Leprosy is a disease originating in the Orient; Egypt and Judea were
formerly the principal infected centers. It was the return of an
expedition to Palestine, under Pompey, that imported the malady to
Italy. In the first years of the Christian Era it is mentioned by
Celsus, who advised that it should be treated by sweating, aided by
vapor baths. Some years later Areteus used hellebore, sulphur baths,
and the flesh of vipers taken as food, a treatment adopted by others,
as, for instance, Musa and Archigenes.
In the second century the disease was in Gaul; Soranus treated the
lepers of Aquitaine, who were numerous.[27]
According to Velly, leprosy was common in France in the middle of the
eighth century epoch, when Nicholas, Abbot of Corbeil, constructed
a leper hospital, which was never much frequented until after the
Crusades of the eleventh and fourteenth centuries. At this period the
number of lepers, or _ladres_, a name given to the unfortunates in
remembrance of their patron saint, St. Lazarus, became so great that
every town and village was obliged to build a leper house in order to
isolate the afflicted. Under Louis VIII. there were 2,000 of these
hospitals; later the number of such asylums reached 19,000.
According to the historians of this time, when a man was suspected
to be a leper he could have no social relations without making full
declaration as to what the real nature of his complaint might be.
Without this precaution his acts were void, from the capitulary of
Pepin, which dissolved all marriage contracts with lepers, to the law
of Charlemagne, that forbade their associating with healthy persons.
The fear of contagion was such that in places where no leprosy existed
they built small houses for any one who might be attacked; these houses
were called _bordes_.[28] A gray mantle, a hat and wallet, were also
supplied the victims, also a _tartarelle_, a species of rattle, or a
small bell, with which they warned all passers near not to approach.
They also had a cup placed on the far side of the road, in which all
persons might drop alms without going near the leper.
Leper houses were enriched, little by little, by the liberality of
kings and nobles and the people, and to be a leper became less inhuman
and horrible than at the beginning.
Lepers, however, were forced to submit to severe police regulations.
They were forbidden under the severest penalties from having sexual
relations with healthy persons, for such intimacy was considered as
the most dangerous method of conveying the contagion. After entering
a leper house the victim was considered as dead under the civil law,
and in order to make the patients better understand their position the
clergy accompanied them to their asylum, the same as to their funeral,
throwing the cemetery dust on them while saying: “Enter into no house
save your asylum. When you speak to an outsider stand to the windward.
When you ask alms sound your rattle. You must not go far from the
asylum without your leper’s robe. You must drink from no well or spring
save on your own grounds. You must pass no plates nor cups without
first putting on your gloves. You must not go barefooted, nor walk in
narrow streets, nor lean against walls, trees, or doors, nor sleep on
the edge of the road,” etc.
When dead they were interred in the lepers’ cemetery by their
fellow-sufferers.
Separated from society, these pariahs, living together, sometimes
reproduced their own species, and finished their days in the most
frightful cachexia, awaking only contempt, disgust, and repulsion among
the healthy of the outside world.
It is true that each time that sanitary measures were relaxed by
the authorities—such, for instance, as the perfect isolation of the
patients—an increase in the number of lepers was noticeable. When this
was observed the old-time ordinances were enforced again with vigor.
It was thus in 1371 the Provost of Paris issued an edict enjoining all
lepers to leave the Capital within fifteen days, under heavy corporal
and pecuniary penalties; and in 1388, all lepers were forbidden to
enter Paris without special permission; in 1402 this restriction was
renewed, “under penalty of being taken by the executioner and his
deputies and detained for a month on a diet of bread and water, and
afterwards perpetual banishment from the kingdom.” Finally, in April,
1488, it was announced “all persons attacked by that abominable, very
dangerous and contagious malady known as leprosy, must leave Paris
before Easter and retire to their hospitals from the date of issuance
of this edict, under penalty of imprisonment for a month on bread and
water; and, where they had property, the sequestration of their houses
and jewels and arbitrary corporal punishment; it was permitted them,
however, to send things to them by servants, the latter being in
health.”
We can understand from this how these poor wretches, at different
epochs, were accused of horrible crimes, among other things poisoning
rivers, wells, and fountains. As regards this accusation, says the
author of the _Dictionnaire des Mœurs des Francais_, Philip le
Long burned a certain number of these poor devils at the stake and
confiscated their wealth, giving it to the Order of Malta and St.
Lazare.
The historians and chronicalers of the eleventh and twelfth century
often designated the person attacked by leprosy by the name of _mesel_,
_mezel_, _meseau_ or _mesiaus_. Meantime Barbazin pretends that it is
necessary to make a distinction.[29]
_Mesel_, according to Barbazin, was a person covered with sores
and ulcers, while the leper was an insensible man. He thinks that
_mesellerie_ was at its origin a different affection than leprosy, and
that these two diseases have been wrongly confounded. “They have both
served,” says he, “to designate a frightful disease, that is reputed
the most dangerous of all maladies.”
As supporting this assertion of Barbazin, we have found in the
Romanesque tongue some documents strongly confirming this point. They
appear more interesting, inasmuch as they have heretofore been unknown
to medical literature, as, for instance:
“Seneschal, I now demand of you, said he (Saint Louis), which you love
better, whether you be _mesiaus_, or whether you commit a mortal sin;
and I, who never have lied, responded that rather would I commit thirty
mortal sins than be _mesiaus_.” (Joinville, _Histoire de Saint Louis_.)
The leprosy, however, was not an absolute cause for divorce, as we
note in the following passage: “A man can leave his wife only for
fornication, and not alone for leprosy, and lepers may marry; and one
may cancel marriage if the husband become leper, and the same may be
said of the bride.”
In the same manuscript another analogous fact shows the invalidation
of the marital act for the reason of _mesellerie_ complicated by
impotence or barrenness.
“A woman who through impotence has lost that which is necessary to
her, so that he cannot cohabit with her, for the reason that he is
_mesiaus_, may marry another, telling the latter, however, that the
first she married was worth nothing, not even an infant, as he could
not cohabit; that nothing can prevent cohabitation in marriage nor the
begetting of children.”
Individuals attacked by _mesellerie_ were in reality outside the pale
of the law. For we read in fact in the “_Coutume de Beauvoisis_, cap.
39,” that “_mesiaus_ must not be called on as witnesses, for custom
accords them no place in the conversation of gentlemen.”
“The second reason is that when a _mesiaus_ calls on a healthy man, or
when a healthy man calls on a _mesel_, the _mesiaus_ may put in the
defense that he is beyond the reach of worldly law, and cannot be held
responsible in such a case.”
These unfortunates besides could not inherit nor dispose of their own
wealth during their lives. The following passage from the “ancient
customs of Normandy” bears witness, _i. e._:
“The _mesel_ can be no man’s heir from the time his disease is
developed, but he may have a life interest, as though he were not a
_mesel_.”
The same as in many other diseases the leprosy presented itself under
different forms and various degrees of gravity, as is proved from the
following passage from _Le Pelerinage de l’humaine lignee_:
“Homs, qui ne scet bien discerner
Entre sante et maladie,
Entre le grant mesellerie
Entre le moienne et le meure.”
This gravity of different forms of leprosy has likewise been mentioned
by the Arabian school, and notably by Avicenna, who had seen numerous
cases complicated with ulcerations of the genital organs; also, by the
Englishman, Gilbert, who wrote in the thirteenth century regarding the
existence of several species of leprosy, which could not always be
easily distinguished by reason of the uncertainty of their symptoms.
As to its character as a constitutional malady we have the word of
the Syrian Jaliah ebn Serapion, who attributes its connection to the
predominance of certain humors; finally, Valescus of Tarentum insists
on the heredity of the disease.
The leprosy, the pork measles and the _mesellerie_ were then only
clinical forms of a single affection of a contagious nature—a
hereditary disease whose symptoms appeared successively on the skin, in
the mucous membranes, the viscera and in the nervous system. It then
required a diathesis, which resembled greatly in its evolution that of
syphilis, with which it has often been confounded.
The physicians of leper hospitals have left behind a great number
of medical documents bearing on the characteristics of the disease,
but their observations are so confused that we can only conclude
that they considered all cutaneous maladies as belonging to the same
constitutional vice.
They recognized, however, the _ladrerrie_ (disease arising from measly
pork), by the following symptoms, the same being laid down by Guy de
Chauliac:
“Eyelids and eyebrows swollen, falling of eye-lashes and eyebrows,
which are replaced by a finer quality of hair; ulceration of septum
of the nose, odor of ozoena, granulated tongue, fœtid breath, painful
breathing, thickening and hardness of the lips, with fissures and
lividity of same; gums tumefied and ulcerated; furfuraceous scales
in the hair, purple face, fixed expression, hideous aspect; forehead
smooth and shiny like a horn; pustules on face; veins on chest much
developed; breasts hard.”
“Thinness of muscles of the hand, especially thumb and index finger;
lividity and cracking of the nails; coldness of the extremities;
presence of a serpiginous eruption; insensibility of the legs,
collections of nodosities around the joints; under the influence
of cold elevations appeared on the cutis, making it appear like
goose-skin.”
“Sensation of pricking, ulcerations of skin; sleep uneasy, fetidity of
sweat; feeble pulse, bad odor of blood, which is viscid and oily to the
touch and gritty after incineration, likewise of a violet black color.”
The contagious characteristic of leprosy through sexual relation was
noticed by physicians attached to hospitals, and was the subject of
police restriction by public sanitary officers. Thus in the thirteenth
century the celebrated Roger Bacon, surnamed the admirable doctor,
wrote that commerce with a leprous woman could be followed by very
serious consequences. This opinion was corroborated by a physician
of the University of Oxford, his contemporary John of Gaddsen, and
by the observations of Bernard Gordon, a celebrated practitioner of
Montpellier. We all know the history of a Countess who came to be
treated for leprosy at Montpellier, when a Bachelor in Medicine charged
with the task of dressing her sores, fell desperately in love with the
leper lady, and from his _amours_ contracted most serious cutaneous
disease.
At this period the leprosy had already begun to assume a venereal type
of marked character, and many prostitutes suffered from attacks. As we
all are aware, Jean Manardi, an Italian doctor, has fully expressed
his opinion on this subject. In a letter addressed to a friend, Michel
Santana, one of the first specialists who treated pox, Manardi remarks:
“This disease has attacked Valencia, in Spain, being spread broadcast
by a famous courtesan, who, for the price of fifty crowns, accorded her
favors to a nobleman suffering from leprosy. This woman having been
tainted, in her turn contaminated all the young men who called on her,
so that more than four hundred were affected in a brief space of time.
Some of these, having followed the fortunes of King Charles into Italy,
carried and spread this cruel malady in their track.”
Another Italian physician, Andre Mathiole, likewise shows the identity
of leprosy with syphilis,—in the following terms: “Some authors have
written that the French have taken this disease from impure commerce
with leprous women while traversing the mountains of Italy.”[30]
We could easily multiply such citations to complete the facts observed
by Fernel and Ambroise Pare in France, and also by many Italian
physicians, from whence it would be easy to understand why Manardi came
to the following conclusion: “Those who have connection with a woman
who has had recent _amours_ with a leper, a courtesan in whose womb the
seeds of disease may linger, sometimes contract leprosy and at other
times suffer from other maladies of a more or less serious nature,
according to their predispositions.”
This modification from _measles_ (the disease from corrupt pork diet)
into leprosy of the venereal type is made progressively through the
intermediary of the ordinary agencies of prostitution,—bawds and
libertines,—who for a very long period eluded the wise laws ordained by
sanitary police for the restriction of lepers. In 1543, the affection
was so wide-spread as to be beyond sanitary control, and the edict of
Francois I., re establishing leper hospitals, amounted to nothing.
There were too many poxed people. The Hospital of Lourcine, which was
specially devoted to these cases at Paris contained 600 patients in
1540, and in the wards of Trinity Hospital and the Hotel Dieu there
were many more. It was the same in the Provinces, notably at Tolouse,
which had the merit of creating the first venereal hospital ever
instituted, under the Gascon name of “_Houspital das rognousez de la
rougno de Naples_.” Finally, fifty years later, in 1606, for want of
lepers, the leper asylums were officially closed. Henry IV., in a
proclamation, gave those remaining “to poor gentlemen and crippled
soldiers.”
Thus ended the epidemic of leprosy in France, which had prevailed from
the second century, observing the same progress in other countries of
Western Europe during the same period of time. Syphilis, the product
of the venereal maladies of antiquity and the leprosy of the Middle
Ages, announced a new era; syphilis was thus contemporaneous with the
_Renaissance_.
In the collection of Guy Patin’s letters, there is an interesting
document relating to the connection of leprosy and syphilis, as witness
the principal passage:
“It was not long since that I saw in Auvergne a patient who was
suspected of measles (_hog disease_), for the reason that his family
had the reputation of being thus afflicted, though he bore on his body
no marks of the disease. This led me to recall the fact that some
families in Paris have been suspected of this taint; but really we
have no measles or leprosy here. In former times there was a hospital
dedicated to such cases in the Faubourg Saint Denis. I have noticed
no cases in Champagne, Normandy nor Picardy, although in all these
Provinces I found asylums formerly used for such cases that are now
turned into hospitals for plague victims. In former times leprosy
was confounded with pox, through the ignorance of doctors and the
barbarity of the age; nevertheless, there are yet a few lepers in
Provence, Languedoc and Poitou.”
We have here the authority of Guy Patin for saying that leprosy had
almost entirely disappeared from France in the sixteenth century.
Although modern Faculties are prone to insist that the real science of
medicine only dates back its origin to the discovery of the microscope,
and that the study of antique medicine is only a retrospective
exposition calculated to show the slight scientific value of ancient
observations, I assert that the many observations recorded by our
medical ancestors are of immense value. Let us cite, as a single
instance, this transformation of a constitutional malady, attenuated
by time, transmitted by heredity through the same masses of people
for ten centuries,—populations having a similar diathesis,—a disease
taking a new vigor and attacking other generations, but destined in a
given time to disappear, most probably, in its turn, in another unknown
metamorphosis. Such an idea may cause a smile in that haughty _section
hors rang_ in medicine, which is so devoted to the culture of specific
germs that but one idea can certainly be adopted as an irrefutable
dogma in medicine—that is, if the facts it represents coincide with the
modifications of the wag—in the tail end of a bacillus.
As for myself, I remain convinced that everything seen in modern times,
through the objective even of an instrument of precision, cannot
destroy the accumulated work of twenty centuries of medical observation
and study.
_Scientiæ enim per additamenta fiunt._