Leprosy

“Even language contributed obstacles to the development and teaching of a reliable semiology. . . It was difficult to teach the recognition of a disease when supposedly different names for symptoms were as imprecise and fluid as, for example, ‘glands’ . . . which also referred to buboes, goiters, and the neck growths of scrofula.” Further linguistic problem was “the frequent disjunction between depictive impressionism and anatomical precision, which may be sampled in various descriptions of ocular symptoms” (e.g., a darkening of the eyes, tending to reddishness, a reddening of the eyes, as a disturbance of the white of the eyes associated with lividness or darkening). “Subsequent authors failed to integrate these traits, nor did they correlate them with the classical descriptions of Galen or Aretaeus (Demaitre, loc 1329-1334). Leanred practitioners “faced a triple challenge of distinguishing – in one decision – between congruent and disparate phenomena, between unequivocal signs, and between potential and confirmed condition. The distinction was all the more challenging because so many signs [e.g., 30 or more] needed to be weighed.” In examples from Marseilles and Ganges, they examiners “hung their decision on a ‘reading’ of the unequivocal and equivocal signs, without much indication about the content of these categories.” Plus, a sign could be unequivocal but insufficient to impute leprosy, e.g., disfigurement of the nose and mouth but not the “corruption“ of the “entire form” (loc 1413-1418, 1423).