LEPROSY.
Leprosy is a disease originating in the Orient; Egypt and Judea were formerly the principal infected centers. It was the return of an expedition to Palestine, under Pompey, that imported the malady to Italy. In the first years of the Christian Era it is mentioned by Celsus, who advised that it should be treated by sweating, aided by vapor baths. Some years later Areteus used hellebore, sulphur baths, and the flesh of vipers taken as food, a treatment adopted by others, as, for instance, Musa and Archigenes.
In the second century the disease was in Gaul; Soranus treated the lepers of Aquitaine, who were numerous.[27]
According to Velly, leprosy was common in France in the middle of the eighth century epoch, when Nicholas, Abbot of Corbeil, constructed a leper hospital, which was never much frequented until after the Crusades of the eleventh and fourteenth centuries. At this period the number of lepers, or ladres, a name given to the unfortunates in remembrance of their patron saint, St. Lazarus, became so great that every town and village was obliged to build a leper house in order to isolate the afflicted. Under Louis VIII. there were 2,000 of these hospitals; later the number of such asylums reached 19,000.
According to the historians of this time, when a man was suspected to be a leper he could have no social relations without making full declaration as to what the real nature of his complaint might be. Without this precaution his acts were void, from the capitulary of Pepin, which dissolved all marriage contracts with lepers, to the law of Charlemagne, that forbade their associating with healthy persons. The fear of contagion was such that in places where no leprosy existed they built small houses for any one who might be attacked; these houses were called bordes.[28] A gray mantle, a hat and wallet, were also supplied the victims, also a tartarelle, a species of rattle, or a small bell, with which they warned all passers near not to approach. They also had a cup placed on the far side of the road, in which all persons might drop alms without going near the leper.
Leper houses were enriched, little by little, by the liberality of kings and nobles and the people, and to be a leper became less inhuman and horrible than at the beginning.
Lepers, however, were forced to submit to severe police regulations. They were forbidden under the severest penalties from having sexual relations with healthy persons, for such intimacy was considered as the most dangerous method of conveying the contagion. After entering a leper house the victim was considered as dead under the civil law, and in order to make the patients better understand their position the clergy accompanied them to their asylum, the same as to their funeral, throwing the cemetery dust on them while saying: “Enter into no house save your asylum. When you speak to an outsider stand to the windward. When you ask alms sound your rattle. You must not go far from the asylum without your leper’s robe. You must drink from no well or spring save on your own grounds. You must pass no plates nor cups without first putting on your gloves. You must not go barefooted, nor walk in narrow streets, nor lean against walls, trees, or doors, nor sleep on the edge of the road,” etc.
When dead they were interred in the lepers’ cemetery by their fellow-sufferers.
Separated from society, these pariahs, living together, sometimes reproduced their own species, and finished their days in the most frightful cachexia, awaking only contempt, disgust, and repulsion among the healthy of the outside world.
It is true that each time that sanitary measures were relaxed by the authorities—such, for instance, as the perfect isolation of the patients—an increase in the number of lepers was noticeable. When this was observed the old-time ordinances were enforced again with vigor. It was thus in 1371 the Provost of Paris issued an edict enjoining all lepers to leave the Capital within fifteen days, under heavy corporal and pecuniary penalties; and in 1388, all lepers were forbidden to enter Paris without special permission; in 1402 this restriction was renewed, “under penalty of being taken by the executioner and his deputies and detained for a month on a diet of bread and water, and afterwards perpetual banishment from the kingdom.” Finally, in April, 1488, it was announced “all persons attacked by that abominable, very dangerous and contagious malady known as leprosy, must leave Paris before Easter and retire to their hospitals from the date of issuance of this edict, under penalty of imprisonment for a month on bread and water; and, where they had property, the sequestration of their houses and jewels and arbitrary corporal punishment; it was permitted them, however, to send things to them by servants, the latter being in health.”
We can understand from this how these poor wretches, at different epochs, were accused of horrible crimes, among other things poisoning rivers, wells, and fountains. As regards this accusation, says the author of the Dictionnaire des Mœurs des Francais, Philip le Long burned a certain number of these poor devils at the stake and confiscated their wealth, giving it to the Order of Malta and St. Lazare.
The historians and chronicalers of the eleventh and twelfth century often designated the person attacked by leprosy by the name of mesel, mezel, meseau or mesiaus. Meantime Barbazin pretends that it is necessary to make a distinction.[29]
Mesel, according to Barbazin, was a person covered with sores and ulcers, while the leper was an insensible man. He thinks that mesellerie was at its origin a different affection than leprosy, and that these two diseases have been wrongly confounded. “They have both served,” says he, “to designate a frightful disease, that is reputed the most dangerous of all maladies.”
As supporting this assertion of Barbazin, we have found in the Romanesque tongue some documents strongly confirming this point. They appear more interesting, inasmuch as they have heretofore been unknown to medical literature, as, for instance:
“Seneschal, I now demand of you, said he (Saint Louis), which you love better, whether you be mesiaus, or whether you commit a mortal sin; and I, who never have lied, responded that rather would I commit thirty mortal sins than be mesiaus.” (Joinville, Histoire de Saint Louis.)
The leprosy, however, was not an absolute cause for divorce, as we note in the following passage: “A man can leave his wife only for fornication, and not alone for leprosy, and lepers may marry; and one may cancel marriage if the husband become leper, and the same may be said of the bride.”
In the same manuscript another analogous fact shows the invalidation of the marital act for the reason of mesellerie complicated by impotence or barrenness.
“A woman who through impotence has lost that which is necessary to her, so that he cannot cohabit with her, for the reason that he is mesiaus, may marry another, telling the latter, however, that the first she married was worth nothing, not even an infant, as he could not cohabit; that nothing can prevent cohabitation in marriage nor the begetting of children.”
Individuals attacked by mesellerie were in reality outside the pale of the law. For we read in fact in the “Coutume de Beauvoisis, cap. 39,” that “mesiaus must not be called on as witnesses, for custom accords them no place in the conversation of gentlemen.”
“The second reason is that when a mesiaus calls on a healthy man, or when a healthy man calls on a mesel, the mesiaus may put in the defense that he is beyond the reach of worldly law, and cannot be held responsible in such a case.”
These unfortunates besides could not inherit nor dispose of their own wealth during their lives. The following passage from the “ancient customs of Normandy” bears witness, i. e.:
“The mesel can be no man’s heir from the time his disease is developed, but he may have a life interest, as though he were not a mesel.”
The same as in many other diseases the leprosy presented itself under different forms and various degrees of gravity, as is proved from the following passage from Le Pelerinage de l’humaine lignee:
“Homs, qui ne scet bien discerner
Entre sante et maladie,
Entre le grant mesellerie
Entre le moienne et le meure.”
This gravity of different forms of leprosy has likewise been mentioned by the Arabian school, and notably by Avicenna, who had seen numerous cases complicated with ulcerations of the genital organs; also, by the Englishman, Gilbert, who wrote in the thirteenth century regarding the existence of several species of leprosy, which could not always be easily distinguished by reason of the uncertainty of their symptoms. As to its character as a constitutional malady we have the word of the Syrian Jaliah ebn Serapion, who attributes its connection to the predominance of certain humors; finally, Valescus of Tarentum insists on the heredity of the disease.
The leprosy, the pork measles and the mesellerie were then only clinical forms of a single affection of a contagious nature—a hereditary disease whose symptoms appeared successively on the skin, in the mucous membranes, the viscera and in the nervous system. It then required a diathesis, which resembled greatly in its evolution that of syphilis, with which it has often been confounded.
The physicians of leper hospitals have left behind a great number of medical documents bearing on the characteristics of the disease, but their observations are so confused that we can only conclude that they considered all cutaneous maladies as belonging to the same constitutional vice.
They recognized, however, the ladrerrie (disease arising from measly pork), by the following symptoms, the same being laid down by Guy de Chauliac:
“Eyelids and eyebrows swollen, falling of eye-lashes and eyebrows, which are replaced by a finer quality of hair; ulceration of septum of the nose, odor of ozoena, granulated tongue, fœtid breath, painful breathing, thickening and hardness of the lips, with fissures and lividity of same; gums tumefied and ulcerated; furfuraceous scales in the hair, purple face, fixed expression, hideous aspect; forehead smooth and shiny like a horn; pustules on face; veins on chest much developed; breasts hard.”
“Thinness of muscles of the hand, especially thumb and index finger; lividity and cracking of the nails; coldness of the extremities; presence of a serpiginous eruption; insensibility of the legs, collections of nodosities around the joints; under the influence of cold elevations appeared on the cutis, making it appear like goose-skin.”
“Sensation of pricking, ulcerations of skin; sleep uneasy, fetidity of sweat; feeble pulse, bad odor of blood, which is viscid and oily to the touch and gritty after incineration, likewise of a violet black color.”
The contagious characteristic of leprosy through sexual relation was noticed by physicians attached to hospitals, and was the subject of police restriction by public sanitary officers. Thus in the thirteenth century the celebrated Roger Bacon, surnamed the admirable doctor, wrote that commerce with a leprous woman could be followed by very serious consequences. This opinion was corroborated by a physician of the University of Oxford, his contemporary John of Gaddsen, and by the observations of Bernard Gordon, a celebrated practitioner of Montpellier. We all know the history of a Countess who came to be treated for leprosy at Montpellier, when a Bachelor in Medicine charged with the task of dressing her sores, fell desperately in love with the leper lady, and from his amours contracted most serious cutaneous disease.
At this period the leprosy had already begun to assume a venereal type of marked character, and many prostitutes suffered from attacks. As we all are aware, Jean Manardi, an Italian doctor, has fully expressed his opinion on this subject. In a letter addressed to a friend, Michel Santana, one of the first specialists who treated pox, Manardi remarks: “This disease has attacked Valencia, in Spain, being spread broadcast by a famous courtesan, who, for the price of fifty crowns, accorded her favors to a nobleman suffering from leprosy. This woman having been tainted, in her turn contaminated all the young men who called on her, so that more than four hundred were affected in a brief space of time. Some of these, having followed the fortunes of King Charles into Italy, carried and spread this cruel malady in their track.”
Another Italian physician, Andre Mathiole, likewise shows the identity of leprosy with syphilis,—in the following terms: “Some authors have written that the French have taken this disease from impure commerce with leprous women while traversing the mountains of Italy.”[30]
We could easily multiply such citations to complete the facts observed by Fernel and Ambroise Pare in France, and also by many Italian physicians, from whence it would be easy to understand why Manardi came to the following conclusion: “Those who have connection with a woman who has had recent amours with a leper, a courtesan in whose womb the seeds of disease may linger, sometimes contract leprosy and at other times suffer from other maladies of a more or less serious nature, according to their predispositions.”
This modification from measles (the disease from corrupt pork diet) into leprosy of the venereal type is made progressively through the intermediary of the ordinary agencies of prostitution,—bawds and libertines,—who for a very long period eluded the wise laws ordained by sanitary police for the restriction of lepers. In 1543, the affection was so wide-spread as to be beyond sanitary control, and the edict of Francois I., re establishing leper hospitals, amounted to nothing. There were too many poxed people. The Hospital of Lourcine, which was specially devoted to these cases at Paris contained 600 patients in 1540, and in the wards of Trinity Hospital and the Hotel Dieu there were many more. It was the same in the Provinces, notably at Tolouse, which had the merit of creating the first venereal hospital ever instituted, under the Gascon name of “Houspital das rognousez de la rougno de Naples.” Finally, fifty years later, in 1606, for want of lepers, the leper asylums were officially closed. Henry IV., in a proclamation, gave those remaining “to poor gentlemen and crippled soldiers.”
Thus ended the epidemic of leprosy in France, which had prevailed from the second century, observing the same progress in other countries of Western Europe during the same period of time. Syphilis, the product of the venereal maladies of antiquity and the leprosy of the Middle Ages, announced a new era; syphilis was thus contemporaneous with the Renaissance.
In the collection of Guy Patin’s letters, there is an interesting document relating to the connection of leprosy and syphilis, as witness the principal passage:
“It was not long since that I saw in Auvergne a patient who was suspected of measles (hog disease), for the reason that his family had the reputation of being thus afflicted, though he bore on his body no marks of the disease. This led me to recall the fact that some families in Paris have been suspected of this taint; but really we have no measles or leprosy here. In former times there was a hospital dedicated to such cases in the Faubourg Saint Denis. I have noticed no cases in Champagne, Normandy nor Picardy, although in all these Provinces I found asylums formerly used for such cases that are now turned into hospitals for plague victims. In former times leprosy was confounded with pox, through the ignorance of doctors and the barbarity of the age; nevertheless, there are yet a few lepers in Provence, Languedoc and Poitou.”
We have here the authority of Guy Patin for saying that leprosy had almost entirely disappeared from France in the sixteenth century.
Although modern Faculties are prone to insist that the real science of medicine only dates back its origin to the discovery of the microscope, and that the study of antique medicine is only a retrospective exposition calculated to show the slight scientific value of ancient observations, I assert that the many observations recorded by our medical ancestors are of immense value. Let us cite, as a single instance, this transformation of a constitutional malady, attenuated by time, transmitted by heredity through the same masses of people for ten centuries,—populations having a similar diathesis,—a disease taking a new vigor and attacking other generations, but destined in a given time to disappear, most probably, in its turn, in another unknown metamorphosis. Such an idea may cause a smile in that haughty section hors rang in medicine, which is so devoted to the culture of specific germs that but one idea can certainly be adopted as an irrefutable dogma in medicine—that is, if the facts it represents coincide with the modifications of the wag—in the tail end of a bacillus.
As for myself, I remain convinced that everything seen in modern times, through the objective even of an instrument of precision, cannot destroy the accumulated work of twenty centuries of medical observation and study.
Scientiæ enim per additamenta fiunt.