Archæological Essays, Vol. 2
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Title: Archæological Essays, Vol. 2
Author: James Young Simpson
Editor: John Stuart
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*** START OF THE PROJECT GUTENBERG EBOOK ARCHÆOLOGICAL ESSAYS, VOL. 2 ***
ARCHÆOLOGICAL ESSAYS
BY THE LATE
SIR JAMES Y. SIMPSON, BART.
M.D., D.C.L.
ONE OF HER MAJESTY’S PHYSICIANS FOR SCOTLAND, AND PROFESSOR OF MEDICINE
AND MIDWIFERY IN THE UNIVERSITY OF EDINBURGH
EDITED BY
JOHN STUART, LL.D.
SECRETARY OF THE SOCIETY OF ANTIQUARIES OF SCOTLAND
VOL. II.
EDINBURGH
EDMONSTON AND DOUGLAS
PUBLISHERS TO THE SOCIETY OF ANTIQUARIES
MDCCCLXXII
_Printed by_ R. & R. CLARK, _Edinburgh_.
CONTENTS OF VOLUME II.
PAGE
I. ON LEPROSY AND LEPER HOSPITALS IN SCOTLAND AND
ENGLAND 1
Communication read before the Medico-Chirurgical
Society of Edinburgh, 3d March 1841, and printed
in the Edinburgh Medical and Surgical Journal
(vol. lvi. p. 301; vol. lvii. p. 121).
[Additional Notes by Joseph Robertson, LL.D.]
II. NOTES ON SOME ANCIENT GREEK MEDICAL VASES FOR
CONTAINING LYKION; AND ON THE MODERN USE OF THE
SAME DRUG IN INDIA 185
Read to the Society of Antiquaries of Scotland, 26th
February 1852. Proc. vol. i. p. 47.
Reprinted separately in 1856, and “Inscribed to Dr.
Sichel of Paris.” Edinburgh: Sutherland and Knox.
III. WAS THE ROMAN ARMY PROVIDED WITH MEDICAL
OFFICERS? 197
Printed as a Pamphlet, at Edinburgh, 1856 (Sutherland
and Knox), and “Inscribed to James Pillans, Esq.,
F.R.S.E., Professor of Humanity in the University
of Edinburgh, etc. etc., as a Small Tribute of sincere
Esteem from an Old and Attached Pupil.”
_With One Plate._
IV. NOTICES OF ANCIENT ROMAN MEDICINE-STAMPS, ETC.,
FOUND IN GREAT BRITAIN 229
Communicated to the Monthly Journal of Medical
Science, January, March, and April 1851.
_With Four Plates._
V. ANTIQUARIAN NOTICES OF SYPHILIS IN SCOTLAND 301
Communicated to the Epidemiological Society of London,
1862. Trans. vol. i. part ii.
Reprinted privately at Edinburgh (Edmonston and
Douglas), “Inscribed to the most learned Physician
of Modern Times, James Copland, Esq., M.D.,
Author of the Dictionary of Practical Medicine.”
ON LEPROSY AND LEPER HOSPITALS
IN SCOTLAND AND ENGLAND.[1]
PART I.
Few subjects in pathology are more curious, and at the same time more
obscure, than the changes which, in the course of ages, have taken place
in the diseases incident either to the human race at large, or to
particular divisions and communities of it.
A great proportion of the maladies to which mankind are liable have, it
is true, remained entirely unaltered in their character and consequences
from the earliest periods of medical history down to the present day.
Synocha, Gout, and Epilepsy, for instance, show the same symptoms and
course now, as the writings of Hippocrates describe them to have
presented to him upwards of two thousand years ago. The _generatio de
novo_ of a really new species of disease “is (says Dr. Mason Good[2])
perhaps as much a phenomenon as a really new species of plant or of
animal.” Dr. Good’s remark is probably too sweeping in its principle;
for, if necessary, it might be easy to show that, if the particular
diseases of particular animal species are liable to alteration at all,
they must necessarily alter more frequently than those animal species
themselves. In pursuing such an inquiry, the pathologist labours under
comparative disadvantages. The physiologist can, by the aid of
geological research, prove that the individual species of plants and
animals inhabiting this and other regions of the earth, have again and
again been changed. The pathologist has no such demonstrative data to
show that, in the course of time, the forms and species of morbid action
have undergone great mutations, like the forms and species of normal
life. But still we have strong grounds for believing that, in regard to
our own individual species alone, the diseases to which mankind are
subject have already undergone, in some respects, marked changes within
the historic era of medicine. Since the first medical observations that
are now extant on disease were made and recorded in Greece, various new
species of human maladies have, there can be little doubt, made their
original appearance. I need only allude to small-pox, measles, and
hooping-cough. Again, some diseases which prevailed formerly, seem to
have now entirely disappeared from among the human race—as, for
example, the Lycanthropia of the Sacred Writings, and of Oribasius,
Aetius, Marcellus, and various old medical authors.[3] Other maladies,
as that most anomalous affection, the English sweating-sickness of the
fifteenth century, have only once, and that for a very short period,
been permitted to commit their ravages upon mankind. And lastly, we have
still another and more extensive class, including maladies that have
changed their geographical stations to such an extent, as to have made
inroads upon whole districts and regions of the world, where they were
formerly unknown, leaving now untouched the localities which, in older
times, suffered most severely from their visitations.
Among this last tribe of diseases no one presents a more curious subject
of inquiry than the European leprosy, or tubercular elephantiasis of the
middle ages. This malady is now almost entirely, if not entirely,
unknown as a native endemic disease on any part of the Continent of
Europe; and yet from the tenth to the sixteenth century it prevailed in
nearly every district of it. Laws were enacted by Princes and Courts to
arrest its diffusion;—the Pope issued bulls with regard to the
ecclesiastical separation and rights of the infected;[4]—a particular
order of Knighthood was instituted to watch over the sick;—and leper
hospitals or lazar-houses were everywhere instituted to receive the
victims of the disease. The number of these houses has certainly been
often erroneously stated, in consequence, as far as I have been able to
trace it, of a strange mistake committed by Ducange, in quoting from
Matthew Paris a passage in which that historian contrasts the respective
possessions belonging in the thirteenth century to the Hospitalarii,
Knights Hospitallers, or Knights of St. John, as they were termed, and
the Knights Templars. The 19,000 lazar-houses in Christendom, as
interpreted by Ducange, mark in Matthew Paris’ work merely the number of
manors or commanderies of the Hospitalarii, and have no reference
whatever to leprosy or lazar-houses.[5] But still that an immense number
of leper-houses existed on the Continent at the period mentioned, is
abundantly shown in many of the historical documents of that age. Louis
VIII. promulgated a code of laws in 1226, for the regulation of the
French leper hospitals; and these hospitals were at that date computed
to amount, in the then limited kingdom of France, to not less than 2000
in number—(_deux mille leproseries_).[6] They afterwards, as is alleged
by Velley,[7] even increased in number, so much so that there was
scarcely a town or burgh in the country that was not provided with a
leper hospital. In his history of the reign of Philip II. Mezeray uses
the same language in regard to the prevalence of leprosy and leprous
patients in France during the twelfth century.[8] Muratori gives a
nearly similar account of the extent of the disease during the middle
ages in Italy;[9] and the inhabitants of the kingdoms of Northern
Europe, equally became its unfortunate victims.[10]
I have no desire, however, to enter at present into the extensive
history of the leprosy of the middle ages, as seen in the different
quarters of Europe. My object is a much more limited and a much more
humble one. I wish only to adduce various evidence to show that the
disease extended to this the most western verge of Europe, and at one
time prevailed to a considerable extent in our own kingdom of Scotland,
which, at the period alluded to, was one of the most remote and
thinly-populated principalities in Christendom. I shall have frequent
occasion, at the same time, to illustrate my remarks by references to
the disease as it existed contemporaneously in England.[11]
In following out the object adverted to, I shall commence by an
enumeration of such leper hospitals as I have detected any notices of in
old Scottish records. The knowledge of the mere existence of most of
these hospitals has been obtained more by the accidental preservation of
charters of casual grants to them than by any historical or traditional
notice of the institutions themselves. The information, therefore, which
I have to offer in regard to most of them is exceedingly slight. The
following meagre notes regarding the two first Lazar or Leper-houses,
Spitals, Spetels, or Spitles,[12] which I shall mention, show the truth
of this remark.
SCOTTISH LEPER HOSPITALS.
_Aldcambus, Berwickshire._—A Leper Hospital existed at Aldcambus, in
the parish of Cockburnspath, Berwickshire, as far back as the reign of
William the Lion.
In the Chartulary of the Priory of Coldingham is preserved a charter by
which that monarch confirms a grant of half a carrucate of land to this
hospital. I shall give a transcript of the charter, which has hitherto
remained unpublished. I do so that it may serve as a fair specimen of
the various similar charter documents to which I shall have occasion to
allude in the course of the following remarks. It is entitled
“Confirmatio donationis Hospitali de Aldcambus facta:”—“Willelmus Dei
gratia Rex Scottorum omnibus probis hominibus totius terre sue Clericis
et laicis salutem. Sciant presentes et futuri me concessisse, et hac
cartâ meâ confirmasse donationem illam, quam David de Quicheswde fecit
Hospitali de Aldcambus et Leprosis ibi manentibus, de illa dimidia
carucata terræ in Aldcambus quam Radulfus Pelliparius tenuit: tenendam
in liberam et puram et perpetuam eleemosinam, cum omnibus libertatibus
et aisiamentis ad predictam terram juste pertinentibus, ita liberé et
quieté sicut carta predicti Davidis testatur: Salvo servicio meo.
Testibus Willelmo de Bosch. Cancellario meo, Waltero Cuming, Davide de
Hastings. Appud Jeddewrith, xvi. die Maij.”[13]
_Aldnestun in Lauderdale._—At Aldneston another leper-house existed.
It was under the control of the Abbey of Melrose. In the Melrose
Chartulary there is preserved a charter headed “Carta Leprosorum de
Moricestun.” In this charter, Walter Fitzallan, Steward of Scotland,
granted to this hospital of Auldnestun and its inmates (Hospitali de
Auldnestun et infirmis fratribus ibidem residentibus), a carrucate and a
half of land in the village of Auldnestun; another carrucate and a half,
which Dame Emma of Ednaham held (tenuit per suas rectas divisas), with
the common pasturage and easement (asiamento) of the forests of
Birkenside and Ligarrdewude (Legerwood), and a right to grind at his
mill without paying multure.[14]
_Kingcase, Ayrshire._—At Kilcais or Kingcase, on a bleak muir in the
parish of Prestwick, and about two miles from the town of Ayr, stood,
for several centuries, an hospital for Lepers. The general tradition of
the surrounding country avers that this hospital was founded by King
Robert the Bruce. In the article on Ayr, recently published by the Rev.
Dr. Auld and Mr. Cuthill, in the New Statistical Account of
Scotland,[15] the foundation charter of Robert Bruce is said to have
been purchased by the Magistrates of that town in 1786. I am obligingly
assured, however, by Mr. Murdoch of Ayr, that no such document is known
to exist among the archives of that town. It is probable that the
hospital existed before the time of Bruce. In a charter to the monastery
of Dalmulin, contained in the Chartulary of Paisley Abbey,[16] and of
the date of the reign of William I. of Scotland, among other lands and
localities in Kyle and the immediate neighbourhood of Kingcase, the term
Spetel-Crag occurs. Now the term Spetel was a prefix applied, both in
Scotland and England, to all hospital lands and possessions, and to
these alone; and history records no other hospital whatever in Kyle,
from which this appellation of Spetel Craigs could be derived. But
whether Bruce was the original founder, or, what is more probable, a
liberal endower of the hospital, we know this at least of the history of
the Kingcase Leper Hospital, that it possessed at one time pretty
extensive lands and property in the parish of Dundonald, and in Kyle
Stewart.[17]
These, like many other hospital grants, came after a time to be
perverted from their original objects of charity, and applied to the
aggrandisement of particular individuals. Thus the family of Wallace of
Newton obtained from James II. a feu-charter of the Kingcase estate of
Spittalshiels, for the annual payment of eight merks Scots, and sixteen
thrave of straw. In reference to this, the land of Spittalshiels has yet
(observes Sir Walter Scott, in a note to his _Lord of the Isles_[18]) to
give, if required, a quantity of straw for the lepers’ beds of Kingcase,
and so much to thatch their houses. Along with Spittalshiels the
Wallaces acquired the office of Hereditary Keeper or Governor of the
Hospital itself, and of the other lands pertaining to it. In the family
of the Wallaces of Craigy this right of patronage and presentation to
Kingcase was long held, with all the remaining endowments of the
hospital. These privileges were exposed at a judicial sale of the estate
of Craigy, and purchased, 1784, by the burgh of Ayr, for £300. The
magistrates, from this right, exact feu-duties from the lands formerly
belonging to Kingcase, to the annual extent of sixty-four bolls oatmeal,
and eight merks Scots money. This revenue has been made over to the
poor’s house of Ayr. In virtue of it the magistrates have the privilege
of presenting a certain number of inmates to this latter
institution.[19]
No records remain as to the original extent of the Kilcais Hospital. The
number of lepers supported was, during the latter years of the
institution, limited to eight. Before the hospital revenues and lands
were despoiled the number might have been greater. The only remnants of
the buildings which are now left consist of the massive side-wall of a
house 36 feet long and 17 wide. This is generally alleged to be the
ruins of the chapel merely of the hospital; and under this view it is
certainly calculated to give us a high opinion of the ancient extent and
endowments of the institution. Sir Robert Gordon, in a description of
Kyle, published in 1654, in Bleau’s _Atlas_, states that the persons
admitted to the charity were then lodged in huts (_tuguria_) in the
vicinity of the chapel.[20]
_Glasgow._—In 1350, in the reign of David II., the Lady of Lochow,
daughter of Robert Duke of Albany, erected a leper hospital at the
Gorbals of Glasgow, near the old Bridge.[21] She endowed this hospital
with some lands and houses in the city. The magistrates of Glasgow seem
to have exercised the privilege both of searching for lepers among the
inhabitants, and of consigning them to this hospital. From the Burgh
Records, presented some time ago by Mr. Smith to the Maitland Club, it
appears that in 1573 the magistrates ordained four persons, named as
lepers, “to be viseit (inspected), and gif they be fund so, to be
secludit of the town to the Hospital at the Brigend.”[22] A similar
edict was issued in regard to two other individuals in 1575,[23] and in
1581 eight more seem to have been dealt with in the same manner.[24] The
Bishops of Glasgow appear also to have had a right to present patients
to the hospital. In 1464, Andrew Muirhead, who then held the bishoprick,
availed himself of the privilege by presenting one patient.
On the 9th August 1589, a report was given in to the magistrates of
Glasgow, stating that six lepers were at that time in the house.[25] As
late as 1664, the ground-rents of this hospital were uplifted by the
water-bailie, an official who, according to an entry in the city records
of Glasgow, was in the custom of giving in annually the number of lepers
in the hospital at the Brigend. This hospital, like that of Kingcase,
was dedicated to the Gallovidian Saint, St. Ninian.
_Edinburgh._—A leper hospital formerly existed at Greenside, which was
then a suburb, and not, as now, a constituent part of the city of
Edinburgh. The history of the hospital and its laws are preserved in the
Town-Council records. In 1584 the city Magistrates issued orders for
finding a commodious place for a leper-house.[26] In 1589, they passed
an Act for building such an institution at Greenside, and apparently
with money granted to them for that purpose, by John Robertson, a
merchant in Edinburgh, and others, in pursuance of some previous
vow.[27] On the 23d November 1591, five leper inhabitants of the city
were consigned to this hospital.[28] Two of the wives of the lepers
voluntarily shut themselves up in the hospital along with their diseased
husbands. I shall afterwards recur to the strict laws which the inmates
were bound to observe. In a charter of rights given to the city in 1636
by Charles I. there are enumerated among the other grants which he
confirms to them, “the lands of old called the Greenside, with the
leper-house and yard situate on the same, arable lands, banks, and
marishes thereof, for the present occupied by the lepers of the said
house.”[29] The hospital, however, does not appear to have been of long
duration. In 1652, the magistrates ordered that the roof of the
leper-house be taken off, and its wood, slates, etc. used to repair the
town milns and other public buildings;[30] and in 1657, a similar
appropriation was made of the stones contained in the walls of the
leper-house, and in the fence around its yard or garden.[31]
_Aberdeen._—In an old manuscript _Description of bothe Touns of
Aberdeen_, by James Gordon, as quoted in the entertaining _Book of Bon
Accord_, the following notice of a leper hospital at Aberdeen
occurs:[32] “Such as go out at the Gallowgate port towards Old Aberdeen,
haff way almost, may see the place where of old stood the lepers’
hospital, called the seick-house, hard by the way syde. To which there
was a chappell adjoyned, dedicated to St. Anna, quhome the Papists
account patronesse of the lepers. The citizens licencit one Mr.
Alexander Galloway, the person of Kinkell, for to build that chappell
anno 1519. Now both these buildings are gone, and scarcely is the name
knowne to many.” “On the 18th August 1574, the Regent Morton, and the
Lords of the Privy-Council commanded the Magistrates of Aberdeen to
uptake fra James Leslie, present possessioure of the croft and myre
pertening to the Lipperfolk, the yeirle dewtie tharof off the five
yeiris bypast; and thairvith, and sic vthir collectioune as may be
hade, to caus the said house be theikkit (thatched, roofed) and reparit
for the resett of the said Lipperfolk in tym cuming: and to caus roup
the said croft and myre, to quha vill giff maist yeirle dewtie tharfor
fra thre yeir to thre yeir: And to caus the haill proffeit to be
employit vpon the upolding of the said hous, and sustentation of the
Liperfolks that salbe tharin.”[33]
In the beginning of the eighteenth century the hospital and grounds were
sold under the direction of the magistrates, and the money received
appropriated to the establishment of a fund for a proposed lunatic
asylum. The leper croft now belongs to King’s College.[34]
_Rothfan, Elgin._—A leper-house seems to have existed from an early
period at Rothfan, near Elgin. John Byseth made a gift to this hospital
at Rothfan of the Church of Kyltalargyn, for the avowed purpose of
maintaining seven lepers, a servant and chaplain. The donor retained to
himself and his successors the privilege of preserving the number
complete, by filling up the vacancies. On his request and presentation,
William, prior of the hospital, was admitted to the church in 1226.[35]
The precise date of Byseth’s charters is not preserved, but they seem to
have been drawn out during the reign of Alexander II. or III. From their
phraseology the hospital evidently was in existence previous to that
time.
The lands pertaining to this hospital are still known under the name of
the Leper Lands,[36] though the institution itself has been long
obsolete.
_Shetland._—Lastly, we have records of several small and temporary
lazar-houses in Shetland. Thus, long ago, Brand (the honest missionary,
as Hibbert terms him) states that in that country the “scurvy sometimes
degenerates into leprosy, and is discerned by hairs falling from the
eyebrows, the nose falling in, etc., which” (he adds), “when the people
come to know, they separate and set them apart for fear of infection,
building huts or little houses for them in the field. I saw the ruines
of one of these houses about half-a-mile from Lerwick, where a woman was
for some years kept for this reason. These scorbutick persons are more
ordinarily in Dunrossness and Delton, and more rare in other
places.”[37]
“Formerly” (says Dr. Edmondston, another and more recent author on the
Shetlands), “when leprosy was very prevalent, the unfortunate
individuals who were seized with it were removed to small huts erected
for the purpose, and there received a scanty allowance of provisions
daily, until the disease put a period to their miserable existence.”[38]
NUMBER OF HOSPITALS, AND EXTENT OF THE DISEASE.
The Scottish lazar-houses that I have thus enumerated, though few in
number, are still sufficient to show that the disease for which they
were instituted was generally diffused over the extent of the kingdom.
Thus, we have found the establishments in question spread from
Berwickshire to Shetland, and from Aberdeen to Ayr. More research than I
have been able to bestow upon the matter would no doubt bring to light
notices of various additional hospitals. In some Scottish towns names
and notices still exist sufficient to lead to the probability of
lazar-houses having formerly existed in them, though that evidence is in
other respects altogether incomplete.
In the immediate neighbourhood of Edinburgh a leper station probably
existed at a date greatly earlier than that of the Greenside Hospital.
In his _Caledonia_,[39] the late excellent antiquary and philologist,
George Chalmers, expresses his belief in the opinion suggested by the
Rev. Mr. White, that the name of the village of Liberton (two miles
south of Edinburgh) is merely a corruption of Liper town,—liper being
the old Scotch term for leprosy; and, as is well known, the letters _p_
and _b_ being constantly interchanged for one another in the composition
and transmutation of words. This idea is certainly in no small degree
countenanced by the circumstance that the lands of Upper Liberton
(Libertune) in some old writs are described under the name of “terrarum
de Spittle town” (Hospital town.)[40]
Besides, the “Oily or Balm Well of St. Catherine’s at Liberton,” had
been long held in high estimation in curing cutaneous diseases, and
still maintained great repute as late as the sixteenth and seventeenth
centuries. In his brief but interesting _Cosmography and Description of
Albion_, Boece, Canon of Aberdeen, at the commencement of the sixteenth
century, states that the oil of this well “valet contra varias cutis
scabricies.”—_Historiæ Scotorum_ (1526), p. xi.[41]
J. Monipennie alleges that its oil or “fatness is of a sudain operation
to heal all salt scabs and humors that trouble the outward skin of
man.”[42] Dr. Hare makes mention of it to the same purpose.[43] After
the institution of the monastery of St. Catherine of Sienna (_Scotticé_,
Sheens) on the Burrow Moor, at a short distance south of the city walls
of Edinburgh, the Dominican nuns belonging to it made, in honour of St.
Catherine, an annual solemn procession to the chapel and balm well of
Liberton.[44]
This “oily or balm well” of Liberton was sufficient to excite the
admiration and engage the protective care of the credulous King James
VI. In a curious monograph[45] on the virtues of the well, published at
Edinburgh in 1664, the author, “Mathew Mackaile, Chirurgo-Medicine.”
indulges himself (p. 117) in the following historical eulogium and
anathema in regard to it:—
“His Majesty King James the Sixth, the first monarch of Great Britain,
of blessed memory, had such a great estimation of this rare well, that
when he returned from England to visit this his ancient kingdom of
Scotland in anno 1617, he went in person to see it, and ordered that it
should be built with stones from the bottom to the top, and that a door
and a pair of stairs should be made for it, that men might have the more
easie access unto its bottom for getting of the oyl. This royal command
being obeyed, the well was adorned and preserved, until the year 1650,
when that execrable regicide and usurper, Oliver Cromwell, with his
rebellious and sacrilegious accomplices, did invade this kingdom, and
not only deface such rare and ancient monuments of Nature’s handwork,
but also the synagogues of the God of nature.”
But it is unnecessary to insist further upon such problematical evidence
in regard to the probable extent and prevalence of the disease in
Scotland. A proof of this, of a much stronger character, is afforded by
the simple fact that, as late as the reign of James I. the victims of
the disease were made the subject of a direct and special legislative
enactment in the Scottish Parliament held at Perth in the year 1427. I
shall quote one short clause from this act “anent Lipper Folke”[46] (as
it is termed), to illustrate both the apparent prevalence of the malady
at that time, and this circumstance, that the burghs of the kingdom are
then spoken of as possessing, or obliged to possess, lazar-houses of
their own. The second clause is to the following effect: “Item, that na
Lipper Folke sit to thig (beg) neither in kirk nor kirkzaird, nor other
place within the burrowes, but at their own hospital, and at the port of
the towne and other places outwith the burrowes.”
It is impossible to form any approach as to the number affected in this
country. The hospitals that I have enumerated do not seem calculated to
contain many patients. As we have already seen, that of Ayr contained at
least eight patients; Rothfan, seven; five were admitted into the
Greenside hospital at its first opening in 1591; and in a report of the
Glasgow hospital, submitted to the magistrates in 1589, six lepers were
reported as then belonging to that institution. These data are entirely
inadequate to draw any conclusion from, and the more so, that here, as
in England, the disease was probably more extensively spread during the
eleventh, twelfth, and thirteenth centuries than afterwards; and it is
exactly at that remote period that all our Scottish records are most
defective.
In these early times the very words employed to designate the disease
show its extent and severity. Somner, Lye, and Bosworth, in their
several Dictionaries of the old Anglo-Saxon language, all quote the
remarkable expression, “_seo mycle adl_,” “the mickle ail” or great
disease, as signifying “elephantiasis” or “leprosie;” and it is worthy
of observation, in reference to the same point, that the delightful old
French chronicler, Sir John Froissart, who visited Scotland in the time
of Robert II., applies, as we shall afterwards see, the analogous term
of “la grosse maladie” to one noted case of leprosy in this country.
Some further idea may be formed of the frequency of the disease, at
least in the border counties of Scotland, when I state that, before the
year 1200, there existed various hospitals for the exclusive reception
of lepers in the immediately adjoining English counties of
Northumberland, Cumberland, and Durham. Three alone of these hospitals
contained as many as ninety-one lepers in all—viz. the hospital of
Sherburne, near Durham,[47] contained sixty-five; St. Nicholas,
Carlisle,[48] contained thirteen; and Bolton, in Northumberland,
founded, as its charter[49] bears, by Robert de Roos, “pro salute animae
meae et omnium antecessorum et successorum meorum,” was endowed for
other thirteen.
I may here take the opportunity of stating that the labours of different
English antiquaries, and more particularly the investigations of Leland,
Dugdale, and Tanner, into the Monastic History of England, tend to show
that at an early period many leper-houses were scattered over England
and Wales. In searching through the works of these authors, and more
particularly through the late splendid edition of the _Monasticon
Anglicanum_, with the numerous additions of Caley, Ellis, and Bandinel,
I have found references to between eighty and ninety English
lazar-houses.[50]
In the second and third volumes of the _Monasticon Anglicanum_ (1st
edition) above ninety[51] charters or other notices of English hospitals
are published, and of these twenty-one at least were hospitals for the
reception of lepers. Bloomefield[52] mentions eighteen leper-houses in
Norfolk alone; and Taylor,[53] in his _Index Monasticus_, enumerates
twenty in that single county. Six of these were placed in Norwich or its
immediate vicinity, and five at Lynne Regis.
OBJECTS, CHARACTER, AND GOVERNMENT OF THE LEPER HOSPITALS.
The leper hospitals, both in Scotland and elsewhere, were intended
merely as receptacles to seclude the infected, not as houses in which a
cure of them was to be attempted. They were charitable and hygienic
rather than medical institutions.
At the present day tubercular leprosy is still regarded as a disease
which sets at defiance all the powers of the medical art. Our ancestors
had so firm a belief in the same doctrine, that, in the case of one of
the unfortunate wretches who was tried in Edinburgh in 1597 for
witchcraft, amongst the gravest of the accusations brought against the
panel was this, that she (Christian Livingstone) “affirmit that she culd
haill (cure) leprosie, quhilk (the libel adds) the maist expert men in
medicine are not abil to do.” Some of the means of cure she had employed
have never, I am afraid, been allowed a place in any of our
pharmacopœias. I may allude, therefore, as a specimen to one of them
amongst others—viz. (and I quote the words of the libel) “she took a
reid cock, slew it, baked a bannock (cake) with the blude of it, and gaf
(gave) the samyn to the Leper to eat.”[54]
I leave it to the dogmatism of the pharmacologists to decide whether
more potent virtues should be ascribed to this recipe of Christian
Livingstone’s or to that deliberately offered with the same purport by
our celebrated countryman Michael Scott. “It ought to be known” (says
the great Fifeshire philosopher) “that the blood of dogs and of infants
two years old or under, when diffused through a bath of heated water,
dispels the Leprosy without a doubt” (_absque dubio liberat
Lepram_).[55]
The miraculous properties of the relics of saints were in some instances
strongly relied upon as an article of the Materia Medica, fit among
other things to cure this incurable malady. Fosbroke[56] mentions a
fountain near Moissac, described by Peyrat (abbot of that place, in the
fourteenth century), the waters of which were so medicated by the
relics of a saint contained in the neighbouring abbey that the crowds of
lepers who resorted to it bathed and were immediately cured. But the
valued fountain was not sufficiently powerful to avert the disease being
communicated to the monks, or to save them even when once they were
contaminated; and at last, according to the confessions of the abbot, it
was shut up in consequence of some of the order dying of the very malady
which their famed waters could infallibly remove.
In the sequel, when considering the causes of the disease, and the
regulations of medical police, adopted in regard to the infected, I
shall have occasion to speak at length of the strict rules to which the
inmates of most of the leper-hospitals were subjected—not for the sake
of medical treatment, but with the purpose only of preventing the
dissemination of the malady.
Besides being places for the isolation of the infected, the
leper-hospitals of Scotland and England were often, like the
corresponding institutions of the continent of Europe, founded and
endowed as religious establishments; and, as such, they were generally
submitted to the sway of some neighbouring abbey or monastery.
Semler[57] quotes, indeed, a Papal bull, appointing every leper-house to
be provided with its own churchyard,[58] chapel, and ecclesiastics—(cum
cimiterio ecclesiam construere, et proprio gaudere presbyterio)—an
order against the latter part of which the poverty of many of the
hospitals in Great Britain formed a very secure guarantee. The Greenside
Hospital in Edinburgh, being founded at a very late period, partook,
perhaps, less of the character of a religious establishment than most
others in the kingdom.
The rules established for the domestic and religious duties of the
inmates belonging to it, by the commissioners appointed by the
magistrates of the city, were few and simple, viz.—
“That the said persons, and ilk ane (every one) of thame leif (live)
quetlie, and gif (give) na sclander, be banning, sweyring, flyting,
skalding, filthie speaking, or vitious leving, or any oyder way, under
the paynes to be enjoynit by the counsall.
“That thair be appoyntit ane ordinair reider to reid the prayeris evrie
Sabboth to the said lepperis, and ane commodious place appoyntit to the
said reider for that effect.”[59]
Over some of our Scotch lazar-houses, chaplains, and religious officers
with the high-church title of priors, were placed.
The prior of Rothfan Hospital was, at the intercession of the founder of
the house, admitted to the church. There was one chaplain under him.
In the records of the burgh of Prestwick there is an incidental entry,
showing that there was a prior placed over the Kingcase Hospital near
Ayr in 1507, for “George Yong, Prior of Kingiscase, accusyt Thome Greif
of four barrels of beyr, and the said Thomas grantyt 24 shillings, but
denyit ye beer.”[60] We have already seen that there were chapels
annexed to the Kingcase and Aberdeen Hospitals. Our history of the other
lazar-houses in Scotland is so imperfect as not to enable us to state
whether they were equally well provided; but certainly many of the
richer leper and other hospitals in England had, as appears from their
better preserved records, free chapels attached to them, with resident
regular or secular canons. In the Sherburne Leper Hospital, near Durham,
there were, besides the prior, four priests and four attendant
clerks.[61] The hospital of St. Giles, Norwich, was provided with a
master or prior, and an establishment of eight regular canons acting as
chaplains, two clerks, seven choristers, and two sisters; while the only
permanent residents to whose wants they were required to minister were
eight poor bed-ridden subjects![62]
Both the ecclesiastical officers of the leper hospitals, and the leprous
inmates themselves, were in general strictly enjoined, by the foundation
charters and regulations of their institutions, to observe strict
religious formulæ, and especially to offer up prayers for the souls of
the founder and his family. That the duties connected with this last
office were in some instances by no means slight, will be sufficiently
apparent by the following extract from the laws of the leper hospital at
Illeford, in Essex, which I translate from the regulations established
for the house in 1346 by Baldok, Bishop of London:—[63]
“We also command that the Lepers omit not attendance at their church, to
hear divine service, unless prevented by grievous bodily infirmity; they
are to preserve silence there, and hear matins and mass throughout, if
they are able; and whilst there, to be intent on prayer and devotion, as
far as their infirmity permits them. We desire also and command that, as
it was ordained of old in the said hospital, every leprous brother
shall, every day, say for the morning duty a Pater noster and Ave Maria,
thirteen times; and for the other hours of the day respectively, namely,
the first, third, sixth hour of the vespers, and again at the hour of
the concluding service, a Pater noster and Ave Maria seven times; and
besides the aforesaid prayers, each leprous brother shall say a Pater
and Ave thirty times every day for the founders of the hospital and the
bishop of the place, and all his benefactors, and all other true
believers, living or dead; and on the day on which any one of their
number departs from this life, let each leprous brother say in addition,
fifty Paters and Aves, three times, for the soul of the departed, and
the souls of all deceased believers. But if any one shall openly
(_manifeste_) transgress the said rules, or any one of them, for each
transgression let him receive a condign punishment according to the
amount of the offence, from the Master of the said hospital, who is
otherwise called the Prior. But if a leprous brother secretly
(_occultè_) fails in the performance of these articles, let him consult
the priest of the said hospital in the Penitential Court.”
In several of the hospitals the passions of the inmates were endeavoured
to be restrained by the laws laid down by their Superior. Thus the
articles of the leper-house of St. Julian, at St. Albans, contain the
following significant regulations of Abbot Michael _de accessu
Mulierum_. “And since by the access of women scandal and evils of no
slight nature arise, we above all things forbid that any woman enter the
hospital of the brothers, with the exception of the common laundress of
the house, who must be of mature age and discreet manner of life (maturæ
aetatis et bonae conversationis), so that no suspicion can attach to
her. And she must not presume to enter the house at suspicious times,
but at the proper hours, so that her entrance and exit may be seen by
all. But if a mother or sister, or any other honest matron, come there
for the purpose of visiting the infirm, she may have access to the one
with whom she wishes to speak, and this may be done by the permission of
the Custos; without which they are not to enter, whatever may be their
rank. But women of light fame and evil reputation are by no means to
enter the houses.”[64]
The Custos, Master, Dean or Prior, and in some houses the Prioress,[65]
seems in general to have had full control over the leprous inmates of
the hospital. Thus, in the laws which have been transmitted to us of the
Sherburne Hospital, it is laid down that members were to be punished for
disobedience or idleness, at the discretion of the prior, by corporal
correction with the birch, “_modo scholarium_.” Offenders who refused to
submit to this chastisement had their diet reduced to bread and water,
and after the third offence were liable to be ejected.[66]
Matthew Paris has left us a copy of the vow which the lepers of the
hospital of St. Julian, at St. Albans, were obliged to take before
admission. I append a translation of it as a document highly
illustrative of this part of our subject:—
“I, brother B, promise and, taking my bodily oath by touching the most
sacred Gospel, affirm, before God and all his saints in this church,
which is constructed in honour of St. Julian the confessor, in the
presence of Dominus R. the Archdeacon, that all the days of my life I
will be subservient and obedient to the commands of the Lord Abbot of
St. Albans for the time being, and to his archdeacon; resisting them in
nothing, unless such things should be commanded as would militate
against the Divine pleasure. I will never commit theft, nor bring a
false accusation against any one of the brethren, nor infringe the vow
of chastity, nor fail in my duty by appropriating anything or leaving
anything by will to others, unless by a dispensation granted by the
brothers. I will make it my study wholly to avoid all kind of usury, as
a monstrous thing, and hateful to God.[67] I will not be aiding and
abetting, in word or thought, directly or indirectly, in any plan by
which any one shall be appointed custos or master of the Lepers of St.
Julian, except the person appointed by the Lord Abbot of St. Albans. I
will be content, without strife or complaint, with the food and drink,
and other things given and allowed me by the master, according to the
usage and custom of the house. I will not transgress the bounds
prescribed to me, without the special license of my superiors, and with
their consent and will; and if I prove an offender against any article
named above, it is my wish that the Lord Abbot or his substitute may
punish me according to the nature and amount of the offence, as shall
seem best to him, and even to cast me forth an apostate from the
congregation of the brethren, without hope of remission, except through
the special grace of the Lord Abbot.”[68]
I have only very briefly to advert to one other subject, before closing
these remarks on the government of the English leper hospitals. I have
already alluded to a special order of knighthood having been established
at an early period for the care and superintendence of lepers.
Belloy[69] carries back the origin of this order in Palestine to a very
early period in the history of the Christian church. We know as a matter
of greater historical certainty that the knights of St. Lazarus
separated from the general order of Knights Hospitallers about the end
of the eleventh or commencement of the twelfth century.[70]
From the locality of their original establishment, and from their
central preceptory being near Jerusalem, they were at first generally
designated Knights of St. Lazarus, or of St. Lazarus and St. Mary of
Jerusalem. Latterly they were conjoined by different European Princes
with the Military Orders of Notre-Dame, Mount Carmel, and St.
Maurice.[71]
Saint Louis brought twelve of the Knights of St. Lazarus into France,
and entrusted them with the superintendence of the Ladreries or leper
hospitals of his kingdom.[72] The first notice of their having acquired
a footing in Great Britain is in the time of King Stephen. During the
reign of that sovereign their head establishment in England at Burton
Lazars, Leicestershire, was built by (as Nicols[73] states) a general
collection throughout the kingdom, but chiefly by the assistance of
Robert de Mowbray. Here they gradually acquired considerable wealth and
possessions.[74] I find that the Hospitals of Tilton, of the Holy
Innocents at Lincoln, of St. Giles, London, the Preceptory of Choseley
in Norfolk, and perhaps various others, were betimes annexed to Burton
Lazars as cells containing “fratres leprosos de Sancto Lazaro de
Jerusalem.” Nicols has printed not less than thirty-five charters
relating to the House of Burton Lazars. Its privileges and possessions
were confirmed by Henry II., King John, and Henry VI. It was at last
dissolved by Henry VIII.[75] The only settlement of the Knights of St.
Lazarus in Scotland that I have been able to find, was in the town of
Linlithgow, and the notice of it is very imperfect and unsatisfactory.
It is contained in a document of the reign of Alexander II., and
preserved in the Chartulary of Newbottle, in which reference is
expressly made to land held “de Fratribus de Sancto Lazaro” at
Linlithgow.[76] That the Lazarites had an establishment or
establishments in Scotland as well as in the sister kingdom, appears
borne out by a fact recorded by Helyot,[77] that in 1342, John Halliday,
a Scotsman, was appointed Governor of the Knights of St. Lazarus both in
England and Scotland, by the Grand Master of Boigny in France, who was
at that period the reputed head of the order. Indeed Pennecuik, on the
authority of Maimbourg (_Histoire des Croisades_), asserts that the
“Knights of St. Lazarus were numerous everywhere, but especially in
Scotland and France.”[78]
The first and original object of the Knights of St. Lazarus seems to
have been the care probably of the sick generally, but in a special
manner of those affected with leprosy.[79] They received lepers into
their order, superintended the inmates of the lazar-houses, and, till
the standing rule to the contrary was allowed to be changed by Pope
Innocent IV., they were obliged to elect a leper to be their Grand
Master;[80] “eatenus consuetudine observatâ ut Miles leprosus domûs
Sancti Lazari Hierosolymitani in ejus Magistrum assumeretur.”[81]
Toussaint de S. Luc, in his History, Ceremonials, etc., of the Order of
St. Lazarus, after it was united in 1608 by Henry IV. of France to those
of Notre-Dame and Mount Carmel, states that the candidates for this
united knighthood were obliged, upon the Holy Evangelists, to swear
_inter alia_, “to exercise charity and works of mercy towards the poor,
and particularly lepers” (_et particulièrement les lepreux_.)[82]
What extent and what kind of sway, if any, the Lazarite Knights of
England and Scotland were ever allowed to exert over the lepers of the
kingdom generally, or over the inmates of these leper cells and
hospitals that more especially belonged to them, I have not been able to
ascertain from any of the British historical records of the middle ages
that I have had an opportunity of consulting. It is, however, only too
probable that the Lazarites, like most of the other early orders of
knights, were induced by pride and avarice to turn from their original
objects of love and charity to others,—to views of power and
aggrandisement for themselves.
EXTENT OF ENDOWMENT OF THE HOSPITALS, DIET, ETC.
Most of the Scottish leper-houses were very poorly or not at all
endowed. Their principal subsistence seems to have been derived from
casual alms. Each of the doomed inmates of the hospitals was, like the
leper-struck heroine of the old Scottish poet, Henryson, by
... cauld and hounger sair
Compellit to be ane rank beggair.[83]
The inmates of the Greenside or Edinburgh lazar-house were allowed four
shillings Scotch (about fourpence sterling) per week, and for the
remainder of their subsistence they were, according to the original
rules of the institution, obliged to beg at the gate of their
hospital.[84] The leper-house at Aberdeen was supported from the public
funds of the town; but in 1591 James VI. granted a charter to “Robert
Abell and remanent of the pure (poor) leprous personis and thair
successors” in the hospital, to draw one peat of custom from every load
of them brought to the markets of Aberdeen, in consequence (as the words
of the original charter bear) “of the smallness of the rent appointit
for the leprous personis in the Hospitall being unable to sustene thame
in meet and fyre, quhairthrow they leif verie miserablie.”[85]
Other Scottish lazar-houses, however, were comparatively wealthy. Thus,
I have already mentioned that the Kingcase Hospital, near Ayr, had some
large and extensive landed properties attached to it.
The inmates of most of the smaller English leper-houses seem also to
have principally depended for their subsistence upon the precarious
contributions of the charitable. One of the lepers of the hospital at
Beccles was, by a royal grant, empowered to beg for his leprous
brothers.[86] Several of the larger English hospitals, however, were
well endowed, and the food, clothing, etc., of the inmates amply
provided for.
In some instances these endowments consisted of the accumulations of
large and voluntary charities; in others they were made up of rich
grants, left for the avowed purpose of founding chantries for the
spiritual peace and pardon of the donor and his family; and in other
cases, again, they were originally obtained as direct propitiations to
the church for misconduct and crime. Indulgences[87] of forty days’
pardon seem to have been occasionally granted by the bishops and other
ecclesiastical dignitaries to all the benefactors of the hospitals.
A bull of Pope Alexander III., which has been already referred to,
granted all leper hospital possessions an exemption from the payment of
tithes.[88] The canon was not universally adhered to in England, for, in
the account which Archbishop Parker drew up in 1562 of the hospitals in
the diocese of Canterbury, while Herbaldone and Bobbing leper-houses are
reported as “not charged with the taxes of the tenths,” it is declared
of the leper hospital of St. Laurence, Canterbury, that “the same is
taxed and payeth the perpetual tenth.”[89]
From the _Valor Ecclesiasticus_, taken in the time of Henry VIII., it
appears that whilst forty-eight hospitals, leper-houses, and
lazar-houses in the diocese of Norwich and county of Norfolk possessed
only a revenue of about £158 in all,[90] the rentals, on the other hand,
of certain individual hospitals were comparatively great for that
period. Thus, the revenues of Herbaldone[91] Hospital, Kent, and St.
James’, London,[92] were each rated at £100; of Sherburne above
£140;[93] of Maiden Bradley at near £200;[94] and those of the
establishment and “veri fair hospital” (as Leland terms it),[95] of
Burton Lazars were valued above £260.[96] In some of these richer
institutions the inmates were, as I have just remarked, well provided
for. As illustrative of this, I may quote the diet-table, etc., of one
or two of the wealthier leper hospitals. Thus, among the rules published
in the Additamenta to Matthew Paris, as established about the middle of
the fourteenth century by the Abbot Michaele for the leper-house of St.
Julian, near St. Albans, we find the following regulations laid down
with regard to the commons of the leprous brothers (de distributionibus
fratrum leprosorum):—[97]
“Let every leprous brother receive from the property of the hospital,
for his living and all necessaries, whatever he has been accustomed to
receive by the custom observed of old in the said hospital, namely,
every week seven loaves, of which five shall be white and two brown,
made from the grain as thrashed from the ear; also, every seventh week,
fourteen gallons of beer, or eight-pence (octo denarios) for the same.
Let him have, in addition to this, on the feasts of all the saints, on
the feast of Saint Julian, the purification of the Blessed Mary, the
Annunciation, the Trinity, Saint Albans, Saint John the Baptist, the
Assumption of the Blessed Mary, and the Nativity of the same, for each
feast, one loaf, one jar of beer, or a penny for the same, and one
obolus, which is called the charity of the aforesaid hospital; also, let
every leprous brother receive, at the feast of Christmas, forty gallons
of good beer, or forty pence for the same. Also, let each receive on the
said feast his share of two quarters of pure and clean corn, which is
called the great charity. Also, at the feast of St. Martin, each leper
shall have one pig from the common stall, and that there may be a fair
division of the pigs amongst the brothers, according to the custom
observed of old, we desire that the pigs, according to the number of
the lepers, may be brought forward in their presence, if it can
conveniently be done, otherwise in another place fit for the purpose,
and there each, according to the priority of entering the hospital,
shall choose one pig (otherwise a sum of money to be distributed equal
to the value of the pigs). Also, each leper shall receive on the feast
of Saint Valentine, for the whole of the ensuing year, one quarter of
oats. Also, about the feast of St. John Baptist, two bushels of salt, or
the current price. Also, at the feast of St. Julian, and at the feast of
St. Alban, one penny for the accustomed pittance. Also, at Easter one
penny, which is called by them ‘Flavvonespeni.’ Also, on Ascension-Day,
one obolus for buying potherbs. Also, on each Wednesday in Lent, bolted
corn of the weight of one of their loaves. Also, on the feast of St.
John the Baptist, four shillings for clothes. Also, at Christmas, let
there be distributed in equal portions among the leprous brothers,
fourteen shillings for their fuel through the year, as has been ordained
of old for the sake of peace and concord. Also, since, by the bounty of
our Lord the King, thirty shillings and fivepence have been assigned for
ever for the use of the lepers, which sum the Viscount of Hertford has
to pay them annually at the feasts of Easter and Michaelmas, we command
that the said 30s. and 5d. be equally divided among them in the usual
manner; and we desire the brothers to be contented with the aforesaid
distributions, which have been accustomed to be made amongst the leprous
brothers of old: But the residue of the property of the said hospital we
order and decree to be applied to the support of the Master and Priests
of the said Hospital.”
The dress of the lepers is laid down in regulations equally precise.
“The brothers are to have a tunic and upper tunic of russet, with a hood
cut from the same, so that the sleeves of the tunic be closed as far as
the hand, but not laced with knots or thread after the secular fashion.
They are to wear the upper tunic closed down to the ankles, and a close
cape of black cloth, of the same length with the hood, as they have been
accustomed of old.” A particular form of shoe was also ordered, and if
the order was disobeyed, the culprit was “condemned to walk daily
barefooted until the Master, considering his humility, said to
him—enough.”—P. 168.
The diet-roll of the large hospital at Sherburne is still more complex
than that of St. Julian’s. I extract the heads of it, and of some other
particulars with regard to the internal economy of the house, from
Surtees’ elaborate work, in which copies of the original documents are
given at full length.
The daily allowance of the lepers of Sherburne was a loaf weighing five
marks, and a gallon of ale to each; and betwixt every two, one mess or
commons of flesh three days in the week, and of fish, cheese, or butter,
on the remaining four; on high festival, a double mess; and, in
particular, on the feast of St. Cuthbert, in Lent, fresh salmon
(_salmones recentes_), if it could be had; if not, other fresh fish; and
on Michaelmas day four messed on one goose. With fresh fish, flesh, or
eggs, a measure of salt was delivered. When fresh fish could not be had,
red herrings (_allecia rubea_) were served three to a single mess; (and
it was specially enjoined that they, or aught that was served up, was
not to be putrid, nor corrupt, nor from animals that had died of
disease)[98]; or cheese and butter by weight; or three eggs. During
Lent each had a razer (_rasarium_) of wheat to make furmenty
(_simulam_), and two razers of beans to boil; sometimes greens or
onions; and every day, except Sunday, the seventh part of a razer of
bean meal, but on Sunday a measure and a half of pulse to make gruel.
Red herrings were prohibited from Pentecost to Michaelmas, and at the
latter each received two razers of apples. The lepers had a common
kitchen, and a common cook, fuel, and utensils for cooking, etc.—viz. a
lead, two brazen pots, a table, a large wooden vessel for washing or
making wine, a laver, two ale vats, and two bathing vats.
The sick had fire and candle, and all necessaries, until they either
convalesced or died; and one of the chaplains was assigned to hear the
confessions of the sick, to read the gospel to them on Sundays and
holidays, and to read the burial-service for the dead. The old woman who
attended on the sick had every week three wheaten loaves, and one mess
of flesh or fish; and when a brother or sister was buried, the
grave-digger had his meat and drink. Each leper had a yearly allowance
for his clothing of three yards of woollen cloth, white or russet, six
yards of linen, and six of canvass, and the tailor had his meat and
drink the day on which he came to cut out their clothes. Four fires were
allowed for the whole community. From Michaelmas to All Saints they had
two baskets of peat on double mess days, and four baskets daily from All
Saints to Easter. On Christmas eve they had four yule logs, each a
cart-load (“unusquisque erit unius quadrigatae”), with four trusses of
straw; four trusses of straw on All Saints eve and Easter eve; and four
bundles of rushes on the eves of Pentecost, St. John Baptist, and St.
Mary Magdalene; and on the anniversary of Martin de Sancta Cruce, every
leper received five shillings and fivepence in money.
The good food, lodging, and raiment provided by the rich endowments of
Sherburne were not without some alloy. The rules of the house were
strict, and the religious duties enforced upon the inmates were of an
austere character. “All the leprous brethren, whose health permitted,
were every day expected to attend matins, nones, vespers, and complines.
The bed-rid sick were enjoined to raise themselves, and say matins in
their bed; and for those who were still weaker, let them rest in peace,
_et quod dicere possint dicant_.” During Lent and Advent all the
brethren were required to receive corporal discipline three days in the
week, and the sisters, in like manner, _donec omnes vapulent_. And all
these, and other laws, Bishop Kellaw “did by his charter confirm and
order ever thereafter ‘_inviolabiter observari_.’”[99]
On the Continent the lazar hospitals partook of the same differences in
regard to poverty and wealth as we have traced in Britain. In France,
some of them, however, had become so very amply endowed by the
commencement of the fourteenth century that they at last excited the
avarice of Philip V., who subjected many of their inmates to the
flames.[100] “They were burned alive” (_on les bruloit tout vifs_), says
the historian Mezeray, “in order that the fire might purify at one and
the same time the infection of the body and that of the soul.”[101] The
ostensible cause for this act of fiendish barbarity was the absurd
allegation, that (as the original ordonnance of Philip bears[102]) the
lepers of France and other parts had been bribed to commit “the
detestable sin and horrible crime” (detestabile flagitium et crimen
horrendum) of poisoning the wells, waters, etc., used by the Christians.
The real cause, there is little doubt, was a desire, through this flimsy
excuse, to rob the richer hospitals of their funds and possessions; and
this appears only too strongly in the anxiety displayed in the special
wording of Philip’s original edict, that all the goods of the lepers be
lodged and held for himself, (ordinavimus, _inter alia_, quod omnia bona
eorum ad manum nostrum ponerentur et tenerentur.)[103] The persecution
of them was again temporarily renewed in 1388, under Charles VI. of
France.[104]
DATES OF THE APPEARANCE AND DISAPPEARANCE OF LEPROSY IN GREAT BRITAIN.
Much has been written regarding the date of the first appearance of
Leprosy in western Europe.
By Astruc,[105] Bach,[106] and others, it has been averred that the
leprosy of the middle ages was introduced from the East by those who
returned from the crusades. Some of our own historians, as Fuller[107]
and Heron,[108] allege that by this means it first reached Great
Britain. It is quite possible, allowing the disease for the sake of
argument to be contagious, that through the increased international
intercourse of that period, it may have been propagated more rapidly and
widely than would otherwise have occurred; but there are ample reasons
and proofs for believing that it existed on the continent of Europe, and
even as far westward as England, before the crusade fanaticism had drawn
any converts from this country.
The first relay of Englishmen engaged in the crusade left in 1096, and
returned two years afterwards. Several English leper-houses were founded
before that period.
Lanfranc, Bishop of Canterbury, and the ecclesiastical favourite of
William the Conqueror, died, according to the evidence of the Saxon
Chronicle in 1089,[109] seven years previous to the first crusade.
During his lifetime he founded two hospitals near Canterbury, one a
house built of stone (lapideum domum decentem et amplum) for patients
affected with various descriptions of diseases (variis infirmitatum
qualitatibus), and the second an hospital constructed of houses of wood,
and specially set aside for lepers (ligneas domos ad opus
leprosorum.)[110] Somner states that this latter institution still
exists at Canterbury as a charitable establishment.[111] Other English
lazar-houses were probably of as early a date, or at least earlier than
the first emigration for the crusades. Brigges alleges that the
leper-house of St. Leonards in Northampton, was founded in William I.’s
reign,[112] or before 1087; and one at Chatham was, according to Tanner,
in existence before the termination of the short reign of his son,
William Rufus.[113]
But more than a century even previous to the date of which we speak,
leprosy had been made a subject of legislation in Great Britain. In a
parliament held by Pepin, King of France in 757 at Campiegne, it was
enacted that leprosy in a husband or wife be regarded as a cause of
separation, and that the sound party might again remarry.[114] Lobineau,
in his history of Brittany,[115] tells us as one of the effects of this
law of divorce, that among the higher ranks of the city of Dol, there
were a number (_quantité_) of husbands who had as many as three wives
living at the same time. Now among the earliest extant code of laws
enacted in any part of Britain, those, namely, of the celebrated Welsh
King, Hoel Dha, who died about the year 950,[116] there is a canon to
the same effect as that referred to, viz. that a married female was
entitled to separation, and the restitution of her goods, provided her
husband was affected with leprosy.[117] There is, however, as we shall
afterwards see, great reason to believe that the word leprosy was then
used as a generic term, including under it many different varieties of
cutaneous affections.
I can offer nothing precise in regard to the exact period of the first
introduction of Leprosy into Scotland. If, as I have already shown to be
highly probable, the term Liberton is merely a conversion from leper
town, it would render it likely that the disease was an early visitant
of this country; for we know that Liberton is mentioned in various old
charters of the reign of David I., who died in 1153.[118] In the
Foundation Charter of Holyrood (1128) the mill and chapel “de
Libertune”[119] are mentioned, and in the chartulary of Kelso, “William,
parsona de Liberton,” signs as witness to some charters dated during the
latter half of the twelfth century.[120] At a later date there figures
repeatedly, in the ancient and well-known verses of Blind Harry, as an
occasional companion of Wallace—
“Thomas Gray, parsone off Libertone,”
a member of the church militant, who in more than one instance seems to
have thrown aside his bell and book for the purpose of sharing in the
brave struggles and hardy adventures of the Scottish patriot.
But I can adduce much more solid proof than this unstable philological
basis affords, for stating that, as far back at least as the latter half
of the twelfth century, the disease was not only known in Scotland, but
that hospitals were by that time actually erected for the seclusion of
the victims of it. The hospital of Auldnestun, in Lauderdale, had, as I
have already stated, three carrucates of land granted to it, as appears
from the Melrose Chartulary, by Walter, the son of Alan. The date of
this grant, as of most others in the old chartularies, is not preserved,
but it is a fixed and well-ascertained fact in Scottish history that the
donor of it, the first of the illustrious, and afterwards royal line of
Stewarts, died himself as a Cluniac monk in Melrose Abbey in the year
1177.[121]
William the Lion, who died in 1214, confirmed, as we have seen, a grant
to the leper-house of Aldcambus; and the hospital of Rothfan, near
Elgin, was evidently established during, if not prior to, the reign of
his son and successor, Alexander II. In the chapter of gifts to this
Rothfan hospital, by John Byseth, Alexander is spoken of as the reigning
prince, the preamble to the grant declaring that the endowment was
bestowed “for the love of charity, for the soul of King William, and for
the salvation of my noble lord King Alexander” (pro salute domini mei
Alexandri nobilis Regis).[122] Alexander II. died in 1249, so that by
this time the disease was certainly spread to the more northern parts of
the kingdom.
All Scottish records of these earlier times are almost, as I have
already observed, so entirely lost, that it now seems impossible to
ascertain whether any leper-houses existed in this kingdom at a date
antecedent to those to which I have thus alluded. That this was the
case, however, is not improbable.
Before the first notice of the earliest Scotch leper-house that I have
been able to trace—viz. that of Auldnestun, about 1170, similar
establishments were abundant in England. The charters of many of them
appear to have been either granted or confirmed in the reign of Henry
I., who died in 1154, and was a contemporary of the Scotch Kings, Edgar,
Alexander I., and David I.; and it is not unworthy of remark that two,
if not more, lazar-houses were founded in England by natives of Scotland
prior to the date of the earliest Scotch leper-house that I have been
able to discover. For Malcolm IV. founded and endowed one in his
principality of Huntingdon in 1165;[123] and sixty years earlier, or in
1101,[124] Matilda, the “gode Queene Maud” of Henry I., and daughter of
Malcolm III. of Scotland, established the hospital of St. Giles,
Bishopsgate, for forty lepers, a chaplain, clerk, and messengers.
But at whatever respective periods the disease first appeared in England
and Scotland, there are strong reasons for believing that it continued
to prevail in the latter kingdom long after it had ceased, or almost
entirely ceased, in the former. In the preface to the statutes of the
leper-house of St. Albans, drawn up about 1350, and already referred to
as published in the supplement to Matthew Paris’ history,[125] it is
stated that the number of lepers that presented themselves for admission
had diminished so much by that time, that their expense of maintenance
was below the revenue of the institution; “in general,” it is added,
“there are now not above three, sometimes only two, and occasionally
only one.” In exactly the same year (1350) that this report was drawn up
for St. Albans, was it thought necessary to institute the leper-house at
Glasgow; and nearly one hundred years later, or in 1427, the Scottish
Parliament deemed it proper to legislate on the subject of lepers.
The hospital of St. Mary Magdalene, at Ripon, was established in 1139
for the relief of all the lepers in that district. In the time of Henry
VIII, it contained only two priests and five poor people to pray for all
“Christen sowlez.”[126]
At Illeford, in Essex, an hospital was instituted in the reign of Henry
II. or Richard I. for thirteen lepers. In one of the reports of the
commissioners for suppressing colleges, hospitals, etc., in the time of
Edward VI., it is observed, in regard to the state of this Illeford
Hospital, that though founded “to find 13 pore men beying Lepers, 2
pryests, and one clerke—thereof there is at this day but one pryest and
2 pore men.”[127]
By the same commission most other lazar-houses were reported as having
no leprous patients, and yet only a few years previously was the
leper-house of Aberdeen built, and forty or fifty years afterwards (in
1591) the Edinburgh hospital at Greenside was established. We have
several later notices of the disease among us. In the Aberdeen
Kirk-Session Register, vol. i., it is stated that, on the 13th May 1604,
the kirk-session ordained “Helene Smythe, ane puir woman infectit with
leprosie, to be put in the hospitall appoyntit for keeping and haulding
of lipper-folkis betwixt the townis; and the keyis of the said hospitall
to be deliverit to her.”[128]
As late as 1693 we have some records of the lepers of Kingcase. On the
11th March of that year a complaint was lodged by the procurator-fiscal
“anent the intruding of the lepers of Kingcase upon the priviledges only
propper to the burgess and freemen (of Prestwick) by there resorting to
the shoar, and taking up certain timber and other wrack, and casting
greater quantities of peats and turf off the common and moss, &c.,
which, being seriously pondered by the magistrates, &c., they ordained
that none of the said lepers of Kingcase do so under the penalty of ane
hundredth pund, _toties quoties_, to be paid by ilk ane (each one) of
them in caise of failyie (failure).”[129]
The disease appears to have continued in the northern islands of
Scotland long after it had disappeared from the mainland, and, indeed,
all other parts of Great Britain. In Shetland it has been known for
centuries. I have already made a quotation from Brand to show that it
was at Lerwick as late as the latter part of the seventeenth century. In
some districts of Shetland it continued still later. Apparently most of
those there affected either belonged to or were sent to the Island of
Papa. I have in my possession a MS. extract from the Session-books of
Walls, showing the expenses incurred in keeping the lepers at Papa from
1736 to 1740. Four of them appear to have died during these years, and
two of the entries are for the “tobacco”[130] used at their funerals.
In 1742 there is a long entry in the Session Records of Walls, earnestly
enjoining a day of public thanksgiving for the supposed total
deliverance of the country from the effects of the leprosy.
The disease, however, was not eradicated entirely. Mr. Jack, the
resident clergyman, who wrote the account of the parish of Northmaven
for the Statistical Account of Scotland, published in 1798, seems to
have seen what he terms several miserable cases of the disease, and
adds, that in many instances there is reason to suspect a hereditary
taint.[131] Dr. Thomson urged his pupil, Dr. Edmondston of Lerwick, to
trace out the history of the disease in the north, and that gentleman
has made the following observations upon it in his work on the Zetland
Isles:—
“Elephantiasis, known by the name of leprosy, was very frequent in
Zetland about sixty years ago, but its occurrence since that time has
only been occasional, and at present scarcely an instance of it is to be
met with. A native of Zetland, a few years ago, was received into the
hospital of Edinburgh, labouring under true elephantiasis. I have seen
obscure degrees of it in Zetland, where the face was bloated, the skin
scaly and rough, and the voice slightly hoarse; but they did not
terminate fatally, nor was the affection apparently communicated to
others. The last instance I saw of it was in the person of a boy. His
friends could assign no cause for its appearance, and said that it had
come on spontaneously, and proceeded gradually. The disease had been
stationary for some time before it fell under my observation.”[132]
As so far confirmatory of the disease having thus longer remained in
Shetland than in the more southern parts of these kingdoms, I may here
mention that in the middle ages it was very common,[133] and has since
long continued to linger in the neighbouring Faroe Islands, and in
Iceland. It appears, from Debes’[134] evidence, that true tubercular
leprosy, as we shall see in the sequel, continued to prevail in the
Faroe Islands (the nearest land north of Shetland) in the middle of the
seventeenth century. Still later—viz. in 1768, Petersen[135] found 280
lepers in the hospitals in Iceland. Olafsen,[136] Troil,[137]
Holland,[138] and Henderson,[139] have each, from personal observation,
described the disease as existing in that island; and the French
Government expedition in 1836, under Gaimard,[140] have, in the
beautiful work they are at present publishing, already given several
excellent coloured sketches of natives affected with tubercular leprosy.
The disease, according to various authors, still prevails in the
northern kingdoms of Norway and Sweden. I am not by any means
sufficiently intimate with the literature of the Scandinavian radesyge,
to venture to offer any decided opinion with regard to its nosological
nature, and its alleged relation to the leprosy of the middle ages. As
far, however, as I am acquainted with the subject, it appears to me that
under the name of radesyge, two, if not more distinct species of disease
were, by Holst and the other authors who first wrote upon it, confounded
and described together. One of these, the radesyge properly so called,
is probably nearly allied to, if not identical with the sibbens of
Scotland. Another of the supposed varieties of the disease, the
spedalskhed or spetälska, seems on the other hand to be a different
nosological species, hereditary, non-contagious, chronic, incurable, and
identical in many, if not in all its characters, with true tubercular
leprosy. The spetälska seems confined to particular and more limited
localities in the north than the radesyge; and when we look to the
descriptions of it as seen at Ostrobothnia by Udmann,[141] or as given
by Hünefeld,[142] in regard to the disease at Bergen, we certainly find
these descriptions very exactly answering to the definitions of
tubercular or Arabian leprosy given by our best nosologists and
pathologists, and which I shall have occasion afterwards to discuss at
some length. Besides, radesyge is a disease which is believed by many to
have made its first appearance in Sweden and Norway during the last
century, while the spetälska was known at a greatly earlier date. The
present hospital for it at Bergen was, as Hünefeld[143] informs us,
founded as early as the year 1268.
In the Second Part I will take an opportunity of considering at length
the nosological nature of the leprosy of the middle ages, particularly
as it was seen prevailing in Great Britain. I will inquire into the
rank, age, etc., of those attacked, and point out some of the causes
which have been considered as connected with the dissemination of the
disease; and lastly, I will endeavour to bring together some of the
strange regulations of medical police that were adopted in England and
Scotland with regard to the infected.
PART II.
THE NOSOLOGICAL NATURE OF THE DISEASE.
In the preceding Part we have shown the extent to which leprosy
prevailed during the middle ages in Great Britain; the number of
hospitals that were instituted for the reception and seclusion of the
infected; the government and regulations of these hospitals; and the
dates of the commencement and disappearance of the disease in the
kingdoms of England and Scotland. Before proceeding farther, we
propose,—in this Second Part,—to pause and discuss the strictly
medical question of the specific nosological nature of the malady, whose
history we have thus far considered.
I have already taken occasion to speak of the leprosy of the middle
ages, as identical with the species of cutaneous disorder, which has
been variously denominated the tubercular leprosy, (_Lepra
tuberculosa_); the leprosy of the Arabians (_Lepra Arabum_); and the
elephantiasis of the Greeks (_Elephantiasis Græcorum_). The particular
form of chronic cutaneous disease, to which these different appellations
have been severally applied, is an affection very distinctly marked in
its more leading symptoms and course. Before, however, attempting to
prove that the European and British leprosy of former times was
specifically identical with the malady in question, it will expedite our
investigation of the question if, in the first instance, we obtain a
precise and perfect picture of the tubercular or Arabian leprosy itself.
By adopting this plan, we shall have placed before us a standard, as it
were, by which we can judge of and test those more or less imperfect
descriptions of the leprosy of the middle ages, which we may in the
sequel have occasion to quote and animadvert upon. And in order to
obtain such a standard of comparison as we have now in view, and that
without any possibility of prejudging the subject, I shall cite the
description of this species of disease from Dr. Bateman of London, and
Dr. Schedel of Paris;—from the first, because the characters which he
has given of this and other cutaneous affections are generally and
justly looked upon by British pathologists as the most clear and
distinct that can anywhere be referred to;—and from the last, because
his account of tubercular leprosy is, I believe, the latest that has
issued from the medical press, and the author has already, by a former
work,[144] distinguished himself by the excellence of his descriptions,
and the precision of his diagnosis of cutaneous diseases.
MODERN DESCRIPTIONS AND DEFINITIONS OF TUBERCULAR LEPROSY.
“The elephantiasis,” says Dr. Bateman[145] “(as described by the
Greeks), is principally characterised by the appearance of shining
tubercles, of different sizes, of a dusky red or livid colour, on the
face, ears, and extremities; together with a thickened and rugose state
of the skin, a diminution or total loss of its sensibility, and a
falling off of all the hair, except that of the scalp.
“The disease is described as very slow in its progress, sometimes
continuing for several years, without materially deranging the functions
of the patient. During this continuance, however, great deformity is
gradually produced. The alæ of the nose become swelled and scabrous, and
the nostrils dilate; the lips are tumid; the external ears, particularly
the lobes, are enlarged and thickened, and beset with tubercles; the
skin of the forehead and cheeks grows thick and tumid, and forms large
and prominent rugæ, especially over the eyes; the hair of the eyebrows,
the beard, the pubes, axillæ, etc., falls off; the voice becomes hoarse
and obscure; and the sensibility of the parts affected is obtuse, or
totally abolished, so that pinching or puncturing them gives no
uneasiness. This disfiguration of the countenance suggested the idea of
the features of a satyr or a wild beast; whence the disease was by some
called _Satyriasis_, and by others _Leontiasis_.
“As the malady proceeds, the tubercles begin to crack, and at length to
ulcerate: Ulcerations also appear in the throat, and in the nose, which
sometimes destroy the palate, and the cartilaginous septum; the nose
falls, and the breath is intolerably offensive. The thickened and
tuberculated skin of the extremities becomes divided by fissures, and
ulcerates, or is corroded under dry sordid scabs, so that the fingers
and toes gangrene, and separate, joint after joint.”
The description of the course and symptoms of the disease, as given by
Schedel, is more minute and detailed.
“_Lepra tuberculosa_, or Greek elephantiasis, is” (he observes),[146]
“characterised by the eruption of fawn-coloured or yellowish-brown
tubercles, various in size, irregular in shape, somewhat shining, and
soft and smooth to the touch. These tubercles are preceded by
erythematous patches, in which the sensibility of the skin is
diminished: slightly elevated at their outset, they become afterwards
more projecting, whilst the sensibility of the parts is usually quite
lost, although they are sometimes painful when touched. They more
frequently occur upon the face, the nose, the ears, the lips, etc.; and
being accompanied with a thickened and rugose state of the skin, they
cause a most hideous distortion of the features, and frightful
deformity.
“The evolution of the leprous tubercles is usually preceded by that of
slight erythematous patches of a tawny red hue in whites, and blacker
than the surrounding integuments in negroes. These patches are worthy of
attention, since they announce the dreadful disease which is about to
appear. When they are of some duration, the skin in these points already
begins to lose its sensibility. Sooner or later, in some cases quickly
in others very slowly, small soft, livid red tumours appear, varying in
size from that of a pea to that of a walnut, or even larger. When these
tubercles come out, the erythematous patches, on which the sensibility
of the integument had become lessened, sometimes become painful; so much
so, that we have heard patients declare that the pain produced by the
handling of the small tumours at this period was similar to that felt
when the cubital nerve receives a blow at the elbow. When they appear
on the face, they are generally accompanied by a puffy swelling of the
surrounding parts.
“Sometimes only small surfaces are attacked. We have seen the nose and
ears alone affected, and much swollen and enlarged. When the disease
occurs on the lower extremities only, it is found on the inferior part
of the thigh, and around the ankles.
“After remaining stationary for a longer or shorter time, the disorder
increases: instead of a few tubercles to be met with here and there, the
whole face is covered with large dusky red lumps, separated by deep
furrows; the features are horribly distorted; the alæ of the nose are
thickened and swollen; the nostrils dilated; the eyebrows tuberculated
and overhanging; the lips enormously thickened; the skin of the forehead
and cheeks is thick, uneven, and tumid; the chin much increased in size,
and the whole of the affected surfaces appear as if smeared with oil,
and of a dusky livid red; the external ears, especially the lobes, are
much enlarged and thickened, and beset with tubercles; the eyebrows and
eyelashes and beard fall off; the sense of smell becomes impaired or
totally lost; that of touch is often strangely affected; the voice grows
husky, and is frequently lost; the eyesight is greatly weakened; the
unfortunate patient is dejected; and the muscular powers depressed in a
singular manner. With regard to the _libido inexplicabilis_, so much
spoken of, our observations do not coincide with those of Dr. Adams, who
mentions actual wasting of the generative organs. In the cases which
have come under our notice we have witnessed quite the reverse, and yet
several were young men in whom the disease was not too far advanced.
“At a still later period the symptoms are even more dreadful; the
tubercles become the seat of ulceration, and sores of an unhealthy
character succeed, and discharge an ichorous fluid, which, on
concreting, form dark adherent scabs of various extent and thickness;
these incrustations are sometimes followed by cicatrices, but this is
unfortunately a rare occurrence. On the extremities the thick and
tuberculated skin becomes divided by fissures, and ulcerates or is
corroded under the dry scabs, so that the fingers and toes mortify and
separate, joint after joint, the miserable patient surviving these
horrid mutilations. Those individuals whom we have seen perish from this
disease were carried off by enteritis; large ulcerations were found in
the ilium, cæcum, and colon, excepting in one case, in which death was
caused by tubercular phthisis.”
In studying the phenomena of this, as of any other disease, it will
simplify our recollection of its more leading and more constant
characters, if we have the principal symptoms of it embodied in a
concise nosological definition, instead of being spread through a long
and detailed description. Two of our last and best British nosologists
give the following definition of tubercular leprosy or Greek
elephantiasis (for I use these terms here and elsewhere as words
perfectly synonymous).
“Elephantiasis” (says Dr. Cullen), “is a contagious disease, with (1)
the face deformed with tubercles; (2) the skin thick, wrinkled, rough,
unctuous, and divested of hair; (3) loss of feeling in the extreme
joints; and (4) the voice is hoarse and nasal.”[147]
In defining the genus elephantiasis, Dr. Good selects the second and
third characters of Cullen as the most distinctive, and adds to these
two others—viz. “(1) eyes fierce and staring; (2) perspiration highly
offensive.” In defining the first species of this genus (or the Greek
elephantiasis of other authors), he introduces as its three
pathognomonic symptoms, the first and fourth characters of Cullen and a
part of the second.[148]
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]
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.”
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]
This author is generally supposed to have lived about 1270, in the reign
of Henry III. or Edward I.[183] Bale places him even much earlier.[184]
Gilbert has a chapter headed “De Lepra.” In this chapter he describes
very minutely the four usual modifications of lepra (the Elephantia,
Leonina, Tyria, and Alopecia), varieties which, he himself observes, are
rarely found pure and simple, but generally mixed together
(_compositas_).[185] To quote in proof of this his long and very
detailed account of the disease would occupy much space and only lead to
repetition. That the description, however, which Gilbert has drawn of
the leprosy of the middle ages is one of the most just and accurate
penned during these times, has been often and freely admitted by
Sauvages, Sprengel, and other competent judges. Further, that the lepra
as described by Gilbert, and as understood by him and his contemporaries
in England, meant the elephantiasis of the Greeks, is evident (without
going into particulars) from the simple fact, that the sagacious
Sauvages refers to and quotes this chapter of Gilbert’s on lepra as one
of the best descriptions extant of Greek elephantiasis.[186]
In an official report given in to the Royal Society of Medicine of Paris
in 1782, upon the Greek elephantiasis, the reporters, MM. Chamseru and
Coquereau, specially allude to Gilbert’s description as the most clear
exposition of it to which they could refer.[187] Again, in an analysis
of the works of this early English author, the learned Professor
Sprengel observes, “Gilbert sometimes relates, though very rarely,
observations which are proper to himself, and which deserve to be
quoted. In this number I include particularly those concerning leprosy.
We may almost look upon them as the first exact description which has
been given of that malady by the Christian physicians of the west. The
spots which foretell it, and the signs of its first invasion, are at
least described by him in a manner agreeable to nature,” etc.[188]
Here, then, we have the direct and positive evidence of an English
physician of the thirteenth century, that the term lepra was then used
in this country specially to designate the varieties of Greek
elephantiasis; and I might adduce (if it were at all necessary), to
demonstrate exactly the same circumstance, the chapter which John of
Gaddesden, Professor of Medicine in Merton College, Oxford,[189] and
Court physician to Edward II., has devoted to lepra or elephantiasis in
his famous _Rosa Anglica_, a work written towards the commencement of
the succeeding or fourteenth century.[190] In this “Opus luculentum et
eruditum” (as at least Leland terms it),[191] the author describes at
considerable length the nature, causes, and premonitory signs, etc., of
lepra and its varieties, and enters minutely into the pathognomonic
signs (signa demonstrativa infallibilia) of the disease, as respectively
taken from the face, from the extremities, from the blood, and from the
humours of the body. A quotation from his signs of leprosy, as taken
from the face, will at once show that by that term (lepra) he meant the
Greek elephantiasis. I shall give the passage in his own words. “A
_Facie_, rotundatio oculorum, contractio palpebrarum, lacrimositas multa
et aquositas oculorum, depiliatio superciliorum et grossities eorum;
dilatatio narium exterius et constrictio interius, et coartatio
anhelitus, quasi si cum naribus loqueretur. Et color faciei lividus
vergens ad fuscedinem mortificatam. Terribilis aspectus faciei cum fixo
intuitu. Contractio et palpebrarum et aurium. Infectio cutis maculosa.
Tuberositas et pustulae in facie et nodositas. Ista omnia et major pars
sunt infallibilia signa lepræ actualis.”[192] In a subsequent part of
his chapter on Lepra, John of Gaddesden strongly states, that “no one is
to be adjudged a leper, and separated from intercourse of mankind (_ab
hominum conversatione separandus_), until the figure and form of the
face is actually changed. Hence cancer (gangrene?) in the feet, or foul
scabbing, must not be considered as arguing the presence of leprosy, nor
nodosities, unless they appear on the face and with the aforesaid
conditions.”[193]
The testimony of Bartholomey Glanville, an English author of the latter
part of the fourteenth century,[194] may be adduced in support of the
same view. In his work “De Proprietatibus Rerum” he describes persons
affected with leprosy (lepra) as having “redde Whelkes and Pymples in
the Face, out of whome oftenne runne Blood and Matter: in such the Noses
swellen, and ben (become) grete, the vertue of Smellynge faylyth, and
the Brethe stynkyth ryght fowle.” When, he further observes, the disease
is so advanced that the infected are “unclene, spotyd, glemy, and
quyttery (ichorous), the Nosethrilles ben stopyl, the Wasen of the Voys
is rough, and the Voys is horse, and the Heere [hair] falls.”[195]
In addition to the preceding direct medical evidence, it may not be
considered irrelevant to the present question to remark that, in most of
the lazar-house charters and notices in England and Scotland that I have
had access to, the inmates of these institutions are described by the
adjective _leprosus_, or by some application of the corresponding noun
_lepra_, as “lepra percussi,” “infecti lepra.” I have, however, met with
one very striking exception to this general rule, and I allude to it
here as confirmatory of what I have stated with regard to the nature of
the disease for which these leper hospitals were instituted in our own
country. The leper hospital of Sherburne was, as I have already had
occasion to mention, endowed for sixty patients, and was hence one of
the largest in England. It was founded in 1181 by Hugh Pudsey, “the
jollie Bishope of Durham.” In a MS. History of the Durham Cathedral and
Diocese, in the Bodleian Library,[196] the inmates of the Sherburne
Hospital, instead of being termed _Leprosi_, are directly designated
_Elephantuosi_. In speaking of the acts of Bishop Pudsey, the MS.
states, amongst other things, that he constructed the hospital of
Sherburne, and planted in it lepers collected from all parts of the
bishoprick. (_Elefantuosos_, in Episcopatu suo circumquaque collectos,
ibidem instituit.)
NATURE OF THE LEPROSY OF SCOTLAND.
I have hitherto said nothing to show that the disease in Scotland was of
the nature of Greek elephantiasis. During the earlier ages at which it
prevailed in this country, medicine was little cultivated, and we have
no professional work of any kind left us by the Scottish physicians of
that period, from which to derive any evidence on this subject.[197]
Amidst this dearth, however, of medical writings during the middle ages
in Scotland, it gives me pleasure to refer to a passage in one of our
earliest Scotch poets, affording proof that the leprosy of this country
was, as on the continent, truly the Greek elephantiasis.
It is well known to the lovers of early Scotch literature that Henryson,
a schoolmaster of Dunfermline, who wrote before the year 1500, composed,
among other things, _The Testament of Cresseid_ as a sequel to the
_Troilus and Cresseid_ of his immediate predecessor Chaucer.[198]
Indulging, like his English prototype, in the wildest forms of
anachronism, the Scottish poet confessedly subjects, in almost every
particular, the ancient and foreign characters of the piece to the
manners, incidents, and institutions of his own times, and of his own
country. In this spirit he afflicts, at last, the fickle and unfortunate
Cresseid with leprosy, as perhaps the most appalling of dooms to which
he could consign her. The poet afterwards sends her “unto yone hospitall
at the tounis’ end.” The particular symptoms which he makes Saturn
invoke upon Cresseid, to transform her into a leper, are exactly the
most marked symptoms of Greek elephantiasis:
Thy cristall ene (eyes) minglit with blude I mak,[199]
Thy voice sa cleir unpleasand, hoir, and hace,
Thy lustie lyre (fair skin) ouirspread with spottis blak,
And lumpis haw (livid[200]) appeirand in thy face;
Quhair thow cummis, ilk (each) man sall fle the place;
Thus sall thow go begging fra hous to hous,
With cop and clapper like ane Lazarous.
In this remarkable passage, those more striking symptoms, the
swellings, lumps, or livid tubercles on the face, the morbid alteration
of the voice and skin, and that turgid and injected appearance of the
eye, which Dr. Good has given as one of his characteristic symptoms of
the _genus_ elephantiasis, are all tersely, yet accurately described.
Indeed, if Sauvages, Swediaur, Cullen, or any of our great nosologists
of the last or present century, had been poets, I greatly doubt
whether, with all their medical knowledge to boot, they could, in four
fettered lines of rhyme, have described the Greek elephantiasis more
faithfully and briefly than we have it described in the four first lines
that I have just quoted from the Dunfermline schoolmaster of the
fifteenth century. Henryson’s account of a leper may not be so
poetically beautiful, but it is pathologically much more true than that
which the American poet, Willis, has recently given of the disease in
his well-known poem of _Helon_. We shall afterwards find that “the cop
and clapper,” alluded to in Henryson’s two last lines, were badges
commonly carried by the inmates of the leper hospitals of Scotland.
In passages subsequent to that which I have quoted, Henryson reiterates
some of the more prominent symptoms. Thus, the hapless Cresseid
afterwards describes what is elsewhere termed “her uglye lipper face,
the whilk before was quhite (white) as lilie flour,” as “deformed in the
figour;” and again also she describes and laments the characteristic
morbid change in the voice:
“My cleir voice and my courtlie carrolling
Is rawk (rank) as roke, full hideous, hoir, and hace.”
But I have still further and stronger proof to adduce that the leprosy
of the Scotch was the tubercular lepra or Greek elephantiasis. It has
been already stated that the disease continued to prevail in the
Shetlands, apparently long after it had left all the more southern parts
of the British Islands. We have found Brand stating in 1700,[201] the
disease to be “discovered (I quote his own words) by hairs falling from
the eyebrows, the nose falling in,” etc. I have shown also that in some
districts of Shetland the disease continued to a later date, and that,
down to 1742, the infected were kept in the island of Papa, or, as it is
sometimes written, Papastour. Through Mr. Charles Duncan, who has kindly
exerted himself in Shetland to procure me information on the present
subject, I have been favoured with the sight of an old but important
document relative to the lepers of Papa, and the symptoms under which
they laboured. The document in question was, as Mr. Duncan informs me,
drawn up for Sir John Pringle, by the Rev. Andrew Fisken, minister of
Delting, Walls, and Sandness. The old copy I refer to belongs to the
Rev. James Barclay (son of the late Dr. Barclay of Lerwick), and I
publish its contents with his permission. The minute description which
it gives of the symptoms in the lepers of Shetland can leave no doubt as
to the disease under which they suffered being the true tubercular
leprosy, or _Elephantiasis Græcorum_, and the value of the evidence
which it affords on this point is only increased by the fact, that the
writer did not himself belong to the medical profession. The importance
of the document must plead as an excuse for its length. The copy which
is quoted below, is marked on the back, in an old handwriting, “Case of
the Lepers in Papa, as drawn up by Mr. Andrew Fisken, about the year
1736 or 1737.” It proceeds as follows:—
“There are in the Island of Papastour in Zetland five women who labour
under a disease that, generally in this place, gets the name of
Leprosie, though others alledge it deserves rather to be called a
scurvy. The disease has the following appearances, viz.—
“The persons affected at first find an unusual itching in their skin,
with small, knotty, hard lumps to be felt under the cuticle; their whole
body appears plumper than ordinary, and their eyes are observed to be
clearer coloured, with a look more piercing than formerly. Their face
and legs are full of small lumps or hard tumours, which in a little
suppurate and throw out a black, thin, ichorous matter, and gradually
encrease, especially in the face, till they turn confluent. It is also
observed that where these lumps do not appear, the skin feels hard and
callous, like a piece of unwrought leather, and the cuticle smoother
than ordinary, and unctuous or greasy, which appears from pouring water
into the palms of their hands, where it will separate into small
globules, such as appear when water is poured out of a greasy vessel.
The extraordinary plumpness, or rather swelling of the body, observed in
the beginning of this disease, does, in a few months, disappear, and
they turn very lean and weak, only their face always, and sometimes also
their legs, continue swelled. A great many little lumps like small hard
seeds are then to be felt everywhere under their skin, which gradually
increase till they break out externally, throwing out a fœtid thin
ichor, which ceases to run in a little time, and a hard scab covers the
part, which sometimes dries, and falling off, leaves the skin entire; at
other times breaks out again, and runs as before. The hair falls off
from their eyebrows, and they have their throats much inflamed,
especially the uvula, which is gradually (and after some years
continuing under the disease) entirely destroyed. Their voice is so
weakened that they cannot speak louder than one whispering. They have
frequent flushes of heat in their skin, which is succeeded by an
universal chilliness, and they are not at that instant able to suffer
the cold air without a very acute soreness in their skin. As the disease
encreases, it appears still the more frightful and loathsome; their face
full of large and deep ulcers, resembles somewhat a lump of rotten cork;
their gums and teeth are quite rotten, and in the night-time they are
much troubled with deep-seated pains in their bodies, and have in the
day-time frequent stitches and pains in all parts of their body, with a
general weight and inactivity of their limbs. The women also cease to
have their menstrua upon their being seized with this distemper. Their
appetite and digestion is as good as ordinary; their stools regular;
nothing extraordinary to be observed in their urine. They sleep pretty
well, but seldom or never sweat any.
“This disease is found by experiment to be very infectious, and seems
also to run in blood, most people that have taken it without infection
from another having been related to three families in the isle. It
affects any age or sex, and it is observed that young persons bear it
longer than those of a more advanced age, some having lived ten years
under it, others only two, some four, some six, etc., but none ever
recover after the symptoms above-written do appear. The persons that
fall into this direful case are, as soon as it is observed, obliged to
retire to a solitary little hut, built on purpose for them, at a
distance from all houses, and are not allowed any converse with their
husbands, wives, or nearest relations, but have their necessaries of
life furnished them by a contribution from all the inhabitants of the
isle, and brought to their hut, which they take in when the person who
brought it has retired to the windward of their house at some distance.
“There has never been any cure of this disease attempted here, save that
a few years ago a young woman in a neighbouring parish had some bolusses
of mercury given her in order to a salivation; but some dangerous
symptoms appearing, the administrator thought fit to proceed no further,
and the patient continues still alive in the same case she was before
taking the mercury.”
In the voluminous MS. Medical Notes, bequeathed by Sir John Pringle to
the College of Physicians of Edinburgh,[202] I find a copy of the above
account of the Papa lepers. Sir Andrew Mitchell of Westshore seems to
have transmitted the account to him without giving any notice of the
writer of it. It is entered in Sir John’s notes under the date of 1759;
but it was without doubt drawn up many years previously. I have already
alluded to an entry in the Session Records of Walls, regarding the
disappearance of leprosy from that parish and district in 1742. The
entry seems to have been made at a sitting of the session “at
North-house in Papastour;” and its expressions[203] show that at the
date of it (17th March 1742) there were no lepers in Papa. From the MS.
extracts furnished to me by Mr. Rannie, session-clerk, it appears that
there is only mention of one other instance afterwards in the
Session-books of the parish, viz. in December 1772 and 1776. The female
who was the subject of it, and whose case is represented in the records
as “singularly clamant,” was ordered to be provided, at the expense of
the session, “with back and bed clothes, a house fit for her to lodge
in, and maintenance to be brought to her daily at the house.” Mr. Rannie
further states, “I have been informed by old persons that she lived but
a short time after she was put into the house built for her in the
common, at a distance from other houses.” He adds, “It has been reported
to me that in Papa, about the year 1778, a leprous woman was put out and
died in the fields before a house could be built; and that about the
same time there were leprous persons in the district of Watness, and
that the son and daughter of a man Henry Sinclair were infected and sent
to the hospital at Edinburgh.”
At a still later date a case of Shetland leprosy was detected in the
Edinburgh Infirmary. In 1798, a male patient from Shetland was for some
time in the hospital wards, under the care of various physicians. As the
form of disease under which he laboured was considered as very
anomalous, Dr. Thomson was requested by Dr. Hamilton to visit the
patient, and detected the case to be one of Greek elephantiasis. I am
kindly permitted to extract the following notes of the case from Dr.
Thomson’s manuscripts:—
“His face was studded all over with small subcutaneous tubercles. The
skin over these tubercles was of a reddish colour, intermixed with
blotches, like those which occur in the _pityriasis versicolor_. The
hair of the eyebrows and eyelids had fallen off, and the skin of the
face, as well as of most of the rest of the body, seemed as if smeared
with oil. His voice was weak and hoarse, so that he seemed to speak as
in a whisper. On inspecting the fauces, they appeared in some places raw
and excoriated, and in others rough and puckered. A slight ulceration
was perceptible on the _septum narium_, and the nose seemed a little
depressed. In various parts of the body, particularly on the arms,
thighs, and legs, besides the small subcutaneous tubercles, other larger
ones were to be perceived by feeling for them. These larger bumps or
tubercles, which were not perceptible to the eye, and which did not
occasion any discoloration of the skin, were without pain, and had a
striking resemblance to the tubercles occurring in the flesh of those
affected with scurvy.”
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]
_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 eos 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).
A decree, issued in the year 1314, by Milo, Bishop of Orleans, shows
that it was occasionally necessary to guard the examinators against
being imposed on in other more serious ways, than by direct
prevarications or misstatements on the part of the suspected individuals
who are subjected to their scrutiny. “Whereas it happens that in the
examination of lepers mistakes as to identity, and deceptions, are
caused by the interposition of other persons, we enact and command that
whenever any person is suspected of the infection of leprosy, he be sent
at his own charge if he have effects, but if not, that two responsible
men of the parish having been sworn (_jurati_) before the priest and the
officers of the church (_gajariis ecclesiae_), be sent at the expense of
the parish with the suspected person to obtain the examination; they
shall conduct the said suspected person to the said examination, and
cause him to be faithfully examined, and bring certificates to us, that
it may not be possible that, for the future, collusion should take place
in the aforesaid matters.”[216]
I have not hitherto been able to find any evidence showing to whom the
examination and seclusion of lepers was, in olden times, entrusted in
England; or to trace out in that kingdom any special laws relative to
this subject. There exist, however, upon record, in reference to one
English case in the fifteenth century, some details that are
particularly interesting in regard to the present point of our inquiry.
The details in question have been preserved in Rymer’s _Fœdera_. The
case to which they refer appears to have been brought under the
cognisance of the Crown by the neighbours of the suspected female, in
consequence of her being alleged to be affected with leprosy, and yet
refusing to seclude herself, as was the usual custom, from intercourse
with society in consequence of it. The reigning monarch, Edward IV.,
issued, in 1468, a Chancery warrant for the proper medical examination
of this supposed case of the disease. The royal warrant, and the medical
certificate which it called forth, have both been preserved by Rymer. I
append a translation of these curious documents, as illustrative both of
the general dread then still entertained of the malady, and of the
minute care which, in this country, was occasionally taken, in order
that a just and accurate judgment might be arrived at in cases of doubt
and difficulty. The documents are entered by Rymer under the title of
“Medicorum Regis, super morbo Lepræ, Certificatio.” They proceed as
follows:—
“To the most Excellent and most Serene Prince and Lord in Christ,
Edward, by the Grace of God, King of England and France, and Lord of
Ireland, We, William Hatteclyff, Roger Marshall, and Dominus de Serego,
Doctors of Arts and Medicine, your physicians, and sworn to watch over
the health of your Person, send due Reverence with humility and
worship:—
“Whereas a Petition was made to You in Your Court of Chancery, with
regard to removing _Johanna Nightingale_, of Brentwoode, in the County
of Essex, from general intercourse with mankind (_a communi hominum
consortio_), because it was presumed by some of her neighbours that she
was infected by the foul contact of Leprosy, and was, in fact, herself a
Leper: Upon which Your writ was then prepared, and afterwards directed
to the Sheriff of the said county, in these words:—
“Edward, by the Grace of God, King of England and France, and Lord of
Ireland, to the Sheriff of Essex, Greeting: Whereas We have heard that
_Johanna Nightingale_ is a leper, and is commonly holding intercourse
with the people of the aforesaid county, and mixes with them both in
public and private places, and refuses to retire to a solitary place, as
is customary and befitting her (_et se ad locum solitarium, prout moris
est, et ad ipsam pertineret, transferre recusat_), to the grievous
injury and, on account of the contagion of the aforesaid disease, the
manifest perils of the aforesaid inhabitants: We, willing to guard
against such dangers, as far as in us lies, and as is just and customary
in such cases, Do charge You, that having taken with You certain
discreet and loyal men of the county of the aforesaid _Johanna_, in
order to obtain a better knowledge of this disease, You go to the
aforesaid _Johanna_, and cause her to be diligently viewed and examined
in the presence of the aforesaid men. And if You find her to be leprous,
as was reported of her, then that You cause her to be removed, in as
decent a manner as possible, from all intercourse with other persons,
and have her betake herself immediately (_indilatè_) to a secluded
place, as is the custom, lest by common intercourse of this kind injury
or danger should in any wise happen to the aforesaid inhabitants.
Witness my hand, at Westminster, this day of July, in the eighth year
of Our reign.”
“Wherefore The Reverend Father in God, Robert, by the Grace of God, Lord
Bishop of Bath and Wells, Your Chancellor of England, consulted us on
this subject, and determined to bring the same Johanna to us, with the
intention that, according to what we have learned from our knowledge of
Medicine, we should give information to Your Highness in Your Chancery,
whether the said Johanna be in fact a Leper or not. We, therefore,
wishing to obey Your Highness, in order that the truth on this subject
might be made most plain and clear, have proceeded after this manner.
First, we examined her person, and as the older and most learned medical
authors have directed in these cases, we touched and handled her (_ipsam
tradavimus et palpavimus_), and made mature, diligent, and proper
investigation, whether the symptoms, indicative of this disease, were in
her or not; and after an examination and consideration of each of the
points, which appeared necessary to be examined and considered, in order
to arrive at a true knowledge of this doubtful matter, We found that the
woman neither had been nor was a Leper, nor ought, on that account, to
be separated from ordinary intercourse with mankind.
“We are taught by Medical Science that the disease of Leprosy is known
by many signs, also that each species of the disease, of which there are
four, viz. Alopecia, Tiria, Leonina, and Elephantia, should be known and
characterised by particular signs, and each should be specifically
distinguished from the rest. Therefore, in the case of the woman brought
before us, on going through upwards of twenty-five of the more marked
(_famosiora_) signs of general leprosy (_Leprae in communi_), we do not
find that she can be proved to be leprous, by them or a sufficient
number of them. And this would suffice, generally, to free her from the
suspicion of leprosy, since it is not possible for any to labour under
the disease, in whom the greater part of these signs are not found. But,
in order to give our opinion on the individual species, going through
upwards of forty distinctive signs of the different varieties of
leprosy, we do not find that this woman is to be marked as suffering
under any of the four kinds, but is utterly free and untainted, as we
have signified by word of mouth to Your Highness in Your said Chancery,
and we are prepared to declare the same more fully to Your Highness by
scientific process (_per processum scientificum_), if, and wherever, it
shall be necessary.
“In testimony whereof, we, the said William Hatticlyff, Roger Marshall,
and Dominus de Serego, have signed our name with our proper hands, and
alternately affixed our seals.”
To the preceding document, which is one of the earliest, if not the very
earliest, English medical certificate which either historical or medical
records have preserved, it is added in the form of a note, “Et
memorandum quod praedicti Willielmus Hatteclyff, Rogerus Marchall, et
Dominus de Serego venerunt in Cancellarium apud Westmonasterium, septimo
die Novembris, anno praesenti (1468), et recognoverunt scriptum
praedictum, et omnia contenta in eodem, forma praedicta.”[217]
PART III.
THE ETIOLOGICAL HISTORY OF THE DISEASE.
To conclude the present hurried sketch of the British leprosy of the
middle ages, it now only remains for me to consider, in relation to the
etiology or causation of the disease, the rank, age, sex, etc., of those
that were attacked by it; the effects of its hereditary transmission;
and the question of its propagation by contagion. In connection with
this last subject, I shall attempt to bring together under one view the
stringent regulations and usages that were adopted by our ancestors,
with a view of preventing the diffusion of the disease by means of
communication between the infected and the healthy; and at the same time
consider the light in which the despised lepers were regarded both by
the civil and ecclesiastical law.
RANK OF THE PERSONS ATTACKED BY LEPROSY.
In this country the leprosy of the middle ages seems to have had its
largest share of victims in the lower classes of society—amongst the
“villeyns” or bondsmen of these times, and the poorer peasantry and
burgesses, who, when shut up in the hospitals, were obliged either to
depend upon the funds of these institutions, or to beg for their
support. The exact trade and calling of the individuals admitted into
the Scottish and English hospitals can only be very imperfectly gathered
from one or two casual notices.[218]
Among the patients of Kingcase leper hospital, in Ayrshire, I have only
found one whose rank I can trace. In the burgh of Prestwick[219] records
for 1478-9, Anne Kerd is formally accused before the magistrates of the
burgh of visiting Kingcase, and further “hir seik soun, att is lepper,
repairis daili in her house [in Prestwick].” This Anne Kerd, having “a
sick son that is leprous” seems from the old _Liber Communitatis_, etc.,
_de Prestwick_ of 1470 to have had assigned her a very small fragment of
the burgh lands only, viz. “a porciunkle of commoun lande quilk acht
after hir lyve to John Haveris airis (which belonged after her life
[death] to John Haveris’ heirs).”[220]
Amongst the citizens of Glasgow who were at different times in the
latter part of the sixteenth century ordered by the magistrates to be
visited, under the suspicion of labouring under leprosy, most are
recorded by their mere Christian name and surname; but two or three are
entered in the burgh records in such terms as to show their occupation
and probable rank, as “Robert ——, fleschor,” in 1573; “Mr. James ——,
fleschor,” “Patrick Bogle, maltman,” and “Andro Lawson, merchand,” in
1581.[221] One of these individuals is reported by the Water Bailies as
confined in the Glasgow leper hospital at the Brigend[222] in 1589,
along with five other lepers. The whole list is interesting for our
present purpose, as showing the trade and calling of the infected
inmates, viz. “Andro Lawson, _merchand_; Stevin Gilmor, _cordener_;
Robert Bogill, sone to Patrick Bogle; Patrick Birstall, _tailzeour_;
Johne Thomsoun, sone to Johne Thomsoune, _tailzeour_; Daniel
Cunninghame, _tinclar_.”
I am not aware of the existence of any similar complete list of the
inmates of other British leper hospitals, to which I could refer with
the view of ascertaining the occupation and rank of those that occupied
them. We have scattered records, however, to show that men of riches
occasionally became the victims of the disease, and passed their
subsequent term of life in the leper hospitals. Thus, Jenkins, in
speaking of the St. Mary Magdalene lazar-house at Exeter, states,
“Richard Orange, Esq., a gentleman of noble parentage, and mayor of this
city (Exeter) in 1454, being infected with the leprosy, notwithstanding
his great wealth, submitted himself to a residence in this hospital,
where he lived many years, and finished his days, and was buried in the
chancel of the chapel. His grave, with a mutilated inscription, is still
extant.”[223]
Some of the leper hospitals were specially endowed for persons above the
lower ranks, who happened to become affected with the disease. In 1491,
Robert Pigot gave by will to the leper hospital of Walsingham, in the
archdeaconry of Norwich, a house in or near that town for the use of two
leprous persons “of good families.”[224]
The malady was found among the clergy as well as among the laity, and
some of the English leper hospitals were specially founded for the
reception of leprous monks alone—as the hospital of St. Lawrence, near
Canterbury, and, according to Tanner,[225] that of St. Bartholomew, at
Chatham. From one of the edicts issued by Henry II. during the height
of his quarrel with Archbishop Becket, it would appear that the
dignitaries of the church occasionally did, or at least might, employ
lepers in the high character of nuncios, for, in order to prevent Becket
from putting the kingdom of England under an ecclesiastical interdict,
Henry took all precautions that no official letters to that effect
should be conveyed into Britain; and to secure this object the more
surely, he enacted, that, if any individual did carry thither letters of
interdict from the Pope or Archbishop, he should be punished “by the
amputation of his feet if a regular; by the loss of his eyes and by
castration, if a secular clergyman; he should be hanged if he were a
layman; and burned if he were a leper” (_si Leprosus, comburatur_).[226]
In the extant account of the British leper hospitals, there are still
preserved some instances in which these institutions were founded by the
wealthy and noble after they had themselves become the victims of the
malady. The leper hospital of Mayden Bradley, in Wiltshire, was founded
by a female member of the rich family of the Bysets[227]—Camden alleges
by a daughter of Manasser Byset, sewer to King Henry II., after she had
herself become a leper. “This hospital,” says Leland, “was builded by
one of the three heirs general of the Bisets, who, being a lazar, gave
her part of the town of Kidderminster _in pios usus_.”[228]
If the earlier biographical notices that we possess regarding the
nobility of Great Britain were as minute on their private as on their
martial and political lives, we might probably have to record many more
notices in regard to their bodily maladies of an import similar to the
following:—The youngest son of Robert Blanchmains, Earl of Leicester,
was himself a leper, and in the reign of Richard II. founded a leper
hospital, dedicated to St. Leonard, on the north part of the town of
Leicester.[229]
The royal families of England and Scotland did not always remain exempt
from the suspicion, at least, and accusation of leprosy, if not from the
actual attack of the disease.
Henry III. courted Margaret, Princess of Scotland, and the sister of
Malcolm IV. The royal lady preferred the brave Hubert de Burgh, the
minister of the English king. Hubert’s enemies afterwards alleged to
King Henry, that he (Hubert) had dissuaded the Scottish princess from
accepting the hand of the English monarch, by telling her “that Henry
was a squint-eyed fool, a lewd man, a _leper_, deceitful, perjured, more
faint-hearted than a woman, and utterly unfit for the company of any
fair and noble lady.”—(Articles of Impeachment, as given by
Speed.)[230]
In reference to this unfounded accusation, I may state that Ryland
mentions it as a local tradition that the leper-house of Waterford in
Ireland was founded by King John (the father of Henry III.) in
consequence of his son’s being affected at Lismore with an eruption that
was supposed to be leprosy.[231] But even supposing the tradition
correct, it could scarcely have been Henry the eldest legitimate son of
John, since, at the date of his father’s expedition into Ireland, 1209
and 1210, Henry was a child of only five or six years of age, and in all
probability did not accompany his royal sire.
Different historians have alleged that Henry IV. was affected with
leprosy in the latter part of his life. The immediate cause of his death
seems to have been epilepsy, terminating, after a time, in an apoplectic
attack; and some authors aver strongly that this was his only disease.
Thus, in his Chronicles of England,[232] the celebrated old printer,
Grafton, upholds that Henry was carried off by “a sore and sudaine
disease called an apoplexie.” Hall, an author somewhat anterior in date,
stoutly maintains this same view, for the king’s disease, as he
observes, “was no lepry striken by the hand of God, as folish friers
before declared, for then he neither would for shame nor for debility
enterprize (as he did), so greate a journey as into Jewrie (Jerusalem),
in his own persone, but he was taken with a sore apoplexye.”[233]
Hollinshed,[234] quoting implicitly this account from “Maister Hall,”
gravely adds, and he “had none other greefe nor maladie.” The dogmatic
authority of Hall on this, as on other points, is not to be over much
relied upon.
We have little doubt that Dr. Lingard[235] had some sufficient evidence
from the records of the times, for stating that Henry had at least “the
most loathsome eruptions on his face.” Rapin[236] and Turner,[237] in
their histories of England, both refer to Mezeray as their authority for
averring that these eruptions consisted of leprosy. I find that
Duchesne[238] also describes Henry as weighed down with a severe and
grievous affection of leprosy; and Maydestone[239] alleges that it was
this last disease, and solemnly considers it as a punishment inflicted
on the king for his cruel treatment of Archbishop Scrope. Iohn Hardynge,
whose authority is the more valuable from his being himself a
contemporary of Henry IV., and a follower of his son, Henry V.,
describes in his rhyming Chronicles of English History the face of the
king as disfigured by leprosy. As a portion of the last personal
confessions of the monarch, Hardynge puts into his mouth the following
penitent lamentations regarding the changes which the ravages of the
disease had wrought upon his frame and face:—
“This wormes mete, this carryon full vnquert,
That some tyme thought in worlde it had ne pere;
This face so foule that _Leprous_ doth apere,
That here afore I have had such a pride
To purtraye oft in many place full wyde,” etc.[240]
These observations are certainly by no means sufficient either decidedly
to confirm or controvert the opinion that Henry IV. was affected with
leprosy; but they serve at least to show that, at the time at which he
lived, rank of the highest kind was not considered as any adequate
barrier against an attack of the disease.
In none of these alleged cases of leprosy in the royal family of England
is the proof of the actual existence of the disease at all indubitable
and complete. The evidence is more certain and satisfactory in regard to
the occurrence of the malady, in its genuine form, in other scions of
the House of Anjou than those who ascended the throne of England. I
allude especially to the case of Baldwin IV., King of Jerusalem, a
direct descendant, like the royal Plantagenets of England, from Fulk,
Count of Anjou and Touraine. All historians seem to agree in stating
Baldwin IV. to have laboured for some years under elephantiasis, and to
have ultimately resigned his sceptre in consequence of disability from
that disease. He was, says Fuller, when speaking of him under the year
1174, “enclined to the leprosie called elephantiasis.”[241] By the year
1183, “the leprosie had arrested him prisoner and kept him at home.
Long” (adds the same historian) “had the king’s spirit endured this
infirmity, swallowing many a bitter pang with a smiling face, and going
upright with patient shoulders under the weight of his disease. It made
him put all his might to it, because when he yielded to his sicknesse,
he must leave off the managing of the State; and he was loth to put off
his royal robes before he went to bed, a crown being too good a
companion for one to part with willinglie. But at last he was made to
stoop, and retired himself to a private life.”[242]
The disease, as has been above observed, did not spare the royal family
of Scotland. At least two cases of leprosy are alleged to have occurred
among the members of it. The first and earliest of these, however, is
much more a matter of fable than of fact, and the story, as told us by
Hector Boece and Dempster, is, in all probability, due rather to their
love of historical romance than their knowledge of historical records.
Fiacre, the subject of it, still holds a place as a saint in the
Catholic calendars of France and Germany. Among the long list of
oaths[243] which Rabelais, in his Pantagruel, long ago put into the
mouth of the garrulous Panurge, one is an imprecation “par l’espine de
Saint Fiacre.” This Saint Fiacre or St. Fithulk (as he was sometimes
termed) was the reputed son of Eugenius IV. King of Scotland. Preferring
a cloister to a court, he is said to have retired into France, and to
have led the life of a religious solitary in a cell granted to him by
Pharo, Bishop of Meaux. After his father was dead and his brother
deposed, the Scottish nobles sent a deputation to Fiacre with an offer
of the throne of his ancestors. But “quhen (to state the result in
Boece’s words) thir ambassatouris was brocht to his presence, he apperit
to thair sicht sa ful of _lipper_, that he was repute be thaim the maist
horribill creature in erd” (on earth).[244] Spottiswood fixes the era
of his death in the year 665.[245]
The case of King Robert the Bruce is a more recent and a more
authenticated instance of leprosy in the royal family of Scotland. All
authorities agree in stating that the Bruce suffered under a “lang
seknes,” as Wyntoun[246] expresses it. Froissart, who visited the
Scottish Court in the reign of his grandson Robert II., describes, in
more than one passage, the Bruce as having been afflicted with and died
of “_la grosse maladie_,” “sore greved with ye great sickenes”[247] as
Lord Berners has translated it.[248] In their editions of Froissart’s
works, Sauvage,[249] Buchon,[250] and Johnes,[251] severally comment
upon “la grosse maladie” of Froissart, as signifying the leprosy. I have
already adverted to this expression as being quite synonymous in words
and meaning with the Saxon term for the disease. Further, that Bruce was
really affected with and died of leprosy, seems to be borne out by the
evidence of the older historians. Hemingford, a contemporary of Bruce’s,
describes him as “lepra percussus;”[252] and Walsingham uses the same
language both in his _Chronica_[253] and in his _Ypodigma
Neustriæ_;[254] Boece speaks of Bruce as dying of leprosy (ex lepra fato
concessit);[255] and Buchanan gives to his disease the more unequivocal
name of elephantiasis (“nam in elephantiam incederat”).[256] Leland, in
the translation which he has given in the first volume of his
_Collectanea_ from the famous _Scalacronica_, speaks of ambassadors
being sent from England to “Murrefe (Moray), the guardiane of Scotlande
in the nonage of King Davy, whos fader dyed of the Lepre;”[257] “_qui
mort estoit de lepre_,” in the words of the original works.[258] In the
old and valuable _Chronicle of Lanercost_, which has only been for the
first time printed within the last two years, the disease and death of
the Bruce are mentioned in terms equally precise. In speaking (p. 254)
of Randolph and Douglas entering England in 1326, the Chronicle states
that the Scottish army was not led by Bruce in person, because “factus
erat Leprosus.”[259] His death is thus announced in a subsequent page
(264) of these old and probably contemporary records, under the year
1329, “mortuus est Dominus Robertus Brus, Rex Scotiæ, leprosus.”
I shall close these remarks by alluding to one other reputed case of
leprosy in a descendant of the royal families of Scotland. The
celebrated Constance, Duchess of Britanny, who was allied to the royal
families both of England and Scotland (being a granddaughter of Malcolm
III. of Scotland, and the English Princess Margaret Atheling, and at the
same time a descendant of a natural daughter of Henry I.), is generally
alleged by historians to have suffered and died from leprosy.[260]
William of Nangris (as Lobineau observes) “has shown that she died of
leprosy (_de la lepre_), a disease with which females were occasionally
attacked in these times.” Lobineau places the date of the decease of
Constance in the year 1201.
SEX OF THE LEPERS.
The modern history of tubercular leprosy would seem to show that the
disease attacks the male in a larger proportion than the female sex.
From the table which Dr. Adams collected and published of patients
admitted into the leper-house of Funchal, Madeira,[261] from 1702 to
1803, it appears that during that period 526 infected males were
admitted into the hospital, while the corresponding list of infected
females amounts only to 373. The enumeration of the lepers in the
Glasgow leper hospital in 1589,[262] and those entered into the
Greenside hospital of Edinburgh in 1591 (the only two old lists of
patients of such institutions in Britain that I am acquainted with),
show the diseased inmates of these two establishments to have been all
males. A large proportion of the English lazar-houses seem, from the
language of their charters, to have been endowed entirely for males
(_fratres leprosi_), but, at the same time, we have abundant evidence in
the same documents that females often suffered from the disease.[263]
Some of the lazar-houses were founded and endowed for admitting infected
inmates of both sexes (_fratres et sorores leprosæ_). Thus Tanner states
that the old lazar-house of St. Nicolas, York, contained both male and
female lepers.[264] Mackarell and Bridges both mention the same fact
with regard to the hospitals of St. Nicolas at Lynne Regis,[265] and of
St. Leonard at Northampton;[266] and the inmates of the leper-house of
St. Giles, Shrewsbury, bore, according to Owen and Blakeway,[267] the
style of the prior, brethren and sisters of St. Giles. A few of the
English hospitals were indeed entirely devoted to the reception of
leprous females. Thus the hospital of Mayden Bradley was founded in the
time of Henry II. for those of the female sex only (_pro mulieribus
leprosis_); and the hospital of St. James, Westminster (which, says
Bishop Tanner, stood on or near the place now occupied by the palace of
the same name), was destined, as the renewed charter of Henry III.
bears, for fourteen leprous girls (_quatuordecim Leprosis
puellis_).[268]
AGE OF THOSE ATTACKED—DURATION OF THE DISEASE.
There are no documents (as far as I am aware) which directly throw any
light on the age of the inmates of the leper hospitals. The expression,
however, of _puellæ_, which I have just quoted as applied to the inmates
of St. James’ Hospital, shows the youth not less than the sex of the
inmates of that institution, and so far demonstrates that the disease
then, as it does now, sometimes attacked its victims very early in life.
Baldwin IV. of Jerusalem, (whose case I have already referred to) was
affected with the disease while still a minor, and surrendered his crown
at the age of 23, in consequence of the ravages which the disease had by
that time made upon his constitution. “He died young,” says Fuller, “at
five-and-twenty years of age—a king happie in this, that he died before
the death of his kingdome.”[269]
King Robert the Bruce, another, as we have already seen, of the royal
victims of the malady, died at the age of 55.[270] But it is difficult
to fix the precise date of the first attack of the disease in the case
of the Scottish king, and hence difficult to deduce the exact duration
of the malady in this particular instance. His faithful biographer,
Barbour, describes him as “tuk with sic a sicknes” before the battle of
Inverury in 1307, “that he mycht nothyr rid na ga”[271]—(that he might
neither ride nor walk). Kerr, in his _History of the Life and Reign of
the Bruce_, seems to hint that this was the commencement of the disease
which ultimately carried him off;[272] and indeed Barbour, in a
subsequent part of his poem, describes his fatal malady as
“beguth”—(begun)
throuch his cald lying
Quhen in his gret myscheiff wes he.—P. 407.
But if the affection commenced in so acute a form at that date, it must
have lasted for the long period of twenty-two years, as his death did
not take place till 1329. If the disease under which the king suffered
so severely in 1307 had been leprosy, it would not in all probability
have left his activity and individual prowess for so long a date
unimpaired. The battle-axe which, on the evening before the battle of
Bannockburn, cleft at a single blow the helmet and skull of Henry de
Bohun, could scarcely have been wielded by the arm of one whose body had
for some years previously been the seat of a mortal disease. Some facts,
however, would seem to show that the malady had assumed a marked and
severe form a considerable time before the Bruce’s death. I have already
shown, from the _Chronicle of Lanercost_, that three years before his
demise the Bruce was already so incapacitated by the inroads of the
leprosy that he was unable to undertake the command of the army in their
descent upon the northern counties of England.[273] The same reason
rendered him, as we are informed by Barbour, unable to attend the
peaceful nuptial feast of his son at Berwick in 1328. It may not be
considered uninteresting to add, as a part both of the history of the
man and of the disease under which he was labouring, that during these
three last years of his life, and whilst “the sicknes” affected his body
“so fellely” (to use Barbour’s words), “and him trawaillat sa that he
considered death certen,” his naturally energetic mind was still active
and vigorous. The accounts of his chamberlain, preserved in the Register
House of Edinburgh,[274] show that, during the very last year of his
life, he was busied in making experiments on ship-building and
navigation in his retirement at Cardross Castle, near the banks of the
Clyde, in Dumbartonshire. Within a month before his death, he indited
from this place a letter (the original of which still exists among the
old archives of Melrose Abbey, preserved in the General Register House,
Edinburgh[275]), desiring his heart to be buried within the precincts of
that monastery,—a wish which he changed, a short time before he
expired, into the well-known commission to his favourite follower and
friend, “ye gentle knighte of Douglas,” viz. “I woll yat, as soone as I
am trespassed oute of this worlde, ye take my harte oute of my body, and
embaume it, and present it to the Holy Sepulchre at Jeruslem, saying my
bodie can nat come.”[276]
HEREDITARY TRANSMISSION OF THE LEPROSY.
Few facts in the history of tubercular leprosy seem to be more
universally admitted by all writers on the disease, both ancient and
modern, than the transmission of the predisposition to it from parents
to offspring. The Greek and Arabian physicians considered it as a malady
in which all the fluids of the body were equally diseased (corrumpens
pariter omnes humores corporis). “Fit itaque (adds Haly Abbas, the
well-known Arabian author of the tenth century, in his chapter “De
Elephantia”), cum humoribus spermatis corruptio, cum et humores et
sperma ex sanguine fiant, in tantum, ut in generatione passio haec
transeat in filios.” (Theoric, lib. viii. cap. 15.) Avicenna and the
later Arabian authors, with Theodoric, Lanfranc, and other European
writers of the middle ages, express a similar belief in the hereditary
transmission of the disease; and in the same spirit, our countryman
Gilbert, writing, as we have already seen, in the thirteenth century,
observes, “Lepra est interdum morbus primus, sicut ex spermatibus primis
matris et patris Leprosis. Sanguis enim corruptus interius, qui est
nutrimentum foetus, corrumpit foetum.”[277]
Amid the scattered fragments relative to the former history of leprosy
in this country, it can scarcely be expected that we should have
preserved for us any individual data bearing directly upon the
transmission of the disease from father to son. I have met, however,
with one notice, which, though imperfect, it may not be considered
uninteresting to quote in regard to the present question. In the Burgh
Records of Glasgow for 1581, Patrick Bogle is ordered to be inspected
for leprosy;[278] and eight years afterwards (1589) “Robert Bogill,
_sone_ to Patrick Bogle,” is reported as an inmate of the leper-house
belonging to the city.[279]
It is unnecessary to adduce the opinions of modern authors in support of
the occasional hereditary transmission of leprosy, as all observers who
have described the disease from their own observations, and that in the
most different and distant parts of the world, seem uniformly agreed
upon this point. Dr. Heineken, in his account of the inmates of the
leper hospital at Funchal, Madeira, in 1825,[280] states that in three
of the cases no hereditary taint was known; the aunt of a fourth (p. 21)
was a lazar; the uncle and two brothers of a fifth (p. 18) laboured
under the same disease; the mother, brother, and son of a sixth (p. 19),
were lepers, and all of them affected before himself; and in a seventh
case (a female aged 35) her father, mother, three sisters, and two
brothers, had already all died of elephantiasis.
Among the seven cases of elephantiasis seen by Dr. Kinnis in the
Mauritius,[281] three were Mozambique slaves, and could give no
satisfactory account of their parentage. Of the remaining four—the
first could give no history of her father and mother, but had brothers
and sisters in perfect health: the ancestors of the second patient had
not been affected with leprosy, but her husband had laboured under it
for two years before death: the third case was a daughter of these
parents, and one of her brothers had died of elephantiasis: the fourth
patient appeared to have inherited the predisposition from the family of
his maternal grandmother, who was never attacked herself, but who lost
two sisters and three nieces by the disease.
These and other similar data show that the predisposition to leprosy,
like the predisposition to other hereditary diseases, may occasionally
show itself only in one or two individual members of a family; and may
sometimes lie dormant for one or two generations, to reappear in a
subsequent one. “God and Nature,” says the reverend author of a
description of the Faroe Isles, formerly quoted, “deals wonderfully with
such people (lepers) in their marriages, for amongst the children, they
beget some clean and some unclean. It has also been taken notice of that
two living together in marriage, though the one be found infected, they
live together as before, as long as one doth but murmur of it, till the
magistrate doth separate them, and yet the sound remaineth uninfected;
whereas another is often taken with the disease by a very little
conversation.... What is this? but that God confirms the truth of his
word, taking pleasure in them that live in a just wedlock, and wander in
lawful ways, putting their hopes in him, that neither fire nor water,
contagious disease, nor dangerous pestilence shall hurt them.”[282]
In some of the few districts of Europe in which cases of the disease
have continued to linger down to a late period, the malady seems to be
transmitted through an old hereditary taint in particular families,
rather than generated by existing external circumstances acting on the
bodies of those who now become its victims. The tubercular leprosy
exists still, or at least existed lately, in the districts of Martigues
and Vitrolles[283] in the south of France. The cases, though very few,
have still been well marked. M. Vidal, who, towards the end of last
century, described several instances of the disease which he saw at
Martigues, states that, with one problematical exception, the malady was
in every case hereditary.[284] “May we not,” he adds, “conclude from
this, that if the local causes which are generally assigned for leprosy
be true, they have not, at least in our country, sufficient power to
originate the disease (la faire naître), but generally only to develope
and perpetuate it in the descendants of ancient lepers?”[285] The same
family predisposition probably perpetuated the malady for some
generations in the few cases that occurred in Shetland, in the latter
part of the last century. The case of the Shetlander Berns, as
mentioned in a preceding Part, was an instance in which the disease was
apparently the result of hereditary transmission from his ancestry.
The predisposition from hereditary constitution to leprosy, and some
other diseases, was well known to our forefathers; and, if we place
credit in the account of the “auld manneris” of the Scotch antecedently
to the reign of Malcolm Canmore, as “compilit be the nobil clerke,
Maister Hector Boëce, Channon of Aberdene,” they were accustomed to
practise hygienic measures that were assuredly more summary than humane,
in order to arrest the diffusion of disease by such channels. For, to
quote the words of Boëce:—“He that was trublit with the falling evil
(epilepsy), or fallin daft or wod (insane), or having sic infirmitie as
succedis be _heritage_ fra the fader to the son, was geldit
(_castratus_), that his infekit blude suld spreid na forthir. The women
that was fallin _Lipper_, or had any other infection of blude, was
banist fra the cumpany of men, and gif scho consavit barne under sic
infirmitie, baith scho and hir barne war buryit quik (if she conceived a
child under such infirmity, both she and her child were buried
alive”).[286]
EXTERNAL EXCITING CAUSES OF LEPROSY IN THE MIDDLE AGES.
The investigation of the causes of diseases has, probably more than any
other department of medicine, been marked by belief without evidence,
and assertion without facts. The history of the opinions which have at
different times been so freely offered and adopted with regard to the
production of leprosy, and the numerous explanations which have been
proposed with respect to the causes of its almost epidemic prevalence in
Europe in the middle ages, and its nearly complete suspension in the
same region of the world at the present day, might easily, if time and
space permitted, be made to form a chapter highly illustrative of the
above general remark. The frequency of the disease in former times has
been confidently ascribed by different authors[287] to peculiarities in
the diet, dress, personal and domestic habits, etc., of our forefathers.
And certainly their mode of life was in many respects specially
calculated to generate derangements and eruptions of the skin. The good
old Saxon practice of bathing[288] appears to have become forgotten
after the date of the Norman conquest; and in the subsequent history of
these early times we might trace various indirect and direct causes of
cutaneous disease, in the close hovels and unventilated dwellings of the
period;[289] in the habits of personal uncleanness;[290] in the rough
straw bedding then generally[291] in use, and which “hard lodging”
Hollinshed describes as still used by the servants in his day, “with
seldome (he adds) anie sheete vnder their bodies to keepe them from the
pricking straws that run oft through the canvas, and rase their hardened
hides;”[292] and probably also in the articles of diet[293] on which the
general community were obliged to subsist in times before the
improvement of agriculture, and the introduction of that “schamefull
intemperance” (as old Boece[294] fanatically terms it), “when na fische
in the see, nor foule in the aire, nor beast in the wod may have rest,
but are socht heir and thair to satisfy the hungry appetit.” For the
investigation of this and other allied questions in the history of the
production of our older epidemic and endemic diseases, the works of
Hollinshed, Strutt, Henry, Chalmers, Macpherson, and others, contain a
great and available mass of materials. But, in consequence of the
unforeseen extent to which our present remarks have already lengthened
out, we are forced to abstain from entering into this topic, and
discussing the notes which we have collected in regard to it. At the
same time, however, we may pause to observe that we believe it would be
no easy matter to point out the exact differences in those physical
conditions of the inhabitants of this country in former and in modern
times, which may have led to the prevalence of the disease amongst our
ancestors, and to its disappearance amongst us. If poverty in diet, or
personal wants, and filth, and wretchedness in their deepest degrees,
could generate the malady, there are certainly still numerous spots in
continental Europe, and even in our own land, where, unfortunately, all
these elements of disease are in our own day in full and active
operation, without any such specific result following; the alleged
causes are present without the alleged effects.
In order to attain anything like satisfactory results of the supposed
physical causes of leprosy in Great Britain in former times, the whole
question would require to be thoroughly investigated in connection with
two others, viz., the allied physical circumstances,—_firstly_, of the
inhabitants of those countries in which the disease in the same way
formerly raged; and, _secondly_, of those districts of the world in
which it is still prevalent. It is only by following such a line of
inquiry that we could hope, if at all, to separate mere matters of
opinion from matters of fact, and at last to obtain, by a kind of
reasoning by exclusion, the exact physical condition or conditions of a
people that are capable of originating or of spreading this particular
species of disease. The difficulty of the problem may be easily
appreciated by glancing for a moment at the diversified _geographical
localities_ and circumstances under which the tubercular leprosy is
known at the present day to appear. In modern times it has been found
existing, to a more or less limited extent, in places the most distant
and the most dissimilar in regard to temperature, climate, situation,
soil, etc., as in Sumatra,[295] under the equator, and in parts of
Iceland almost within the verge of the Arctic Circle;[296] in the
temperate regions of both hemispheres, as (in the southern) at Hamel en
Aarde[297] in the Cape district, and (in the northern) at Madeira[298]
and Morocco;[299] in the dry and arid plains of Arabia,[300] and in the
wet and malarious districts of Batavia[301] and Surinam;[302] along the
shores of Guiana,[303] and Sierra Leone,[304] and in the interior of
Africa,[305] Hindostan,[306] Asia Minor,[307] and Asiatic Russia;[308]
on the sea-coast, as at Carthagena,[309] and thousands of feet above
the level of the ocean, as on the table-land of Mexico;[310] on some of
the islands in the Indian,[311] Chinese,[312] Caribbean,[313] and
Mediterranean[314] seas, and on the continents of Asia, Africa, and
America.
CONTAGION AS A CAUSE OF LEPROSY.
Most modern pathologists seem inclined to call in question the
contagious nature of tubercular leprosy, as it at present exists in
different parts of the globe.
Cullen, Darwin, and Good are almost the only English physicians of later
times that have admitted the contagious character of the disease, and
that not from personal observation. The evidence bearing against the
doctrine of this mode of its diffusion is principally of a simply
negative kind. In some of the districts in which the malady is endemic,
the sick are seen to maintain a free intercourse with the healthy,
without the disease being frequently or at all communicated to the
latter; the nurses of the lazar hospitals are alleged to remain
uninfected; lepers often continue long in the midst of their families
without spreading the scourge to any of the other members; and
occasionally a husband and wife are seen living in wedlock for years,
one of them deeply affected by the disease, and the other remaining
perfectly sound. Instances, exceptional to these general remarks, are
certainly occasionally observed, as in a case quoted in a previous page
from Dr. Kinnis, of a wife becoming infected subsequently to both her
husband and daughter suffering from an attack of the malady. In such
cases as this, however, we must recollect that the repetition of the
disease in two or more members of the same family may merely depend upon
the same external or general morbific agencies, acting upon the
constitution of all the sufferers.
At least, whenever, from circumstances, this source of fallacy is
avoided, the evidence of the contagion of leprosy seems to become more
and more defective. Thus, when the disease happens to be imported in the
person of an infected individual from a district in which it is endemic,
to one in which it is unknown, the malady seems to have no tendency
whatever at the present day to spread to any of the inhabitants of the
new and healthy locality. Persons labouring under tubercular leprosy are
occasionally, for example, sent from southern stations to England and
France. In such not unfrequent cases the malady has never, I believe,
been known to be communicated, in one single instance, from the infected
person to those resident inhabitants of the new district, among whom he
was living in free and daily intercourse.[315]
Did the leprosy extend and prevail over Europe in the middle ages as
independently of propagation by contagion as the perpetuation of the
disease seems to be in most localities at the present day?
If we deferred to the mere opinion of the older medical and historical
authors, the contagious character of the disease at that era would
appear to be undoubted. These authors express an unanimous opinion on
its contagious propagation; and it is not till we come down to the
professional writers of the seventeenth century, as Fernelius[316] and
Forestus,[317] that we find this doctrine ventured to be called in
question.
The evidence, however, left us by the older authorities and physicians
on this point, is an evidence of opinion rather than of facts. They have
bequeathed to us merely their own dogmatic inferences, without
vouchsafing to state any of the individual data upon which their general
deductions were founded. As far, however, as we may judge by a few loose
fragments which we may still gather up from amid the imperfect and
scattered records of the disease, the European leprosy, if it were
contagious, when epidemic in the middle ages, was at least less so than
the combined medical and popular belief of those times would seem to
represent it. In the Edinburgh hospital in 1590, two of the lepers’
wives lived uninfected with their husbands; and a few of the English
leper hospitals, as those of Ripon, St. Magdalene, Exeter, and St.
Bartholomew, near Oxford, were endowed for the purpose of serving as
retreats at one and the same time both for the merely poor and the truly
leprous.
Individuals stricken with leprosy were sometimes looked upon by the
superstitious spirit of the age as persons directly smitten by the hand
of God; and we find in history traces of rich and noble, and even of
royal devotees, endeavouring to expiate their sins and propitiate the
good will of Heaven, by occasionally devoting themselves, and that with
perfect impunity, to such duties to the sick as offered the most certain
means of calling down the disease upon their own bodies, provided it had
been at all so contagious as was generally supposed. Saint Louis (Louis
IX.) of France visited the leper hospitals every third month, personally
rendered the most abject services to their inmates, fed them, and bathed
their sores with his own hands.[318] Henry III. of England is reported
to have annually, on Shrove Tuesday, engaged in the same duties.[319]
Robert II., the son of Hugh Capet, enacted the devotee in the same
manner, imprinting kisses with his lips on the hands of the lepers (_ore
proprio figens leprosorum manibus oscula, in omnibus Deum
collaudabat_).[320] The old English historian, Matthew Paris, relates,
in his usual quaint and gossiping style, an anecdote illustrative of a
similar degree of charitable penance and defiance of contagion being
practised by the Scottish Princess Matilda, the queen of Henry I. of
England. Speaking of some transactions in the year 1105, he observes—
“At the same time David (King of Scotland), the brother of Matilda,
Queen of the English, came to England to visit his sister, and when, on
a certain evening, he came by her invitation to her chamber, he found
the house filled with lepers (_domum invenit Leprosis plenam_), and the
Queen standing in the midst, having laid aside her cloak, she with both
hands girded herself with a towel, and water being placed in readiness,
she began to wash their feet, and wipe them with the towel, and
embracing them with both hands, kissed them with the utmost devotion.
Upon which her brother addressed her thus; ‘What is this which you are
doing, my Lady? in truth if the King knew this, he would never deign to
kiss with his lips your mouth, contaminated by the pollution of the
lepers’ feet!’ and she, smiling, replied, ‘Who knows not that the feet
of an Eternal King are to be preferred to the lips of an earthly king?
Behold it was for this that I invited you, dearest brother—that you
might learn by my example to perform similar actions. Do, I beseech you,
that which you see me doing.’ And when her brother had made answer that
he would by no means do such things, as she persevered in her employment
David with a smile withdrew.”[321]
In quoting, against the alleged strong contagion of the olden leprosy,
the preceding instances of complete exposure to the infection of the
disease, and yet, at the same time, of complete escape from it in some
well-known historical personages, let it not be inferred that the
victims of the malady were usually looked upon by the general community
with feelings of devotion and pious commiseration. On the contrary, the
subjects of this “_foedissimus omnium morborum_” were, as a body,
regarded alike by the church and by the people as objects of disgust.
The Council of Ancyrus decreed that lepers were only to be allowed to
worship amongst the Hyemantes, or those public penitents who, on account
of the enormity and turpitude of some of their sins, were obliged to
stand in the open air, and not even allowed to come under the porch of
the church.[322] The Council of Worms granted to lepers a liberty of
receiving the sacrament of the body and blood of Christ, but not with
those in perfect health.[323] Guido de Monte Rocher, in his _Manual for
Curates_, states, that to some lepers the sacrament cannot be given,
because “non possunt corpus Dominicum sic recipere et tractare in ore
suo, quin rejicerent ipsum, sic multi, quibus reciderunt labia et dentes
et sunt totaliter corrosi usque ad guttur.”[324]
The preamble to the laws of the hospital of St. Julian’s, drawn up by
Abbot Michael, asserts, that “amongst all infirmities the disease of
leprosy may be considered the most loathsome, and those who are smitten
with it ought at all times, and in all places, and as well in their
conduct as in their dress, to bear themselves as more to be despised and
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