Chapter V: Part III: The Etiological History of the Disease (1)

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]

A knowledge of the laws and customs of the Jews in all probability never reached, or at least certainly never influenced, the opinions of the inhabitants of Tonquin—a kingdom which was formerly a part, and long a tributary, of China, and where the general religion is the idolatry of Fo and of Lanzo, with sects of the literati or followers of Confucius;[329] yet in that country those infected with leprosy are treated on the same principles of separation from the general community as we find applied to them in other and distant districts. “In Tonquin, leprosy is so common,” says Richard in his history of that country, “that there are pieces of land assigned where those attacked by it must reside. They are shut out from society; and it is even lawful to kill them if they enter cities or towns.”[330] In a country like Tonquin, it is difficult to conceive how laws and usages of this kind could have originated in anything except a belief in the contagious nature of the disease, as derived from the observation of its mode of diffusion. At all events, the old institutions and customs of the different kingdoms of Europe, in regard to lepers, seem all to have been originally founded on such a belief in the possibility of the contagious communication of this dreadful and dreaded disease from the sick to the healthy. These institutions and customs I propose now to sketch very briefly, and that principally as they bear upon the usages formerly observed towards lepers in England and Scotland. I shall consider them as they refer to—1. The separation of the infected from the general intercourse of society; 2. The laws prohibiting their entrance into towns; and 3. The restrictions under which they were placed as inmates of the hospitals.

SEPARATION OF LEPERS FROM THE GENERAL AND HEALTHY COMMUNITY.

After all that I have already had occasion to state relative to the objects of the leper hospitals, and the selection of the infected, it is almost unnecessary to add that in Great Britain, as upon the Continent,[331] lepers were obliged, either by law or usage, to seclude themselves from society when once the disease was discovered upon their persons.

The chancery warrant of Edward IV., quoted in the Second Part of these papers, speaks of the retirement of a leper from society as a matter of custom and duty, and empowers the sheriff of the county to remove the suspected person to a secluded place, as is the usage (_prout moris est_), provided the actual existence of the disease was made out.[332]

There exist in the old records of Scotland both local and general enactments enforcing the retirement and seclusion of lepers. The Scottish “Burrow Lawes” (_Leges Burgorum_) are generally allowed to have been drawn up as early as the twelfth century.[333] They are a code intended apparently for the government of the four first royal burghs of Scotland, viz. Berwick, Roxburgh, Edinburgh, and Stirling. Their sixty-fourth chapter contains some regulations regarding “lippermen.” The first of these regulations provides in the following terms for the lodgment in hospital and sustenance of the “lippermen” of the burghs:[334]—

“Gif ony man dwelland or borne in the King’s Burgh is striken with leprosie, and hes substance and geir of his awin to sustaine and cleath himselfe, he sall be put in the hospitall of that burgh quhere he dwells. And gif he hes na thing to liue upon, the burgesses of that burgh sall make ane collection amongst them, for meat and claith to him; and that collection sall be the summe of twentie shillinges.”[335]

The canons of the Church of Scotland, as drawn up or authorised by the provincial ecclesiastical councils held at Perth in the years 1242 and 1269, speak of those attacked by leprosy in this country, as being “separated from society in accordance with general custom (_de consuetudine generali a communione hominum separantur_) and retired to secluded situations.”[336]

I have already, in Part II., quoted a clause from the acts of the Perth Parliament of 1427, empowering and enforcing the dignitaries and officers of the church to search diligently in their parish visitations for any persons affected with leprosy, and to commit them to the keeping of either the civil or ecclesiastical authorities, according as they happened to be “Clerkes” or “Seculars.”

PROHIBITIONS AGAINST THE INFECTED ENTERING TOWNS.

Lepers were compelled, by other reasons than mere custom or common law, to retire from society. They were of necessity driven to seek the asylum of the lazar hospitals, in consequence of the statutes, both of the general country and of local communities, prohibiting any citizen from retaining a person labouring under leprosy in his house, and preventing the infected from entering within the gates of the towns and villages.[337]

The old Scottish Burrow Lawes have stringent clauses upon this head, for they hold that “na man should presume, or be so bauld as to harberie or ludge ane lipperman within the burgh, under ane full amerciament.” And further, “lippermen sall not enter within the towne, bot in passing throw it, and sall not gang fra dure to dure, but sall sit at the ports of the burgh, and sall seek almes fra them that passes in and comes furth.”[338]

By the later general act of the Perth Parliament, the unfortunate beings affected with the disease were again prohibited from entering towns except for the purpose of purchasing victuals, and this they were only allowed to do on three days of the week, the act strictly providing that—

“_Item_, Na lipper folke, nouther man nor woman, enter nor cum in ane Burgh of the Realme but thrise in the oulk (week) that is to saie, Mondaie, Wednesdaie, and Fridaie, fra ten hours to twa after noone; and quhair faires and mercattis fallis on thay dayis, that they leave their entrie in the Burrowes, and gang on the morne to get their living.”[339]

Various towns and local judicatories in the country seem to have at different times passed laws enforcing more strictly the observance of exclusion of the infected from their own limits and districts. Some of these local enactments have been preserved; and I shall quote such as I have been able to discover, with a view to show the general fear formerly entertained of the contagion of the disease, and the measures that were adopted to prevent its communication.

Thus, in the statutes of the Society of Merchants or Guildry of Berwick-upon-Tweed, said to have been drawn up by the mayor and others in “the Zeare of God 1283-84,” it is strictly provided that “Na lipper man sall enter within the portes of our burgh; and gif any by chance enters within them, he sall be incontinent put forth be the sergant of the burgh. And gif any lipper man uses commonlie contrair this our discharge, to come within our burgh, his claithes wherewith he is cled sall be taken from him and sall be brunt, and he being naked sall be ejected furth of the burgh. Because it is provyded be the common councill, that some gude man sall gather almes to them, that they may be sustained in ane place competent for them without the burgh. And this is to be understand of lipper folk, indwellers within the burgh, and not of them quha dwells without the burgh.”[340]