spot (xiii, 2), discoloration of the hair (3)—were manifest, isolation was pronounced at once; but if some of the signs were wanting, a seven-days quarantine was ordered, at the term of which a new inspection had to take place; should then the symptoms remain doubtful, another week's quarantine was imposed. The appearance of "the living flesh" in connexion with whitish blotches was deemed an evident sign of the infection (10). White formations covering the whole body are no sign of leprosy unless "live flesh*' (ulceration) accompany them; in the latter case, the patient was isolated as suspect, and if the sores, which might be only temporary pustules, should heal up, he had to appear again before the priest, who would then declare him clean (12-17). A white or reddish nodule affecting the cicatrix of an ulcer or of a burn would be regarded a doubtful sign of leprosy, and condemned the patient to a seven-days quarantine, after which, according as clearer signs appeared or not, he would be declared clean or unclean (18-28). Another suspicious case, to be re-examined after a week's seclusion, is that of the leprosy of the scalp, in which, not leprosy proper, but ringworm should most likely be recognized. In all cases of acknowledged leprous infection, the patient was to "have his clothes hanging loose, his head bare, his mouth covered with a cloth" and he was commanded to cry out that he was defiled and unclean. As long as the disease lasted, he had to "dwell alone without the camp" (or the city). Like the presence of leprosy, so the recovery was the object of a sentence of the priest, and the reinstatement in the community was solemnly made according to an elaborate ritual given in Lev., xiv.
In connexion with leprosy proper, Leviticus speaks also of the "leprosy of the garments" (xiii, 47-59) and "leprosy of the house" (xiv, 34-53). These kinds of leprosy, probably due to fungous formations, have nothing to do with leprosy proper, which is a specifically human disease.
Bennett, Diseases of the Bible (London, 1887); Dyer, Leprosy (New York, 1897); Hansen and Looft, Leprosy in its Clinical and Pathological Aspects (London. 1895); Report of the Leprosy Commission to India (London, 1893); Thin, Leprosy (London, 1891); Barthclinus, De morbis biblicis (Copenhagen 1671); Pruner, Die Krankheiten des Orients (Erlangen, 1847); Trusen, Die Sitten, Gebräuche und Krankheiten der alien Hebräer (Breslau, 1833); Lelois, Traité pratique et théorique de la lèpre (Paris, 1886); Sauton, La Léprose (Paris, 1901).
Charles L. Souvay.
IV. Leprosy in the Middle Ages.—As a consequence of the dissemination of leprosy in Europe, legislation providing against the spread of the disease (which was considered to be contagious) and regulations concerning the marriage of leprous persons, as well as their segregation and detention in institutions—which were more charitable and philanthropic than medical, partaking of the character of asylums or almshouses—gradually came into operation. The historical researches of Virchow concerning leper-houses (leprosoria) have established the fact that such institutions existed in France as early as the seventh century at Verdun, Metz, Maestricht, etc., and that leprosy must even then have been widespread. In the eighth century St. Othmar in Germany and St. Nicholas of Corbis in France founded leper-houses, and many such existed in Italy. (See Virchow in "Archiv für pathologische Anatomie", XVIII-XX, Leipzig, 1860.) Legislative enactments against the marriage of lepers, and providing for their segregation, were made and enforced as early as the seventh century by Rothar, King of the Lombards, and by Pepin (757) and Charlemagne (789) for the Empire of the Franks. The earliest accounts of the founding of leper-houses in Germany is in the eighth and ninth century; in Ireland (Innisfallen), 869; England, 950; Spain, 1007 (Malaga) and 1008 (Valencia); Scotland, 1170 (Aldnestun); the Netherlands, 1147 (Ghent). The founding of these houses did not take place until the disease had spread considerably and had become a menace to the public health. It is said to have been most prevalent about the time of the Crusades, assuming epidemic proportions in some localities: in France alone, at the time of the death of Louis IX, it was computed that there were some two thousand such houses, and in all Christendom not less than nineteen thousand (Hirsch, "Handbook of Geographical and Historical Pathology", tr. Creighton, London, 1885, p. 7, note. Cf. Raymund, "Histoire de l'Eléphantiasis", Lausanne, 1767, p. 106). Mézeray (Hist. de France, II, 168) says: "Il y avait ni ville ni bourgade, que ne fust obligée de bâtir un hôpital pour les (lepreux) retirer". For Italy we have Muratori's statement (Antiq. Ital. Med. Ævi, III, 53), "Vix ulla ci vitas quæ non aliquem locum leprosis destinatum haberet."
There is, however, good reason to doubt the accuracy of the above figures (19,000) as estimated by our medieval informants. Besides, "it would be a mistake", writes Hirsch (op. cit., p. 7). "to infer from the multiplication of leper-houses, that there was a corresponding increase in the number of cases, or to take the number of the former as the measure of the extent to which leprosy was prevalent, or to conclude, as many have done, that the coincidence of the Crusades implies any intrinsic connexion between the two things; or that the rise in the number of cases was due to the importation of leprosy into Europe from the East. In judging of these matters we must not leave out of sight the fact that the notion of 'leprosy' was a very comprehensive one in the middle age, not only among the laity but also among physicians; that syphilis was frequently included therein, as well as a variety of chronic skin diseases, and that the diagnosis with a view to segregating lepers was not made by the practitioners of medicine but mostly by the laity."
Simpson, in his admirable essay on the leper-houses of Britain (Edin. Med. and Surg. Journal. 1841-42), writes: "I have already alluded to special Orders of Knighthood having been established at an early period for the care and superintendence of lepers. We know that the Knights of St. Lazarus separated from the general Order of the Knights Hospitallers about the end of the eleventh or beginning of the twelfth century (Index. Monast., p. 28). They were at first designated: Knights of St. Lazarus and St. Mary of Jerusalem. St. Louis brought twelve of the Knights of St. Lazarus to France and entrusted them with the superintendence of the 'Lazaries' (or leper hospitals) of the Kingdom. The first notice of their having obtained a footing in Great Britain is in the reign of Stephen (1135-54) at Burton Lazars (Leicestershire). I find that the hospitals of Tilton, of the Holy Innocents at Lincoln, of St. Giles (London), Closely in Norfolk, and various others are annexed to Burton Lazars as 'cells' containing 'fratres leprosos de Sancto Lazaro de Jerusalem'. Its [Burton's] privileges and possessions were confirmed by Henry II, King John and Henry VI. It was at last dissolved by Henry VIII." (See Lazarus, St., Order of.)
As has already been stated, these institutions were intended principally as houses to seclude the infected, and not so much as hospices for the curative treatment of the disease, which was considered then, as now, an incurable disorder. They were founded and endowed as religious establishments, and as such they were generally placed under the control and management of some abbey or monastery by a papal Bull, which appointed every leper-house to be provided with its own churchyard, chapel, and ecclesiastics—"cum cimuterio ecclesiam construere et propriis gaudere presbyteris" (Semler, "Hist. Eccles. Select."). The English and Scotch houses were under the full control of a custos, dean, prior, and, in some cases—as in the hospital of St. Lawrence, Canterbury which contained lepers of both sexes—a prioress. The eccle-