Archæological Essays, Vol. 2

by James Young Simpson

Norway.—Returning again to Shetland as a starting point, we find that the part of the continent of Europe which lies nearest to Shetland, and that in nearly a direct line westward, is the district of Bergen in Norway. The distance between Shetland and the seaport of Bergen does not exceed thirty geographical degrees. In the first part of the present essay I offered some reasons for believing that the spedalskhed prevalent in Bergen was a disease different, on the one hand, from the radesyge of other parts of Norway, and probably identical on the other hand with the Greek elephantiasis or tubercular leprosy.

The descriptions of those authors who had observed the disease at Bergen seemed to justify this view. In 1751 Pontoppidan, the Bishop of Bergen, cites the account and words which we have above quoted from Debes in reference to the Faroe Isles, as exactly applying to the disease in the district of Bergen. When it at last (he states) breaks out in ugly boils on the face, they are generally sent to hospitals erected for that purpose, of which there is one at Bergen and another at Molde in Romsdalen.[207] The excellent account of the disease in the Bergen hospital, which was drawn up a few years ago by the preacher Wellhaven, shows the malady to correspond in every important particular with the Greek elephantiasis;[208] and the long and more strictly medical description of the Bergen disease given in 1786 by Buchner,[209] appeared to be altogether confirmatory of the same opinion. I have lately become acquainted with a proof to the same effect, of such a strong character as to render it supererogatory to adduce the detailed descriptions of Buchner or Wellhaven in evidence. The Norwegian Government has recently (and with an anxiety towards the promotion of medical science that reflects little honour on the other richer courts of Europe) commissioned some of its more distinguished physicians to institute a complete inquiry into the nature of the endemic cutaneous diseases both of Norway and of other localities. Since the former part of the present paper was printed, Dr. Fäye of Christiania has, as one of these commissioners, visited this country with the purpose of examining into the nature of the Scottish sibbens, etc.; and I have learned from him with pleasure that the physician sent to Bergen to examine the spedalskhed, is prepared, after a careful study of the disease there, to report it as tubercular leprosy, and hence a species of malady perfectly distinct from the more general Scandinavian radesyge.

The date of the first appearance of leprosy in the Faroe Isles and in Iceland seems to remain undetermined.[210] In both localities it appears to have prevailed severely in the fifteenth and sixteenth centuries.[211] In all probability, however, it was introduced long previous to these dates. At all events, it appeared much earlier in Bergen, for, as I have already stated in the first part, one of the leper hospitals in that city was founded as early as the year 1268.

There is no evidence, as far as I know, of the period of its first appearance in Shetland. It had reached, however, as far as the north of Scotland early in the thirteenth century; for, as we have already shown, the leper hospital of Elgin was in existence in the year 1226,[212] or more than forty years, at least, previously to the institution of similar receptacles for the diseased in Bergen.

Errors in adjudging Individuals to the Leper Hospitals—Cautions inculcated by the Medical Authorities.

While arguing, as I have done in the preceding paragraphs, to show that the epidemic leprosy for which so many lazar-houses were formerly founded in Europe and in Great Britain was the Greek elephantiasis, I by no means wish to insist that patients affected with that disease alone were admitted into these receptacles. There is only too great probability for the belief that persons who had the misfortune to be affected with any foul and inveterate cutaneous malady were isolated and shut up along with those actually labouring under true leprosy. After syphilis appeared, towards the commencement of the sixteenth century, with some analogous symptoms, and when the elephantiasis itself was already disappearing from most localities, we know for certain that a large proportion of the inmates of the continental lazar-houses consisted of cases of secondary venereal and other severe skin-affections. Dr. Bateman[213] adduces the strongest possible evidence in proof of this from the direct and personal observations made in the sixteenth and seventeenth centuries in the leper hospital at Ulm by Horst, at Alcmaer by Forrestus, and by Reedlin at Vienna. Similar errors were in all probability only too common even when the elephantiasis was more common and better known, and mistakes in the selection of the proper inmates of the hospitals would constantly occur in these times, from the kind of persons to whom the responsible and important task of selecting the infected was entrusted. The Act that we have already quoted of the Perth Parliament “anent lipper-folk” defines those who were charged in Scotland with the duty of searching out the affected. In the third clause it is statute “That the Bishoppes, Officialles and Deanes, inquyre diligentlie in their visitation of ilk (each) Paroch Kirk, gif ony be smitted (affected) with Lipper, and gif ony sik (such) be foundin, that they be delivered to the king gif they be Seculares, and gif they be Clerkes, to their Bishoppes, and that the Burgesses gar (oblige them to) keepe this statute under the paine conteined in the statute of Beggers [namely, gif they have broken it (the statute of beggars) they sall be in fourtie shillings to the King]; and quhat leprous that keepis not this statute, that he be banished for ever off that Burgh, quhair he disobeyis, and in likewise to Landwart.”[214]

In extenuation of the above edict, we must recollect that, at the period at which it was enacted (in 1427), the ecclesiastics to whom in this country it entrusted the selection of lepers were in reality the only existing physicians of the general community, and some of them seem to have devoted themselves as much to the practice of medicine as to the study of theology. But, even to a strictly non-medical observer, the diagnosis would, in the latter stages, be less free from doubt than might be at first supposed. For when once the tubercular leprosy became in any case completely developed in all its distinctive deformity, and with its full concourse of marked and peculiar external characters, as falling off of the hairs of the eyebrows, swelling and thickening of these parts, tubercles of the face, hoarseness of the voice, etc., there were few or no diseases for which it could be readily mistaken, provided any proper degree of care was observed. In the earlier stages and less marked cases of the disease, errors in the adjudgment of cases, in all probability, often occurred, and affections that had no relation to elephantiasis, except in their obstinacy and locality, were, we cannot doubt, frequently mistaken for true instances of tubercular leprosy.

Such errors, it has been often averred, would be almost as apt to happen in the hands of the truly medical, as of the non-medical examiners, in consequence of the knowledge and distinction of cutaneous diseases being exceedingly imperfect at these early periods of medical history. And it is certainly true that, in the writings of the older Arabian, Continental, and English physicians, we find almost all the different species of chronic cutaneous disease mixed up and described together under a few general heads and designations, as Lentigo, Impetigo, Morphea, Albaras, Gutta Rosea, etc. Indeed,the proper discrimination and diagnosis of different cutaneous affections was little known and studied until the end of the last century. At the same time, however, it must be recollected that the tubercular lepra, or Greek elephantiasis, certainly forms a striking exception to this general observation. For, in the medical writings of the thirteenth, fourteenth, and early part of the fifteenth century, the leprosy is almost uniformly described with a care and a minuteness that strangely contrasts with the superficial manner in which the whole remainder of chronic cutaneous diseases are either passed over or confounded together.

I would willingly appeal, in support of this last allegation, to the different chapters on lepra, as compared with those on the other cutaneous diseases, in the works of the Arabian physicians, and of those European medical authors of the middle ages whose writings I have already referred to. Indeed, the accounts and diagnosis of tubercular lepra, as given by Rhazes, Theodoric, Lanfranc, Arnold de Villeneuve, Gilbert, etc., might well stand as models of medical description even at the present day. And if, in France, the strong and earnest injunctions of Bernhard Gordon were in any degree respected, that no person be adjudged as requiring separation for leprosy until the second stage (according to his division of the disease) had supervened, and the signa infallibilia of the malady had already shown themselves in the usual marks traceable in the corruptio figurae et formae of the suspected individual, cases of unjust condemnation to the lazar-houses would be much less common than might be otherwise imagined. We have already seen that in England, in the fourteenth century, John of Gaddesden inculcated the same salutary rules and precautions, and insisted that no one be separated from the general community as a leper, unless already “figura et forma faciei corrumpantur.”

Certainly, on some occasions, the examination to which the patient was subjected, in order to ascertain if he were truly a leper or not, seems to have been of the most searching and scrutinising nature. I have already alluded to the strict rules of examination that have been preserved for us in the works of different authors, and quoted the method recommended by Guy de Chauliac to be followed by physicians before they remitted suspected patients with medical certificates to the magistrates (cum literis medicorum ad rectores). In the Examen Leprosorum, published by Gesner, and which appears to have been drawn up as an official formula, if I may so term it, for examining into suspected cases, the details are most elaborate and searching. There are between fifty and sixty signs of the disease which the examiner is requested to look for. Twelve of these signs are taken from the general state of the body; seven or eight of them from the hands and feet; six from the blood; five from the face; six from the mouth; eight from the eyes and eyebrows, etc. etc. The document commences by stating, “that it is the duty of the physician to be versed in, and attentive to, the signs of the disease, and to ponder often (revolvere multoties) upon them. He should put his trust (it adds) not in one sign, but in many, and he should see what signs are proper (propria) to the leprosy, and what are equivocal.” Before making the examination, the document states that (as is also recommended by Guy de Chauliac[215] and others), the physician should, in the first instance, give some words of encouragement and consolation to the patient, and show that this disease is the salvation of his soul, and that Christ has not despised such, although the world may shun them (quod haec aegritudo salus est animae, et tales Christus non despexit, licet mundus cos fugiat). Further, in order to have more certainty in the examination, it is added that the patient should be made, in the first place, to take oath to tell the truth on those points on which he is interrogated. We have already found De Chauliac recommending the examining physician to take the same precaution, “faciat eos jurare veritatem dicere de interrogendis” (p. 310).