a chronic cutaneous tubercular disease, prevalent, from the earliest historical times, among the ancient Jews and Egyptians, and a malady that was very common during the middle ages in the different kingdoms of Europe, and which still exists to a great extent in many quarters of the old and new world. Leprosy is one of the most incurable and most loathsome of human maladies. When speaking of the cases of it which he saw in Syria, in the seventeenth century, the old English traveller Maundrell describes it as a "distemper so..." Leprosy.

noisome that it might well pass for the utmost corruption of the human body on this side the grave." In many medical works, from the time of Aretaeus, Ætius, and the later school of Greek physicians, down to our own days, the affection is described under the name of elephantiasis, or elephant disease, because, to quote the words of Aretaeus, "It is disgusting to the sight, and terrible in all respects (et visu fedus et in omnibus terribilis), like the beast of the same name."

When leprosy, or the elephantiasis of the Greek physicians, is fully developed, it is characterized by the presence of dusky red, or livid tubercles of different sizes upon the face, lips, nose, eye-brows, ears, and extremities of the body. The skin of the tuberculated face is at the same time thickened, wrinkled, and shining, and the features very greatly distorted. The hair of the eye-brows, eyelashes, and beard falls off; the eyes are often injected, and the conjunctiva swelled; the voice becomes hoarse and nasal; the sense of smell is impaired or lost; and that of touch, or common sensation, is strangely altered, for, whilst the tuberculated and other affected parts are, in the first instance, sometimes supersensitive, latterly, in the course of the disease, they become paralyzed or anæsthetic. As the malady proceeds onwards in its course, the tubercles soften and open; ulcerations of similar mucous tubercles appear in the nose and throat, rendering the breath extremely offensive; tubercular masses, or leprom tubercles, as shown by dissection, begin to form also internally upon various mucous membranes, and on the surface of the kidneys, lungs, &c.; cracks, fissures, and circular ulcers appear on the fingers, toes, and extremities, and joint after joint drops off by a kind of spontaneous gangrene. Sometimes the upper and sometimes the lower extremities are specially affected by this mortification and mutilation of parts. Dr Halbesk, in looking down from a neighbouring height into the large leper hospital of Hamel en Arade, tells us that he noticed particularly two of the leper inmates sowing pease in the field. "The one had no hands, the other had no feet—these members being wasted away by disease. The one who wanted the hands was carrying the other who wanted the feet upon his back, and he again carried in his hands the bag of seed, and dropped a pea every now and then, which the other pressed into the ground with his foot; and so they managed the work of one man between the two." The duration of tubercular leprosy from its first commencement to its fatal termination is usually about nine or ten years.

An endless variety of medical measures has been tried with the hope of arresting or curing tubercular leprosy with little or indeed no success. But though the disease in individual subjects seems to be beyond the power of medical control, yet the malady, as affecting individual communities and kingdoms, has sometimes been more or less completely arrested in its course and prevalence.

Leprosy still exists in Palestine and Egypt, the countries from which we have the first accounts of it. On the reputed site of the house of Naaman at Damascus, stands at the present day an hospital filled with unfortunate patients affected, like him, with leprosy. Outside the Zion gate at Jerusalem there is still a leper village, the inhabitants of which yet speak to you "afar off," as they did in the time of Christ. But the same disease is now almost unknown at the present hour in the central and western kingdoms of Europe, and yet in the middle ages it prevailed in one and all of them, to a frightful extent. Laws were enacted by almost all the princes and courts of Europe to arrest its diffusion among their subjects; the pope issued bulls with regard to the ecclesiastical separation and rights of the infected; a particular order of knighthood was instituted to watch over the sick; and leper hospitals or lazars houses were everywhere instituted to receive the victims of the disease. The number of these houses has certainly been often erroneously stated, in consequence of a strange mistake committed by Ducange, in quoting from Matthew Paris a passage in which that historian contrasts the respective possessions belonging in the thirteenth century to the Hospitalarii, Knights Hospitallers, or Knights of St John, as they were termed, and the Knights Templars. The 19,000 lazars-houses in Christendom, as interpreted by Ducange, mark in Matthew Paris's work merely the number of manors or commandaries of the Hospitalarii, and have no reference whatever to leprosy or lazars-houses. But still, that an immense number of leper-houses existed on the Continent at the period mentioned, is abundantly shown in many of the historical documents of that age. Louis VIII. promulgated a code of laws in 1226 for the regulation of the French leper hospitals; and these hospitals were, at that date, computed to amount, in the then limited kingdom of France, to not less than 2000 in number (deux mille leproseries). They afterwards, as is alleged by Velley, even increased in number, so much so, that there was scarcely a town or burgh in the country that was not provided with a leper hospital. In his history of the reign of Philip II., Mezeray uses the same language in regard to the prevalence of leprosy and leprous patients in France during the twelfth century. Muratori gives a nearly similar account of the extent of the disease during the middle ages in Italy; and the old Scandinavian historians amply prove that the inhabitants of the kingdoms of Northern Europe equally became its unfortunate victims.

In England and Scotland, during the middle ages, leprosy was as rife as it was on the neighbouring continent of Europe. Almost every large town in Great Britain had a leper hospital or village near it, for the reception and separation of the diseased. Some cities were provided with more than one. There were six leper hospitals in Norwich or its immediate vicinity, and five at Lynn Regis.

The ancient leper hospitals of this and other countries were intended for the isolation of the infected, not for their cure. They were charitable, hygienic, and religious, rather than medical institutions. A few of them, indeed, were well endowed, as that of Sherburne, Maiden-Bradley, Burton lazars, and others in England, and Kingcase in Scotland; but the greater part of these institutions were supported by voluntary charity; and the principal subsistence of the inmates seems to have been derived from casual alms. By some of the old forest laws of England, game and animals found dead in the wood and fields were sent to the nearest leper hospital; and in Scotland the fish left putrid and unsold in the burgh markets, were adjudged to them. The lepers were usually, by law, restricted as to the districts and places in which they presented themselves to beg for subsistence. According to the Scottish "Barrow Lawes," it was ordained that lepers "sall not gang fra dure to dure, but sall sit at the ports of the burgh, and seek alms fra them that passes in and furth;" and the Scottish parliament of 1427 enacted, that they should not be allowed to sit and beg, "neither in kirk nor in kirk-yarde, nor other places within the burrowes, but at their owne hospital." In the leper hospital of Edinburgh, the inmates begged alternately for the general community, sitting for this purpose at the door of the hospital; but they were ordered there not to "cry or ask for alms, utherways then be their clapper." For the inmates of this and other similar institutions in this and other countries, were usually obliged by law to warn those approaching them of the presence of an infected fellow-mortals, by using a rattle or wooden clapper; whilst, at the same time, they held in their hand a "cop," or receiving dish, into which the charitable might drop their alms.

In Great Britain, as on the Continent, those affected, or supposed to be affected, with leprosy, were obliged to seclude themselves from society, or enter a leper hospital, both by general custom and usage, and by direct legal enactments in regard to them, made both by the court and church. Besides, according to the tenor of various old civil codes and local enactments in this and other countries, when a person became affected with leprosy, he was considered as legally and politically dead, and lost the privileges belonging to his right of citizenship. The church also took the same view; and on the day on which he was separated from his fellow-creatures, and consigned for the remainder of life to a lazarus-house, they performed over and around the yet living sufferer the various solemn ceremonies for the burial of the dead, and the priest terminated the long and fearful formula of his separation from his living fellow-creatures, by throwing upon the body of the poor outcast a shovelful of earth, in imitation of the closure of the grave.

The ritual of the French church retained, till a very late period, the various forms, prayers, and ceremonies of social isolation and banishment, to which the leper was thus subjected on the day of his living funeral. But in France, as in most other parts of Central Europe, the ceremonial is no longer required, as the malady has entirely, or almost entirely, disappeared. Isolated cases of it still occasionally occur in some villages on the shores of the Mediterranean, near Marseilles. It has been seen also during the present century in several sea-board localities in Spain; and one of the Greek islands, at the present day, continues to form a leper hospital. In Europe, however, the disease is now principally confined to Norway; but in that small kingdom, at the last census, there were found to be upwards of 2000 of its population affected with leprosy; and more than one hospital yet exists for it in Iceland. In Great Britain, no indigenous case of the disease was seen from the end of the last century till a few years ago, when one or two cases occurred in the old haunts of the disease among the western islands of Scotland, and elsewhere; and it is quite possible that it may yet revisit us again to some extent. One or two hospitals for the reception of lepers have lately been built in Canada.

Few or no physicians at the present day hold that leprosy is a disease which spreads from the infected to the healthy by contagion. But there is ample reason for believing that the affection is often transmitted hereditarily from generation to generation. Further, there are local or endemic causes in certain parts of the world capable of producing it; as we see it sometimes attack Europeans who have been residing for a succession of years in districts in the West Indies, and other countries where the disease is prevalent. What these endemic causes or conditions are, we know not. The frequency of the malady in former times has been confidently ascribed, by different authors, to peculiarities in the diet, dress, personal and domestic habits, &c., of our forefathers; and, certainly, their mode of life was, in many respects, specially calculated to generate derangements and eruptions of the skin. The good old Saxon practice of bathing appears to have become forgotten after the date of the Norman conquest; and in the subsequent history of these early times, we might trace various indirect and direct causes of cutaneous disease, in the close hovels and unventilated dwellings of the period; in the habits of personal uncleanness; in the rough straw-bedding then generally in use, and which "hard lodging" Hollinshied describes as still used by the servants in his day, "with seldome (he adds) anie sheete vnder their bodies to keepe them from the pricking straws that run off through the canvas, and rase their hardened hides;" and probably, also, in the articles of diet on which the general community were obliged to subsist, in times before the improvement of agriculture, and the introduction of that "scamefull intemperance," as old Boece fanatically terms it, "when na fische in the see, nor foule in the aire, nor beast in the wod, may have rest, but are socht heir and thair to satisfy the hungry appetit." For the investigation of this and other allied questions in the history of the production of our elder epidemic and endemic diseases, the works of Hollinshied, Strutt, Henry, Chalmers, Macpherson, and others, contain a great and available mass of materials. We will only, however, here pause to observe, that we believe it would be no easy matter to point out the exact differences in those physical conditions of the inhabitants of this country, in former and in modern times, which may have led to the prevalence of the disease amongst our ancestors, and to its disappearance amongst us. If poverty in diet, or personal wants, and filth and wretchedness in their deepest degrees, could generate the malady, there are certainly still numerous spots in continental Europe, and even in our own land, where, unfortunately, all these elements of disease are, in our own day, in full and active operation, without any such specific result following. The alleged causes are present without the alleged effects.

In order to obtain anything like satisfactory results of the supposed physical causes of leprosy in Europe in former times, the whole question would require to be thoroughly investigated in connection with two others,—viz., the allied physical circumstances, firstly, of the inhabitants of those countries in which the disease, in the same way, formerly raged; and, secondly, of those districts of the world in which it is still prevalent. It is only by following such a line of inquiry that we could hope, if at all, to separate mere matters of opinion from matters of fact, and at last to obtain, by a kind of reasoning by exclusion, the exact physical condition or conditions of a people that are capable of originating or of spreading this particular species of disease. The difficulty of the problem may be easily appreciated by glancing for a moment at the diversified geographical localities and circumstances under which the tubercular leprosy is known at the present day to prevail. In modern times it has been found existing, to a more or less limited extent, in places the most distant and dissimilar in regard to temperature, climate, situation, soil, &c., as in Sumatra, under the equator, and in parts of Iceland almost within the verge of the arctic circle; in the temperate regions of both hemispheres, as (in the southern) at Hamel en Arade, in the Cape district, and (in the northern) at Madeira and Morocco; in the dry and arid plains of Arabia, and in the wet and malarious districts of Batavia and Surinam; along the shores of Guiana and Sierra Leone, and in the interior of Africa, Hindostan, Asia Minor, and Asiatic Russia; on the seacoast, as at Carthagena; and thousands of feet above the level of the ocean, as on the table-land of Mexico; on some of the islands in the Indian, Chinese, Caribbean, and Mediterranean seas; and at many sites far in the interior of the continents of Asia, Africa, and America. (G. Y. S.)