Each of the several authors just now named has described, with greater or less precision, the symptoms of the prevailing leprosy, or chronic incurable cutaneous disease, for the reception and seclusion of the victims of which the numerous lazar-houses in Europe were established. The details which they all individually give of the leading characters of the malady[173] are in their essential points altogether similar; and the symptoms which they describe it as presenting are exactly those which distinguish Greek elephantiasis. The disease is portrayed with brevity and precision by some of them. Others enter into a detail of its phenomena, greatly more minute than the descriptions I have quoted from Bateman and Schedel; and several give a history of the marks to be derived from the blood, urine, extremities, eyes, face, voice, etc., in a manner so very elaborate and minute, as might surprise us at the present day, did we not recollect the immense importance that depended in these times upon a just and faithful distinction of the disease, when, in a suspected case, a fellow-being might,—by the absence of the more characteristic signs—be saved, or—by their presence—be condemned, for the remainder of life, to all the horrors of a lazar-house. A few, as Guy de Chauliac, Argelata, etc., in the thirteenth and fourteenth centuries, and in still later times, Gregory Horst, Forrestus, etc., add a most minute and detailed account of the various symptoms which the physician ought to look for in examining a suspected person, and point out the exact mode in which he ought to proceed with this examination before venturing to consign a suspected person to the seclusion of a leper hospital, and thus for ever doom him to be a despised “child of St. Lazarus.”
In an essay such as the present, it would be out of place to attempt to show, by the exact words of each of the authors to whom I have just now alluded, the truth of the proposition that the lepra in their writings, and consequently the lepra of Europe in their times, was strictly identical with the elephantiasis of the Greeks, and that the leper hospitals were specially intended for those affected with this disease. As examples, however, of the whole, I may cite the observations of two of the authors whom I have named; and I shall select for this purpose Gordon and Guy de Chauliac, principally from their two names standing higher in medical history than most of the others that I have enumerated—from their living at a time when the disease was most prevalent,—and from their descriptions of the malady itself being on the whole more than usually concise and methodic.
Bernhard Gordon was, at the commencement of the fourteenth century, one of the first, if not the first Professor of Medicine in the newly-established school of Montpellier. “He has left us,” says Dr. Freind,[174] “a large volume called Lilium Medicinae(for in that affected age everything writ in Physick, was either a Lily or a Rose), a book mightily celebrated in those times.” This volume is generally stated to have been written about the year 1305[175] or 1309.[176] From the very long chapter which is devoted in this work to the consideration of leprosy, I shall translate the account which the author gives of his threefold stages or classes of symptoms of the disease—viz. the occult, the infallible, and the last or terminating signs.
1. “The occult premonitory signs (signa occulta in principio) of leprosy are (he states) a reddish colour of the face, verging to duskiness; the expiration begins to be changed; the voice grows raucous, the hairs become thinned and weaker, and the perspiration and breath incline to fœtidity; the mind is melancholic with frightful dreams and nightmare; in some cases scabs, pustules, and eruptions, break out over the whole body; the disposition of the body begins to become loathsome, but still, while the form and figure (forma et figura) are not corrupted, the patient is not to be adjudged for separation, but is to be most strictly watched (nondum est judicandus ad separationem, sed est fortissime comminandus.)
2. “The infallible signs (signa infallibilia) are enlargement of the eyebrows, with loss of their hair; rotundity of the eyes; swelling of the nostrils externally, and contraction of them within; voice nasal; colour of the face glossy (lucidus), verging to a darkish hue; aspect of the face terrible, with a fixed look, and with acumination and contraction of the pulps of the ears. And there are many other signs, as pustules and excrescences, atrophy of the muscles, and particularly of those between the thumb and forefinger; insensibility of the extremities; fissures and infections of the skin; the blood, when drawn and washed, containing black, earthy, rough, sandy matters, and other marks which authors prominently mention, but for me, those suffice which are to be found in the face. The above are those evident and manifest signs, which, when they do appear, the patient ought to be separated from the people (quibus apparentibus patiens est a populo sequestrandus), or, in other words, secluded in a leper-house.
3. “The signs of the last stage, and breaking-up (naufragium) of the disease are, corrosion and falling-in of the cartilage forming the septum of the nose; fissure and division (scissura) of the feet and hands; enlargement of the lips, and a disposition to glandular swelling; dyspnœa and difficulty of breathing; the voice hoarse and barking; the aspect of the face frightful, and of a dark colour; and the pulse small and imperceptible.”[177]
After giving the above accurate description of the leprosy, Gordon, in a subsequent page,[178] earnestly states, “No one ought to be adjudged as a leper unless there manifestly appear a corruption of the figure (corruptio figurae), or that state which is indicated by his signa infallibilia. And I repeat to you this (he adds), as often as I have occasion to mention the corruptio figurae, because, as it appears to me, lepers are at the present day very injudiciously adjudged. Whoever, therefore, has ears, let him attend to this, if he will.”
The other medical author whom I particularised for quotation, Guy de Chauliac, practised first at Lyons, and afterwards at Avignon. He was one of the most celebrated surgeons in the fourteenth century,[179] and was successively medical attendant upon Popes Clement VI. and Urban V.[180] From the notice which he gives of the Black Death Pestilence of 1363, it would seem that he was then stationed at Avignon, and engaged in the Composition of his ”Inventarium sive Collectorium Partis Chirurgicalis Medicinae.” In the long disquisition on lepra, contained in the 6th treatise of this work,[181] De Chauliac, after stating the usual subdivision of the disease into four varieties or species (Elephantia, Leonina, Tyria, Alopecia), goes on to describe the common signs of all the varieties of leprosy, (signa communia Omnium specierum Lepræ). The signs or symptoms indicating the actual presence of the disease are, he says, some unequivocal, others equivocal (quædam univoca, quædam equivoca). Among the former set (signa univoca) he ranges the six following symptoms:—“(1.) rotundity of the ears and eyes; (2.) thickening and tuberosity of the eyebrows, with falling off of their hair; (3.) dilatation and disfiguration of the nostrils externally, with stricture of them within, and fœtidity of the lips; (4.) voice raucous and nasal; (5.) fœtidity of the breath, and of the whole person; (6.) fixed and horrible satyr-like aspect.”
I question if any of our modern nosologists, or any recent writers on cutaneous diseases, have proposed a more correct definition, or accurate and concise diagnosis of the Elephantiasis Græcorum than is presented in the above enumeration of its pathognomonic symptoms by the old French surgeon.
De Chauliac adds a list of sixteen signs of leprosy, which, from their not being constant, he terms equivocal (equivoca). Among these he gives tuberosity and hardness of the flesh, particularly of the joints and extremities; insensibility and feeling of torpor in the limbs; falling off of the hairs; tubercles (grana) under the tongue and palpebræ, and behind the ears; an unctuous condition of the skin, as seen when water is thrown upon it; with symptoms from the blood, urine, etc. “By these unequivocal and equivocal signs, lepers (says he) are examined; but (he judiciously goes on to observe), in the examination and judgment of lepers there must be much circumspection, because the injury is very great, whether we thus submit to confinement those that ought not to be confined, or allow lepers (leprosos) to mix with the people, seeing the disease is contagious and infectious. Therefore ought the physician repeatedly to examine the affected, and consider and re-consider those signs which are unequivocal, and those that are equivocal, and let him not venture to judge by one sign, but by a concourse of many, and particularly of those that are unequivocal.”