In the Second Part I will take an opportunity of considering at length the nosological nature of the leprosy of the middle ages, particularly as it was seen prevailing in Great Britain. I will inquire into the rank, age, etc., of those attacked, and point out some of the causes which have been considered as connected with the dissemination of the disease; and lastly, I will endeavour to bring together some of the strange regulations of medical police that were adopted in England and Scotland with regard to the infected.
PART II.
THE NOSOLOGICAL NATURE OF THE DISEASE.
In the preceding Part we have shown the extent to which leprosy prevailed during the middle ages in Great Britain; the number of hospitals that were instituted for the reception and seclusion of the infected; the government and regulations of these hospitals; and the dates of the commencement and disappearance of the disease in the kingdoms of England and Scotland. Before proceeding farther, we propose,—in this Second Part,—to pause and discuss the strictly medical question of the specific nosological nature of the malady, whose history we have thus far considered.
I have already taken occasion to speak of the leprosy of the middle ages, as identical with the species of cutaneous disorder, which has been variously denominated the tubercular leprosy, (Lepra tuberculosa); the leprosy of the Arabians (Lepra Arabum); and the elephantiasis of the Greeks (Elephantiasis Græcorum). The particular form of chronic cutaneous disease, to which these different appellations have been severally applied, is an affection very distinctly marked in its more leading symptoms and course. Before, however, attempting to prove that the European and British leprosy of former times was specifically identical with the malady in question, it will expedite our investigation of the question if, in the first instance, we obtain a precise and perfect picture of the tubercular or Arabian leprosy itself. By adopting this plan, we shall have placed before us a standard, as it were, by which we can judge of and test those more or less imperfect descriptions of the leprosy of the middle ages, which we may in the sequel have occasion to quote and animadvert upon. And in order to obtain such a standard of comparison as we have now in view, and that without any possibility of prejudging the subject, I shall cite the description of this species of disease from Dr. Bateman of London, and Dr. Schedel of Paris;—from the first, because the characters which he has given of this and other cutaneous affections are generally and justly looked upon by British pathologists as the most clear and distinct that can anywhere be referred to;—and from the last, because his account of tubercular leprosy is, I believe, the latest that has issued from the medical press, and the author has already, by a former work,[144] distinguished himself by the excellence of his descriptions, and the precision of his diagnosis of cutaneous diseases.
Modern Descriptions and Definitions of Tubercular Leprosy.
“The elephantiasis,” says Dr. Bateman[145] “(as described by the Greeks), is principally characterised by the appearance of shining tubercles, of different sizes, of a dusky red or livid colour, on the face, ears, and extremities; together with a thickened and rugose state of the skin, a diminution or total loss of its sensibility, and a falling off of all the hair, except that of the scalp.
“The disease is described as very slow in its progress, sometimes continuing for several years, without materially deranging the functions of the patient. During this continuance, however, great deformity is gradually produced. The alæ of the nose become swelled and scabrous, and the nostrils dilate; the lips are tumid; the external ears, particularly the lobes, are enlarged and thickened, and beset with tubercles; the skin of the forehead and cheeks grows thick and tumid, and forms large and prominent rugæ, especially over the eyes; the hair of the eyebrows, the beard, the pubes, axillæ, etc., falls off; the voice becomes hoarse and obscure; and the sensibility of the parts affected is obtuse, or totally abolished, so that pinching or puncturing them gives no uneasiness. This disfiguration of the countenance suggested the idea of the features of a satyr or a wild beast; whence the disease was by some called Satyriasis, and by others Leontiasis.