The medieval diagnosis of leprosy • 207 



nose" may well refer to the contracted/collapsed nose that is 

 so common in advanced, borderline, lepromatous leprosy 

 and lepromatous leprosy. All in all a modem leprologist has 

 little to add to his description of LRL. 



It is remarkable that the famous physician, Claudius 

 Galenos (a.d. 130-201), who has been held in such high 

 regard through the ages, should fail to add to previous knowl- 

 edge. 



Medieval texts 



When we move on to the medieval writers we must remem- 

 ber that their knowledge of the classical literature came from 

 translations of the original Greek and Latin into Arabic and 

 retranslations into Latin. From this time until the end of the 

 lyth century, the terms lepra and elephas (and derivatives) 

 are used alternately to describe the same disease. The confu- 

 sion with biblical "leprosy" is a later phenomenon. 



One is frequently struck by the simple mention of what is 

 obviously intended as a description, but without the defini- 

 tion and explanation that we expect from a medical text. It 

 probably means that the text is intended as a vade mecum, 

 while the detailed teaching is presumed from a direct teacher- 

 student relationship. The teaching hexameters in Flos Medic- 

 ina (de Gaddesen 1492) provide good examples: 



De Signis Variarum Specierum Leprae 

 Candescit cutis in tyria, mollescit et albet. 

 Nee membris lymphae profusio facta cohacret, 

 Signa leoninae: manuum fissuraque pedum, 

 Aspcra rupta cutis, macies, pruritus et ardor. 

 Vox est rauca, color citrinus, mobile lumen. 

 Fit gingivarum corrosio, naris acuta 

 contrahit et spasmat, species elephancia nervos, 

 corrugat naris, oculos facit esse rotundos, 

 tubera dura rigent, caro livida, sqalidus unguis 



Or in translation: 



When the skin pales and is blotched, it is taken as symptom 



of tyria. 

 Then there is no longer lymph to be found in abundance in 



the members, 

 Leo you know from the cracks which are found in the 



hands and the feet. 

 Also in them you find broken skin, leanness and itching 



and buming. 

 Hoarse voice and a face with the color of lemon, and eyes 



which are roving. 

 Gums which are eaten away, while the nostrils arc pinched 



and obstmcted. 



Amaldusde Vila Nova (a.d. 1235-1312) is a typical propo- 

 nent of medieval knowledge of leprosy, from De Signis Lep- 



rosorum Libcllus we glean: 



Si vox rauca est, forte signum est leprae [laryngeal infiltra- 

 tion] 



In superciliis oculorum leprosi non habet pilos maxime 

 apud angulos |madarosis| 



Supercilia habent quandam rotunditatem, qua videntur 

 quasi spherica et rotunda (lagophthalmos with re- 

 tracted eyelids] 



Oculi videntur quasi exire locum eorum |lagophthalmos 

 with pscudocxophthalmos] 



Facies — habet aspectum niultum terribilem [lagophthalmos 

 and /or facial infiltration] 



Leprosi cognascuntur ex vulnere existente in naribus Jendo- 

 nasal ulceration] — excoriatio in profunditate nasi [in 

 contradistinction to e.g. scrofulosis]. 



He even has an excellent description of how to examine for 

 loss of sensation: 



Item facias ipsum cooperiri ne videat et sibi die: cave quod 

 ego te pungam, et no pungctur, et post die punxi te in pede. 

 Si dicat quod sic, signum est leprae. 



He also presents the first definite description of ulnar loss of 

 sensation and paralysis. This speaks highly of his acute 

 powers of observation: 



Item debet pungi cum acu a minimo digito manus ct sibi 

 vicio usque ad brachium, quod in instis digitis magis aliis 

 ratio est, quod sunt debiliores et ideo citius dimittuntur a 

 regimine naturae. 



Taken as a whole, this presents a clear picture of LRL. Indi- 

 vidual symptoms might be read as referring to HRL, but it is 

 obvious that the descriptions as a whole cover one single 

 condition, LRL. 



Conclusions 



From the earliest description of leprosy in the Mediterranean 

 world through the Medieval period, leprosy is well de- 

 .scribed. An exact correlation with modem, immunological 

 classification is not possible. It is possible to define 

 classification using the terms that are used in paleopathology. 

 The literature descriptions cover LRL. No clear reference to 

 HRL can be found. It is not possible to reconcile the descrip- 

 tions with other diseases, nor is it possible to read descrip- 

 tions of other diseases as leprosy. Available paleopathologi- 

 cal findings present the same picture (e.g., M0ller- 

 Christensen et al. 1952. 



We are left with a puzzling problem: Why does HRL only 

 appear toward the end of the 19th century? Has the immu- 

 nological response of the population changed? Is it a question 

 of interaction with other mycobacterial diseases, such as 

 tuberculosis? Or, most improbable, has Mycobacterium lep- 

 rae changed? 



Zagreb Paleopathology Symp. 1988 



