Nomenclature of the Disease.
Leprosy, such as it is portrayed in the descriptions and definitions which we have quoted from Bateman, Schedel, Cullen, and Good (and I might have cited any of our modern medical writers to the same effect), has had at different times, and by different authors, a great variety of appellations applied to it. In order to understand the nosological nature of the disease, as it formerly prevailed in Europe, it is requisite to state a few uninteresting but indispensable facts, in regard to the changes which have occurred in its nomenclature.
In the medical writings of Aretæus, Aetius, and the later school of Greek physicians, the disease is described under the title of elephantiasis, for (says Aretæus) “it is disgusting to the sight, and terrible in all respects (est visu fœdus et in omnibus terribilis), like the beast of the same name.”[149] The Arabian medical authors applied the corresponding term of “Das Fil,” “elephant disease,” or elephantiasis, to an affection entirely different, and one apparently unknown to the Greek physicians, namely, the tumid, Barbadoes, or Cochin leg of modern pathologists. At the same time the Arabian authorities described the disease, known to the Greeks under the name of elephantiasis, by the Arabic terms “Judam,” or “Juzam” and “Aljuzam.”[150] The confusion thus apt to arise from describing two different diseases under a corresponding name was greatly increased by the errors committed by the Latin translators of Avicenna, Rhazes, and other Arabic authors. These translators rendered the Das fil or Elephant disease of the Arabic original, by the words elephanta and elephantiasis; and having thus, first, by an improper adaptation, appropriated the use of the latter Greek term to a disease very different in its specific characters from the elephantiasis of the Greeks themselves, they subsequently added to the intricacies of the subject by translating the Arabic “Juzam” (the disease that was in reality identical with the elephantiasis of the Greeks) by the term lepra—a term which the Greek physicians had generally applied to different forms of scaly eruption, but never to any form of tubercular disease.[151]
By these unfortunate mistakes medical men were betrayed into great confusion in the use of these several terms. An identity in names did not signify an identity in objects. The tumid leg, das fil, or elephantiasis of the Arabians, is a disease perfectly different from the tuberculous face affection or elephantiasis of the Greeks.
Again, the term lepra, as used by the Greek physicians themselves, signifies morbid changes in the skin, marked by the presence of scales, and which changes in the skin have no relation whatever to either the Arabian or Greek elephantiasis; but the same term lepra, as used by the Arabic translators, was applied to designate the latter of these two affections, viz. the Arabic “Juzam,” or elephantiasis of the Greeks. Hence, the elephantiasis of the Greeks and the lepra of the Arabians, or more properly of the Arabian translators, are expressions altogether synonymous, as being employed to designate the same individual disease; and it is of the first importance to hold this fact in view in studying the histories of the European leprosy, which have been left us by our own and by other medical authors of the middle ages.[152] For we must further recollect that the knowledge of the Greek tongue was almost entirely lost during the dark ages, and that nearly all learning being then confined to the Moors and Arabs, the scholastic language was principally the Arabic. Thus it happened, that when the love of literature and the pursuit of science began to revive about the twelfth century, the medical as well as the philosophical writings of the ancient Greeks were read and studied by the inhabitants of Western Europe through the medium of Arabic translations of them, or in Latin versions made from these translations.[153] The designations of individual diseases were known to the learned student, and to the medical practitioner and author of the times in question, by the names only under which they were described in these versions. The elephantiasis of the Greeks, or corresponding juzam of the Arabians, was rendered by the term lepra in almost every Latin translation from the Arabian or Saracenic school; and hence it is that we find this term lepra used by the medical and other authors of the succeeding period, as the common appellative for the individual disease to which the two former designations were originally applied. In many medical works of the middle ages the single name “lepra”[154] is employed; in the writings of others, and more particularly of later authors, it has the distinctive designation (Lepra Arabum) added to it,[155] in order to discriminate it from the Lepra Græcorum or scaly eruptions, to which that term was primarily applied by the Greeks. In still more modern times, and with the same view, the Elephantiasis Græcorum, Juzam, or Lepra of the Arabians, or rather of the Arabian translators, has been very frequently termed (as I believe was first proposed by Vidal)[156] tuberculous leprosy (Lepra tuberculosa), in order to distinguish it from the other very different disease, the scaly leprosy of the Greeks (Lepra vulgaris, Lepra squamosa, etc.) But, whatever may be the difference in the nomenclature of different authors, we are to hold this in recollection, that the various terms of the elephantiasis of the Greeks (Elephantiasis Græcorum), the juzam or leprosy of the Arabian translators (Lepra Arabum), the tuberculous leprosy of modern European authors (Lepra tuberculosa, Lepra nodosa), and the simple leprosy (Lepra) of most authors of the middle ages,[157]—all signify that same specific and individual disease, whose distinctive characters we have already traced from Bateman and Schedel, and from Cullen and Good.
Specific Character of the Leprosy which prevailed during the Middle Ages.
Having premised the preceding tedious but necessary digression upon the nomenclature of leprosy, we now proceed to consider the question whether the particular form of disease that prevailed on the Continent and in Great Britain during the middle ages, and for the victims of which so many hospitals were built, and so many laws enacted, answered or not, in its nosological characters, to the Elephantiasis Græcorum, Lepra Arabum or Arabian leprosy, such as we have found that malady depicted in the standards already referred to, and such as it is known to prevail at the present day in different localities in the new and old world, that I shall afterwards take occasion to specify. We begin our inquiry into the nature of the disease, by considering the characters of the leprosy as it was seen prevailing, almost epidemically, in the middle ages.
1. Upon the Continent of Europe.—To obtain a solution of this part of our problem, let us turn to the works of the medical authors of these early times, and endeavour to ascertain from them the nature of the disease which they denominated leprosy.
Various minute descriptions of leprosy (lepra) have been left us in the writings of different European physicians and surgeons of the middle ages, who had an opportunity of studying the disease in different kingdoms upon the Continent during the period of its actual prevalence. Amongst others we may especially refer to the accounts of it, written during the thirteenth century, by the monk Theodoric,[158] afterwards a distinguished surgeon of Bologna; by the celebrated Lanfranc, who was first a practitioner in Milan,[159] and subsequently in Paris; and by Professor Arnold Bachuone,[160] of Barcelona, reputed in his day the greatest physician in Spain. Valescus de Taranta,[161] a physician of Montpellier; Bernhard Gordon,[162] Professor of Medicine in the same city; the famous French Surgeon, Guy de Chauliac;[163]—Vitalis de Furno,[164] Cardinal of Albany; and Petrus de Argelata,[165] a practitioner of Bologna, have each left us descriptions of leprosy drawn up during the fourteenth century; and during the two succeeding centuries, we have more or less accurate accounts of the disease given by Professors Montagnana[166] of Padua and Matthew Ferrari de Gradi[167] of Pavia, by Ambrose Paré,[168] Joannes Fernelius,[169] Palmarius,[170] Hildanus[171] and various others.[172]