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.

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 are 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 dominis 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 cos fugiat). Further, in order to have more certainty in the examination, it is added that the patient should be made, in the first place, to take oath to tell the truth on those points on which he is interrogated. We have already found De Chauliac recommending the examining physician to take the same precaution, “faciat eos jurare veritatem dicere de interrogendis” (p. 310).

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 as more humble than all other men.” The canons of the Church of Scotland, as drawn up in the thirteenth century, deal with the unfortunate lepers more humanely than most other ecclesiastical judicatories; for after recommending them to be admonished to respect the churches of their districts, it is added that, if they cannot be induced to do so, let no coercion be employed, seeing that affliction should not be accumulated upon the afflicted, but rather their miseries commiserated (cum afflictis addi non debeat afflictio, sed ipsorum, miseriis sit potius miserandum.)[325] But the contempt displayed towards them seems to have been almost proverbial as late as the age of Elizabeth. Thus Shakespeare makes Margaret of Anjou exclaim to the afflicted and suspicious Henry VI., after the murder of his uncle, the Duke of Gloucester,

Why dost thou turn away and hide thy face?

I am no loathsome leper, look on me.[326]

Maundrell, one of our early English travellers in Palestine, alludes to some cases of leprosy in terms portraying simply but strongly the fearful effects and character of the disease. After speaking of some cases of leprosy that he met with in his journey, he states (to quote his own words), “At Sichem, near Naplous, there were not less than ten lepers,—the same number that was cleansed by our Saviour not far from the same place, that came a-begging to us at one time. Their manner is to come with small buckets in their hands to receive the alms of the charitable, their touch being still held infectious, or at least unclean. Their whole distemper was so noisome that it might (he adds) well pass for the utmost corruption of the human body on this side the grave.”[327]

Various authors have alleged that the institution of leper hospitals, and laws for the separation and seclusion of the infected, were formed more from imitation of the Levitical institutions regarding the leprosy than from direct observation and proofs of the contagious character of the disease. The avoidance, however, and separation of the sick, have been recommended and followed by authors and by communities over whom the Levitical laws could have exercised no influence, direct or indirect, and to whom, indeed, these laws were in all probability totally unknown.

After describing the horrors and course of elephantiasis or tubercular leprosy, the old Roman physician, Aretæus, adds, “seeing the infected with this disease are such, who would not fly them? (aufugiat), or who would not turn aside from a leper, even although he were a son, or a father, or a brother, since there is fear lest the disease should be communicated? (quum metus est ne morbus communicaretur). Hence, many have banished those that were dearest to them into solitudes and mountains.”[328]