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own name: "leprosy" is a word ". . to beused with caution, since it tends to have asocio-historical, in addition to a medicalconnotation" (XI International LeprosyCongress, Workshop on Human Aspects inthe Treatment of Leprosy Patients, MexicoCity, 1978).

The fact is that when it comes to the point,that is, "leprosy," not "roses," Shakespeareknew very well what that meant: "Will knitand break religions, bless the accurs'd; makethe hoar leprosy ador'd; place thieves andgive them title, knee and approbation" (Ti-111011 of Athens, Act IV, Sc. III, line 34). "Begeneral leprosy! Breath infect breath, thattheir society, as their friendship, may bemerely poison!" (Tinton of Athens, Act IV,Sc. I, line 30).

McGeoch (4) clarifies: "It is well to pointout here that Shakespeare frequently usedthe words leprosy, serpigo, tetter, itch, Blainand pox in a non-specific sense in the formof a curse or deprecatory figure of speech":"And in the porches of mine ears did pourthe leperous distilment; whose effect holdssuch an enmity with blood of man" (Ham-let, Act I, Sc. V, line 61).

It is clear, therefore, that Shakespearewould have objected to the repeated misuseof his name to justify the continued "cursingand deprecating" of hanseniasis patientswith the "hoar leprosy" of the 16th century.

I am hopeful that the new terminologicalpolicy of the U.S. Public Health Service be-comes adopted by the U.S. Department ofHealth and Human Services and by all othercountries whose educational and preventiveprograms continue to be hindered by thehorrifying label "leprosy," "the most neg-ative of all medical terms" (6).

—Dr. Abrahão RotbergR. Pedroso Alvarenga 1255/74São Paulo 04531, Brazil

REFERENCES1. LENDRUM, F. C. The tragic name of "leprosy."

Modern Hosp. 64 (1945) 79-80.2. LETAYE, S. Recherche sur la mentalité des malades

de le lépre. Rev. Psicolog. Norm. Patolog. 1 (1955)3-59.

3. MANGIATERRA, NI. ["Semantic therapy" in anti-hansenic health education.] Neol. Hans. 2 (1970)15-17.

4. McGEocti, A. H. Shakespeare—the dermatologist.Aust. J. Dermatol. 3 (1955) 53-64.

5. PEARSON, E. A. Leprosy or Hansen's disease: a studyof semantic conflict. Hans. Abstr. News 5 (1974)5-13.

6. RoLsTox, R. H. and CIIESTEEN, H. E. The identi-fication of psychosocial factors related to the re-habilitation of leprosy patients. Baton Rouge, Lou-isiana: Louisiana State University School of SocialWelfare, 1970.

The "Ex Libris" of Dr. N. A. Torshujev

To THE EDITOR:In Leviticus 13, verse 45, the Old Tes-

tament gives clear instructions that a "lep-er" must make himself recognized and mustwarn the healthy of his approach. The un-founded fear and prejudice has remainedwith us and will probably persist long afterthe disease is eradicated from our planet. Itwas, however, officially practiced in theMiddle Ages when leprosy sufferers wereobliged by law or long practice to carry ahorn, clapper, or bell to signal their presenceand to solicit alms; a Belgian dictionary ofthe 15th century gives the definition "in-

strumentum leprosorum cum tribus Lobu-lis cuius sonitu excitantur homilies ad be-neficiendum eis"! ( 3 ).

Leprosy had a great impact on medievalChristian art and literature and, indeed, theclapper was the quasi-official attribute of the"lepers" in medieval paintings, engravings,statues, stained glass windows, and in beau-tiful miniatures of cherished prayer books.In the Codex Practicus of Theoderich, Bish-op of Burgundy, on a miniature by Vincentde Beauvais, in the famous Evangeliariumof Geilers (Strassburg 1515), we see the dif-ferent forms of clappers. Not a single orig-

650^ International Journal of Leprosy^ 1986

FIG. 1. "Leper" with clapper, 16th century; Cos-

tunic Library, Berlin, Germany.

inal clapper remained for posterity since theywere buried with the "lepers," hidden, ordestroyed ( 3).

Lipperheide's Costume Library in Berlinkept a collection of drawings of the clothes,hats, outfits, horns, clappers, and bells stig-matizing the leprosy sufferers (Fig. 1). Theiconography of leprosy is a wealth of knowl-edge on this fascinating subject, the historyof medicine, and leprosy in particular. TheGerman Leprosy Relief Association orga-nized a prized exhibition in Munich in 1982,presenting a voluminous collection of theiconography of leprosy ( 3 ).

The "leper with clapper" even appearedon a colorful stamp issued in 1961 by Mo-naco, honoring the role played by the "OrdreSouverain de Matte" in the fight against lep-rosy (Fig. 2). The stamp shows a "leper" intypical clothing with a clapper in his handon the street of a medieval town. The illus-tration was certainly taken, if not copied,

FIG. 2. "Leper" with clapper, 1961 postage stamp,

Monaco.

from a 17th century print exhibited in theBerlin Costume Library (Fig. 1).

The "Ex Libris" labels are destined tomark the name of the books' owner. Inter-estingly, they usually show the professionof the proprietor of the book. Great artistsof the 16th century, Albrecht Darer, LucasCranach and Hans Holbein, were among themany masters of the "Ex Libris" art. To myknowledge, there is only one "Ex Libris"ever printed which shows a "leper" with aclapper. It was the opus of the Russian artistL. A. Litosenko, and it was commissionedby Dr. N. A. Torshujev (Fig. 3). The "ExLibris" clearly shows the profession of theowner. Dr. Torshujev was a professor ofdermatology of the medical school in Ros-tov on the Don River in the U.S.S.R. Hewas a recognized expert on leprosy andsyphilis, a prolific writer (see the Int. J. Lepr.1965-1973), and a most efficient scientist,responsible for leprosy control and the fightagainst venereal diseases in his country. His"Ex Libris" shows, in front of Gothic me-dieval buildings, a "leper" with a clapperand a prostitute, both in their "uniforms"as known from the iconography and historyof leprosy, syphilis, and prostitution. Those

54, 4^ Correspondence^ 651

(pleasure in arts), wrote G. Semmell, a doc-tor in the village of Zagorsk, on his "ExLibris." The largest collection of "Ex Li-bris" labels was that of Dr. E. Alexandrovic,an army doctor in Leningrad. He left hiscollection of 26,800 "Ex Libris" labels tothe Academy of Science in 1958. The Acad-emy of Fine Arts in Leningrad kept 2500"Ex Libris" labels, a collection of Dr. E.Sokolovsky ('). Studying the "Ex Libris" ofhundreds of physicians, each of them re-flects the special interest of the owner in thefield of medical sciences. The "Ex Libris"of Dr. Torshujev merits our special atten-tion.

— Laszlo Kato, M.D.Director of ResearchThe Salvation ArmyCatherine Booth Hospital4375 Montclair AvenueMontreal, Canada 11413 2.15

FIG. 3. "Ex Libris" of Dr. Torshujev.

1.who know Dr. Torshujev can recognize with 1 .

certainty that both were inspired by the il-lustration from the Berlin Costume Library.

The literature of "Ex Libris" illustrations 3.is richly documented and catalogued by col-lectors. The medical profession is leading inthis graphic art ( 2 . 4). "In arte voluptas" 4 •

Osler on Leprosy

REFERENCESADARJUKOV, V. J. The Russian Ex Libris, 1922.GRIVANOV, E. D. "Ex libris" of physicians and med-ical institutions in Russia and the U.S.S.R. Com-mun. Bibl. Hist. Med. Hung. 27 (1963) 223-240.KATO, L. Clapper, Horn and Bell. Monograph.Montreal: Institute of Microbiology and Hygiene,University of Montreal, 1972.VERESCHAGIN, V. A. The Russian Ex Libris, 1902.

To THE EDITOR:Much of Sir William Osler's medical

practice (') and many long sections of hisfamous textbook (") dealt with illnessessuch as typhoid, tuberculosis, malaria andparasitic diseases, which have now largelybeen banished to the care of physicians intropical developing countries. In spite of this,it is surprising to find that Osler wrote onleprosy ( 7-10) since he states that "One ofthe most striking differences between dis-eases of this continent and those of Asia orAfrica is the absence of leprosy" (9).

There were only a few hundred patientswith leprosy in North America in Osler'stime. He gives their distribution as follows:

"In the northern part of New Brunswickleprosy has existed in a couple of countiessince the early part of the century. The casesas recognized are segregated in the lazaretteat Tracadie . . . . Leprosy in Cape Bretonhas almost died out . . . . In British Colum-bia the disease has been introduced by theChinese, but . . . there are only eight casesat present in the settlement on Darcy Island. . . . Among the Icelandic immigrants inManitoba there are a few cases . . . . to "NewScandinavia," as parts of Minnesota andWisconsin have been called, the disease wasintroduced by the immigrant Swedes andNorwegians . . . . The disease has not spread. . . . In California leprosy has been intro-