In Scotland the laws and ordinances, civil and ecclesiastical, against lepers have been more numerous. In 1242 and 1269, canons of the Scots Church were made, ordering that lepers should be separated from society in accordance with general custom. In 1283-84, the statutes of the Society of Merchants, or the Guildry, of Berwick provided that lepers should not enter the borough, and that “some gude man sall gather alms for them.” In 1427 the Parliament of Perth authorised ministers and others to search the parishes for lepers[205].
We conclude, then, that little was made of leprosy by English legislators (rather more by the Scots), just as we have found that in the endowment of charities, the leprous had only a small share, and that share a somewhat exaggerated one owing to the morbid sentimentality of the chivalrous period. The most liberal estimate of the amount of true leprosy at any time in England would hardly place it so high as in the worst provinces of India at the present day. In the province of Burdwan, with a population of over two millions, which may be taken to have been nearly the population of England in the thirteenth century, there are enumerated 4604 lepers, or 2·26 in every thousand inhabitants. But even with that excessive prevalence of leprosy, and with no seclusion of the lepers, a traveller may visit the province of Burdwan, and not be aware that leprosy is “frightfully common” in it. In medieval England the village leper may have been about as common as the village fool; while in the larger towns or cities, such as London, Norwich, York, Bristol, and Lincoln, true lepers can hardly have been so numerous as the friars themselves, who are supposed to have found a large part of their occupation in ministering to their wants. A rigorous scepticism might be justified, by the absence of any good diagnostic evidence, in going farther than this. But the convergence of probabilities does point to a real prevalence of leprosy in medieval England; and those probabilities will be greatly strengthened by discovering in the then habits of English living a vera causa for the disease.
Causes of Medieval Leprosy.
What was there in the medieval manner of life to give rise to a certain number of cases of leprosy in all the countries of Europe? Granting that not all who were called leprosi and leprosae, were actually the subjects of lepra as correctly diagnosed, and that the misnomer was not unlikely to have been applied in the case of princes, nobles and great ecclesiastics, we have still to reckon with the apparition of leprosy among the people in medieval Europe and with its gradual extinction, an extinction that became absolute in most parts of Europe before the Modern period had begun.
Of the “importation” of leprosy into Britain from some source outside there can be no serious thought; the words are a meaningless phrase, which no one with a real knowledge of the conditions, nature and affinities of leprosy would care to resort to. The varying types of diseases, or their existence at one time and absence at another, are a reflex of the variations in the life of the people—in food and drink, wages, domestic comfort, town life or country life, and the like. No one doubts that the birth-rate and the death-rate have had great variations from time to time, depending on the greater or less abundance of the means of subsistence, on overcrowding, or other things; and the variation in the birth-rate and death-rate is only the most obvious and numerically precise of a whole series of variations in vital phenomena, of which the successions, alternations, and novelties in the types of disease are the least simple, and least within the reach of mere notional apprehension or mere statistical management. The apparition and vanishing of leprosy in medieval Europe was one of those vital phenomena. It may be more easily apprehended by placing beside it a simple example from our own times.
The pellagra of the North Italian peasantry (and of Roumania, Gascony and some other limited areas) is the nearest affinity to leprosy among the species of disease. Strip leprosy of all its superficial and sentimental characters, analyse its essential phenomena, reduce its pathology to the most correct outlines, and we shall find it a chronic constitutional malady not far removed in type from pellagra. In both diseases there are the early warnings in the excessive sensibility, excessive redness and changes of colour, at certain spots of skin on or about the face or on the hands and feet. In both diseases, permanent loss of sensibility follows the previous exaggeration, blanching of the skin will remain for good at the spots where redness and discoloration were apt to come and go, and these affections of the end-regions of nerves will settle, in less definite way, upon the nervous system at large,—the cerebro-spinal nervous system, or the organic nervous system, or both together. What makes leprosy seem a disease in a different class from that, is the formation of nodules, or lumps, in the regions of affected skin in a certain proportion of the cases. If leprosy were all anaesthetic leprosy, its affinities to pellagra would be more quickly perceived; it is because about one-half of it has more or less of the tuberculated character that a diversion is created towards another kind of pathology. But the fact that some cases of leprosy develop nodules along the disordered nerves does not remove the disease as a whole from the class to which pellagra belongs. In both diseases we are dealing essentially with a profound disorder of the nerves and nerve-centres, commencing in local skin-affections which come and go and at length settle, proceeding to implicate the nervous functions generally, impairing the efficiency of the individual, and bringing him to a miserable end. The two diseases diverge each along its own path, leprosy becoming more a hopeless disorder of the nerves of tissue-nutrition, and so taking on a structural character mainly but not exclusively, and pellagra becoming more a hopeless disorder of the organic nervous system (digestion, circulation, etc.) with implication of the higher nervous functions, such as the senses, the intellect, and the emotions, and so taking on a functional character mainly but not exclusively. The correlation of structure and function is one that goes all through pathology as well as biology; and here we find it giving character to each of two chronic disorders of the nervous system, according as the structural side or the functional side comes uppermost.
What, then, are the circumstances of pellagra, and do these throw light upon the medieval prevalence of leprosy? Pellagra has been proved with the highest attainable scientific certainty to be due to a staple diet of bread or porridge made from damaged or spoilt maize. It followed the introduction of maize into Lombardy at an interval of two or three generations, and its distribution corresponds closely to the poorer kinds of maize on colder soils, and to the class of the peasantry who get the worst kind of corn or meal for their food. The cases of the disease among the peasantry of Lombardy and some other maize-growing provinces of Northern Italy, were about one hundred thousand when last estimated; the endowed charitable houses and lunatic asylums are full of them. The connexion of the disease with its causes is perfectly well understood; but the economic questions of starvation wages, of truck, of large farms with bailiffs, and of agricultural usage, have proved too much for the chambers of commerce and the Government; so that there is as yet little or no sign of the decline of pellagra in the richest provinces of Italy. This disease is not mentioned in the Bible, therefore it has no traditional vogue; it is not well suited to knight-errantry, because it is a common evil of whole provinces; its causes are economic and social, therefore there is no ready favour to be earned by systematic attempts to deal with them; and there is absolutely no opening for heroism and self-sacrifice of the more ostentatious kind. These are among the reasons why this great object-lesson of a chronic disorder of nutrition, proceeding steadily before our eyes, has been so little perceived. It is in pellagra, however, that we find the key to the ancient problem of leprosy. The two diseases are closely allied in the insidious approach of their symptoms, in their implicating the tissue-nutrition through the nerves, or the nervous functions through the nutrition, in their cumulating and incurable character, and in their transmissibility by inheritance. Thus nosologically allied, they may be reasonably suspected of having analogous causes; and as we know the cause of modern pellagra to be something noxious in the habitual diet of the people, we may look for the cause of medieval leprosy in something of the same kind.
The dietetic cause is not far to seek, and it cannot be stated better than in the following well-known passage by the philosophical Gilbert White in his Natural History of Selborne[206]:—
“It must, therefore, in these days be, to a humane and thinking person, a matter of equal wonder and satisfaction, when he contemplates how nearly this pest is eradicated, and observes that a leper is now [1778] a rare sight. He will, moreover, when engaged in such a train of thought, naturally inquire for the reason. This happy change perhaps may have originated and been continued from the much smaller quantity of salted meat and fish now eaten in these kingdoms; from the use of linen next the skin; from the plenty of bread; and from the profusion of fruits, roots, legumes, and greens, so common in every family. Three or four centuries ago, before there were any enclosures, sown-grasses, field-turnips, or field-carrots, or hay, all the cattle which had grown fat in summer, and were not killed for winter use, were turned out soon after Michaelmas to shift as they could through the dead months; so that no fresh meat could be had in winter or spring. Hence the marvellous account of vast stores of salted flesh found in the larder of the eldest Spencer even so late in the spring as the 3rd of May (600 bacons, 80 carcases of beef, and 600 muttons)[207]. It was from magazines like these that the turbulent barons supported in idleness their riotous swarms of retainers, ready for any disorder or mischief. But agriculture is now arrived at such pitch of perfection, that our best and fattest meats are killed in the winter; and no man needs eat salted flesh, unless he prefers it, that has money to buy fresh.
“One cause of this distemper might be no doubt the quantity of wretched fresh and salt fish consumed by the commonalty at all seasons as well as in Lent, which our poor now would hardly be persuaded to touch.... The plenty of good wheaten bread that now is found among all ranks of people in the south, instead of that miserable sort which used, in old days, to be made of barley or beans, may contribute not a little to the sweetening their blood and correcting their juices.”