The history of leprosy in Britain can hardly be the history of leprosy alone, but of that disease along with others which were either mistaken for it or conveniently and euphemistically included under it. That there was leprosy in the country is undoubted; but it is just as certain that there was lues venerea; that the latter as a primary lesion led an anonymous existence or was called lepra or morphaea if it were called anything; that the remote effects of the lues were not known as such, being taken for detached or original outcomes of the disordered humours and therefore in the same general class as leprous manifestations; and that the popular and clerical notions of leprosy were too superstitious and inexact, even if the diagnostic intention had been more resolute than it was, to permit of any clear separation of the leprous from the syphilitic, to say nothing of their separation from the poor victims of lupus and cancer of the face, of scrofulous running sores, or of neglected skin-eruptions more repulsive to the eye than serious in their nature. I shall give some proof of each of those assertions—as an essential preliminary to any correct handling of the historical records of British leprosy.
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].”