James Young Simpson

“ 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. ”

“ In fact, in war the devastations produced by sickness and disease have often been found greatly more formidable and fatal than any devastations produced by the sword; fevers, dysenteries, and other distempers of the camp, have carried off far more soldiers than the ball or bayonet; malarious and morbific agency has sometimes terminated a campaign as effectually as the highest military strategy; and armies have occasionally, in later times, been as completely destroyed by the indirect ravages of disease as by the direct effects of battle. ”

“ 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 ”

“ 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. ”

“ 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. ”

“ For the soldier who is obliged to endure cold is neither in a fit state for enjoying health, nor for marching. Nor should he make use of unwholesome nor of marsh waters. For a draught of bad water induces, like a poison, disease in those who drink it. And, moreover, in this case, the unremitting diligence of the generals, tribunes, and their assistants, as wielding the highest authority, will be required, so that their sick comrades may be restored by seasonable articles of food, and be cured by the skill of the physicians (arte medicorum) . ”

“ 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. ”

“ From all this may be inferred how much the more diligently an army ought to be trained in the exercise of arms, seeing, as we do, that the habit of labour procures alike health in the camp and victory in the battle-field. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Medical men are, for the most part, agreed upon two points in relation to the history of syphilis—viz. that it is a species of disease which was unknown to the Greek, Roman, and Arabian physicians; and that it first began to prevail in Europe in the later years of the fifteenth century. ”

“ 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? ”

“ The term diathesis in this inscription is used in a different sense from that in which we now employ the same word in modern medicine. At the present day we apply the term diathesis to designate the tendency or predisposition to some special disease, or class of diseases. In the times of the Roman physicians, it was often used as synonymous with disease itself; and in the Latin translations of the Greek texts of Galen, Aetius, etc., it is hence rendered usually by the general word “affectus,” “affectio,” etc. ”

“ At least, whenever, from circumstances, this source of fallacy is avoided, the evidence of the contagion of leprosy seems to become132 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. ”

“ 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. ”

“ The silence of Wyntoun, Fordun, and our other early Scotch chroniclers, as to the disease of which King Robert Bruce died, may not improbably be explained by their reluctance to associate the heroic monarch with an odious and degrading malady. But the King’s metrical biographer names his disease, or at least its origin; and it would be interesting to know if that disease can be identified with leprosy. ”

“ 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. ”

“ The non-existence of syphilis in ancient times, and the circumstance of its original appearance in Europe about the date alluded to, are opinions strongly borne out by two sets of facts. For, first, no definite account of this marked and extraordinary species of disease is to be found in the writings of any one of the ancient Greek or Roman physicians, historians, or poets ”

“ 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 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 ”

“ 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) . ”

“ 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,98 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) . ”

“ 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.” ”

“ If we judged of the nature of the inscription by the characters of the letters, as given by Gough, the disputed word might perhaps be more correctly read DRYCUM or DRYXUM. And possibly, in this way, it may signify an astringent and detergent collyrium, made from the bark, acorn, or galls of the DRYS (δρυς) or oak—a tree that held a place in the materia medica of Hippocrates, Galen, and the other ancients, and which still maintains its place in our own modern Pharmacopœias. ”

“ Three sons who are not to have patrimony—The son of a priest, the son of a leper, and the son of a man who had paid his patrimony as blood land. The son of a leper is not to have it, because God has separated him from worldly kin—that is, such son as a leper may have after being adjudged to a lazar-house ”

“ The Register House, Edinburgh, contains a curious and valuable series of these Accounts, detailing the daily expenses of the kings of Scotland from the reign of James III. down to the ascension of the English throne by James VI. At the time of the first appearance of syphilis in our northern realm, the throne of Scotland was occupied by James IV., a prince who was a great patron of the arts and sciences of his time. He was a practitioner in them also, as well as a patron of them. At different times we find him busily experimenting in chemistry, in physiology, and in medicine. ”

“ 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. ”