back with them not only numerous diseases, but also the word "laza- 

 retto," as applied to a place for the isolation of the victims of com- 

 municable maladies. As a result lazarettoes were built outside the 

 gates of nearly all the principal cities of Europe. Leprosy itself had, 

 however, been introduced into Europe many centuries earlier. It is 

 spoken of as a foreign disease by the earlier Greek and Latin writers. 

 Pliny thinks that leprosy was introduced into Europe by Pompey 

 returning, to Rome from. Syria after his celebrated triumph over fif- 

 teen nations in Asia. It is implied that leprosy walked with the three 

 hundred princes before the triumphal car of the conqueror. These 

 surmises give rise to the interesting query whether leprosy was not 

 the first quarantinable disease introduced by sea. As a quarantinable 

 disease leprosy takes precedence in several ways. For instance, it 

 was the first quarantinable disease (quarantinable from the point of 

 view of the United States quarantine regulations) of which the 

 causative germ was discovered. 



During the epoch of the crusades leprosy became widespread in 

 Europe and resulted in the extensive establishment of isolation sta- 

 tions. Leper houses existed at Metz, Verdun, and Maestricht as 

 early as the seventh century, for long before the crusades the disease 

 had spread from Italy into the Roman colonies of Gaul, Britain, and 

 Spain, and thence into the most remote countries. Mathew Paris 

 estimates that at the time of the great epidemic of leprosy in western 

 Europe succeeding the movement against the Mohammedans 19,000 

 lazarettoes were in operation in Europe. Religious orders conducted 

 the houses bearing the name of St. Lazarus, but in northern Europe 

 many dedicated to St. George were under secular supervision. Not 

 only were persons suffering from leprosy and other contagious dis- 

 eases sent to such asylums, but the insane and individuals whose sep- 

 aration from society was deemed an advantage to the populace or the 

 ruling powers were also confined there. In these places of isolation 

 quarantine measures, that afterwards had their application at maritime 

 stations and ultimately were directed against yellow fever, developed 

 primarily. Lepers were not strictly confined to the leper houses. 

 They were, however, required to wear a special costume, to limit their 

 walks to certain roads, to give warning of their approach by sounding 

 a clapper, and to forbear communicating with healthy persons and 

 drinking from or bathing in any running stream. 



PEST AND EAKLT VIEWS OF ETIOLOGY. 



In connection with pest and later with syphilis the greatest advances 

 of mediaeval times took place in public sanitary methods, leading to 

 the establishment of maritime and land quarantines. During the 

 Middle Ages more attention was given to the isolation of leprosy than 

 of other diseases now known to be virulently contagious, for the reason 



