LEPROSY 397 



At one time or another there were as many as 200 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 owing to the fact that diagnosis was not accurately or 

 carefully made, it is certain that these institutions frequently housed 

 persons suffering from diseases other than leprosy. Bury St 

 Edmunds, Bristol, Canterbury, London, Lynn, Norwich, Thetford, 

 and York were centres for lepers. Burton Lazars and Sherburn, 

 in Durham, were two of the more famous leper institutions. 



Elsewhere, the writer has furnished the evidence obtainable in 

 support of the view that true leprosy {elephantiasis grmcorum) was 

 prevalent in England in the Middle Ages.* It existed there anterior 

 to the crusades, which ^er se had little or no effect in spreading the 

 disease in England. It was generally supposed from the eleventh 

 century that leprosy was a contagious and hereditary disease, and 

 that it depended upon these two characters for its extension in 

 England, But probably such was not the case, for it is fairly certain 

 that strict segregation was never carried out. The disease as an 

 endemic disease reached its zenith in the thirteenth century or 

 earlier, and declined till final extinction in the eighteenth. In 

 England itself it disappeared approximately in the sixteenth century. 

 Probably the famine of 1315, and the Black Death of 1349, materi- 

 ally assisted in the extermination of lepers. The disease being 

 diffused neither by contagion nor heredity has under favourable 

 hygienic circumstances a tendency to die out. Hence the decline 

 and final extinction of leprosy in Great Britain was due to this 

 general tendency under favouring circumstances, viz., to an extensive 

 social improvement in the life of the people, to a complete change in 

 the poor and insufiicient diet, and to general sanitary advancement. 



At the present time the distribution of the disease is mostly 

 Asiatic. Norway contains about 1200 lepers, Spain a smaller 

 number. Scattered through Europe are perhaps another 2000 to 

 3000, in India 100,000, and a number in Japan. The Cape 

 possesses a famous leper hospital on Eobben 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 tuber culated, the ancesthetic, or (maculo-ansesthetic), 

 and the mixed. Lepra tuberculosa is that form of the disease 

 affecting chiefly the skin, and resulting in a nodular tuberculated 

 growth or a diffuse infiltration. It causes great disfigurement. The 

 ancesthetic form causes a destruction of the nerve fibres, and so 



* The Decline and Extinction of Endemic Leprosy in the British Islands, 1895, 

 p. 108. 



