De Chauliac subsequently details at great length the precise mode in which the physician ought to conduct the examination of every suspected case of leprosy referred to him. The patient is, first of all, as we shall afterwards see, recommended to be consoled upon his unfortunate lot, and sworn in to tell the truth in answer to all the interrogatories put to him. In immediately afterwards proceeding to the examination itself, De Chauliac orders inquiries to be instituted into the predisposition, hereditary or otherwise, of the suspected individual; if he were exposed by intercourse with the infected; if his mind were clear and tranquil; if he feels punctures in the flesh, etc. He then recommends the pulse to be examined, and some blood drawn, and treated in such a manner by inspection and straining, as to ascertain its colour, its sediment, the quality of its coagulum, etc. After this he recommends the countenance to be considered, and the patient dismissed for the day, with an order to bring a specimen of his urine with him on the following morning. “In the meantime,” he adds, “let the physician cogitate upon what he has seen, and what he may yet see in the case.
“On the morrow, when the suspected person returns to the physician, let the latter, in the first place, examine the urine, and consider if it shows any sign of disposition towards leprosy. All this being done, let him next again consider the face, and ascertain in regard to the eyebrows if they have lost their hair, and if they are swollen and tuberose; if the eyes themselves are round, particularly towards the internal angles, and if the whites of them are of a darkish hue; in regard to the nose, if it be deformed, enlarged, and internally ulcerated; in regard to the eyes, if they are rounded and shortened; in regard to the voice, if it is raucous and nasal; in regard to the lips and tongue, if they are ulcerated and tuberculated; if the breathing be difficult and fœtid; and if the features be changed and frightful. And let the examiner consider these things deeply, because the signs from the face are more certain than the others. Afterwards make the person strip himself naked (ipsum expoliare), and examine concerning the colour of the whole body, if it is darkish and morphous; concerning the substance of the flesh, if it is hard and irregular, and tuberose, particularly about the joints and extremities; if it is scabrous, pruriginous, or serpiginous and ulcerous; if its corion is rough, like the skin of the goose; and if the muscles are consumed; if there is a feeling of sleeping in the limbs; if he feels perfectly when pricked along the back of the leg, and is certain in respect to the spot and kind of instrument. Then pour water upon his body, and see if it is unctuous, and if salt adheres to it when it is thrown upon its surface. Lastly, let the physician return again to the consideration of the face and countenance, and with that dismiss the person.
“Let all the ascertained signs (cautiously, adds our author) be pondered over, and let the physician deliberate naturally concerning these signs, both individually and in concourse. If he should find that the suspected person has, along with a disposition to leprosy, some of the slighter equivocal signs of the disease, the individual is to be watched at his own house, and secretly, that he may be placed upon a good regimen, and have the advice of medical men, otherwise he will truly become leprous. If, however, he presents many equivocal with a few of the unequivocal signs, he is vulgarly termed cassatus (marked, denounced); and such individuals must be narrowly watched, in order that they take a proper regimen, and have the good advice of physicians; and in order that they confine themselves within their own houses and mansions. Let them not freely mix with the people, because they are sinking into leprosy. If, again, they are found with many, both of the unequivocal and equivocal signs, they must be separated with kind and consoling words from the people, and committed to the leper hospitals (in Malanteria ducendi). But if they are sound they must be set free (absolvendi), and sent with a medical certificate to the Rector.”
It would, I believe, be considered altogether a work of supererogation to append to the preceding details by Gordon and Guy de Chauliac any formal remarks in the way of comparing the Lepra of the fourteenth century with the Elephantiasis Græcorum of Bateman, Schedel, or any of our modern standards, and thus insisting further upon the perfect and entire identity of the individual disease passing under these two different designations. The accounts given of the malady by the two ancient and the two modern writers just named, undoubtedly agree as exactly as we ever find the accounts of one and the same disease by four different authors do; and, as I have already said, the same remark might be extended to the relative early descriptions of the lepra, as left by numerous other authors in these times, and the recent descriptions of the Elephantiasis Græcorum, as drawn up from personal observation in different parts of the world by Kinnis, Ainslie, Heineken, Casan, Cazenave, and the other modern writers that I shall afterwards have occasion to refer to when speaking of the present geographical habitats of the disease.
But indeed the intrinsic evidence which is afforded by the extracts that I have given from Gordon and De Chauliac, and by the other similar descriptions to which I have referred in the works of the medical authors of the thirteenth and fourteenth centuries, renders it unnecessary to add here any further comment to prove the double proposition, first, that the leprosy of the middle ages, as the disease prevailed upon the continent of Europe, was identical with the Elephantiasis Græcorum; and, secondly, that it was for the victims of this specific malady that the numerous leper hospitals were established, they alone being the individuals who were intended to be (in the language of Gordon and De Chauliac) adjudged, separated from the people, and consigned to the lazar-houses (”judicati”—“a populo sequestrandi”—“in Malanteria ducendi”).
So far with regard to leprosy, as seen and described by the early continental authors. Let us now return to the nature of the disease as it prevailed in Great Britain.
2. Nature of the Leprosy in England.—Reasoning analogically, it may certainly, with the greatest probability, be presumed that the incurable disease which is known in the lazar-house charters and older histories of this country, under the same name as on the continent,—which prevailed here during the same periods as on the continent,—and for which the same systems of medical seclusion and police were adopted,—was entirely the same disease as that described by and known to the continental medical authors of the middle ages.
To some minds, such considerations may in themselves be sufficient to fix the identity of the disease, as it prevailed on the continent, and as it prevailed in our own country; and certainly they tend very strongly to show that if, as I have attempted to prove, the epidemic leprosy of continental Europe was the tubercular or Arabian leprosy, the leprosy of England and Scotland was of the same specific nature. But I believe I can adduce still more direct and satisfactory evidence to establish this important point.
The first valuable medical work by an English author that has been transmitted to us is the Compendium Medicinae of Gilbert.[182]