval period, in the British Museum, I have collected some receipts (or their headings) which relate, as an index of later date prefixed to the MS. says, to “the pox of old[146].”
Some have refused to see in such cases any real correspondence with the modern forms of syphilis because only local effects are described and no constitutional consequences traced. But no one in those times thought of a primary focus of infection with its remoter effects at large, in the case of any disease whatsoever. Even in the great epidemic of syphilis at the end of the fifteenth century, the sequence of primary and secondary (tertiaries were unheard of until long after), was not at first understood; the eruption of the skin, which was compared to a bad kind of variola, the imposthumes of the head and of the bones elsewhere, together with all other constitutional or general symptoms, were traced, in good faith, to a disordered liver, an organ which was chosen on theoretical grounds as the minera morbi or laboratory of the disease[147]. The circumstances of the great epidemic were, of course, special, but they were not altogether new. No medieval miracle could have been more of a suspension of the order of nature than that luxuria, immunditia, and foeditas, with their attendant corruptio membrorum, should have been free from those consequences, in the individual and in the community, which are more familiar in our own not less clean-living days merely because the sequence of events is better understood. That such vices abounded in the medieval world we have sufficient evidence. They were notorious among the Norman conquerors of England, especially notorious in the reign of William Rufus[148]; hence, perhaps, the significance of the phrase lepra Normannorum. That particular vice which amounts to a felony was the subject of the sixth charge (unproved) in the indictment of the order of the Templars before the Pope Clement V. in 1307. Effects on the public health traceable to such causes, for the most part sub rosa, have been often felt in the history of nations, from the Biblical episode of Baal-peor down to modern times. The evidence is written at large in the works of Astruc, Hensler and Rosenbaum. We are here concerned with a much smaller matter, namely, any evidence from England which may throw light upon the classes of cases that were called leprous if they were called by a name at all.
Under the year 1258, Matthew Paris introduces a singular paragraph, which is headed, “The Bishop of Hereford smitten with polypus.” The bishop, a Provençal, had made himself obnoxious by his treacherous conduct as the agent of Henry III. at the Holy See in the matter of the English subsidies to the pope. Accordingly it was by the justice of God that he was deformed by a most disgraceful disease, to wit, morphea, or again, “morphea polipo, vel quadam specie leprae[149].” According to the medical teaching of the time, as we find it in Gilbertus Anglicus, morphaea was an infection producing a change in the natural colour of the skin; it was confined to the skin, whereas lepra was in the flesh also; the former was curable, the latter incurable; morphaea might be white, red, or black[150]. The account of morphaea by Gordonio is somewhat fuller. All things, he says, that are causes of lepra are causes of morphaea; so that what is in the flesh lepra is morphaea in the skin. It was a patchy discoloration of the skin, reddish, yellowish, whitish, dusky, or black, producing terribilis aspectus; curable if recent, incurable if of long standing; curable also if of moderate extent, but difficult to cure if of great extent[151]. In this description by Gordonio a modern French writer on leprosy[152] discovers the classical characters of the syphilis of our own day: “not one sign is wanting.”
No doubt the medical writers drew a distinction between morphaea and lepra, as we have seen in quoting Gilbert and Gordonio. Gaddesden, also, who mostly copies them, interpolates here an original remark. No one should be adjudged leprous, he says, and separated from his fellows, merely because the “figure and form” (the stock phrase) of the face are corrupted: the disease might be “scabies foeda,” or if in the feet, it might be “cancer.” Nodosities or tubercles should not be taken to mean leprosy, unless they are confirmed (inveterate) in the face[153]. But how uncertain are these diagnostic indications, as between lepra and morphaea, lepra and “scabies foeda,” lepra and “cancer in pedibus!” If there were any object in calling the disease by one name rather than another, it is clear that the same disease might be called by a euphemism in one case and by a term meant to be opprobrious in another. Although leprosy was not in general a disease that anyone might wish to be credited with, yet there were circumstances when the diagnosis of leprosy had its advantages. It was of use to a beggar or tramp to be called a leper: he would excite more pity, he might get admission to a hospital, and he might solicit alms, under royal privilege, although begging in ordinary was punishable. It is conceivable also that the diagnosis of leprosy was a convenient one for men in conspicuous positions in Church and State. It is most improbable that the “lepra Normannorum” was all leprosy; it is absurd to suppose that leprosy became common in Europe because returning Crusaders introduced it from the East, as if leprosy could be “introduced” in any such way; and it is not easy to arrive at certitude, that all the cases of leprosy in princes and other high-placed personages (Baldwin IV. of Jerusalem who died at the age of twenty-five,[154] Robert the Bruce of Scotland,[155] and Henry IV. of England[156]) were cases that would now be diagnosed leprous.
Instances may be quoted to show that the name of leper was flung about somewhat at random. Thus, in an edict issued by Henry II., during the absence of Becket abroad for the settlement of his quarrel with the king, it was decreed that anyone who brought into the country documents relating to the threatened papal interdict should have his feet cut off if he were a regular cleric, his eyes put out if a secular clerk, should be hanged if a layman, and be burned if a leprosus—that is to say, a beggar or common tramp. Again, in the charges brought for Henry III. against the powerful minister Hubert de Burg in 1239, one item is that he had prevented the marriage of our lord the king with a certain noble lady by representing to the latter and to her guardian that the king was “a squinter, and a fool, and a good-for-nothing, and that he had a kind of leprosy, and was a deceiver, and a perjurer, and more of a craven than any woman[157]” etc.
There is also a curious instance of the term leprous being applied to the Scots, evidently in the sense in which William of Malmesbury, and many more after him, twitted that nation with their cutaneous infirmities. When the Black Death of 1348-9 had reached the northern counties of England, the Scots took advantage of their prostrate state to gather in the forest of Selkirk for an invasion, exulting in the “foul death of England.” Knighton says that the plague reached them there, that five thousand of them died, and that their rout was completed by the English falling upon them[158]. But the other contemporary chronicler of the Black Death, Geoffrey le Baker[159], tells the story with a curious difference. The Scots, he says, swearing by the foul death of the English, passed from the extreme of exultation to that of grief; the sword of God’s wrath was lifted from the English and fell in its fury upon the Scots, “et [Scotos] per lepram, nec minus quam Anglicos per apostemata et pustulos, mactavit.” The apostemata and pustuli were indeed the buboes, boils and carbuncles of the plague, correctly named; but what was the lepra of the Scots? It was probably a vague term of abuse; but, if the clerk of Osney attached any meaning to it, it is clear that he saw nothing improbable in a disease called lepra springing up suddenly and spreading among a body of men.
We conclude, then, that lepra was a term used in a generic sense because of a real uncertainty of diagnosis, or because there was some advantage to be got from being called leprosus, or because it was flung about at random. But there is still another reason for the inexact use of the terms lepra and leprosus in the medieval period, namely, the dominant influence of religious tradition. The heritage or accretion of religious sentiment not only perverted the correct use of the name, but led to regulations and proscriptions which were out of place even for the real disease.