“At a still later period the symptoms are even more dreadful; the tubercles become the seat of ulceration, and sores of an unhealthy character succeed, and discharge an ichorous fluid, which, on concreting, form dark adherent scabs of various extent and thickness; these incrustations are sometimes followed by cicatrices, but this is unfortunately a rare occurrence. On the extremities the thick and tuberculated skin becomes divided by fissures, and ulcerates or is corroded under the dry scabs, so that the fingers and toes mortify and separate, joint after joint, the miserable patient surviving these horrid mutilations. Those individuals whom we have seen perish from this disease were carried off by enteritis; large ulcerations were found in the ilium, cæcum, and colon, excepting in one case, in which death was caused by tubercular phthisis.” In studying the phenomena of this, as of any other disease, it will simplify our recollection of its more leading and more constant characters, if we have the principal symptoms of it embodied in a concise nosological definition, instead of being spread through a long and detailed description. Two of our last and best British nosologists give the following definition of tubercular leprosy or Greek elephantiasis (for I use these terms here and elsewhere as words perfectly synonymous). “Elephantiasis” (says Dr. Cullen), “is a contagious disease, with (1) the face deformed with tubercles; (2) the skin thick, wrinkled, rough, unctuous, and divested of hair; (3) loss of feeling in the extreme joints; and (4) the voice is hoarse and nasal.”[147] In defining the genus elephantiasis, Dr. Good selects the second and third characters of Cullen as the most distinctive, and adds to these two others—viz. “(1) eyes fierce and staring; (2) perspiration highly offensive.” In defining the first species of this genus (or the Greek elephantiasis of other authors), he introduces as its three pathognomonic symptoms, the first and fourth characters of Cullen and a part of the second.[148] NOMENCLATURE OF THE DISEASE. Leprosy, such as it is portrayed in the descriptions and definitions which we have quoted from Bateman, Schedel, Cullen, and Good (and I might have cited any of our modern medical writers to the same effect), has had at different times, and by different authors, a great variety of appellations applied to it. In order to understand the nosological nature of the disease, as it formerly prevailed in Europe, it is requisite to state a few uninteresting but indispensable facts, in regard to the changes which have occurred in its nomenclature.