206 • Jobs G. Andersen 



Figure 1 . The relationship between different classifications of leprosy. 



Classical texts 



Unfortunately the earliest literary reference to leprosy in the 

 Mediterranean world has been lost. We know it only from a 

 quotation in the works of Oribasius (a.d. 326-403). He men- 

 tions that Straton, famulus of Erasistratos from Keos (300- 

 250 B.C.) describes elephas as a new disease. It is not clear 

 how much of Oribasius's description is attributed to Straton, 

 and how much represents his own observations. In any event 

 the nodules, ecchymosis-like skin lesions, and the nonheal- 

 ing ulcers definitely point toward LRL. The picture is more 

 appropriate to leprosy in light-skinned races. This may be 

 confusing to leprologists who are accustomed to dealing with 

 dark-skinned races. 



Albinovarus Cornelius Celsus (25 b.c.-a.d. 37) mentions 

 leprosy as a relatively new disease in Italy. He writes a re- 

 markably lucid, beautiful Latin, which leaves no doubt that 

 he describes LRL: "Crebri tumores" exactly fits the appear- 

 ance of partly confluent, nodular infiltration. "Summa cutis 

 indaequaliter crassa, tenuis, dura, mollisque, quasi squamis 

 exasperatur" reads as a description of borderline lepromatous 

 leprosy with the characteristic, irregular, ring lesions with a 

 flat center, pseudopodia-like spread, and a shift to the lep- 

 romatous side with widespread macules. "Digiti in manibus 

 pedibusque sub tumore conduntur" recalls the patients with 



partial digital absorption and swelling of hands and feet due 

 to reversal reaction. "Ossa quoque vitiari dicantur" could be 

 a reference to peripheral absorption or to ulcer-induced bone 

 destruction. In any case it fits very well into the whole pic- 

 ture. 



Caius Publius II Plinius (a.d. 23-79) is a typical poly- 

 historian who writes extensively about everything. He is not 

 a medical man. The main interest in his writings is the fact 

 that he specifically mentions that leprosy was unknown in 

 Italy prior to the return of Gnaeus Pompeius Magnus (106- 

 48 B.C.) from the Pontine campaign in 62 B.C. 



Aretaios Kappadox (ca. a.d. 200) is without doubt the 

 most lucid and informative of the authors from this period. A 

 number of interesting points can be gleaned from his writ- 

 ings: Elephas (i.e., leprosy) is also known as leo. This pre- 

 sumably refers to facial infiltration. He is aware of the insid- 

 ious beginning of the disease, and mentions that foul- 

 smelling respiration is characteristic. "Tumors of the body" 

 easily reads as "nodular infiltration." Hoarse voice and loss 

 of hair arc characteristic symptoms. Leprous alopecia geo- 

 graphica is extremely rare in dark-skinned races, but fairly 

 common in advanced borderline lepromatous or lepromatous 

 leprosy in light-skinned races. 



As a surgeon I am particularly intrigued by the first men- 

 tion of plantar cracks and ulcers. The expression "loss of 



Zagreb Paleopalbotogy Symp. I9RH 



