BACTERIA AND DISEASE 309 



have of it in this country come from Ireland, and date back 

 to the fifth and sixth centuries. Even at that period of 

 time also various classical descriptions of the disease had 

 been written and various decrees made by the Church coun- 

 cils to protect lepers and prevent the spread of the disease, 

 which was often looked upon as a divine visitation. In the 

 tenth century leprosy was prevalent in England ; it reached 

 its zenith in the thirteenth century, or possibly a little 

 earlier, and declined from that date to its extinction in the 

 sixteenth. But even two hundred years later leprosy was 

 endemic in the Shetlands, and it is recorded that in 1742 

 there was held a public thanksgiving in Shetland on account 

 of the disappearance of leprosy. 



At one time or another there were as many as two hun- 

 dred institutions in the British Isles for the more or less 

 exclusive use of lepers. Many of these establishments were 

 of an ecclesiastical or municipal character, and probably the 

 exact diagnosis of diseases was a somewhat lax matter. 

 Bury St. Edmunds, Bristol, Canterbury, London, Lynn, 

 Norwich, Thetford, and York were centres for lepers. Bur- 

 ton Lazars and Sherburn, in Durham, were two of the 

 more famous leper institutions. 



At the present time the distribution of the disease is 

 mostly Asiatic. Norway contains about 1200 lepers, Spain 

 approximately the same number. Scattered through Europe 

 are perhaps another 600 or 700, in India 100,000, and a large 

 number in Japan. The Cape possesses a famous leper hos- 

 pital on Robben Island, with a number of patients. The 

 disease is also endemic in the Sandwich Islands. 



Descriptions of the pathological varieties of leprosy have 

 been very diverse. The classification now generally adopted 

 includes three forms: the tuberculated, the anesthetic (or 

 maculo-anaesthetic), and the mixed. Lepra tuberculosa is 

 that form of the disease affecting chiefly the skin, and 

 resulting in nodular tuberculated growth or a diffuse infil- 



