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pearance is not equally marked in all; but the following may serve as their general history and form.
[This description is longer than our limits will permit, aud, in the face, not materially different from other authors.]
The body usually escapes better than the limbs, but is not always entirely free. The genitals have been already described.
In the upper and anterior part of the thigh, nearly in contact with the lower part of the scrotum, there is, in almost every case, a firm (to appearance) glandular swelling, moveable and prominent, or concealed, according as the patient is fat or lean, or in proportion to the progress of the disease. It is remarkable that none of the women are without it. In most of the men these tumours are particularly prominent, extending gradually upwards. In some there are also inguinal buboes. In every case the swellings are indolent, never giving pain, nor becoming discoloured, nor showing any disposition to suppurate.
When the disease arrives at such a state, as to distort the lip, nose, eye-brow, or lobes of the ear, it will require little more than common observation to detect it. But, if these are so little affected as to reuder it doubtful, we should always examine the upper anterior part of the thigh, towards the genitals, for that tumour, which I have called glandular, but the exact nature of which cannot be ascertained without dissection. In the mean time it may be easily distinguished from those buboes in the groin, which are formed by venereal or any other causes, producing inflammation in the genitals or lower extremities. These are usually in the hollow of the groin, hard, and immoveable till they begin to lessen, as inflammation subsides. On the contrary, the tumour from leprosy is never very hard, always more or less moveable, without pain or discolouration of the integuments, usually much larger than the common bubo, and lower in its situation. There is, indeed, some variety in the height, size, and mobility, but never sufficient to confound it with the inguinal bubo. It should be further remarked, that in a few instances I have found the inguinal bubo and femoral tumour in the same subject. In two subjects also, in whom the disease was, in other respects, well marked, I have discovered only a general thickening of the integuments over the part where the femoral tumour is usually found. In one of these was a similar, thongh smaller, tumour in the band. In young subjects, particularly boys, before the age of puberty, if we see any marks of approach towards that state, we ought to suspend our judgment, till we discover signs of the disease the most unequivocal and certain.
The two diseases, with which that of the lazar house has been coufounded, are the leprosy of the Greeks, and the elephantiasis of the moderns, or, as it is usually termed in England, the Barbadoes leg. This confusiou has been much increased, because the disease of lazar house has been by some authors called leprosy, and by others elephantiasis, or even in the same work has been called by both names. It is true, that the most accurate among the ancient writers use no other term than elephantiasis: but that this confusion has existed among the moderns, will appear by quotations from two well received authors, whose object was to characterize the diseases with more accuracy than their predecessors. Dr. Mead remarks, that “the Syrian leprosy," (which before he calls elephantiasis), “ did not differ in nature, but degree, from the leprosy of the Greeks;" and Vogel, after describing the elephantiasis of the ancients, adds, as a division elephantia ; " Eadem duntaxat in pede valde tumido et duro.” Thus we see Mead considers leprosy and elephantiasis as the same disease, without hinting at the enlarged limb; and Vogel considers the elephantiasis of the ancients and the moderns as the same disease, only attacking different parts. ft may, therefore, be right to observe, that when I use the single term elephantiasis, my wish is to confine it to the modern disease.
Thas we have,
1. The Arabian or Syrian leprosy, or elephantiasis of the ancients; the disease already described.
2. The leprosy of the Greeks.
3. The elephantiasis, or elephantiasis of the moderns, called also the Barbadoes leg.
[A description of the two latter diseases follows.]
To conclude this part of the subject, it may be enough to remark generally: 1st. That lepra Grecorum is distinguishable by the scales being
coeval with, and as general as the disease--whilst in lepr.. arabum they never appear but in an advanced stage, and then
only partially. 2dly. That elephantiasis of the moderns, or the Barbadoes leg, is
distinguishable by the enlarged glands being always in the groin -by the pain and increase they suffer with each returning paroxysm of fever-by the sudden swelling of the limb at the same time-by the thickening of the skin, without any loose furfuraceous scales, and by the tubercles, if there are any, being horny and rough, instead of the semi-transparent smoothness
of those in the Arabian leprosy. Though the lazars rarely arrive at old age, they, for the most part, seem to die of other complaints. I recollect, at the period of an influenza, these people suffered earlier and more severely than any others.
Though, by the account from a woman who resided for some time in the house, it is certain that the disease cannot be highly infectious, yet it is right to remark some circumstances, which I shall leave others to determine, whether they should be considered as merely coincident.
The porter of the house is become a lazar since his residence in the lazaretto: but he is the only servant, since its establishment, who has shown the disease.
Besides the married couple now in the house, the accounts I collected mention two other women, whose husbands were lazars; but in these cases we must recollect the same mode of life, local residence, and probably some consanguinity.
It appears not only that the Greek writers were unacquainted with the swelled leg and foot, which afterwards acquired the name of elephantiasis among the Arabs, but that the Latins were ignorant both of this and of the elephantiasis of the Greeks. By an attention to these particulars, we shall readily discover the cause of that confusion of names above mentioned.
When the medical school was transferred from Greece to Arabia, where the swelled leg and foot was a frequent disease, and the elephant often in sight, it was impossible not to be struck with the similarity. I pretend not to deiermine whether the Arabs had
previously distinguished this swelling by a name which had reference to that animal; but it is certain that the term elephantiasis was by them applied to a disease no where noticed by the Greek physicians, from whom the word was adopted.
When the sciences found iheir way back to the west, and the Salernian school was established, it is well known that the Arabic writers were at first the principal sources of information; and, as the Arabians had not only appropriated the term elephantiasis to a disease of their own, but had given the term leprosy to elephantiasis of the Greeks, a confusion must have arisen in the translations through the different languages. However, the Latins soon found it necessary to distinguish between a disease which was easily cured, viz. the leprosy of the Greeks, and one which the old writers had denominated a cancer of the whole body; that is, a disease gradually increasing in whatever part it combienced, and without a remedy. Hence the distinction between lepra Grecorum and lepra Arabum, which last they perceived must be the elephantiasis of the Greeks.
Though they had thus discovered the difference between the Greek and Arabian leprosy, they had less inducement to inquire after the Greek and Arabian elephantiasis, because they were equally ignorant of both, or saw them so seldom, as to confound them with the more intractable state of other diseases, with which they were better acquainted. At length the appearance of syphilis produced a more accurate research whether this disease could be discovered in the writings of the fathers of physic who, about this time, began to be studied in their native tongues. It was then found that the Arabian writers confined the term elephantiasis to a disease in which the leg and foot are much swelled, and which was unnoticed by the Greeks.
To pursue the subject through the whole controversy, would be more ostentatious than useful. Those who wish to follow it beyond the quotations produced by Lorry, may consult Sebastian Aquilianus, Nicol. Leonicenus, and several others, preserved in the Luisinian collection. To do justice to the industry of these writers, we should recollect, that the works of Aretæus were not recovered from the rubbish under which they were concealed for near half a century after that time. The Italians, therefore, could only discover the meaning of the Asiatic Greeks from the writings of Galen and bis commentators, whose descriptions are very obscure, and scattered in different parts of his works.-Adams on Morbid Poisons, second edition, 1807.
Dr. GOURLAY, in his History of Madeira, considers this wasting of the testicles as a leading character of the disease.
About six years ago, a case occurred at St. Bartholomew's Hospital. The subject was a mulatto, and, though by no means young, had no hair on the pubes. He died in the house, and his body was afterwards examined. We do not recollect any record of the event, so that, if any gentleman, a student at the time, has preserved minutes, we shall very thankfully receive them.
The next case was in the same house, and particularly interesting, by having attracted the notice of a considerable number of the faculty in the metropolis, and by being recorded in several collections. The following is Mr. Lawrence's account in the sixth volume of the Medico-Chirurg. Trans.
" An inguinal gland on each side was rather more distinct than usual. The condition of the generative organs corresponded with the description of Dr. Adams just alluded to. Not only had their development been arrested from the time when the disease broke out, but they had actually undergone diminution decay. The scrotum was shrivelled, and seemed empty; the testes could with difficulty be felt; they were soft, and about the size of small borse-beans."
The following is Dr. Roberts's account of the same subject in the Med. Trans. of the London College of Physicians:
“His genitals diminished in size, from which also the hair disappeared, as well as from the eye-brows and arm-pits; that, after his landing, some tubercles were formed also on the hands and feet, and he confessed, what might reasonably be expected, that he had no sexual desires:"_" there were, besides, glandular tumours near the groin on both sides.”
The last case is contained in the Medico-Chirurg. Journal, and was transcribed in our last Retrospect.
We conceive from this time it will be impossible to mistake a disease so strongly marked, and, whilst we must feel every sentiment of commiseration for sufferers so wretched that nature seems on that account to have placed a veto against their propagation, it is at least some relief to reflect that they are no longer to be dreaded as formidable to the softer sex, or dangerous hy an intercourse with the rest of the world. Under these apprehensions, they were once driven into wilds and uninbabited deserts: in the
of improved society, they were only sentenced to a solitary confinement: in the present improved state of knowledge, they are permitted all the few enjoyments their unhappy condition permits.
Account of the fatal Accident which happened in the Leadhills
Company's Mines, the 1st March, 1817. By Mr. JAMES BRAID, Surgeon, Leadhills.
On 1st March last, I was sent for, about seven o'clock A. M., to try if any thing could be done for a number of men, who were
found in the Leadhills Company's mines, who appeared to be suffocated.
On the 30th December, 1816, a young man, who kept a fireengine nearly 600 feet below the surface, was found dead, and the air where he was not, to be at all agreeable:---the usual modes of resuscitation were tried, but without any good effects.
On the 24th of February, 1817, there were several men very severely affected from the bad state of the air, but, by giving thein gentle laxatives, and keeping them quiet, they got pretty well again in the course of a few days.
On the 1st of March, none of the men had got to bank when I arrived, except a few who had been down only a very short time, and returned upon finding the air so bad. By and bye, a number. of those who had been down for a short time, at 25 fathoms, were brought up, and most of them quite furious. Some were disposed to fight; others, supposing every one they saw. disposed to lay hands on them, made efforts, under the most extrenie terror, to escape; others, quite listless, appeared to take no notice of wbat was going on around them. Some were singing, and some praying. Many were as if intoxicated with ardent spirits: those who had seen them in that state assured me their actions were very much the
Many of them vomited, and others had the inclination, but could not do so. Some evacuated the contents of the rectum, and others had the desire without effect. The pulse was different-in some remarkably quick and feeble; in others slow, feeble, and irregular. Most complained of insufferable head-ache, which was somewhat relieved after vomiting. To those who had a desire to vomit without effect, I gave an emetic of sulphate of zinc; and to those troubled with tenesmus, a laxative glyster: both were followed by an alteration of symptoms.
In the course of two or three hours from the time they were brought to bank, the pulse was greatly accelerated, and hard. I prescribed a brisk purgative, after the operation of which they found themselves greatly relieved, and, by enjoining a cooling regimen, most of them got pretty well, in the course of a few days,
other medicines. Upon inquiring of the men how it affected then, they said they first felt a difficulty of breathing, and had frequent involuntary deep inspirations--then a violent pain and beating in the head, with ringing of the ears the inferior extremi. ties became weak, and very painful immediately above the knees, and they could with difficulty support the body-the heart palpitated violently-great anxiety, and in some followed by vomiting. They now became giddy, and lost all recollection, and were, as has been remarked, affected as if they had taken a large dose of ardent spirits.
There were four men, however, at 25 fathoms, who were irrecoverably lost through their own imprudence of going to work at irregular hours. Though six o'clock A. M. was the proper hour, two had gone before four, and other two a little after, in order