MEDICINE
35
MEDICINE
contact ; e. g. two women in the aforesaid leper-huts re- mained uncontaminated thoiigli their husbands were both affected, and yet the children born to them were, like the fathers, elephantisiac, and became so in early life. On the children of diseased parents a watch for the appearance of the malady is kept; but no one is afraid of infection, and the neighbors mix freely with them, though, like the lepers of the Old Test., they live " in a several house." Many have attributed to these wretched creatures a libido inexplebilis (see Proceedinr/s of Med. and Chirurg. Soc. of London, Jan. i860, iii, 1G4, from which some of the above remarks are taken). This is denied by Dr. Robert Sim (from a close study of the disease in Jerusalem), save in so far as idleness and in- activity, with animal wants supplied, may conduce to it. It became first prevalent in Europe during the crusades, and by their means was diffused, and the ambiguity of designating it leprosy then originated, and has been generally since retained. Pliny {JVaf. Hist, xxvi, 5) as- serts that it was unknown in Italy till the time of Pom- pey the Great, when it was imported from Egypt, but soon became extinct {Paul. yEgin. ed. Sydenh. Soc. ii, (5). It is, however, broadly distinguished from the XtTrpa, XtvKi], etc. of the Greeks by name and symptoms, no less than by Roman medical and even popular writers ; comp. Lucretius, whose mention of it is the earliest — ■ "Est elephas morbus, qui propter fiumiua Nili,
Gignitur ^gypto iu niediu, ueque prteterea usquam." It is nearly extinct in Europe, save in Spain and Nor- wa,v. A case was seen lateh^ in the Crimea, but may have been produced elsewhere. It prevails in Turkey and the Greek Archipelago. One case, however, indig- enous in England, is recorded among the medical fac- similes at Guy's Hospital. In Granada it was generally fatal after eight or ten years, whatever the treatment. This favors the correspondence of this disease with one one of those evil diseases of Egypt, possibly its " botch," threatened in Deut. xxviii, 27, 35. This " botch," how- ever, seems more probably to mean the foul ulcer men- tioned by Aretaeus (Be Sign, et Cans. Morb. A cut. i, 9), and called by him ricpSra or taxapi]. He ascribes its fre- quency iu Egypt to the mixed vegetable diet there fol- lowed, and to the use of the turbid water of the Nile, but adds that it is common in Cojle-Syria. The Tal- mud speaks of the elephantiasis (Baba Kama, 80 b) as being " moist without and dry within" (Wunderbar, Bib- lisch-Talmudische Med. Stes Heft, 10, 11). Advanced cases are said to have a canceraas aspect, and some even class it as a form of cancer, a disease dependent on faults of nutrition.
It has been asserted that this, which is perhaps the most dreadfid disease of the East, was Job's malady. Origen, llexapla on Job ii, 7, mentions that one of the Greek versions gives it, loc. cit., as the affliction which befel him. Wunderbar"(((< sup. p. 10) supposes it to have been the Tyrian leprosy, resting chiefly on the itching implied, as he supposes, by Job ii, 7, 8. Schmidt {Bib- lischer Med. iv, 4) thinks the "sore boil" may indicate some graver disease, or complication of diseases. But there is no need to go beyond the statement of Script- ure, which speaks not only of this " boil," but of " skin loathsome and broken," " covered with worms and clods of dust;" the second symptom is the result of the first, and the " worms" are probably the larvne of some fly, known so to infest and make its nidus in any wound or sore exposed to the air, and to increase rapidly in size. The " clods of dust" would of course follow from his " sit- ting in ashes." The " breath strange to his wife," if it be not a figurative expression for her estrangement from him, may imply a fetor, which in such a state of body hardly requires explanation. The expression my " bow- els boiled" (xxx, 27) may refer to the burning sensation in the stomach and bowels, caused by acrid bile, vi^hich is common in ague. Aretieus {De Cur. Morb. A cut. ii, 3) has a similar expression, ^epj.ui<yit] tCjv CTr\ayx^^'>v diov airb irvpoQ, as attending sjmcope. The " scaring dreams" and " terrifying visions" are perhaps a mere
symptom of the state of mind bewildered by imaccount- able afflictions. The intense emaciation was (xxxiii, 21) perhaps the mere result of protracted sickness.
The disease of king Antiochus (2 Mace, ix, 5-10, etc.) is that of a boil breeding worms (ulcus vermhwsuni). So SuUa, Pherecydes, and Alcman, the poet, are men- tioned {VlvLt.Vita Sullce) as similar cases. The exam- . pies of both the Herods (Josephus, A nt. xvii, 6, 5 ; War, i, 33, 5) may also be adduced, as that of Pheretime (Herod, iv, 205). There is some doubt whether this dis- ease be not allied to phthiriasis, in which lice are bred, and cause idcers. This condition may originate either in a sore, or in a morbid habit of body brought on by uncleanliness, suppressed perspiration, or neglect; but the vermination, if it did not commence in a sore, would produce one. Dr. Mason Good (iv, 504-6), speaking of l-idXiQ, ;[(a\(«(Tjuoc=cutaneous vermination, mentions a case in the Westminster Infirmaiy, and an opinion that universal phthiriasis was no unfrequent disease among the ancients ; he also states (p. 500) that in gangrenous ulcers, especially in warm climates, innumerable grubs or maggots will appear almost every morning. The camel, and other creatures, are known to be the habitat of similar parasites. There are also cases of vermina- tion without any wound or faulty outward state, such as the VenaMedinensis, known in Africa as the "Guinea- worm," of which Galen had heard only, breeding under the skin, and needing to be drawn out carefully by a needle, lest it break, when great soreness and suppura- tion succeed (Ereind, Hist, of Med. i, 49 ; De Mandelslo's Travels, p. 4; and Paul. ^gin. t. iv, ed. Sydenh. Soc). Rayer (iii, 808-819) gives a list of parasites, most of them in the skin. This " Gumea-worm," it appears, is also found in Arabia Petraja, on the coasts of the Cas- pian and Persian Gulf, on the Ganges, in Upper Egypt and Abyssinia (ib. 814). Dr. Mead refers Herod's dis- ease to LvTo^wa, or intestinal worms. Shapter, without due foundation, objects that the word in that case should have been not (jki'o\i]%, but tvXi) {Medica Sacra, p. 188).