LEPBOSY 155 



1897, Hansen again defended segregation, which he 

 maintained had largely caused the decrease of leprosy in 

 Norway. At the same time he advocated more humane 

 isolation after the proposals of our own Leprosy Commission 

 in India. At this same Congress, Besnier suggested that 

 the nasal secretion played an important role in spreading 

 the disease. 



Occiurrence and Distribution. — During the Middle Ages this 

 disease was prevalent in England, and many leper houses, 

 or hospitals, were established all over the country, some of 

 the largest being at Burton, Thetford, St. Giles's (London), 

 Sherburn, etc. It is probable that many other skin 

 diseases were misdiagnosed as leprosy. It became finally 

 extinct in the eighteenth century. Doubtless its extinction 

 was largely due to its tendency to die out under favourable 

 circumstances.* Endemic leprosy still exists in Iceland, 

 Norway, Spain, India (100,000), Japan, the Cape, the West 

 Indies, and the Sandwich Islands. Generally speaking, it 

 shows signs of decline rather than increase. 



Pathogenesis. — One of the different forms of the same 

 disease generally predominates — either the nodular or 

 ' tubercular ' (lepra tuberculosa), in which the new forma- 

 tion has its seat in the skin or mucous membrane ; or the 

 anaesthetic (lepra ansesthetica), in which the nerves are 

 chiefly affected. In the skin variety the hands and face 

 are mostly affected, and larger or smaller swellings appear 

 (red or blue in colour), which become hard. These 

 tubercles consist of granulation tissue, and may ulcerate 

 and cicatrize, producing great deformities. In the 

 anaesthetic form the nerve-stems become the seat of the 

 granulations in the interstitial connective tissue. The 

 spindle-shaped swellings compress and separate the nerve - 



* For further information see 'The Decline and Extinction of 

 Leprosy in the British Islands ' (Newman), p. 109. 



