An Account of a Visitation of the Leprous Persons in the Isle of Guadaloupe: In a Letter to Mons. Damonville, Counsellor and Assistant-Judge at Martinico, and in the Office of King's Physician at Guadaloupe. By John Andrew Peyssonel, M.D. F.R.S. Translated from the French

14th. He rested well, and was seemingly well beyond expectation. His diarrhoea still continuing troublesome, he took the hartshorn decoction, with an addition of diascordium. 15th. I cut off the threads of the external wound, and continued dressings of digestive in the common method. 16th. He grew visibly better each day after; and on Sept. 7th I discharged him from any further attendance, his wound being entirely healed over, and he is in all respects very well, free from pain, or any inconvenience from the wound. He was kept seven and twenty days on chicken-broth, and never admitted to use any solids during that time: afterwards he was indulged with young chickens, &c. VII. An Account of a Visitation of the leprous Persons in the Isle of Guadaloupe: In a Letter to Mons. Damonville, Counsellor and Assistant-Judge at Martinico, and in the Office of King's Physician at Guadaloupe. By John Andrew Peyssonel, M.D. F.R.S. Translated from the French. SIR, Received the letter, which you honoured me with, and the order for visiting the persons afflicted with the leprosy. I was sensible of the misfortune of being ordered upon that commission: commission: I say misfortune; for such you will perhaps think it, when you have read this letter. It is now about 25 or 30 years since a very particular disease shewed itself in many persons in this island Grande Terre. Its beginning is imperceptible: there appear but a few livid-red spots upon the skins of the white people, and of a yellowish red upon the blacks. These spots in the beginning are not accompanied with pain, or any other symptom; but nothing can take them away. The disease increases insensibly, and continues several years in shewing itself more and more. These spots increase, and extend indifferently over the skin of the whole body. Sometimes they are a little prominent, but flat. When the disease makes a progress, the upper part of the nose swells, the nostrils are enlarged, the nose becomes softened; tuberosities appear upon the cheek-bones; the eyebrows are inflated; the ears grow thick; the ends of the fingers, and even the feet and toes, swell; the nails become scaly; the joints of the feet and hands separate and mortify: ulcers of a deep and of a dry nature are found in the palms of the hands and soles of the feet, which grow well, and return again. In short, when the disease is in its last stage, the patient becomes frightful, and falls to pieces. All these symptoms come on by very slow degrees, one after another, and sometimes require many years to shew themselves: the patient is sensible of no sharp pain; but feels a kind of numbness in his hands and feet. These people perform their natural functions all the while, eating and drinking as usual: and when even the mortification has taken off the fingers and toes, the only ill confe- consequence, that attends, is the loss of those parts, that drop off by the mortification; for the wound heals of itself, without any application: but when it comes to its last period, the poor sick persons are horribly deformed, and truly worthy of compassion. This shocking disease is observed to have several other unhappy characters; as, 1st, that it is hereditary, and that some families are more apt to be seized with it than others: 2dly, that it is infectious, being communicated per coitum, and also caught by keeping company with those so diseased: 3dly, that it is incurable, or at least that no remedy has yet been found to cure it. They have in vain tried mercurials, sudorifics, and every other regimen used in venereal complaints, under a notion, that this leprosy was the consequence of some venereal taint: but, instead of being of service, these methods rather served to destroy the patients; for, far from lessening the disease, the antivenereal medicines unlocked the distemper, the most dreadful symptoms appeared, and all those so treated perished some years sooner than the others, who did not take these medicines. A very just fear of being infected with this cruel distemper; the difficulty of examining infected persons before the disease came to its state; the length of time of its lying concealed, by the care of the patients to keep it secret; the uncertainty of the symptoms, which distinguish it in the beginning; produced an extraordinary dread in all the inhabitants of this island. They suspected one another, since virtue and merit had no shelter from this cruel scourge. They called this distemper the leprosy; and consequently presented several memoirs to the generals and intendants, intendants, laying before them all these facts above- mentioned; their just apprehensions; the public good; the trouble, that this distrust caused in this colony; the complaints and hatred, that these ac- cusations occasioned among them; the laws made formerly against such leprous persons, and their ex- pulsion from civil society. They required a general visitation of all persons suspected of this distemper, that such, as were found infected, might be re- moved into particular hospitals, or into some separate places. These memorials were sent to court, which, giving due attention to these just representations, issued or- ders for the required visitations in the most conve- nient manner, for the good of the public and of the state. In the mean time, the post of physician-botanist became vacant in the island of Cayenne. The mini- ster was pleased to name me for it; and altho' this island was much more fertile in philosophical disco- veries than all the others, he thought proper to change my destination, and sent me to this isle Guadaloupe; and did not forget the article of the leprosy in my instructions. When I arrived at Martinico in 1727, Monsieur Blondel de Juvencourt, then intendant of the French isles, communicated to me both the orders of the court, and all the memoirs, that related to this affair. A tax was then laid upon the Negroes of the inhabitants of the Grande Terre, to raise a necessary fund for this visitation, thus made at the expense of the colony; and Mons. le Mercier Beausoleil was chosen treasurer of this fund. Being arrived at Guadaloupe, the Count de Moyencourt, and Mons. Mefnier, ordinator and subdelegate to this intendance, communicated to me the orders of the general and intendant. I began then to inform myself of the necessary instructions for acquitting myself of this dangerous commission, the disagreeable consequences of which I easily foresaw. I had so often heard of these leprous spots, that I judged it necessary to know, whether what was said was true: for I could not comprehend, that a disease, which has so dreadful an end, and the symptoms then so terrible, should continue ten or fifteen years without any other appearance than these simple spots; which, in themselves, had nothing very bad. I demanded an inquest to be made, in order to satisfy myself of this fact: several surgeons, as practitioners, and several honest inhabitants, as observers, were accordingly called together, who all proved the same fact in this inquest; which you, Sir, may, and must, have seen in the register of the subdelegation of this island. I am, most sincerely, SIR, Your most humble and obedient Servant, August 10. 1748. Peyffonel. RESULT of the VISITATION. 1st, NONE of the patients, whom we visited, had any fever; and they all declared, that they found no inconvenience nor pain; but, on the contrary, eat, drank, and slept well, performing every natural natural function; which was proved by their plumpness, which appeared even when the disease was most confirmed. 2. The disease began to shew itself in the Negroes by reddish spots, a little raised, upon the skin, being a dry kind of tetter, neither branny nor scabbed, and without any running, but of a livid-red, and very ill-conditioned. The Negroes sometimes bring these spots with them from their own country. The spots are constantly found upon every person troubled with this disease; and are in greater numbers, in proportion as the disease grows more inveterate. 3. Among the whites the disease shews itself at the beginning by spots of a livid violet colour, without pain; which are followed by little watery bladders, particularly upon the legs, which burst, and leave small ulcers with pale edges, and different in their natures from the common ulcers. 4. In proportion as the disease increased, the hands and feet grew larger, without any signs of inflammation; since neither redness, nor pain, nor any oedematous appearance accompanied it; but it was the very flesh, that increased in bulk. And this growth of the hands and feet was not attended with any sharp pain, but only a kind of numbness. 5. This bloated state of the hands and feet was succeeded by white deep ulcers under the skin, which became callous and insensible; and which emitted only a clear serous matter like water, and were but little painful. Afterwards the ends of the fingers became dry, the nails became scaly, and, I don't know how, they were eaten away; the ends of the fingers dropt off; then the joints separated without without pain, and the wounds cicatrized of themselves, without the least need of medicines. In the increase of the distemper hardnesses and lumps were formed in the flesh, the colour became tarnished, the nose swelled, and the nostrils grew wide: at last the nose softened like paste, the voice became hoarse, the eyes round and brilliant, the forehead covered with tetters and lumps, as well as the face; the eyebrows became very large, the countenance was horrible, the breath foetid, the lips swelled, large tubercles were formed under the tongue; the ears grew thick and red, and hung down; and, such was the insensibility of all the parts, that we run pins thro' the hands of several, without their feeling any thing of it. In short, we were assured, that these people perished by degrees, falling into a mortification; and the limbs dropt off of themselves, without any considerable pain, continuing still to perform well their natural functions. 6. These leprous people lived thus easy, if I may be allowed the expression, for several years, even fifteen or twenty; for the disease begins insensibly, and shews itself but very slowly. 7. Antivenereal remedies, which were ordered for almost every patient we saw, were of no service: if they sometimes palliated some symptoms, they very often hastened the progress of the disease: besides, we never found the parts of generation at all infected, nor any thing, that looked like the pox, about them. 8. Some of these people had indeed particular symptoms. In some the hair fell off; which was replaced by a finer kind: in others, worms were found found in their ulcers: want of sleep, or frightful dreams, afflicted some; while others quite lost their voice, or it became effeminate like that of eunuchs; and others, we found, stunk extremely. 9. Almost all of them, being desirous of concealing their disorders, endeavoured to deceive us, by alleging false excuses for the causes of their sores and ulcers: the greater part of them pretended, that the rats had eaten off their toes, and that burns had caused their ulcers. These were the figures, that everywhere presented to us. 10. We were confirmed in our opinions by experience, supported by verbal process, that this was the state of the diseased; that the distemper could neither be the pox, nor the effect of an inveterate one: that it had no symptom of that disease; but that it had every character of what the ancients called leprosy, elephantiasis, or such other names, as they were pleased to give it. So that we do not hesitate to pronounce, that those infected with this disease, as we have described it, ought to be treated as leprous persons, and subject to the ordinances, which his majesty was pleased to issue against such persons. 11. Again, we are well assured, from our observations, that the distemper is contagious, and hereditary; and yet the contagion is not so active, nor poisonous, as that of the plague, small-pox, nor even as the ring-worm, itch, scald, and other cutaneous disorders: for, if that were the case, the American colonies would be utterly destroyed; and these persons so infected, mixed as they are in every habitation, would have already infected all the Negroes, whom they come near. 11. We 12. We believe, that this contagion does not take place but by long frequenting the company of the infected, or by carnal knowledge. Besides, we have observed, that even such long frequenting, or cohabiting with them, are not always sufficient to communicate the disease; because we have seen women cohabit with their husbands, and husbands with their wives, in the distemper, while one is found, and the other infected. We see families communicate and live with leprous persons, and yet never be infected; and thus, altho' experience, and the information of the sick, prove the contagion, we are of opinion, that there must be a particular disposition in people to receive the poison of the leprosy. 13. As to what regards the distemper's being hereditary, it is assuredly so. We have seen entire families infected; and almost every child of a leprous father or mother fall insensibly into the leprosy; and yet, in several other families, we have seen some children sound, and others tainted; the father has died of the disease, and the children grew old without any infection: so that, tho' it is certainly hereditary, yet we believe it is of the same nature with those in families troubled with the consumption, gravel, and other hereditary distempers; which are transmitted from father to son, without being so very regular, as to affect every one of the family. 14. We could never find out any certain rule of judging, at what age the disease shews itself first in those, who were begotten by infected parents: but we have, as far as we could, observed, with regard to women or girls, that the symptoms begin with the menses, and continue slightly till they have lain- in of one or two children: but that then more visible, and indeed more cruel, symptoms appeared. As to men, or infants, there is no rule to know it in them. 15. For the explanation of the causes, symptoms, and what we think the most likely means of cure, we refer to a particular dissertation. Let it suffice here to observe, that we do not imagine, that the air, water, or manner of living, can produce it; for we have found as many sick in the low marshy places, as in more airy saline places: and if many Negroes were infected in the Grand Terre, where they drink the foul waters of ponds and lakes, we see an equal number ill in places, where they have fresh rivers and running waters; but they may prove proper causes for unlocking, and disposing persons to receive, the disease. 16. We believe, and are persuaded, that the origin of this disease among the Negroes comes from Guinea: for almost all the Negroes from that country told us they came from thence with these reddish spots, the first and certain signs of the distemper begun. 17. As to the infected Whites and Mulattoes of this island, we were informed, that the disease was not known among the Whites till about 25 or 30 years ago; when, out of charity, they received a miserable object from the island of St. Christopher's, whose name was Clement; who, about the year 1694, fled hither. It was the family of the Josselins, called the Chaloupers, that protected him; which family, as also that of the Poullins, we found infected by communication with this sick man, as old Poulin declared to us. It is thought, that others were infected by communication with the Negro women, especially in the beginning, when the disease is much concealed, and at a time when they did not mistrust one another; which is very probable, since we saw many Mulatto children, born of female Negroes, infected and leprous. 18. However this be, this distemper has had its progress; and in this visitation, which we made, we examined 256 suspected persons; that is, 89 Whites, 47 free Mulattoes, and 120 Negroes: among whom we found 22 Whites, 6 Mulattoes, and 97 Negroes, infected with the leprosy, amounting to 125. There were six Whites and five Negroes more, whom we could not visit, for reasons set forth in the verbal process. The remaining persons, which were 131, appeared to us very found: not that we can answer for the consequences, especially with respect to the children, who are the offspring of leprous persons; whether declared such by us, or dead before the visitation, suspected of infection. This is the opinion, declaration, and result of the visitation made by us, the physicians and surgeon appointed for that purpose. At Basseterre, the day above-mentioned. Peyssonel. Lemoine. Moulon. A second visitation was made in October 1748.