THE PLAGUE

Several great epidemics of the Plague had already devastated the world; the plague of Athens in the fifth century, B. C.; the plague of the second century, in the reign of Marcus Aurelius; the plague of the third century, in the reign of Gallus; then came that most terrible epidemic of the sixth century, known by the name of the inguinal pestilence, which, after ravaging Constantinople spread into Liguria, then into France and Spain. It was in 542, according to Procopius, that an epidemic struck the world and consumed almost all the human species.[10]

“It attacked the entire earth,” says our author, “striking every race of people, sparing neither age nor sex; differences in habitation, diet, temperament or occupation of any nature did not stop its ravages; it prevailed in summer and in winter, in fact, at every season of the year.

“It commenced at the town of Pelusa in Egypt, from whence it spread by two routes, one through Alexandria and the rest of Egypt, the other through Palestine. After this it covered the whole world, progressing always by regular intervals of time and force. In the springtime of 543 it broke out in Constantinople and announced itself in the following manner:

“Many victims believed they saw the spirits of the departed rehabilitated in human form. It appeared as though these spirits appeared before the subject about to be attacked and struck him on certain portions of the body. These apparitions heralded the onset of the malady. It is but fair to say that the commencement of the disease was not the same in all cases. Some victims did not see the apparitions, but only dreamed of them, but all believed they heard a ghostly voice announcing their inscription on the list of those who were going to die. Some claim that the greater number of victims were not haunted either sleeping or waking by these ghosts and the mysterious voice that made sinister predictions.

“The fever at the onset of the attack came on suddenly,—some while sleeping, some while waking, some while at work. Their bodies exhibited no change of color, and the temperature was not very high. Some indications of fever were perceptible, but no signs of acute inflammation. In the morning and at night the fever was slight, and indicated nothing severe either to the patient or to the physician who counted the pulse. Most of those who presented such symptoms showed no indications of approaching dissolution; but the first day among some, the second day in others, and after several days in many cases, a bubo was observed on the lower portion of the abdomen, in the groin, or in the folds of the axilla, and sometimes back of the ears or on the thighs.

“The principal symptoms of the disease on its invasion were as I have pointed out; for the remainder, nothing can be precisely indicated of the variations of the type of the disease following temperament; these other symptoms were only such as were imprinted by the Supreme Being at his divine will.

“Some patients were plunged into a condition of profound drowsiness; others were victims to furious delirium. Those who were drowsy remained in a passive state, seeming to have lost all memory of the things of ordinary life. If they had any one to nurse them they took food when offered from time to time, and if they had no care soon died of inanition. The delirious patients, deprived of sleep, were eternally pursued by their hallucinations; they imagined themselves haunted by men ready to slay them, and they sought flight from such fancied foes, uttering dreadful screams. Persons who were attacked while nursing the sick were in the most pitiable condition—not that they were more liable to contract the disease by contact, however, for nurses and doctors did not get the disease from actual contact with the sufferers, for some who washed and laid out the dead never contracted the malady, but enjoyed perfect health throughout the epidemic; some, however, died suddenly without apparent cause. Many of the nurses were overworked keeping patients from rolling out of bed and preventing the delirious from jumping from high windows. Some patients endeavored to throw themselves in running water, not to quench their thirst, but because they had lost all reason. It was necessary to struggle with many of the sick in order to make them swallow any nourishment, which they would not accept without more or less resistance. The buboes enfeebled certain patients who were neither drowsy nor delirious, but who finally succumbed to their atrocious sufferings.

“As nothing was known of this strange disease, certain physicians thought its origin was due to some source of evil hidden in the buboes, and they accordingly opened these glandular bodies. The dissection of the bubo showed sub-adjacent carbuncles, whose rapid malignity brought on sudden death or an illness of but few days’ duration. In some instances the entire body was covered by black spots the size of a bean. Such unfortunates rarely lived a day, and generally expired in an hour. Many cases died suddenly, vomiting blood. One thing I can solemnly affirm, that is, that the wisest physicians gave up all hope in the case of many patients who afterwards recovered; on the contrary, many persons perished at the very time their health was almost re-established. For all these causes, the malady passed the confines of human reasoning, and the outcome always deceived the most natural predictions.

“As to treatment, the effects were variable, following the condition of the victim. I may state that, as a fact, no efficacious remedies were discovered that could either prevent the onset of the disease or shorten its duration. The victims could not tell why they were attacked, nor how they were cured.

“Pregnant women attacked inevitably aborted at death, some succumbing while miscarrying; some going on to the end of gestation, dying in labor along with their infants. Only three cases are known where women recovered of plague after aborting; while only one instance is on record where a newly-born child survived its mother in this epidemic. Those in whom the buboes increased most rapidly in size, maturated and suppurated, most often recovered, for the reason, no doubt, that the malignant properties of the bubonic carbuncle were weakened or destroyed.

“Experience proved that such symptoms were an almost sure presage of a return to health. Those, on the contrary, in whom the tumor did not change its aspect from the time of its eruption, were attacked with all the symptoms I have before described. In some cases the skin dried and seemed thus to prevent the tumor, although it might be well developed, from suppurating. Some were cured at the price of a loss of power in the tongue, which reduced the victims to stammer and articulate words in a confused and unintelligible manner for the rest of their days.

“The epidemic at Constantinople lasted four months, three months of which time it raged with great violence. As the epidemic progressed the mortality-rate increased from day to day, until it reached the point of 5,000 deaths per day, and on several occasions ran up to as high as 10,000 deaths in the twenty four hours.”

Let us pass over this very important description that Procopius gives of the moral effect of this epidemic on the people, of the scenes of wild and heart-rending terror, of curious examples of egotism and sublime devotion, of instances of blind superstition developed in a great city under the influence of fear and the dread of a very problematical contagion.

Evagre, the scholastic, another Greek historian of the sixth century, recounts in his works the story of the plague at Constantinople. He states that he frequently observed that persons recovering from a first and second attack subsequently died on a third attack; also that persons flying from an infected locality were often taken sick after many days of an incubating period, falling ill in their places of refuge in the midst of populations free, up to that time, from the pestilence.

In following the progress of this epidemic from the Orient to the Occident, it was noticed that it always commenced at the sea-ports and then traveled inland. The disease was carried much more easily by ships than it could be at the present time, inasmuch as there were no quarantines and no pest-houses for isolating patients. It entered France by the Mediterranean Sea. It was in 549 that the plague struck Gaul. “During this time,” says Gregory of Tours, “the malady known as the inguinal disease ravaged many sections and the province of Arles was cruelly depopulated.”[11]

This illustrious historian wrote in another passage: “We learned this year that the town of Narbonne was devastated by the groin disease, of so deadly a type that when one was attacked he generally succumbed. Felix, the Bishop of Nantes, was stricken down and appeared to be desperately ill. The fever having ceased, the humor broke out on his limbs, which were covered with pustules. It was after the application of a plaster covered with cantharides that his limbs rotted off, and he ceased to live in the seventieth year of his age.

“Before the plague reached Auvergne it had involved most all the rest of the country. Here the epidemic attacked the people in 567, and so great was the mortality that it is utterly impossible to give even the approximate number of deaths. Populations perished en masse. On a single Sunday morning three hundred bodies were counted in St. Peter’s chapel at Clermont awaiting funeral service. Death came suddenly; it struck the axilla or groin, forming a sore like a serpent that bit so cruelly that men rendered up their souls to God on the second or third day of the attack, many being so violent as to lose their senses. At this time Lyons, Bourges, Chalons, and Dijon were almost depopulated by the pestilence.”

In 590 the towns of Avignon and Viviers were cruelly ravaged by the inguinal disease.

The plague reached Marseilles, however, in 587, being carried there by a merchant vessel from Spain which entered the port as a center of an infection. Several persons who bought goods from this trading vessel, all of whom lived in one house nevertheless, were carried off by the plague to the number of eight. The spark of the epidemic did not burn very rapidly at first, but after a certain time the baleful fire of the pest, after smouldering slowly, burst out in a blaze that almost consumed Marseilles.

Bishop Theodorus isolated himself in a wing of the cloister Saint Victor, with a small number of persons who remained with him during the plague, and in the midst of their general desolation continued to implore Almighty God for mercy, with fasting and prayer until the end of the epidemic. After two months of calm the population of the city commenced to drift back, but the plague reappeared anew and most of those who returned died. The plague has devastated Marseilles many times since the epoch just mentioned.

Anglada[12] who, like the writer, derives most of his citations from Gregory of Tours, thinks that the plague that devastated Strasbourg in 591 was only the same inguinal disease that ravaged Christendom. He cites, in support of his assertion, that passage from the historian poet Kleinlande translated by Dr. Boersch: “In 591 there was a great mortality throughout our country, so that men fell down dying in the streets, expiring suddenly in their houses, or even at business. When a person sneezed his soul was apt to fly the body; hence the expression on sneezing, ‘God bless you!’ And when a person yawned they made the sign of the cross before their mouths.”

Such are the documents we possess on the great epidemic of inguinal plague of the fourth century, documents furnished by historians, to whom medical history is indebted, and not from medical authors, who left no marks at that period.

THE BLACK PLAGUE.

The Black Plague of the fourteenth century was more destructive even than the bubonic pest of the sixth century, and all other epidemics observed up to the present day. In the space of four years more than twenty five millions of human beings perished—one-half the population of the world. Like all other pestilences, it came from the Orient—from India, and perhaps from China. Europe was invaded from east to west, from south to north. After Constantinople, all the islands and shores of the Mediterranean were attacked, and successively became so many foci of disease from which the pestilence radiated inland. Constantinople lost two-thirds of its population. Cyprus and Cairo counted 15,000 deaths. Florence paid an awful tribute to the disease, so great being the mortality that the epidemic has often been called Peste de Florence; “100,000 persons perished,” says Boccaccio. Venice lost 20,000 victims, Naples 60,000, Sicily 53,000, and Genoa 40,000, while in Rome the dead were innumerable.

In Spain, Germany, England, Poland, and Russia the malady was as fatal as in Italy. At London they buried 100,000 persons in the cemeteries. It was the same in France. Avignon lost 150,000 citizens in seven months, among whom was the beautiful Laura de Noves, immortalized by Petrarch, who expired from the plague in 1348, aged forty-one years. At Marseilles 56,000 people died in one month; at Montpellier three quarters of the population, including all the physicians, went down in the epidemic. Narbonne had 30,000 deaths and Strasbourg 16,000 in the first year of the outbreak. Paris was not spared; the Chronique de Saint Denis informs us that “in the year of Grace 1348, commenced the aforesaid mortality in the Realms of France, the same lasting about a year and a half, increasing more and more until Paris lost each day 800 inhabitants; so that the number who died there amounted to more than 500,000 people, while in the town of Saint Denis the number reached 16,000.[13]

Among the victims were Jeanne de Bourgogne, wife of Philip VI.; Jeanne II., Queen of Navarre, grandchild of Philip the Beautiful. In Spain, died Alphonse XI. of Castille. “Happily,” says the Chronicle, “during the years following the plague the fecundity of women was prodigious—as though nature desired to repair the ravages wrought by death.” The symptoms and history of this plague have been described by several ocular witnesses, among others Guy de Chauliac, the celebrated surgeon and professor at Montpellier, who has left the following recital in quaint old French:

“The disease was such that one never before saw a like mortality. It appeared in Avignon in the year of our Saviour 1348, in the sixth year of the Pontificate of Clement VI., in whose service I entered, thanks to his Grace.

“Not to displease you, I shall briefly narrate for your edification the advent of the disease.

“It commenced—the aforesaid mortality—in January and lasted for the space of seven months.

“The disease was of two kinds. The first type lasted two months, with a continued fever and spitting of blood. This variety killed in three days, however.

“The second type of the disease, prevailing during the epidemic time, also had a continued fever, with apostumes and carbuncles at the external parts, principally on the axilla and in the groin; all such attacked usually died in five days.

“The malady was so contagious, especially that form in which blood-spitting was noticed, that one not only caught it from sojourning with the sick, but also, it sometimes seemed, from looking at the disease, so that men died without their servants and were buried without priests.

“The father visited not his son, nor the son his father. Charity was dead and hope disappeared.

“I call the epidemic great, inasmuch as it conquered all the earth.

“For the pestilence commenced at the Orient, and cast its fangs against all the world, passing through Paris towards the West.

“It was so destructive that it left only a quarter of the population of mankind behind.

“It was a shame and disgrace to medicine, as many doctors dared not visit the sick through fear of becoming infected; and those who visited the sick made few cures and fewer fees, for the sick all died save a few. Not many having buboes escaped death.

“For preservation, there was no better remedy than to fly from the infection, to purge one’s self with aloe pills, to diminish the blood by phlebotomy, to purify the air with fire, to comfort the heart with cordials and apples and other things of good odor; to console the humors with Armenian bole and resist dry rot by the use of acid things. For the cure of the plague we used bleedings and evacuations, electuaries, syrups and cordials, and the external apostumes or swellings were poulticed with boiled figs and onions mixed with oil and butter; the buboes were afterwards opened and treated by the usual cures for ulcers.

“Carbuncles were leeched, scarified and cauterized.

“I, to avoid infamy, dared not absent myself from the care of the sick, but lived in continual fear, preserving myself as long as possible by the before-mentioned remedies.

“Nevertheless, towards the end of the epidemic, I fell into a fever, which continued with an aposthume in the groin, and was ill for nigh on six weeks, being in such danger that all my companions believed I should die; nevertheless, the bubo being poulticed and treated as I have above indicated, I recovered, thanks be to the will of God.”

According to the records of that time, many persons died the first day of their illness. These bad cases were announced by a violent fever, with cephalgia, vertigo, drowsiness, incoherency in ideas, and loss of memory; the tongue and palate were black and browned, exhaling an almost insupportable fetidity. Others were attacked by violent inflammation of the lungs, with hemorrhage; also gangrene, which manifested itself in black spots all over the body; if, to the contrary, the body was covered by abscesses, the patients seemed to have some chance for recovery.

Medicines were powerless, all remedies seeming to be useless. The disease attacked rich and poor indiscriminately; it overpowered the robust and debilitated; the young and the old were its victims. On the first symptom the patients fell into a profound melancholy and seemed to abandon all hope of recovery. This moral prostration aggravated their physical condition, and mental depression hastened the time of death. The fear of contagion was so great that but few persons attended the sick.

The clergy, encouraged by the Pope, visited the bedsides of the dying who bequeathed all their wealth to the Church. The plague was considered on all sides as a punishment inflicted by God, and it was this idea that induced armies of penitents to assemble on the public streets to do penance for their sins. Men and women went half naked along the highways flagellating each other with whips, and, growing desperate with the fall of night, they committed scandalous crimes. In certain places the Jews were accused of being the authors of the plague by poisoning the wells; hence the Hebrews were persecuted, sometimes burned alive by the fanatical sects known as Flagellants, Begardes and Turlupins, who were encouraged in their acts of violence by the priests, notwithstanding the intervention of Clement VI.

Physicians were not only convinced of the contagious nature of the disease, but also believed that it could be transmitted by look and word of mouth. Such doctors obliged their patients to cover their eyes and mouth with a piece of cloth whenever the priest or physician visited the bedside. “Cum igitur medicus vel sacerdos, vel amicus aliquem infirmum visitare voluerit, moneat et introducat aegrum suos claudere et linteamine operire.”

Guillaume de Machant, poet and valet de chambre of Philip the Beautiful, mentions this fact in one of his poems, i. e.:

And, in the preface of the “Decameron,” Boccaccio remarks in his turn, “The plague communicated direct, as fire to combustible matter. They were often attacked from simply touching the sick, indeed it was not even necessary to touch them. The danger was the same when you listened to their words or even if they gazed at you.”

One thing is certain, that is, that those who nursed the patients surely contracted the disease.

All the authorities of the Middle Ages concur in their statements as to the contagious nature of the plague. The rules and regulations enforced against the afflicted were barbarous and inhuman. “Persons sick and well, of one family, when the pest developed,” says Black,[14] “were held, without distinction, in close confinement in their home, while on the house door a red cross was traced, bearing the sad and desperate epitaph, ‘Dieu ayez pitie de nous!’ No one was permitted to leave or enter the plague-stricken house save the physician and nurse, or other persons who might be authorized by the Government. The doors of such dwellings were guarded and kept closed until such a time as the imprisoned had all died or recovered their health.”

We can well judge of the terror inspired by the pestilence by the precautions taken by the physicians in attendance on the sick. In his treatise on the plague Mauget describes the costume worn by those who approached the bedsides of patients:

“The costumes worn, says he, “were of Levant morocco, the mask having crystal eyes and a long nose filled with subtile perfumes. This nose was in the form of a snout, with the openings one on each side; these openings served for respiratory passages and were well filled at the anterior portion with drugs, so that at each breath they contained a medicated air. Under a cloak the doctor also wore buskins made of morocco; closely sewed breeches were attached to the bottines above the ankle; the shirt, the hat and gloves were also of soft morocco.”

Thus accoutered the doctor resembled a modern diver clad in a bathing suit of leather.

In order not to alarm the population all public references to funerals were forbidden. In the ordinances of magistrates of Paris, passed September 13, 1553, we read, “And likewise be it declared that the aforesaid Chamber forbids by statute all criers of funerals and wines, and all others, no matter what be their state or condition, to render for sale at any church, house, doorway or gate of this city, or on the streets thereof, any black cloth or mourning stuffs such as are used for mortuary purposes, under penalty of forfeiture of their licenses and property, and confiscation of all goods, especially of the aforesaid black cloths.”

Let it be well understood that the great epidemics of plague in the sixth and twelfth centuries were of a nature to terrify ignorant populations. The narratives of the historians of that epoch show them to be imbued with the superstitious ideas of antiquity. This attack of an invisible enemy whose blows fell right and left paralyzed and terrified every one. “In the midst of this orgie of death,” remarks Anglada, “the thought of self-preservation absorbed every other sentiment. Dominated by this selfish instinct the human mind shamelessly displayed its cowardice, egotism and superstition. Social ties were rudely sundered, the affections of the heart laid aside. The sick were deserted by their relatives; all flew with horror from the plague-breathing air and contact with the dreadful disease. The corpses of the victims of the epidemic abandoned without sepulture exhaled a horrible putrid odor, and became the starting point of new infectious centres. The worse disorder overthrew all conditions of existence. Human passion raged uncontrolled; the voice of authority was no longer respected; the wheels of civilization ceased to revolve.”

As to the other epidemics of the plague that periodically devastated France from the fourteenth to the eighteenth century we possess but few historical documents. We have had in our hands an opuscule by Pierre Sordes, who was attacked by the plague in 1587, at the age of twenty, who afterward wrote a treatise on the epidemic, which work he dedicated to Cardinal de Sourdis, the Archbishop of Aquitaine.

The author in this monograph endeavors to explain the remedies then in use for preservation against the infection of the disease. “Avoid all fatigue, anger, intemperance, too much association with women, as the act ennervates our forces and enfeebles our spirits. One should clothe himself in the wools of Auvergne and the camulets of Escot.” Moreover, says our author, “one should perfume his clothes with laurel, rosemary, serpolet, marjolane, sage, fennel, sweetbriar, myrrh, and frankincense.” When the room was to be disinfected “one should use fumigations of good dry hay. One should not go out early without eating and taking a drink. One should close the ears with a little cotton scented with musk and hold in his mouth a clove or piece of angelica root. One should hold in his hand a piece of sponge saturated in vinegar, which should be smelled frequently. One should wear upon his stomach an acorn filled with quicksilver and a small pouch containing arsenic. Finally, one should take twice a week a pill composed of aloes, myrrh, and saffron.”

Notwithstanding all these precautions, Pierre Sordes was attacked by the plague; having a buboe in the left groin, which caused him acute pain and to which he applied “un emplastre de diachyllum cum gummis” and afterwards a blister. Not being able to obtain resolution, feeling his strength undermined and perceiving his entire body “covered with black lumps and spots, fatal prognostic signs to all who are found thus marked, I called for a surgeon, the last one left alive, and he brought his cautery and with it pierced through the apostume. From then the fever disappeared little by little, and I was perfectly cured eight days after the application of the aforesaid cautery, with the exception that, reading in a draught Bartas “Treatise on the Plague,” I brought on another attack of fever that well nigh carried me off.

“This is my experience at Figeac in the year 1587, when the plague destroyed 2500 people, with all the miseries and calamities that can be read in Greek and Roman histories.”

LE MAL DES ARDENTS.

Towards the end of the tenth century a new epidemic appeared in Europe, the ravages of which spread terror among the people of the Occident; this disease was known by the name of mal des ardents, sacred fire, St. Anthony’s fire, St. Marcell’s fire, and hell fire.

This great epidemic of the Middle Ages is considered by many modern writers as one of the forms of ergotism, notwithstanding the contrary conclusions arrived at by the Commission of 1776, composed of such men as Jussieu, Paulet, Saillant, and Teissier, who were ordered to report as to the nature of the disease by the Royal Society. According to the work of this Commission the mal des ardents was a variety of plague, with buboes, carbuncles and petechial spots, while St. Anthony’s fire was only gangrenous ergotism. This is a remarkable example of the confusion into which scientific facts were allowed to fall through the fault of careless authors. It is in such instances that we may estimate the importance of history. We find in the “Chronicles of Frodoard,” in the year 945, the following: “The year 945, in the history of Paris and its numerous suburban villages, a disease called ignis plaga attacked the limbs of many persons, and consumed them entirely, so that death soon finished their sufferings. Some few survived, thanks be to the intercession of the Saints; and even a considerable number were cured in the Church of Notre Dame de Paris. Some of these, believing themselves out of danger, left the church; but the fires of the plague were soon relighted, and they were only saved by returning to Notre Dame.”

Sauvel, the translator of Frodoard, remarks that at this epoch the Church of Notre Dame served as a hospital for the sick attacked by the epidemic, and sometimes contained as high as six hundred patients.

Another historian of the time was Raoul Glaber,[15] who mentions that “in 993 a murderous malady prevailed among men. This was a sort of hidden fire, ignis occultus, the which attacked the limbs and detached them from the trunk after having consumed the members. Among some the devouring effect of this fire took place in a single night.

“In 1039,” continues our author, “divine vengeance again descended on the human race with fearful effect and destroyed many inhabitants of the world, striking alike the rich and the poor, the aristocrat and the peasant. Many persons lost their limbs and dragged themselves around as an example to those who came after them.”

In the Chronicle of France, from the commencement of the Monarchy up to 1029,[16] the monk Adhemar speaks of the epidemic in the following terms: “In these times a pestilential fire (pestilential ignis) attacked the population of Limousin; an infinite number of persons of both sexes were consumed by an invisible fire.”

Michael Felibien, a Benedictine friar of Saint Maur, also left notes on the epidemic of gangrene. He states in his History of Paris: “In the same year, 1129, Paris, as the rest of France, was afflicted by the maladie des ardents. This disease, although known from the mortality it caused in the years 945 and 1041, was all the more terrible inasmuch as it appeared to have no remedy. The mass of blood, already corrupted by internal heat which devoured the entire body, pushed its fluids outwards into tumors, which degenerated into incurable ulcers and thus killed off thousands of people.”

We could make many more citations, derived from ancient writers, but we think we have quoted enough authors to prove that the mal des ardents was only the plague confounded with the symptoms known as gangrenous ergotism. Could it not have been a plague of a gangrenous type? We cannot positively affirm, however, that it had no connection with poisoning by the sphacelia developed in grain, particularly on rye. Its onset was sudden, and often very rapidly followed by a fatal termination. The mal des ardents had no prodroma with general symptoms and marked periods, as in gangrenous ergotism, but it had, to the contrary, an irregular march, rapid in its evolution, “devouring,” as Mezeray says, “the feet, the arms, the face, and private parts, commencing most generally in the groin.”

THE ERUPTIVE FEVERS OF THE SIXTH CENTURY —— VARIOLA, MEASLES, SCARLATINA.

Before the sixth century, the terrible period of the plague, one never heard of the eruptive fevers. Small-pox, measles and scarlet fever were unknown to the ancients. Neither Hippocrates nor Galen nor any of the Greek physicians who practiced in Rome make mention of these diseases. The historians and poets of Greece and Italy who have written largely on medical subjects remain mute on these three great questions in pathology. Some authors have endeavored to torture texts for the purpose of throwing light on the contagious exanthemata, but they have not been repaid for their fresh imagination.[17] It is admitted to-day that the eruptive fevers are comparatively new diseases, which made their appearance in the Middle Ages.

The first document that the history of medicine possesses on this point is that left by Marius, Bishop of Aventicum, in Switzerland, who says, in his chronicle, “Anno 570, morbus validus cum profluvio ventris et variola, Italiam Galliamque valde affecit.”[18]

Ten years later, Gregory of Tours described the symptoms of the new disease in the following terms:[19]

“The fifth year of the reign of Childebert, 580, the region of Auvergne was inundated by a flood and numerous weather disasters, which were followed by a terrible epidemic that invaded the whole of Gaul. Those attacked had violent fevers, accompanied by vomiting, great pain in the neighborhood of the kidneys, and a heaviness in the head and neck. Matter rejected by the stomach looked yellowish and even green, many deeming this to be some secret poison. The peasants called the pustules corals.[20] Sometimes, after the application of cups to the shoulders or limbs, blisters were raised, which, when broken, gave issue to sanious matter, which oftentimes saved the patient. Drinks composed of simples to combat the effects of the poison were also very efficacious.

“This disease, which commenced in the month of August, attacked all the very young children and carried them off.

“In those days Chilperic was also seriously afflicted, and as the King commenced to convalesce his youngest son was taken with the malady, and when his extremity was perceived he was given baptism. Shortly afterwards he was better, and his eldest brother, named Chlodobert, was attacked in his turn. They placed the Prince in a litter and carried him to Soissons, in the chapel of Saint Medard; there he was placed in contact with the good Saint’s tomb, and made vows to him for recovery, but, very weak and almost without breath, he rendered his soul to God in the middle of night.

“In those days, Austrechilde, wife of King Gontran, also died of the disease; while Nantin, Count of Angouleme, also succumbed to the same malady, his body becoming so black that it appeared as though calcined charcoal.”

Gregory of Tours, in another chapter, narrates:

“The year of the reign of King Childebert, 582, another epidemic broke out; this was accompanied by blackish spots of a malignant nature, with pustules and vesicles, and carried off many victims.

“Touraine was cruelly devastated by this disease. The patient attacked by fever soon had the surface of his body covered by vesicles and small pustules. The vesicles were white and very hard, presenting no element of softness, and were accompanied by great pain; when they had attained maturity they broke and allowed the humor within to escape. Their sticking to the clothing of the body added considerably to the pain. Medical art was wholly impotent in the presence of this malady, at least when God did not come to the doctor’s aid.

“The wife of Count Eborin, who was attacked by the disease, was so covered by vesicles that neither her hand nor the sole of her foot nor any portion of her body was exempt; even her eyes remained closed. Soon after the fever ceased the fall of the pustules occurred, and the patient recovered without more inconvenience.”

Small-pox came, then, from the Orient—that eternal center of all pestilences and curses. From the seventh century the Saracen armies spread the malady wherever they passed—in Syria, Egypt, and Spain; in their turn, the Crusaders, in returning from the Holy Land, brought the disease into France, England, and Germany. From thence the great epidemics of the twelfth and thirteenth centuries, after which the small-pox became epidemic, appearing and disappearing without causation, but always destroying myriads of victims. “In 1445,” says Sauvel “from the month of August to Saint Andres’ day (November 30), over 6,000 infants died in Paris from small-pox.[21] The physicians knew neither the nature nor the treatment of the new disease.[22]

The measles was first noted at the same time as the small-pox, making its first appearance as an epidemic in the sixth century.

It is more than probable that the measles originated in Egypt, and according to Borsieri, it had such an extension throughout Western Europe that there were but few persons who had not suffered attacks. The history of measles, however, is less clearly defined than that of small-pox, although Anglada says that it figured among the spotted diseases, of which Gregory of Tours speaks.[23] But it was only in the sixteenth century that Prosper Martian exactly describes the disease.

Says Martian, “It is a disease of a special type peculiar to children, who can no more avoid it than small pox. It commences with a violent fever, followed, towards the third day, by an eruption of small red spots, which become elevated by degrees, making the skin feel rough to the touch. The fever lasts until the fifth day, and when it has ceased the papules commence to disappear.”

Measles was designated in the middle ages under the name Morbilli, which signified a petty plague, the same that Morbus meant a special plague. It is then fair to presume that the type of disease was no more serious than it is at the present day.

It is probable that the measles of the sixth century included at the same time small-pox, measles and scarlet fever, of which the ancients made no differential diagnosis. Anglada affirms the co-existence of all forms of eruptive fevers and gives the following reasons:

“The contemporaneous appearance of variola and rubeola represents the first manifestation of an epidemic constitution, resulting from a collection of unknown influences as to their nature, but manifest by their effects. The earth was from thence prepared to receive scarlatina, and it soon came to bear its baleful fruits. We do meet some mention of scarlet fever in the writings of the Arabian School, but it is merely suspected and only vaguely indicated. But when we remember how difficult it often is to diagnose at first between variola and measles, we are not astonished at the indecision manifested in adding another exanthematous affection to the medical incognito. It was only after innumerable observations and the experience of several centuries that the third new disease received its nosological baptism. There is nothing to prove that it did not co-operate with earlier epidemics of variola and rubeola, remaining undistinguished as to type, however.”

What clearly proves that there was confusion between the various fevers of exanthemata is that Ingrassias describes scarlatina in 1510, under the name of rosallia, adding, “Some think the measles and rosallia are the same malady; as for me, I have determined their differences on many occasions. Nonnulli sunt qui morbillos idem cum rossalia esse existimant. Nos autem soepissime distinctos esse affectus, nostrismet oculis, non aliorum duntaxat relationi confidentes inspeximus.”[24]

These facts appear conclusive enough to admit that measles and scarlet fever are, like variola, the products of the epidemic constitution developed during the sixth century, as contemporaries of the bubonic plague, all these maladies representing the medical constitution of the first centuries of the Middle Age.

THE SWEATING SICKNESS OF ENGLAND.

The name of Sweating Sickness was given to the great epidemic of fever that appeared in England in the fifteenth century, and from thence extended over Continental Europe. This epidemic broke out in the month of September, 1486, in the army of Henry VII., encamped in Wales, and soon reached London, extending over the British Isles with frightful rapidity. Its appearance was alarming and during its duration, which was only a month, it made a considerable number of victims. “It was so terrible and so acute that within the memory of man none had seen its like.”

This epidemic reappeared in England in 1513, 1517 and 1551. It was preceded by very moist weather and violent winds. The mortality was great, patients often dying in the space of two hours; in some instances half the population of a town being carried off. The epidemic of 1529 can only be called murderous; King Henry VIII. was attacked and narrowly escaped death. Although flying from village to village the nobility of England paid an enormous tribute to the King of Terrors. The Ambassador from France to London, M. du Bellay, writing on the 21st of July, 1529, remarks, “The day I visited the Bishop of Canterbury eighteen of the household died in a few hours. I was about the only one left to tell the tale, and am far from recovered yet.”

This same year the sweating sickness spread all over Europe. It made terrible ravages in Holland, Germany and Poland. At the famous synod of Luther and Zwingle, held at Marburg, the Reformed ministers seized by fear of death prayed for relief from the pestilence. At Augsburg in three months eighteen thousand people were attacked and fourteen hundred died.

This epidemic did not extend as far as Paris, but it developed in the north of France and Belgium. Mezeray mentions this fact in the following terms: “A certain disease appeared this year (1529), commencing in England. It was of a contagious nature, and passed over from France to the Lower Countries, and thus spread over most of Europe. Those attacked sweated profusely; it was for this reason that the malady was called the English Sweat. First one had a hard chill, then a very high fever, which carried the patient off in twenty-four hours, unless promptly remedied.”

Fernel, physician to Henry II., who practiced in Paris, likewise speaks of this sudorific sickness in one of his works.[25] He says: “Febres sudorificae quae insolentes magno terrore in omnem inferiorem Germaniam, in Galliam, Belgicam, et in Britanniam ab anno Christi millesimo quingentesimo vigesim autumno potissimum pervagatae sunt.”

It prevailed almost always in summer and autumn, especially when the weather was moist and foggy. Contrary to what is seen in other epidemics, it was observed that the weak and poor, the old and infants were not attacked as often as robust persons and those in affluent circumstances.

The symptoms noted by physicians, such as Kaye and Bacon, may be classed into three distinct periods: 1. The period of chill, characterized by pains and formication in the limbs an extraordinary prostration of the physical forces—a tremulous, shaky period. 2. The period of sweat, preceded by a burning heat all over the body and an unquenchable feverish thirst. The patient was agitated, disquieted by terror and despair. Many complained of spasms in the stomach, followed sometimes by nausea and vomiting, suffocation and lumbar pains—a constant symptom ever—headache, with palpitation of the heart and prÆcordial anxiety. 3. This period was announced by a high delirium, sometimes muttering, sometimes loquacious; a fetid sweaty odor, irregular pulse, coma, and, in the last-named condition, death always occurred.

The duration of the disease was most frequently but a few hours, rarely exceeding a day, whether the termination was favorable or fatal.

Convalescence was always long, often being complicated by diarrhoea or dropsy. It has been remarked in this connection that the malady might be confounded with the miliary sweat observed in Picardy and central France, but in the first named disease no cutaneous eruption was observed. Fernel clearly affirms this statement, as he says: “In this affection there is no carbuncle, bubo, exanthema nor eczema, but simply a hypersecretion of sweat.”

Such was the sweating sickness of the sixteenth century, which made so few victims in France, but which destroyed so many people in England and Germany. The origin of this disease has been often discussed, and also its nature; but all theories emitted by various authors partake of the doctrines of other days and are too antiquated to be revamped. We will content ourselves with saying that the classification of periods made by us is logical, and we consider the sweating sickness of the fifteenth century as a pernicious fever, in which the sweating stage predominated and consequently became the characteristic symptom of the affection.

THE SCURVY.

It has been supposed by many that Hippocrates described scurvy under the name of enlarged spleen, an affection attributed to the use of stagnant water and characterized by tumefaction of the gums, foul breath, pale face, and ulceration of the lower limbs. But the study of this Hippocratic passage leads us to think that these symptoms were more of the character of scrofula than of scurvy. The recital by Pliny of the diseases of the Roman soldiers while on an expedition to Germany seems to indicate scurvy, which Coelius Aurelianus, and after him the Arabian physicians, claims presented only a slight analogy to that affection.

Springer thinks that we may find the first traces of scurvy in the expedition of the Normans to Wineland, in the first years of the eleventh century. In admitting that the men commanded by Eric Thorstein were obliged to winter on the western shores of Wineland and almost all succumbed to an endemic malady of that country, proves that it was nothing but scurvy, although that word’s only signification, in Danish, is ulceration of the mouth.

We have, besides, another document, which has great authentic value, a proof transmitted to us by our earliest and best chronicler of the Middle Ages, by Joinville, the friend and companion of Saint Louis in his Crusade into Palestine. In his memoirs he gives a very succinct recital of the epidemic of famine and scurvy which attacked the French army on the banks of the Nile in 1248, just after the battles of Mansourah. Says Joinville: “After the two battles just mentioned, commenced our great miseries in the army; at the end of nine days the bodies of our dead soldiers arose to the surface of the water (their tissues were corrupted and rotten), and these corpses floated to a point between our two camps (those of the King and the Duke of Bourgogne), at a point where a bridge touched the water. So many had been slain that a great crowd of corpses floated on the stream for a long distance. The bodies of the dead Saracens were sickening; the army servants threw open a portion of the bridge and permitted the dead infidels to float down the river, but they buried the dead Crusaders in great pits dug in the ground. I saw among other dead the body of the Chamberlain of the Count D’Artois, and many other friends among the slain.

“The only fish we had eaten for four months were of the variety called barbus, and these barbus fed on the dead bodies, and for this cause and other miseries of the country where never a drop of rain fell sickness entered our army of such a sort that the flesh on the limbs dried and the skin on the legs became black and like old leather boots, and many sick rotted in their groin; and all having the last named symptom died. Another sign of death was when the nose bled.”

The relation of Joinville leaves no doubt as to the nature of the epidemic that attacked the Crusaders. Here we have a pen picture of the debility, the hemorrhages, the livid ecchymosis of the skin, the fungous tumefaction and bleeding of the gums, which characterize the disease known as scurvy.

According to the writings of some German physicians of the fifteenth century, this malady was endemic in the septentrional portions of Europe upon the shores of the Baltic Sea. In Holland numerous epidemics of scurvy were observed among the lower classes of the population, coinciding with bad conditions of public hygiene. Food consisting of salt and smoked meats, dwellings located on marshy ground, cold atmospheres charged with fogs, etc., etc.

This was the same affection that attacked our colonies in Canada, but at that time we had no knowledge of the therapeutic indications in such emergencies, and quote as a proof of this a remarkable observation inscribed on the registers of Cartier on his vessels during his sojourn in Canada: “The disease commenced in our midst in a curious and unknown manner; some patients lost their flesh and their limbs grew black and swollen like charcoal, and some were covered over with bloody splotches like purpura; after which the disease showed itself on the hips, thighs, arms, and neck, and in all the mouth was infected and rotten at the gums, so that all the flesh fell off to the roots of the teeth, which also most often dropped out; and so terrible was this plague that on my three ships by February only ten healthy men were about out of a crew of over a hundred.

“And, as the disease was unknown to us, the Captain of the ships was asked to open a few bodies to see if we could possibly detect the lesion and thus be able to protect the survivors. We found the hearts of the dead to be white and withered, surrounded by a rose colored effusion; the liver healthy, but the lung black and mortified and all its blood retired to the sac of the heart. The spleen likewise was impaired for about two finger-lengths as though rubbed by a rough stone.”

From this autopsy rudely made[26] it is true we discern most of the signs of scrofula; a profound alteration of the blood and an effusion of the liquids into certain viscera, denoting a diminution in the amount of fibrin and the number of globules, alterations that also serve to explain the tendency to hemorrhages observed in very serious cases of scurvy.

LEPROSY.

Leprosy is a disease originating in the Orient; Egypt and Judea were formerly the principal infected centers. It was the return of an expedition to Palestine, under Pompey, that imported the malady to Italy. In the first years of the Christian Era it is mentioned by Celsus, who advised that it should be treated by sweating, aided by vapor baths. Some years later Areteus used hellebore, sulphur baths, and the flesh of vipers taken as food, a treatment adopted by others, as, for instance, Musa and Archigenes.

In the second century the disease was in Gaul; Soranus treated the lepers of Aquitaine, who were numerous.[27]

According to Velly, leprosy was common in France in the middle of the eighth century epoch, when Nicholas, Abbot of Corbeil, constructed a leper hospital, which was never much frequented until after the Crusades of the eleventh and fourteenth centuries. At this period the number of lepers, or ladres, a name given to the unfortunates in remembrance of their patron saint, St. Lazarus, became so great that every town and village was obliged to build a leper house in order to isolate the afflicted. Under Louis VIII. there were 2,000 of these hospitals; later the number of such asylums reached 19,000.

According to the historians of this time, when a man was suspected to be a leper he could have no social relations without making full declaration as to what the real nature of his complaint might be. Without this precaution his acts were void, from the capitulary of Pepin, which dissolved all marriage contracts with lepers, to the law of Charlemagne, that forbade their associating with healthy persons. The fear of contagion was such that in places where no leprosy existed they built small houses for any one who might be attacked; these houses were called bordes.[28] A gray mantle, a hat and wallet, were also supplied the victims, also a tartarelle, a species of rattle, or a small bell, with which they warned all passers near not to approach. They also had a cup placed on the far side of the road, in which all persons might drop alms without going near the leper.

Leper houses were enriched, little by little, by the liberality of kings and nobles and the people, and to be a leper became less inhuman and horrible than at the beginning.

Lepers, however, were forced to submit to severe police regulations. They were forbidden under the severest penalties from having sexual relations with healthy persons, for such intimacy was considered as the most dangerous method of conveying the contagion. After entering a leper house the victim was considered as dead under the civil law, and in order to make the patients better understand their position the clergy accompanied them to their asylum, the same as to their funeral, throwing the cemetery dust on them while saying: “Enter into no house save your asylum. When you speak to an outsider stand to the windward. When you ask alms sound your rattle. You must not go far from the asylum without your leper’s robe. You must drink from no well or spring save on your own grounds. You must pass no plates nor cups without first putting on your gloves. You must not go barefooted, nor walk in narrow streets, nor lean against walls, trees, or doors, nor sleep on the edge of the road,” etc.

When dead they were interred in the lepers’ cemetery by their fellow-sufferers.

Separated from society, these pariahs, living together, sometimes reproduced their own species, and finished their days in the most frightful cachexia, awaking only contempt, disgust, and repulsion among the healthy of the outside world.

It is true that each time that sanitary measures were relaxed by the authorities—such, for instance, as the perfect isolation of the patients—an increase in the number of lepers was noticeable. When this was observed the old-time ordinances were enforced again with vigor. It was thus in 1371 the Provost of Paris issued an edict enjoining all lepers to leave the Capital within fifteen days, under heavy corporal and pecuniary penalties; and in 1388, all lepers were forbidden to enter Paris without special permission; in 1402 this restriction was renewed, “under penalty of being taken by the executioner and his deputies and detained for a month on a diet of bread and water, and afterwards perpetual banishment from the kingdom.” Finally, in April, 1488, it was announced “all persons attacked by that abominable, very dangerous and contagious malady known as leprosy, must leave Paris before Easter and retire to their hospitals from the date of issuance of this edict, under penalty of imprisonment for a month on bread and water; and, where they had property, the sequestration of their houses and jewels and arbitrary corporal punishment; it was permitted them, however, to send things to them by servants, the latter being in health.”

We can understand from this how these poor wretches, at different epochs, were accused of horrible crimes, among other things poisoning rivers, wells, and fountains. As regards this accusation, says the author of the Dictionnaire des Moeurs des Francais, Philip le Long burned a certain number of these poor devils at the stake and confiscated their wealth, giving it to the Order of Malta and St. Lazare.

The historians and chronicalers of the eleventh and twelfth century often designated the person attacked by leprosy by the name of mesel, mezel, meseau or mesiaus. Meantime Barbazin pretends that it is necessary to make a distinction.[29]

Mesel, according to Barbazin, was a person covered with sores and ulcers, while the leper was an insensible man. He thinks that mesellerie was at its origin a different affection than leprosy, and that these two diseases have been wrongly confounded. “They have both served,” says he, “to designate a frightful disease, that is reputed the most dangerous of all maladies.”

As supporting this assertion of Barbazin, we have found in the Romanesque tongue some documents strongly confirming this point. They appear more interesting, inasmuch as they have heretofore been unknown to medical literature, as, for instance:

“Seneschal, I now demand of you, said he (Saint Louis), which you love better, whether you be mesiaus, or whether you commit a mortal sin; and I, who never have lied, responded that rather would I commit thirty mortal sins than be mesiaus.” (Joinville, Histoire de Saint Louis.)

The leprosy, however, was not an absolute cause for divorce, as we note in the following passage: “A man can leave his wife only for fornication, and not alone for leprosy, and lepers may marry; and one may cancel marriage if the husband become leper, and the same may be said of the bride.”

In the same manuscript another analogous fact shows the invalidation of the marital act for the reason of mesellerie complicated by impotence or barrenness.

“A woman who through impotence has lost that which is necessary to her, so that he cannot cohabit with her, for the reason that he is mesiaus, may marry another, telling the latter, however, that the first she married was worth nothing, not even an infant, as he could not cohabit; that nothing can prevent cohabitation in marriage nor the begetting of children.”

Individuals attacked by mesellerie were in reality outside the pale of the law. For we read in fact in the “Coutume de Beauvoisis, cap. 39,” that “mesiaus must not be called on as witnesses, for custom accords them no place in the conversation of gentlemen.”

“The second reason is that when a mesiaus calls on a healthy man, or when a healthy man calls on a mesel, the mesiaus may put in the defense that he is beyond the reach of worldly law, and cannot be held responsible in such a case.”

These unfortunates besides could not inherit nor dispose of their own wealth during their lives. The following passage from the “ancient customs of Normandy” bears witness, i. e.:

“The mesel can be no man’s heir from the time his disease is developed, but he may have a life interest, as though he were not a mesel.”

The same as in many other diseases the leprosy presented itself under different forms and various degrees of gravity, as is proved from the following passage from Le Pelerinage de l’humaine lignee:

This gravity of different forms of leprosy has likewise been mentioned by the Arabian school, and notably by Avicenna, who had seen numerous cases complicated with ulcerations of the genital organs; also, by the Englishman, Gilbert, who wrote in the thirteenth century regarding the existence of several species of leprosy, which could not always be easily distinguished by reason of the uncertainty of their symptoms. As to its character as a constitutional malady we have the word of the Syrian Jaliah ebn Serapion, who attributes its connection to the predominance of certain humors; finally, Valescus of Tarentum insists on the heredity of the disease.

The leprosy, the pork measles and the mesellerie were then only clinical forms of a single affection of a contagious nature—a hereditary disease whose symptoms appeared successively on the skin, in the mucous membranes, the viscera and in the nervous system. It then required a diathesis, which resembled greatly in its evolution that of syphilis, with which it has often been confounded.

The physicians of leper hospitals have left behind a great number of medical documents bearing on the characteristics of the disease, but their observations are so confused that we can only conclude that they considered all cutaneous maladies as belonging to the same constitutional vice.

They recognized, however, the ladrerrie (disease arising from measly pork), by the following symptoms, the same being laid down by Guy de Chauliac:

“Eyelids and eyebrows swollen, falling of eye-lashes and eyebrows, which are replaced by a finer quality of hair; ulceration of septum of the nose, odor of ozoena, granulated tongue, foetid breath, painful breathing, thickening and hardness of the lips, with fissures and lividity of same; gums tumefied and ulcerated; furfuraceous scales in the hair, purple face, fixed expression, hideous aspect; forehead smooth and shiny like a horn; pustules on face; veins on chest much developed; breasts hard.”

“Thinness of muscles of the hand, especially thumb and index finger; lividity and cracking of the nails; coldness of the extremities; presence of a serpiginous eruption; insensibility of the legs, collections of nodosities around the joints; under the influence of cold elevations appeared on the cutis, making it appear like goose-skin.”

“Sensation of pricking, ulcerations of skin; sleep uneasy, fetidity of sweat; feeble pulse, bad odor of blood, which is viscid and oily to the touch and gritty after incineration, likewise of a violet black color.”

The contagious characteristic of leprosy through sexual relation was noticed by physicians attached to hospitals, and was the subject of police restriction by public sanitary officers. Thus in the thirteenth century the celebrated Roger Bacon, surnamed the admirable doctor, wrote that commerce with a leprous woman could be followed by very serious consequences. This opinion was corroborated by a physician of the University of Oxford, his contemporary John of Gaddsen, and by the observations of Bernard Gordon, a celebrated practitioner of Montpellier. We all know the history of a Countess who came to be treated for leprosy at Montpellier, when a Bachelor in Medicine charged with the task of dressing her sores, fell desperately in love with the leper lady, and from his amours contracted most serious cutaneous disease.

At this period the leprosy had already begun to assume a venereal type of marked character, and many prostitutes suffered from attacks. As we all are aware, Jean Manardi, an Italian doctor, has fully expressed his opinion on this subject. In a letter addressed to a friend, Michel Santana, one of the first specialists who treated pox, Manardi remarks: “This disease has attacked Valencia, in Spain, being spread broadcast by a famous courtesan, who, for the price of fifty crowns, accorded her favors to a nobleman suffering from leprosy. This woman having been tainted, in her turn contaminated all the young men who called on her, so that more than four hundred were affected in a brief space of time. Some of these, having followed the fortunes of King Charles into Italy, carried and spread this cruel malady in their track.”

Another Italian physician, Andre Mathiole, likewise shows the identity of leprosy with syphilis,—in the following terms: “Some authors have written that the French have taken this disease from impure commerce with leprous women while traversing the mountains of Italy.”[30]

We could easily multiply such citations to complete the facts observed by Fernel and Ambroise Pare in France, and also by many Italian physicians, from whence it would be easy to understand why Manardi came to the following conclusion: “Those who have connection with a woman who has had recent amours with a leper, a courtesan in whose womb the seeds of disease may linger, sometimes contract leprosy and at other times suffer from other maladies of a more or less serious nature, according to their predispositions.”

This modification from measles (the disease from corrupt pork diet) into leprosy of the venereal type is made progressively through the intermediary of the ordinary agencies of prostitution,—bawds and libertines,—who for a very long period eluded the wise laws ordained by sanitary police for the restriction of lepers. In 1543, the affection was so wide-spread as to be beyond sanitary control, and the edict of Francois I., re establishing leper hospitals, amounted to nothing. There were too many poxed people. The Hospital of Lourcine, which was specially devoted to these cases at Paris contained 600 patients in 1540, and in the wards of Trinity Hospital and the Hotel Dieu there were many more. It was the same in the Provinces, notably at Tolouse, which had the merit of creating the first venereal hospital ever instituted, under the Gascon name of “Houspital das rognousez de la rougno de Naples.” Finally, fifty years later, in 1606, for want of lepers, the leper asylums were officially closed. Henry IV., in a proclamation, gave those remaining “to poor gentlemen and crippled soldiers.”

Thus ended the epidemic of leprosy in France, which had prevailed from the second century, observing the same progress in other countries of Western Europe during the same period of time. Syphilis, the product of the venereal maladies of antiquity and the leprosy of the Middle Ages, announced a new era; syphilis was thus contemporaneous with the Renaissance.

In the collection of Guy Patin’s letters, there is an interesting document relating to the connection of leprosy and syphilis, as witness the principal passage:

“It was not long since that I saw in Auvergne a patient who was suspected of measles (hog disease), for the reason that his family had the reputation of being thus afflicted, though he bore on his body no marks of the disease. This led me to recall the fact that some families in Paris have been suspected of this taint; but really we have no measles or leprosy here. In former times there was a hospital dedicated to such cases in the Faubourg Saint Denis. I have noticed no cases in Champagne, Normandy nor Picardy, although in all these Provinces I found asylums formerly used for such cases that are now turned into hospitals for plague victims. In former times leprosy was confounded with pox, through the ignorance of doctors and the barbarity of the age; nevertheless, there are yet a few lepers in Provence, Languedoc and Poitou.”

We have here the authority of Guy Patin for saying that leprosy had almost entirely disappeared from France in the sixteenth century.

Although modern Faculties are prone to insist that the real science of medicine only dates back its origin to the discovery of the microscope, and that the study of antique medicine is only a retrospective exposition calculated to show the slight scientific value of ancient observations, I assert that the many observations recorded by our medical ancestors are of immense value. Let us cite, as a single instance, this transformation of a constitutional malady, attenuated by time, transmitted by heredity through the same masses of people for ten centuries,—populations having a similar diathesis,—a disease taking a new vigor and attacking other generations, but destined in a given time to disappear, most probably, in its turn, in another unknown metamorphosis. Such an idea may cause a smile in that haughty section hors rang in medicine, which is so devoted to the culture of specific germs that but one idea can certainly be adopted as an irrefutable dogma in medicine—that is, if the facts it represents coincide with the modifications of the wag—in the tail end of a bacillus.

As for myself, I remain convinced that everything seen in modern times, through the objective even of an instrument of precision, cannot destroy the accumulated work of twenty centuries of medical observation and study.

ScientiÆ enim per additamenta fiunt.

THE SYPHILIS.

If the true syphilis—the variety that appeared in the fifteenth century—was unknown in the Middle Ages, there still exist documents which fully affirm the existence of contagious venereal diseases several hundreds of years before the Italian wars of Charles VIII. and Louis XII. The maladies which, in times of antiquity, afflicted the Hebrews and Romans, as a result of impure sexual commerce, are to-day only the results of the progress made by prostitution after the Crusades; that is to say, they are merely the products of debauchery and leprous virus imported from the Orient.

As early as the twelfth century France knew the mal malin or mal boubil, an affection characterized by sores and ulcerations on the arms and genital organs. Gauthier de Coinci, Prior of the Abbey of St. Medard de Soissons, at the beginning of the thirteenth century considered these maladies as impure and contagious, and warned his priests in the following verselets:

We are permitted to suppose from these lines that the disease was localized in “a wicked place that the hands must not touch,” and that it was only an affection of the same nature as the gorre and grand gorre, one of the numerous expressions applied to all contagious maladies of the sexual organs. This fact cannot be contested, for at the same epoch, in a poem entitled “Des XXIII Manieres de Vilains,” we find an imprecation launched by this anonymous author against all blackguards and bawds:

Or, as given in French:

Now, the opuscle, from which these verses are derived, was reprinted in 1833 by Francisque Michel, and is contemporaneous with the manuscripts of the thirteenth century, analyzed by M. Littre in a note on syphilis,[31] where our erudite author says: “At this epoch the venereal diseases had an analogous form to those we observe to-day.”

This document dates back 200 years before the discovery of America, and is duly authenticated by the testimony of Guillaume Saliceti, a physician and Italian priest of the thirteenth century. “When a man has received a corruption of the penis, after having cohabited with an obscene woman or for other cause, there comes a tumor in the groin.”[32] And some years after Lanfranc, a student of Salicetis, wrote, in his turn, in his Parva Cyrurgia, that “buboes appear following ulcers on the penis.” His description of chancres and other venereal accidents is very remarkable.

Another writer of the thirteenth century, Michel Scott, a Scotch physician, alchemist, and philosopher, who lived in France and Germany for many years, says in one of his numerous works:[33] “Women become livid and have discharges. If a woman is in such a condition and a man cohabit with her his penis is easily diseased, as we often see in adolescents who, ignorant of this fact, often contract a sore organ or are attacked by leprosy. It is also well to know that if a discharge exist at the epoch of conception, the fetus is more or less diseased, and in this case a man must abstain from all connection, and the woman should resist sexual advances, if she have foresight.”

This passage leaves no possible doubt as to the existence of blenorrhagia with the discharge and as to the presence of an hereditary syphilitic diathesis, for if the author gives the last-mentioned the name of leprosy it is only for the reason that at this period no positive term was in use to designate venereal diseases,[34] which were confounded with leprosy, with or without reason, the former only being, perhaps, a transformation of the latter.

About a century later, that is to say, on August 8th, 1347, Queen Jeanne of Naples, Countess of Provence, sent to Avignon the statutes relating to the establishment of houses of prostitution in that city. Article IV. of this law regulated police measures in the following terms: “The Queen ordains that every Saturday the bailiff and a barber deputed by the Councilmen shall visit every debauched girl in the place, and if they find any one who has the disease arising from venery, that such a one may be separated from the other girls and lodged apart, to the end that no one may have commerce with her, and that the young may thus avoid contracting disease.”[35]

These statutes were first made known by Astruc,[36] and have been inserted without reserve by Grisolle in his Traite de Pathologie Interne; also by Cazenave in his Traite des Syphilides; but Jules Courtet, and after him Rabutaux and Anglada, have considered these documents as somewhat apocryphal.

We shall not stop to discuss the authenticity of these documents; they have characteristics that make their genuineness almost indisputable. Besides, we can quote other authors against whom no arguments can be used; for instance, we will cite John of Gaddesen, a physician of the English Court, who affirmed that sexual connection with a leprous woman produced ulcers of the penis;[37] besides, his compatriot Gilbert, who described in his Compendium Medicinal, in the year 1300, the treatment of gonorrhoea and chancre so common after the Crusades; or Gui du Chauliac, who in 1360 noticed “the ulcers born of commerce with a tainted woman, impure and chancrous (ex coitu cum foetida vel immunda vel cancrosa muliere).”[38] Again, note Torella, of Italy, who considered pox as a contagious malady which had existed from times of antiquity, and which had made its appearance at different epochs, but of which the symptoms, poorly understood by medical men, prevented isolation and its proper pathological identity.[39]

We need not reproduce the text of all the French and especially the Italian doctors, who established the identity of venereal diseases before the year 1494—such writers as Montagnana, Petrus Pintor, Nicolas Leonicenus, Joseph Grunpeck, etc. As to these works, they have all been mentioned by Fracastor, in his celebrated Treatise on Contagious Diseases (de morbis contagiosis), a work at once a fine poem, whose Latinity is perfect and a monograph of true scientific exactitude.

Fracastor described the patient as well as the disease: “The victims were sad and broken with pale faces.”

“They had chancres on their private parts; these chancres were changeable; when cured at one point they reappeared at another; they always broke out again.”

“Pustules with crusts were raised on the skin; in some these commence on the scalp first; this was the usual case; in a few they appeared elsewhere. At first these were small, afterwards increasing in size, appearing like unto the milk crust in children. In some these pustules were small and dry—in others large and humid. Sometimes they were scarlet, sometimes white, sometimes hard and pink. These pustules opened at the end of some days, pouring out an incredible quantity of stinking and nasty liquid, once opened they became true phagedenic ulcers, which not only consumed the flesh but even the bone.”

“Those whose upper regions were attacked had malignant fluxions, that eat away the palate, the trachea, the throat and the tonsils. Some patients lost their lips, others their noses, others their eyes, others their private parts.”

“Large gummy tumors appeared in many and disfigured the limbs. These growths were often the size of an egg or a French roll of bread. When opened these tumors discharged a whitish mucilaginous liquid. They were principally noted on the arms and legs; while ulcerating sometimes they grew callous, at other times remaining as tumors until death.”

“As if this were not sufficient, terrible pains oftimes attacked the limbs; these generally came when the pustules appeared. These pains were long abiding and well nigh insupportable, aching most at night, not only affecting the articulation, hut also the bones and nerves of the limbs. Sometimes the patient had pustules without pains, at other times pains without pustules; but the great majority had pustules and pains.”

“The patients were plunged into a condition of languor. They became thin, weak, without appetite, sleeping not, always sad and in a sullen humor, the face and the limbs swollen, with a slight fever at times. Some suffered with pains in the head, pains of long duration, which did not recede before any remedies.”

“Although the greater majority of mortals have taken this disease by contagion, it is no less certain that a great number of others contracted it from infection. It is impossible to believe, in fact, that in such a short time the contagion that marches so slowly by itself and which is communicated with such difficulty, should overrun such a number of countries, after having been (as it is claimed), imported by a single fleet of Spanish ships. For it is well known that its existence was determined in Spain, France, Italy and Germany and all through Scythia at the same period of time. Without doubt the malady originated spontaneously, like the petechial fever, or it had always existed.”

“A barber, my friend, has a very old manuscript, containing directions for the treatment of the affection. This has for its title: ‘Medicine for the thick scabs, with pains in the joints.’ The barber remembered the remedy laid down in this work, and at the very commencement of the new malady thought he recognized the contagion by the name of the thick scabs. But physicians having examined this remedy found it too violent, inasmuch as it was composed of quicksilver and sulphur. He would have been happier had he not consulted the doctors; he would have grown wealthy by incalculable gains.”

We see from this that the syphilis of the fifteenth century did not present precisely the same symptoms as the variety of to day. Formerly secondary and tertiary accidents supervened much more rapidly, besides being very violent in their manifestations. Besides the disease was exceedingly malignant often causing, death in a short time, which fact led many authors of that epoch to consider the symptoms due to a pestilence brought about by general causes.[40] Nicholas Massa wrote in fact, that: “The patient has pains in the head, arms, and especially the legs, which are always intensified at night. The buboes in the two groins are salutary when they suppurate. We observe a chafed and scaly condition of the palms of the hands and soles of the feet. Ulcers of a bad appearance are frequently noted on the penis; these ulcers are hard and callous and very slow in healing. In exploring the throat we often discover a relaxed condition of the uvula and the presence of sordid ulcers, which rarely suppurate. With all this eruptive process we note certain hard tumors that adhere to the skin and bone and bear the name of gummata. These tumors may ulcerate and produce osseous caries.”[41]

We notice the same errors in all the descriptions given by the authors of the sixteenth century; they exhibit an imperfect knowledge of the symptomatology, of the genesis and primitive constitutional accidents. We see that as yet clinical medicine had no existence, and that our predecessors were ignorant of the art of co-ordinating the signs of a disease in a thoughtful manner. Nevertheless, their descriptive powers in writing on venereal diseases, as before noted, were excellent, and had the merit of exactitude and honest observation; as, Pierre Manardi observes: “The principal sign of the French disease consists in pustules coming out on the end of the penis in men and at the entrance of vulva or neck of womb among women. Most frequently these pustules ulcerate; I say frequently for the reason that I have seen patients in whom these ulcers were hard as warts, cloves or apple seeds.”

Here we have the aspect of primary syphilis presented by a physician whose name will, with justice, remain attached to the disease as long as it has a history. The secondary symptoms of the malady have never been more dramatically pictured than by Fernel, who remarks: “They had horrible ulcers on them, which might be mistaken for glands, judging from size and color, from which issued a foul discharge of a villainous infecting kind, enough to give a heart-ache; they had long faces of a greenish-black complexion, so covered with sores that nothing more hideous could be imagined.”[42]

Relative to the duration of secondary symptoms, under date of 1495, Marcello de Cumes wrote from the camp of Novarro that “the pustules on the face, like those of leprosy and variola, lasted a year or more when the patient was not treated.”[43]

The physiognomy of the unfortunates whose faces were adorned with lumps and whose foreheads bore the sadly characteristic corona veneris, has been well described in the following verses by Jean Lemaire, of Belgium, a poet and historical writer of fifteenth century. The portrait is exact:

Meantime, the symptoms of syphilis were not long in losing some of their acute features. Already, in 1540, Antoine Lecocq noted this fact in France:[44] “Sometimes,” says he, “the virus seems to expend its strength on the groins in tumefaction of the glands; and, if this bubo suppurates, it is well. This tumor we call bubo; others call it poulain (colt or filly) for mischief’s sake, as those who are thus attacked separate their legs while walking, horse style.” Fernel declared that the venereal disease at the end of the sixteenth century so little resembled that of his early days that he could scarcely believe it the same. He remarks: “This disease has lost much of its ferocity and acuteness.”

On his part, Fracastor remarked, in 1546, that “For six years past the malady has changed considerably. We now notice pustules on but few patients, and they have but few pains, and these are generally slight; but more gummy tumors are observed. A thing that astonishes the world is the falling out of the hair of the head and baldness in other portions of the body. It sometimes happens that in the worst cases the teeth become loose and even fall out.”[45]

These phenomena were evidently due to the action of mercurial ointment, which was much used in Italy from the time it was recommended by Hugo, of Boulogne, in the malum mortuum, or malignant leprosy of the Occident. In France guaiac was much used, or holy wood, which was then known as sanctum lignum, when only the Latin equivalent was in vogue. Besides, mention is made of mercurial stomatitis following inunctions with the so-called Neapolitain ointment in the Prologue of Pantagruel, by Rabelais.

This passage from Dr. Francis Rabelais[46] leads us to think that physicians were undecided about caring for syphilitic patients in the fifteenth century, almost all doctors, in fact, refusing to examine into the character of a disease of which they knew nothing; a disease whose infecting centers were the most degraded and ignoble public places; a malady not described in the works of Hippocrates nor Galen.

So, this lues venerea, as it is called by Fernel, made numerous victims in all countries. It spread in the towns and throughout the rural districts, and, at times, caused such ravages that, in the large cities, the authorities were obliged to use sanitary measures against the pox, as had been done at other times in the case of leprosy. Syphilitics were expelled from places and forbidden, under severe penalties, from having intercourse with healthy people. But it soon came to be known that contagion could only occur through sexual connection, and the patients then hid in hospitals, where they were specially treated by the methods laid down by the first syphilographers,—vapor baths, mercurial inunctions, frictions, etc. Unfortunately, no prophylactic measures were instituted against prostitutes, although they were recognized as having a monopoly in venereal disorders; for they did not believe at that time, like Jean de Lorme, who said: “The pox may be caught by touching an infected person; by breathing the same air; by stepping, barefooted, in the patient’s sputa, and in many other manners.”

Even the poets wrote sonnets, poems and ballads upon this mal d’amour (lovesickness). One could form an immense volume by collecting all the verses written and published on this subject during the sixteenth century. But no poem indited during that period presents so great an interest to medical science as the ballad of Jean Droyn, of Amiens, dedicated to the Prince, in which the author, stronger in the etiology of syphilis than the doctors of his time, advised young men who feared grosse verole (the pox) not to indulge in liasons with girls of the town without first being satisfied with their pathological innocence.

This ballad was published at Lyons in 1512, that is to say, seventeen years after the appearance of the disease in the army of Charles VIII., at an epoch when the majority of doctors considered the affection as an infectious malady due to the action of a pestilential miasm in the air. We shall reproduce but a few lines of this poetical-medical-historical document:

In the final stanzas of this poem, which will not bear a more complete reproduction owing to a maudlin sentimentality existing in modern times, we find that the Prophet Job is not regarded as strictly virtuous, for we read:

Notwithstanding the undoubted proof of the antiquity of venereal diseases, Astruc, as we all know, defends the American origin of the malady, and endeavors to support his views on the hypothesis emitted by Ulrich de Hutten in 1519, i.e., at the siege of Naples, at the end of 1494, a Spanish army commanded by Gonsalva of Cordova came to the rescue of the besieged. Their soldiers communicated to the girls of the town and the courtesans of the neighborhood the maladie Americaine (American disease), which was contracted in turn, after the capture of Naples, by the army of King Charles, and afterwards spread throughout France. But history informs us that the King of France did not return to Paris with his troops from the Italian campaign until the month of March, 1496. Now it was on the 6th of March, in this same year, that Parliament issued a proclamation regulating the pox, in which the first section reads: “To-day, the 6th of March, whereas in the City of Paris a disease of a certain contagious character, known as verole (pox), prevails, the which has made much progress in the Realm the past two years, as well at Paris as in other places, and there is reason to fear, this being Springtime, that it may increase, it is deemed expedient to take cognizance of the same.”

Other testimony is gathered from the narrative of the voyages of Christopher Columbus by his contemporary Petrus Martyr, of Anghierra, historian attached to the court of Ferdinand and Isabella. According to the notes given him by the great navigator on his return to Spain, authentic records kept from day to day,[47] the Spanish and Italian sailors of Columbus found “people who lived in the Age of Gold; with no ditches, no fences, no books, no laws. The men were entirely naked, the women only protected by a belly-band of light material; notwithstanding all this, their morals were pure.” Besides, Petrus Martyr (La Syphilis au XV. Siecle) proves there was syphilis in Spain in 1487.

When Columbus returned to Europe a second time he left behind him, under orders of his brother, a hundred of his companions in arms, who were a collection of adventurers from all the nations of the earth. These men committed all sorts of excesses among the unfortunate Indians—steeping themselves in lust and every manner of crime, violating the women, and indulging in wholesale debauchery. Says Charles Renaut: “Looking at matters from this standpoint, I am ready to believe that the Spaniards carried the disease to the natives of Hispanola, and that the latter did not give the malady to the Spanish.”

We shall not dwell further on the origin of syphilis, nor its connection with leprosy and other cutaneous maladies which were so prevalent in Europe throughout the Middle Ages. We may consider the disease as something new, and trace its period of invasion and development to the discovery of America, or assert that it arose from a semi extinct affection (leprosy), assuming a new type under the influence of a special epidemic constitution.

One thing is clearly proven, i.e., that syphilis was preceded by contagious venereal affections, which lost the irregular and malignant forms of the fifteenth century. When then the civilized nations of earth create a true Public Health Service, syphilis will be vanquished, and will pass away to the ranks of other extinct maladies.