DISSERTATION VII. ON THE LEPROSY. TH λлga (lepra) from λETIS (lepis) a scale, the body, in this dreadful disease, being covered with thin white scales, or smooth shining patches, so as to give it, in some instances, the appearance of snow. Nosologists class some species of this malady under the order Squama, or scaly diseases, and other species of it under the order Tuberculæ, or tubercular affections. That kind of Leprosy which is described by Moses in Leviticus xiii, appears to have been what was termed by the Greeks Leuce, (λeuxn,) and by the Arabians Albaras, or more correctly Baras. In some instances it has been considered as assuming the form of Elephantiasis, and in others not appearing very dissimilar from the Frambasia, or Yaws, of the West Indies.* HE LEPROSY derives its name from the Greek term 1 The Leuce or White Leprosy is thus described by Mr. Robinson, a medical practitioner of India :-" One or two circumscribed patches appear upon the skin, (generally the feet or hands, but sometimes the trunk or face,) rather lighter-coloured than the neighbouring skin, neither raised nor depressed, shining and wrinkled, the furrows not co-inciding with the lines of the contiguous sound cuticle. * See Dr. T. Bateman's Practical Synopsis of Cutaneous Diseases: Order II. p. 25, and Order VII. p. 273. London 1819, 8vo., Fifth edition. The skin thus circumscribed is so entirely insensible, that you may with hot irons burn to the muscle, before the patient feels any pain. These patches spread slowly until the skin of the whole of the legs, arms, and gradually often of the whole body, becomes alike devoid of sense: wherever it is so affected, there is no perspiration; no itching, no pain, and very seldom any swelling. Until this singular apathy has occupied the greater part of the skin, it may rather be considered a blemish than a disease: nevertheless it is most important to mark well these appearances, for they are the invariable commencement of the most gigantic and incurable diseases, that have succeeded the fall of man: and it is in this state chiefly (though not exclusively) that we are most able to be the means of cure. The next symptoms-are the first which denote internal disease or derangement of any functions. The pulse becomes very slow, not small but heavy, as if moving through mud:'-the toes and fingers numbed, as with frost, glazed and rather swelled, and nearly inflexible. The mind is at this time sluggish and slow in apprehension, and the patient appears always half asleep. The soles of the feet and the palms of the hands then crack into fissures, dry, and hard as the parched soil of the country; and the extremities of the toes and fingers under the nails are incrusted with a furfuraceous substance, and the nails are gradually lifted up, until absorption and ulceration occur. Still there is little or no pain; the legs and fore-arms swell, and the skin is every where cracked and rough. Contemporary with the last symptoms, or very soon afterwards, ulcers appear at the inside of the joints of the toes and fingers, directly under the last joint of the metatarsal or metacarpal bones, or they corrode the thick sole under the joint of the os calcis, or os cuboides. There is no previous tumour, suppuration, or pain, but apparently a simple absorption of the integuments, which slough off in successive layers of half an inch in diameter. A sanious discharge comes on; the muscle pale and flabby, is in turn destroyed; and the joint being penetrated as by an augur, the extremity droops, and at length falls a victim to this cruel, tardy, but certain poison. The wounds then heal, and other joints are attacked in succession, whilst every revolving year bears with it a trophy of this slow march of death. Thus are the limbs deprived one by one of their extremities, till at last they become altogether useless. Even now death comes not to the relief of, nor is desired by the patient, who dying by inches,' and a spectacle of horror to all besides, still cherishes fondly the spark of life remaining, and eats voraciously all he can procure: he will often crawl about with little but his trunk remaining, until old age comes on, and at last he is carried off by diarrhoea or dysentery, which the enfeebled constitution has no stamina to resist."* In the Elephantiasis, to which the Leuce or Baras may be considered as having an affinity, and probably sometimes terminating in it, "the tubercles," when the malady has for some time proceeded, "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 scales, so that the fingers and toes gangrene and separate, joint after joint.-Aretæus and the ancients in general consider Elephantiasis as an universal cancer of the body, and speak of it with terror."+ According to Dr. J. M. Good, this disease is called by the Arabians juzam and juzamlyk, though more generally, judam and judamlyk, from an Arabic root which imports erosion, truncation, excision. From Arabic the term juzam has passed into India, and is the common name for * Ibid, pp. 311–313. the same disease, among the Cabirajas, or Hindoo physicians, who also occasionally denominate it Fisádi khún, from its being supposed to infect the entire mass of blood, but more generally khora.* Maundrell, in a letter appended to his Travels, tells us, that at Sichem, (now Naplosa,) he saw several Lepers, who came begging to him all at the same time: "The distemper," says he, "as I saw it on them, was quite different from what I have seen it in England; for it not only defiles the whole surface of the body with a foul scurf, but also deforms the joints of the body, particularly those of the wrists and ankles, making them swell with a gouty scrofulous substance, very loathsome to look upon. thought their legs like those of old battered horses, such as are often seen in drays in England. The whole distemper indeed, as it there appeared, was so noisome, that it might well pass for the utmost corruption of the human body.on this side the grave: and, certainly, the inspired penmen could not have found out a fitter emblem, whereby to express the uncleanness and odiousness of vice."+ I Michaelis in his Commentaries on the Laws of Moses' (C. iv. Part ii. Art. 207, 208, 209, 210, 211,) has entered at large into a discussion of the nature of the Jewish Leprosy, and also shown with much force of reasoning the wisdom of the Mosaic regulations for the prevention of contagion, and reducing the virulence of the disease itself. He states that M. Peyssonel, a physician, was sent to Guadaloupe to enquire into the nature of the Leprosy that broke out in that island, about 1730; and details from him an account of the disease very similar to what has been already given; to which M. Peyssonel adds,-" It has been remarked, that this horrible disorder has, besides, some very lamentable properties; as, in the first place, Ibid, p. 317, note. + Dr. A. Clarke's Comment. on Levit. xiii. 2. that it is hereditary; and hence some families are more affected with it than others: secondly, that it is infectious; -thirdly, that it is incurable, or at least no means of cure have hitherto been discovered."* After the lapse of several thousand years, Leprosy is still a common disease throughout all Syria: it was, of course, endemic in Palestine, the country into which Moses conducted the Israelites. In Egypt, where they had previously dwelt, it is said to be still more frequent and virulent. To this the climate, no doubt, contributed in some degree. But other causes beside this may have tended to increase its influence among the Israelites. They were poor, and had been oppressed; and cutaneous diseases, and indeed almost all kinds of infectious disorders, prevail most among the poor, because they cannot keep themselves cleanly, and at a distance from infected persons. They had also partly dwelt in the damp and marshy parts of Egypt, and facts have proved that a very damp situation will produce, if not leprosy itself, at least a disease very similar to it. It is likewise material to notice, that their residence along the Nile and the marshy districts, rendered it easy for them to procure different kinds of fish, than which nothing, it is said, more effectually spreads and aggravates cutaneous disorders, if constantly or even frequently used as the entire or principal diet; thus we find at this day, in Norway and Iceland, a disorder, which, if not leprosy, comes very near it in similarity of symptoms, and which is ascribed to their eating great quantities of fish.t During the Crusades, numbers of the pilgrims and soldiers who visited the East, were affected with severe cutaneous diseases; by whom the Leprosy is said to have been imported • Michaelis's Commentaries on the Laws of Moses, vol. iii. Art. 208. pp. 258-260. + Ibid, pp. 273-277. |