LEPROSY.
Geographical Distribution (§ 1)..
Biblical Conception (§ 2).
General Treatment of Lepers (§ 3).
Lepra Mosaica (§4).
Lepra Tuberosa (§ 5).
Lepra Maculosa, Lepra Anaesthetica (§ 6).
This disease has existed from times preceding the ages of which history takes cognizance in its backward sweep, has spread widely over the civilized and barbarous world, and still exists endemically in some regions. The Hebrews were i. Geo- sorely afflicted with it before leaving
graphical Egypt (indeed, the banks of the Nile,
Distribu- with their humid atmosphere, seem to tion. have been a cradle of the disease) ; so much so, that, according to the historian Manetho (Josephus, Apion, i. 26), the Egyptians drove them out on account of this plague of leprosy. It probably existed in Syria before the Hebrews came bringing it with them into that country. From Egypt and Palestine it spread to Greece and Italy, and other countries bordering upon the Mediterranean. It appears to have been introduced into Central and Western Europe somewhere between the twelfth and thirteenth centuries, probably through the agency of the returning crusaders, and spread with alarming rapidity. Toward the end of the fifteenth century it had almost disappeared from those sections of Europe. At present, leprosy, or Elephantiasis Grecorum, is found on the coasts and islands of the Mediterranean, Black, and Caspian Seas, in Norway, Asia Minor, Syria, and Palestine, on the coasts of the Indian and China Seas, in the islands of the Australian Archipelago, in South and Central America, in Hawaii, in some parts of the United States, and in Iceland.
By almost all peoples and races, leprosy has been regarded as a visitation of God on account of some sin, and the lepers have been kept apart from the rest of the people. The Jews were told that it came upon a man for idolatry, blasphemy, unchastity, theft, slander, false witness, false judgment, perjury, infringing the borders of a neighbor, devising malicious plans, or creating discord between brothers. Lepers were considered unclean (Lev. xiii. 44-46), had to rend their garments (excepting in the case of the women), cover 2. Biblical their faces, go with unkempt hair, Conception, and cry, " Unclean, unclean! " They had to live without the camp or city; had a special part of the synagogue reserved for them; and any thing they touched, or any house
Leprosy
THE NEW SCHAFF-HERZOG
into which they entered, was declared unclean. An elaborate ceremonial was prescribed for the cleansing cf the leper when the disease had left him (cf. Lev. xiv., and see Diseases and the Healixg Art, Hebrew). Among the Jews, not only was leprosy considered as attacking human beings, but also it was declared to be in garments, houses, and vessels (Lev. xiii. 47-59, xiv. 33-53) ; and ceremonies were prescribed for their cleansing. The exact nature of this leprosy of garments and houses is not known. Its distinctive signs were, in a garment, greenish or reddish spots which spread; in a house, greenish or reddish streaks lower than the surface of the wall which spread. This was, probably, in either case, a species of mildew, or else indicated the presence of some fungus, which, by contact, would generate disease in the human (see House, The Hebrew, and Its Appointments). The Jerusalem Targum regarded it as a visitation on a house built with unjust gains.
The Persians went even further than the Jews, and excluded foreign lepers from their country. The Greek writers thought leprosy was a punishment for some sin against Phcebus. The Arabs will neither sleep near nor eat with 3. General lepers, nor marry into families known Treatment to be leprous. By the Church of Rome of Lepers, in early ages, lepers were regarded as dead, and the last rites of the Church were said over them. In 757 a.d. it was declared a ground for divorce, and the sound party could marry again. In France, at different times, laws were passed forbidding lepers to marry. The leper lost all control of his property, and could not inherit any; he could not act as a witness, nor challenge to a duel. Oddly enough, while, in general, leprosy was regarded as a punishment, in some parts of Europe it was held to be a sign of divine preference for those attacked; as, in a woman, it was to preserve her chastity. Lepers were regarded as saints, and received much honor and alms. All over Europe the lepers had to live apart, and had special churches, priests, etc. In the fifteenth century a special dress was prescribed for them. The houses in which these unfortunate ones lived were called " lazar-houses." They were generally located just outside the gates of the cities, in close proximity to some body of water, so that the inmates could bathe. They were usually religious in character. The inmates had to be silent, and attend morning prayer and mass; and in some of the houses they had to say so many prayers each day that they had very little time for anything else. No woman was allowed to enter the male lazar-houses, excepting the washerwoman; and she had to be of sober age and good manners, and must enter the house at a fixed time of day, when she could be seen of all. A female relative had to obtain special permission before she could speak to a male leper. These houses were supported largely by begging, entirely by alms.
Between what is called " leprosy " in the English Bible, and the leprosy as described by the best authorities on skin diseases, there is very little correspondence: indeed, the writer is inclined to adopt the theory advanced in the article on lep-
rosy in Smith's Dictionary of the Bible (American
edition, ii. 1630), that the leprosy of the Mosaic
dispensation (Lepra Mosaica) is not
4. Lepra one disease, but an enumeration of Mosaica. certain symptoms, which, on account
of their frightful character, and tendency to spread, would render the individual an object of aversion, and demand his separation. It is certainly but in few points akin to Elephantiasis Grecorum, the modern leprosy. The symptoms of leprosy, as in Lev. xiii., and the expressions used there and elsewhere, " leprous," " white as snow " lead one to conjecture that Lepra Mosaica is analogous to Lepra vulgaris, more commonly called Psoriasis. Of Lepra Mosaica (Heb. zara'ath), the leprosy of Lev. xiii., xiv., the most marked symptoms were " a rising, a scab, or a bright spot," " in the skin of the flesh " (Lev. xiii. 2), with a hair turned white in the rising, scab, or bright spot, these being deeper than the scarf-skin (xiii. 3), and spreading of the scab, etc. (xiii. 7, 8). As a more advanced case " quick raw flesh in the rising " (xiii. 10) is noted. Verse 18 implies that the disease may take its origin in a boil, with the same symptoms. In verse 29 the disease appears in the beard, or hair of the head, coming in the form of a scall, with thin yellow hairs in the patches. These are all the symptoms; they are probably given merely as initial symptoms, so that the priest might recognize the onslaught of different diseases in their earliest stages. The " rising " may correspond to the tubercles of Lepra tuberculosa, or the bulla of Lepra anasthetica of recent authors. The scall of the head may be the Morphea alopeciata, or Foxmange, placed by Kaposi (Hautkrankheiten, Vienna, 1880) as a subdivision of the second form of leprosy, Lepra maculosa. Verses 12-17 state that if the patient is white all over he is clean, no doubt because the disease had then run its course. In this case it is probably a general Psoriasis.
Modern leprosy, Elephantiasis Grecorum, is divided into three varieties: (1) Lepra tuberosa, the tubercular form; (2) Lepra maculosa, the spotted or streaked form; (3) Lepra anceslhetica, the anesthetic form. For months or years before the outbreak of the disease, the patient may have vague prodromal symptoms, as weakness, loss of appetite, sleeplessness, lassitude, slight fever, diarrhea and sometimes pemphigus blebs (little blisters).
In Lepra tuberosa the disease begins with the outbreak, on the general surface of the body, of irregular or round-shaped spots, in size from a finger-nail to the palm of the hand; at first red, and disappearing under pressure; soon becoming gray to sepia brown or bronze color. Over the spots the skin is smooth and glistening (as if painted with oil), or bronzed and thickened, or slightly prominent, and painful on pressure. The spots are distributed over the trunk and extremities, face, hands, and feet. In some situations they become confluent; in some, disappear; in others, disappear
5. Lepra in the center, while the peripheries ex- Tuberosa. tend, thus forming ring shapes. The
tubercles, the distinctive type of this form, appear after the disease has lasted months or years; are of various sizes, up to that of a hazel-