The patient, John Berns, was 28 years of age. On making inquiry, it was found (as I am informed by Dr. Thomson) that some of his ancestors had been affected with the same disease.
An accurate drawing of the morbid appearances presented by Berns’ face was made at the time by Mr. Syme, now Professor of Drawing in the Dollar Academy. A copy of this drawing, with a history of the patient’s ailments, was forwarded to the late Dr. Willan; and I have Dr. Thomson’s authority for stating that Dr. Willan at once declared it also as his opinion, that Berns’ case was a genuine instance of the tuberculous leprosy or Elephantiasis Græcorum; a disease of which, as he informed Dr. Thomson, he had only seen one example in a patient shown him by Dr. Baillie.
Let us for a moment recapitulate the preceding evidence, with regard to the nosological nature of the English and Scottish leprosy:—First, various authors who personally witnessed the leprosy of the middle ages upon the Continent of Europe, in describing it, have described a disease having all the most characteristic symptoms of Greek elephantiasis. Secondly, in England a cutaneous disease prevailed at the same period, bearing the same name,—presenting the same chronic incurable character,—having its victims subjected to the same civil laws and restrictions,—marked (as we know from Gilbert, Gaddesden, and Glanville’s observations and writings) by the same train of nosological symptoms—and hence identical in nature with the continental disease and with the elephantiasis of the Greeks. Thirdly, in Scotland we find a malady having the same similarity in its general date,—in its name,—in its course,—and in the civil regulations enforced regarding it, with its symptoms, as they are accidentally described by Henryson in the sixteenth century, identical with those of Greek elephantiasis. Fourthly, in a part of the country where the disease has continued to prevail down to a later period, the infected, as described by eye-witnesses in the earlier part of the last century, presented the most unequivocal signs of the affection alluded to. And, lastly, we have as high medical evidence as could be adduced in regard to cutaneous affections (the evidence, namely, of Drs. Willan and Thomson), for asserting that the malady was seen in the members of a Shetland family in which it had been hereditarily transmitted,—and hence, in one of the last, if not the very last Scotch leper, was decidedly marked by the true and genuine characteristics of the Elephantiasis Græcorum.
Leprosy in the Northern Countries lying nearest to Shetland.
On a former occasion I alluded to the existence of true tubercular leprosy in the neighbouring Faroe Isles, in Iceland, and the nearest coast of Norway, as corroborative of the disease which has long existed in the Shetlands being of the same nosological nature. I might now, if additional proof were necessary, reverse the order of the evidence which I have just brought forward, and proceed to show at length that the disease which long existed, and still does remain, in Bergen and Iceland, and for which leper hospitals also are still maintained in these localities, is, in reality, the tubercular leprosy or Greek elephantiasis; and, from this point, argue back, that the disease which formerly prevailed in Shetland,—and, if in Shetland, in Scotland generally,—was of the same nosological nature. On this head, however, I shall content myself with offering a very few observations in proof of the specific character of the malady in the districts lying most contiguous to Shetland, and leave without further comment the inference deducible from such evidence.
In the Faroe Isles.—These islands form the nearest land north of the Shetlands. The great cutaneous disease which formerly infected the inhabitants of Faroe had all the characters of tubercular leprosy. In proof of this, I may appeal to the description of the malady, given in the seventeenth century by Debes, who was Provost of the churches in these islands, and wrote an account, which was much esteemed at the time, of the country and its inhabitants. He observes, “As for the Leprosye itself, I would not omit, for the reader’s sake, to mention something of its nature. Physicians write that there are three sorts of Leprosies; namely, Tyria, from the serpent Tyrus. In this leprosy, the patient’s skin is soft, and sometimes falleth off in shells, and they have many spots and white wartes thereon. The second is called Alopecia, by reason the hairs fall off as those of a fox; he that is infected with this leprosy hath a red face, and his beard and eyebrows fall off. The third sort is called Elephantiasis, from the elephant, to whom they become like in their skin; the body and face of him that is infected with this disease is full of knobs. The Leprosie wherewith they are troubled in this country is usually Elephantiasis, for the face and limbs of almost all the infected are full of blue knobs, that break out sometimes as boyls, whereby they look very deformed in the face, being besides all hoarse, and speaking through their noses.”[204]
Iceland.—That the leprosy of Iceland (the next land north of the Faroe Isles) is of the nature of the Elephantiasis Græcorum, is a point which might be proved by any of the descriptions of it by Petersen, Troil, Henderson, and Holland. Dr. Holland’s account is more concise than the others. He states—
“The leprosy of the Icelanders (Likthra, Holdsveike, or Spitelska), exhibits in many instances all the essential characters of the genuine elephantiasis or Lepra Arabum; and is a disease of the most formidable and distressing kind. Indolent tumours of the face and limbs are, generally, among the first symptoms of the complaint, attended by swellings of the salivary, inguinal, and axillary glands. The nostrils, ears, and lips are progressively affected with swelling deformity. The skin over the whole, or different parts of the body, becomes thick and hard; sometimes exhibiting a shining or unctuous surface, sometimes one rough and scabrous, which at a more advanced period of the disease displays numerous cracks or fissures. The senses are usually much enfeebled; and anæsthesia of the extremities generally occurs. The voice assumes a peculiar hoarseness and nasal tone, frequently with swelling of the tonsils, but without any hindrance of deglutition until the disease has made great progress in the habits of the patient: the breath and perspired matter are extremely fetid; and the hairs and nails frequently fall off. The tumours in different parts of the body gradually pass into malignant ulcers, which discharge an acrid unhealthy matter; in this state the patient often lingers during a long time; or where the disease has a more speedy termination, all the symptoms are rapidly aggravated, and he is carried off in a state of extreme debility and wretchedness.”[205]
The lepers in Iceland are received into four different hospitals, which have been long established for that purpose.[206]