THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES 
 
 GIFT OF 
 
 SAN FRANCISCO 
 COUNTY MEDICAL SOCIETY
 
 THE NEW SYDENHAM 
 
 SOCIETY. 
 
 INSTITUTED MDCCCLVIII. 
 
 VOLUME CLVII.
 
 PRIZE 
 
 ESSAYS ON LEPROSY. 
 
 NEWMAN. 
 EHLEES. IMPEY. 
 
 LONDON: 
 THE NEW SYDENHAM SOCIETY, 
 
 1895.
 
 59^
 
 iBiomedisal 
 
 
 CONTENTS, 
 
 On the History of the Decline and Final Extinc- 
 tion OF Leprosy as an Endemic Disease in the 
 British Islands. By George Newman, M.D. . 1 
 
 Conditions under which Leprosy has declined in 
 
 Iceland. By Edward Ehlers, M.D. . .151 
 
 Leprosy in South Africa. By S. P. Impey, M.D., 
 
 M.C. . . . . .189 
 
 On Spontaneous Recovery from Leprosy. By S. P. 
 
 Impey, M.D., M.C. . . . .207 
 
 NOTICE. 
 
 These Prize E>isays on Leprosi/ are — by the permission of 
 the Committee in, charge of the National Leprosy Fund under 
 the Presidency of H.B.H. the Prince of Wales — reprinted 
 from the type used for their original publication. 
 
 598206
 
 ON THE HISTORY OF THE DECLINE AND 
 FINAL EXTINCTION 
 
 LEPROSY AS AN ENDEMIC DISEASE 
 IN THE BRITISH ISLANDS. 
 
 GEORGE NEWMAN, M.D., 
 
 FELLOW OF THE BOYAL HISTOEICAL SOCIETY, ETC.
 
 PEEPATORY NOTE. 
 
 This paper is the result of a careful investigation into the 
 history of leprosy in the British Islands. As a matter of 
 convenience chronological order has been followed, as far 
 as possible, and a large number of isolated events, instead 
 of being incorporated in the text, have been placed on sepa- 
 rate sheets, and bound as a list of dates to accompany the 
 paper. A list of leper-houses with the authorities for their 
 existence has also been appended. 
 
 It has been found that a considerable quantity of his- 
 torical matter could not be included from its diffuseness and 
 from its lack of authenticity. The dates have been revised 
 and the most commonly accepted figures in all cases adopted. 
 
 I am much indebted to various works on Leprosy and 
 kindred diseases, particularly to that of Dr. Charles 
 Creighton on ' Epidemics in Britain,^ and to Sir James 
 Young Simpson^s classical papers in the ' Edinburgh Medical 
 Journal ' of 1841. It has not been my desire to incorporate 
 all the information on the subject that could be found, but 
 rather to make what was well known the basis of opera- 
 tions, adding that which was less widely known. I am also 
 much obliged to Professor J. E. Lloyd of Bangor, for his 
 notes on Leprosy in Wales. 
 
 GEORGE NEWMAN. 
 
 20, Queen Square, London, W.C. ; 
 August, 1895.
 
 TABLE OF CONTENTS. 
 
 PAGE 
 
 Historical Notes . . . , . -5 
 
 Rt-'gavding the Decrease in Lepers in England . . 53 
 
 The Kind of Leprosy in the Middle Ages . . -58 
 
 Leprosy and Syphilis . . . . .64 
 
 The Function of the Leper Hospitals : Was Segregation Carried 
 
 Out? . . . . . .66 
 
 Observations on the Cause of the Decline of Leprosy as an 
 
 Endemic Disease in England . . . .69 
 
 Physical and Social Conditions in England during the Leprosy 
 
 Period . . . , . • /O 
 
 General Physical and Social Condition in China, India, and 
 
 Iceland . . . . , .So 
 
 Conclusions and Applications of the Foregoing . . 89 
 
 Predisposing Conditions of Endemic Leprosy in England . 103 
 
 Conclusions . . . . . .108 
 
 Leprosy in the British Islands : A List of Chief Dates . no 
 
 List of Leper-Houses Established in the British Islands during 
 
 the Middle Ages ..... 137 
 
 Appendix ...... 146
 
 HISTOEICAL NOTES. 
 
 I PROPOSE at the outset to give in some detail tlie pro- 
 gressive history of leprosy in the British Islands from the 
 earliest times to the present day. 
 
 In order to obtain a more or less chronological order, I 
 shall frequently make use of the different histories of leper 
 institutions. In adopting this plan it is not wished to ex- 
 aggerate or unduly emphasize the place these institutions 
 held with regard to leprosy in England, as will be hereafter 
 pointed out ; but simply and solely as a scaffolding by which 
 the more easily to build the united history of the disease. 
 So large a part of such a survey would be isolated facts 
 and dates, that I have drawn up these separately in chrono- 
 logical order, and they are printed on the accompanying- 
 separate sheets. 
 
 There can, I think, be no doubt that many and various 
 diseases were included in the comprehensive term "leprosy." 
 As far as possible I shall endeavour to eliminate all diseases 
 not true leprosy or Elephantiasis Grgecorum. 
 
 All authorities, both ancient and modern, seem quite 
 decided that true leprosy was at one time endemic in these 
 islands. Of that I also think there can be now no possible 
 doubt. 
 
 The earliest date that we have any knowledge of leprosy 
 being " brought to England " was in the year 60 b.c.^ It 
 existed in Egypt in the reign of Husapti at least three 
 thousand years before Christ, it was common in India and 
 China four hundred years before Christ, and was known in 
 Spain, Italy, and England about sixty or more years before 
 ' Parton, 'Hist, of St. Giles.'
 
 6 HISTOEICAL NOTES. 
 
 Christ. These are only approximate dates : it probably oc- 
 curred much earlier. 600 a.d, witnessed an increase in leprosy 
 in the British Islands,^ and about the same date it is recorded 
 of the Glasgow saint, Kentigern, that mundahat leprosos. Sir 
 James Simpson^ states that the Blythe Leper Hospital at 
 Nottingham was established in 625 a.d., other authorities 
 think it was 638, and the majority believe the first English 
 leper-house did not exist until the eleventh century. It is, 
 however, almost certain that leper-houses existed in Ireland 
 as early as 869, and leprosy was certainly prevalent at the 
 beginning of the tenth century. Hywel Dda (a Welsh king 
 and famous law giver, who died about 950) enacted several 
 laws relative to leprosy.'^ " That a married female was 
 entitled to separation and the restitution of her goods and 
 propert}^ provided her husband was affected with leprosy " 
 (Celtic General Repository, vol. iii, p. 199). It was about 
 this time that a law was instituted in England causing leprosy 
 to be a valid cause for divorce. 
 
 It was in the eleventh century that the first " hospitals " 
 and pest houses were built ; but we must not necessarily 
 assume that the existence and building of leper houses and 
 like institutions implied a new or even an increasing disease. 
 The leper-house period — roughly from the eleventh to the 
 fourteenth centuries inclusive — may have been due to the 
 awakening of humanitarian ideas, or to some rough medical 
 or ecclesiastical intention of thereby preventing the spread 
 of the disease. In all probability leprosy was at its 
 zenith not later than the twelfth century, even though 
 many leper-houses date after that. Whether that be the exact 
 period of its zenith, it seems quite clear that leprosy was a 
 pre-Norman disease in the British Islands. 
 
 Some have said the returning Crusaders "brought" leprosy 
 back to England. This, now, is surely a discarded view. 
 
 ' Parton, loc. cit. ; Nichols, 'Leicestershire;' Laiiigan, ' Eccles. Hist, of 
 Ireland,' vol. iii, jjp. 83 — 88. 
 
 ' ' Archfeological Essays,' vol. ii. 
 
 ^ Professor J. E. Lloyd, of Bangor, writes : " The laws now included in 
 the codes attributed to Hywel Dda are quite certainly not all due to him. 
 The one enactment, which I feel with some confidence may go back to his 
 time, is that making leprosy a legitimate ground of divorce."
 
 HISTORICAL NOTES. 7 
 
 The first return of any Crusaders cannot have been before 
 1098^ for they only left in 1095 ; yet there were at least 
 three famous leper-houses before that date — Canterbury, 
 Northampton, and Chatham, — and Hugh, Bishop of London, 
 and other noteworthy people of the time, had died of leprosy. 
 (Besides earlier records of the disease, for which see the 
 chronology in the Appendix.) 
 
 From the establishment of the leper house at Canterbury, 
 before 1089, up till tlie end of the fifteenth century, British 
 history has many like establishments to record.^ 
 
 The disease was present in Scotland from the time of 
 Stephen till the commencement of the seventeenth century, 
 and in Ireland from the fifth to the eighteenth. 
 
 With these preliminary remarks I will take some of the 
 chief leper-houses, and outline something of their history. 
 
 The first of which we have much record is Canterbury. 
 Somner" states that leprosy became "a national malady, and 
 accordingly in all parts provision was made for the receipt 
 and relief of the infected persons." " There are,'' he says, 
 "three houses at Canterbury — St. James's, St. Laurence's, and 
 Herbal." Other historians give St. James's, St. Nicholas', and 
 St. Laurence's, and others only two. There can be no doubt 
 that Lanfranc, then Archbishop of Canterbury, founded a 
 hospital here before 1089,^ and it is recorded that previously 
 to this Becket performed miracles, giving health to the 
 leprous.* Northampton^ and Chatham^ were established 
 very shortly thereafter, both in the eleventh century and 
 pi'obably both in the reign of William II. The latter was 
 founded in 1078, on the south side of what is now the High 
 Street, by the celebrated Bishop Gundulph, for the recep- 
 tion of lepers of both sexes. The endowments were small, 
 and though they were afterwards augmented by different 
 benefactors, the proceeds were seldom sufiicient to sup- 
 port the inmates, who were hence accustomed to be supplied 
 
 ^ See the accompanying list of leper-houses, dates, &c. 
 ■^ Somner, ' Antiquities of Canterbury,' p. 80. 
 ' Simpson, loc. cit. ; Somner, ' Antiquities of Canterbury.' 
 ^ Matthew Paris. 
 
 * Brigges, ' History of Northampton.' 
 
 * Tanner, ' Notitia Monastica,' 1 744, p. 211.
 
 8 HISTOEIOAL NOTES. 
 
 with provisions from the Priory at Rochester. These lepers 
 seem to have lived a corporate life, and were possessed of a 
 common seal. A chapel was built for them in the reign of 
 Henry I. (i loo-i 135), St. Bartholomew's, which was increased 
 by Henry III, Edward I, and Edward III, and underwent 
 various royal additions up till Edward IV. 
 
 Remegius, Bishop of London, was the first builder of the 
 house at Lincoln. It was primarily intended for ten lepers, 
 who were to be outcasts and slaves (villani, servi) of Lincoln. 
 In the space of two hundred years from its foundation the 
 character of its inmates had changed, for Edward Ill's com- 
 missioners found nine poor brethren and sisters in it, only one 
 of whom was a leper. In 1457 ^^ was, by order of Henry VI, 
 annexed to the large and famous leper-house at Burton, in 
 order, as it was stated in the charter, " for the better main- 
 tenance of three of the king's servants that should happen 
 to be lepers, either at Lincoln or in the hospital of St. Giles, 
 near London.''^ Provision was also made for the possibility 
 of other lepers requiring its shelter. One hundred and fifty 
 years after the establishment of the Holy Innocents, Lincoln 
 had another leper-house (1280).^ ''The place where the leper- 
 house stood," says Cookson,^ " is now called the Malandry 
 Closes, and stands on the Lincoln and Sleaford turnpike 
 just outside Little Bargate, the ancient south entrance to 
 the city. ' Malandry ' is a corruption of maladerie." 
 
 York and London had hospitals almost simultaneously with 
 the first foundation at Lincoln. 
 
 There was near the city of York a lepers' hospital during 
 the time of Maud the empress (daughter of Henry I.; married 
 emperor of Germany, and disputed Stephen's right to the 
 throne in England). Maud was the benefactress, and it was 
 probably the same as that afterwards known as St. Nicholas 
 outside Walmgate Bar, which was of royal foundation. It con- 
 sisted of ofiicers and several male and female lepers, and at 
 the Dissolution (1536-40) had rents and lands of the yearly 
 value of nearly ;^30.* It is not improbable that a number of 
 
 ' ' Monasticon Anglicanum,' Sir William Dugdale, p. 627. 
 " Tanner, ' Notitia Monastica,' ed. by Nasmith, 1787. 
 
 * Lincoln Topographical Soc, 184 1. 
 
 * Tanner, loc. cit. ; Dugdale, loc. cit.
 
 HISTORICAL NOTES. 9 
 
 liospitals existed at York ; although Tanner cites one for 
 lepers, we have authority for believing that previously to 1365 
 there were four hospitals especially set apart for lepers/ and 
 in a number of York wills in various years up till 1454, 
 four leper hospitals are mentioned.^ 
 
 Of the leper-houses in London, St. Giles'/ situated in 
 fields to the north-west, was tlie largest and best known.* 
 This ai"ose from the munificence of Matilda (daughter of 
 Malcolm, king of Scotland), queen of Henry I. Matilda's 
 charter ordained foriy lepers and three officers, to which were 
 added afterwards, when revenues increased, various other 
 officers. The original endowment was ^3. Some think this 
 amount very small (Maitland), but it must be remembered 
 that the inmates were allowed to beg and accept alms. As 
 at the markets of Chester, Shrewsbury, and elsewhere, they 
 did this systematically, using the advertising medium of a 
 clap-dish.^ In some localities this begging reached such a 
 degree that Proctors^ were appointed to go round to the 
 churches and other assemblies of the public, to collect 
 alms on behalf of the lepers. This, as might naturally 
 be supposed, was after a time grossly abused, all sorts of 
 idlers claiming to be Proctors for the collection of alms. 
 Funds for the St. Giles' Hospital were augmented by royal 
 grants of land in Middlesex and Holborn, etc., in addition to 
 Henry II's liberality, which included 6oa\ from his private 
 purse on every St. Michael's Feast Day. There was also 
 30s. 5tZ. " perpetual alms " to buy them lights. This generous 
 charter seems to have no date affixed, but William de 
 
 ' ' Testamenta Ebor.,' vol. i, p. 75 ; vol. ii, pp. 26, 55, and 93. 
 
 ° Robertson, Appendix, ' Arch. Essays,' vol. ii. 
 
 ^ St. Giles, the patron of this and other hospitals in England and abroad, 
 was an Athenian (nobility) by birth, and flourished at the end of the seventh 
 century. He lived in great piety in a hermitage at the mouth of the 
 Rhone, and afterwards in a forest near Nimes. He was " fed by a tame hind," 
 which various hunters tried to kill. He obtained the favour of the French 
 king, and his abbey became a centre of the Benedictine monks. A con- 
 siderable town was built about it, called " St. Giles," which played a no 
 small part in the wars of the Albigenses. 
 
 ^ Parton, ' History of St. Giles.' 
 
 * Ducange, v, Scandelloe ; Izache, 'Exeter,' p. 11. 
 
 * Phillips, 'History of Shrewsbury.'
 
 10 ^ HISTORICAL NOTES. 
 
 Mandeville, Earl of Essex, was one of the witnesses (there- 
 fore between ii 66-1 189). There was a still further in- 
 crease of wealth in the time of Henry III. From Pope 
 Alexander IV. the hospital received a confirmation of its 
 estates and privileofes, and it was also taken under the special 
 protection of the Roman See. Thus John's interdict was 
 disabled. The probable date of this fully confirmatory bull 
 was during Henry Ill's reign. Edward I. granted the 
 hospital two charters, the first in 1290, for the recovery of 
 debts and certain rents, which it seemed impossible to get 
 without ; indeed, it was about this time that, owing to many 
 dissensions and quarrellings, the influence and position of the 
 hospital began to decline. It was so with many others in 
 England. In his second charter Edward I. refers to these 
 disorders, and after more or less radical changes, took the 
 whole institution under his special charge, and appointed 
 Geoffry de Birston, master. Edward II. issued two charters, 
 the one relative to the carrying on of the convalescent home 
 (or " middle court " as it was called), the other on the subject 
 of the persisting abuses. For the first time also the charter 
 refers to the necessity of no one being admitted who was not 
 a leper (it appears that matters of diagnosis had become 
 very slack), and that there should be no mixing of the healthy 
 with the diseased. In the time of Edward III, by the 
 king's command, St. Giles was annexed to Burton Lazars 
 (in 1354; it is said Edward III. sold it for forty marks 
 annually) owing to the continual abuses and disorders. In 
 1347, owing to Edward Ill's proclamation that all lepers do 
 leave the city within fifteen days, fourteen lepers applied at 
 and entered St. Giles' Hospital. This was at the time of the 
 great plague, and it is possible that some of these fourteen 
 were not true lepers. When the hospital was handed over 
 to Burton Lazars the number of lepers therein was greatly 
 reduced. It would seem that in 1392, Richard II. re-sold 
 the benefaction to the Abbot of Tower Hill for iio marks 
 annually. Henry VIII, in 1539, dispossessed St. Giles, first 
 keeping it and its revenue to himself for six years, and then 
 bestowing it on one of his favourites, Lord Lisle, in 1545, 
 together with the authority and funds of Burton Lazars. 
 Lord Lisle fitted it up as a private residence and leased out
 
 HISTORICAL NOTES. 11 
 
 subordinate parts to tenants. The number of lepers in hos- 
 pital at its dissolution must have been very small compai-ed 
 with what had been in the past. Parton' thinks the deci*ease 
 was caused " from the reduction of the income for their 
 maintenance and from the decrease of the disorder itself, 
 which about that period (1539) was in many places beginning 
 to disappear." 
 
 It will be noticeable from the accompanying list that the 
 leper houses — not necessarily the leprosy, but probably — 
 were more frequent in some parts of England than others. 
 The western counties were comparatively free in comparison 
 with the eastern, and of the latter Norfolk, with its capital 
 Norwich, affords a striking example of the numerous lazar- 
 ettos. Norwich itself boasted of six different hospitals. There 
 is evidence to prove that Norwich was not a very healthy 
 city, for during the plague of 1348-9 nearly '' 60,000 people 
 died in that city alone " (much more likely 5,000; the whole 
 population of Norfolk in 1349 cannot have been more than 
 10,000).^ The following is the list recorded by Simpson^ 
 and Tanner :* 
 
 St. Mary Magdalene . founded before 11 19. 
 
 St. Mary and St. Clement ,, „^' 1370. 
 
 St. Giles . . . „ „ 1249. 
 
 Without St. Magdalene's Grate ,, ,, 1370- 
 
 Without St. Bonnet's Gate date unknown. 
 Without St. Stephen's Gate ,, „ 
 
 The last of the pre-Stephen leper establishments was at 
 Oxford.^ About half a mile from Magdalene Bridge, and a 
 little to the north of the road to Cowley, there stand some of 
 the remains of the ancient hospital of St. Bartholomew, 
 founded by Henry I. for lepers. Henry established it soon 
 after the erection of his palace at Beaumont. He intended 
 it for twelve men, and endowed it with ^23 per annum from 
 the fee-farm, anciently payable to the crown from the city of 
 
 1 Parton, ' History of St. Giles.' 
 
 - Dugdale, ' Geographical Encyclopaedia.' 
 
 ^ Loc. cit. 
 
 ■• ' Nostitia Monastica,' 1787. 
 
 * ' Rot. Chart. Turr.,' Lond., vol. i, p. 99.
 
 12 HISTORICAL NOTES. 
 
 Oxford. Several other contributions, lands, etc., were after- 
 wards added, yet in the reign of Edward II. it was in such 
 great poverty that tlie number of " leprous brethren " was 
 necessarily reduced to six, in addition to whom were two 
 " whole brethren.'^ A new charter was obtained at this 
 period. This institution, like so many of the others, was by 
 no means free from internal disputes and quarrellings, only 
 in the present instance they were between the corpora- 
 tion and colleges, especially Oriel, At the second foundation 
 of the hospital, in the reign of Edward II, the sum of nine- 
 pence per week was fixed for each of the inmates.'' 
 
 In many instances the leper hospitals were situated at the 
 gates of the city^ — as in London, York, Norwich, etc. — and 
 the lepers were not allowed entrance within the walls. Fre- 
 quently one finds the remains of hospitals in the midst of 
 the city or town in the present day, but in the middle ages 
 they were on the outskirts of the towns, and the enormous 
 increase in size of the towns may make it appear that the 
 hospitals were situate in the midst of them. Bury St. 
 Edmunds was just such an example. About a century ago 
 the five gates of the town were all pulled down, to afford a 
 more convenient passage for traffic, but in the xv cent, 
 there were remains of five different hospitals (St. Saviour's, 
 St. John's, St. Peter's, St. Stephen's, and St. Nicholas'). 
 Of these St. Saviour's was the most celebrated in Bury, and 
 must have been a very extensive building, for it is said that 
 Parliament assembled there early in xv cent.^ Dr. Creighton 
 says that St. Saviour's was not for lepers.* 
 
 At this period (Stephen's reign) it was found necessary 
 to establish leper houses in Aylesbury, St. Albans, Bristol, 
 Maiden-Bradley, Shrewsbury, Gloucester, Pilton, Warwick, 
 Ilford, Colchester, and, a few years later, the great Burton 
 lazar house, to which in after years others were annexed. 
 
 Eudo Dapifer, in the reign of Henry I, founded St. Mary 
 Magdalene's, eastward of St. Botolph's at Colchester. 
 King Stephen augmented this endowment, and Hichard I. 
 
 1 Robert Gardner, ' Hist, of Oxford,' 1852. 
 
 - Ducange, v, Scandelloe. 
 
 ^ Thomas Dugdale, 'England and Wales,' vol. ii, p. 327. 
 
 ■• ' Epidemics in Britain,' Creigliton.
 
 HISTORICAL NOTES. 13 
 
 granted the lepers " libert}^ to hold a two days' fair." ^ We 
 shall have occasion to notice that, amongst the different 
 methods for supplying necessary funds, this quaint and 
 curious plan of '' fairs " was adopted. 
 
 At Ilford, in Essex, a hospital was instituted in the reign 
 of Henry II. or before (Lysons). It was dedicated to the 
 Virgin Mary and St. Thomas the Martyr, and was founded 
 by Adelicia. Re-patronage of the house was confirmed by 
 at least two kings — Richard II. and Henry IV. Amongst 
 the old regulations there were two which read as follows : — 
 
 " That no married leper be admitted unless his wife at 
 the same time become a nun. 
 
 " That the lepers go not out of the enclosure without 
 leave." ^ 
 
 The primary establishment was for '' thirteene pore men 
 beying lepers, two pryests, and one clerke ; thereof there is 
 at this day but one pryest and two pore men ." Such was the 
 report in the commission of Edward VI. By tlie same 
 royal commission (1547) most of the leper houses in Eng- 
 land were reported as empty, although many apparently 
 existed in Scotland and Cornwall. Harehope, in Peebleshire, 
 "would appear to be the first leper house north of the Tweed. 
 It was founded by David I, who endowed it with land before 
 
 I ISO- 
 Gloucester had one of the few westerly leper houses;^ it 
 was situated in St. John's Parish and dedicated to St. 
 Margaret. The exact date of its foundation is not known, 
 but Alford, Bishop of Worcester, granted the lepers of it the 
 privilege of burial in their own churchyard, about the 
 middle of the twelfth century. Near to this is the hos- 
 pital of St. Mary Magdalene (or King -James's, as it is other- 
 wise called), which owed its foundation to the Priory of 
 Lanthony, and, like St. Margaret-'s, was originally intended 
 for persons afflicted with leprosy. It was, however, in the 
 reign of James I. diverted from its original object and made 
 a charity for " nineteen poor persons.'^ 
 
 ^ Thomas Dugdale, 'England and Wales,' vol. iii, p. 503; Sir William 
 Dugdale, loc. cit., p. 631. 
 - Sir W. Dugdale, loe. cit., p. 628. 
 ^ Bigland, 'Gloucestershire;' Dugdale, 'England and Wales,' vol. v.
 
 14 HISTORICAL NOTES. 
 
 Another of the chief hospitals in the west was at Shrews- 
 bury ;^ it stood without the town in the east suburb. It 
 existed unquestionably in the reign of Henry II. (Owen and 
 Blakeway speak of it having a prior as early as 1 136). The 
 expressions in Henry's charter seem to imply, not a new 
 foundation, but a gift to one already existing. It was 
 supported and confirmed by royalty up till the second year 
 of Henry V. -John, in 1 204, granted the Shrewsbury lepers 
 the privilege of taking a handful of corn or flour from all 
 sacks exposed in Shrewsbury market. 
 
 There are many records of King John's dealings with 
 lepers to be found in documents of old leper-houses. Sir 
 Duffus Hardy^ tells us of a case in his reign where leprosy 
 was pleaded and allowed, and the land belonging to the 
 leper adjudged to his sister. In many cases, however, 
 lands and belongings were taken entirely away from the 
 leper's family, e. g. " The King to the Sheriff of Somerset, 
 greeting : We command you to give to Geoffrey de St. 
 Martin seizin of the lands which belonged to William of 
 Newmarch in your bailiwick. For we have committed to 
 him the custody thereof, so that he answer for them to us 
 at our exchequer ; and if he (William of Newmarch) have 
 given away any of his lands after he fell sick of the leprosy, 
 cause the same to be restored to his Barony,"'' which arrange- 
 ment signifies that the leper had not even a voice in the 
 disposal of his estate. 
 
 In a northern suburb of the City of Worcester'* there 
 stood a leper hospital, founded before 1268 and dedicated 
 to St. Osw^ald." The original endowment was for a Master, 
 Chaplain, and four lepers. Green states that " small-pox 
 was introduced to this country from the last of the crusaders, 
 who also brought over leprosy, and that the two diseases 
 were often confounded." Stowe affirms that this house was 
 
 ' Blakeway, 'History of Shrewsbury;' Phillips, 'History of Shrews- 
 bury ;' Tanner, loc. cit., p. 640 
 
 - " Rot. Litt. Claus.," ' Record Commission,' Duffus Hardy. 
 
 ^ 6 Johan, 1204. 
 
 ■* ' Hist, of Worcester,' Valentine Green, i, 240. 
 
 ^ St. Oswald, King of Xorthumbria, son of Ethelfritb of Bernicia : con- 
 verted to Christianity at lona : died, 642.
 
 HISTORICAL NOTES. 15 
 
 founded by St. Oswald himself. It may have been so, and 
 it may have been founded primarily for diseases other than 
 leprosy. The first authentic date I have been able to find 
 is 1268, when William de Beauchamp left ten shillings to it 
 in his will. 
 
 Maiden-Bradley.^ This, like many others of its kind, was 
 founded by the liberality of one great family — the Bisets, 
 cup-bearers to Henry II. In the beginning of the fourteenth 
 century one of the heiresses, being herself a leper, gave her 
 share of the heritage to help establish an hospital for leprous 
 women at Maiden-Bradley, in Wiltshire. This hospital was in 
 all probability founded by Manser Biset on the family land in 
 Wiltshire. In King John^s wars, Ralph d'Auxeville was im- 
 prisoned and threatened with death, but the leprous sisters of 
 Bradley came to the rescue and provided a ransom. On ac- 
 count of this kindness, d'Auxeville granted them lands as en- 
 dowment for their hospital, 5 virgates (=150 acres), and these 
 lands, with all the men that worked on them, were to be the 
 support of the hospital, and much of this property, including 
 Cumberton, Oldingtou, and the Mill of Mytton, remained in 
 the possession of Maiden-Bradley for upwards of three hun- 
 dred years. Lord Manser Biset conferred the church and 
 living of Kidderminster upon the lepers of Bradley, and 
 Walter Cantilope, Bishop of Worcester, assigned to them 
 certain tithes of his parish in 1241. At the suppression of the 
 monasteries and hospitals (1536—40), by fai'»tlie larger portion 
 of their property went to the avaricious courtiers of Henry 
 VIII, Maiden-Bradley passing into the hands of one of the 
 most grasping of these plunderers, John Dudley, best known 
 as the Duke of Northumberland (Burton). 
 
 Sir William Dugdale^ states that John, Earl of Moreton, 
 afterwards king of England, gave a plot of land, in the 
 twelfth century, without the Lachford Gate at Bristol, on the 
 road leading to Bath, to build a hospital for the lepers of 
 the town (St. John's). In 1437, ^^^ patronage of it was 
 held by the mayor of Bristol. There were two other hos- 
 pitals for lepers at Bristol. An interesting legend ascribes 
 
 ' Hoare's ' Wiltshiie ;' Tanner, loc. cit. ; Burton's ' Bewdley,' p. 83; 
 Burton's 'Kidderminster,' p. 15. 
 - 'Monastic. Anglican.,' p. 670.
 
 16 HISTORICAL NOTES. 
 
 the discovery of the virtues of the Bath springs to King 
 Bladud, " son of Lord Hudibras, king of Britain," (about two 
 thousand 3'ears ago ?) In his youth be became infected with 
 leprosy, and at the petition of the courtiers, who feared the 
 contagion, his father banished hitu from tlie palnce. The 
 queen on his departure gave him a ring, as a token by 
 which he should make himself known to her if he ever 
 recovered. The young prince, when he reached Keynsham, 
 met with a swine-herd, by whom he was retained as an 
 assistant. In a short time he perceived that he had tainted 
 the pigs with leprosy. The pigs, " impelled by sudden 
 phrenzy,'' ran up the valley to the spot where the hot spi-ings 
 boiling up mixed their waters with decayed weeds and 
 formed a bog. On washing themselves in this water the 
 leprosy was dispelled. He doing likewise became whole, and 
 i-eturned to the palace with the ring. Hence, so it is said, 
 arose the value of the Bath springs — probably legendary only. 
 
 Buckinghamshire liad many records of the disease but 
 not man}' hospitals, because there were so few places to 
 establish them ; but at Aylesbury there were two.^ They 
 were both empty and destitute by 1360, which, seeing- 
 leprosy was by no means extinct by that date, is significant of 
 the common mismanagement of these places. 
 
 In the neighbouring county of Hertford, Geoffry de 
 Gorham, the sixth abbot, founded, in the time of Henry I, 
 a hospital at St. Albans." He was a mau of great energy 
 apparently, and enlisted the interest of two popes and two 
 kings. In 1344, Abbot Michael de Montmore made special 
 regulations for the government of the hospital. It was 
 intended for six lepers and officers. Henry II. gave it a 
 charter confirming its position and rights : " Sciatis me 
 concessisse et presenti carta conjirmassefirmaose leprosis sancti 
 Juliani de Heoed quiquid Gaufridas, Ahhas Sancti Alhani, 
 consilio et communi assensu totius convent us sici, et alii eis 
 rationahiliter concesserunt et dedernni." ^ 
 
 ' 'Magna Britaiinica,' Lysons, 1806; Sir "NY. Dugdale, loc. cit., p. 631 
 Tanner, loc. cit. 
 
 ^ Speed, ' Hist, of Great Britain,' 1632. 
 
 => 'Add. Hist, de S. Albano;' Sir NV. Dugdale, loc. cit., p. 618.
 
 HISTORICAL NOTES. 17 
 
 The following were some of the rules to be observed by 
 all the lepers iu the St. Julian Hospital •} 
 
 " That those who were infected were to humble themselves 
 below all other men. 
 
 " That they should wear a habit suitable to their infir- 
 mities, viz., a tunic and upper tunic of russet cloth, a hood 
 and black cloak, stockings and flat shoes, with upper leathers 
 about their ankles. 
 
 " That those admitted be single persons, or, if married, to 
 part by consent and vow chastity, and if afterwards found 
 incontinent to be expelled. 
 
 " To go to church regularly, and continue in brotherly love. 
 
 " None to go beyond the bounds prescribed. 
 
 " None to go into the bake-house or brew-house. 
 
 " None to touch anything, because persons under such a 
 distemper are not to handle what is for the common use of 
 men.'" 
 
 Their diet was not very varied. Each leper had seven 
 loaves every week — five of white, and two of brown or black 
 bread. Every seventh month each man had fourteen gallons 
 of ale, and on Christmas Day each had forty gallons of ale ; 
 on St. Martin's Day each had a pig from the common herd. 
 
 ^' For some years previous to 1349" (according to Mr. 
 Trail) ^ '' only one, two, or three of the six beds could find 
 leprous occupants.'" 
 
 The mastership of Julian's is twice mentioned in the 
 abbey chronicles as a valuable piece of jDreferment. In 
 1254, the lands of the hospital were so heavily taxed for the 
 king and the pope that the miselli, according to Matthew 
 Paris, had barely the necessities of life. In 1350, the 
 revenues were too large for its need, and new statutes were 
 made ; the accommodation of its six beds was by no means 
 in request, the number of inmates never being more than 
 three. The fate of the other leper houses of St. Albans 
 Abbey, and that of St. Mary de Pratis, founded by Abbot 
 Warren, about a century after St. Julian's (for women), is not 
 less instructive. The date of foundation is unknown, but in 
 
 ' 'Monastic. Anglican.,' 17 18, p. 157. 
 
 ' 'Social Life in England,' H. D. Trail, D.C.L., 1893; Simpson, loc. cit. 
 
 2
 
 18 HISTORICAL NOTES. 
 
 1254 it had a churcli and a hospital occupied by misellse. A 
 century later we hear of the house being shared between 
 sisters and nuns.^ 
 
 Hampshire had its fair share of leper institutions, even 
 though the population was at one time very scant indeed (so 
 much of the district being covered with forest). The leper 
 house on Magdalene Hill at Winchester was perhaps the 
 most important in the locality. It possessed a handsome 
 chapel, one of the first in England that survived till the 
 eighteenth century, when it was wholly demolished. 
 
 There were hospitals for lepers also at Christ Church, An- 
 dover, Newport (Isle of Wight) and Southampton (see list). 
 
 St. Louis brought twelve of the Knights of St. Lazarus 
 into France, and entrusted them with the superintendence of 
 the leper hospitals of his kingdom. They acquired a foot- 
 ing in England in the time of Stephen, especially at Burton 
 Lazars, in Leicestershire, possibly, for that very reason, one 
 of the foremost leper hospitals in Britain,^ and to w^hich 
 hospital all the others in the country were made subject.^ 
 As the Maiden-Bradley hospital was established by the 
 interest of a great family, so also was the hospital at Burton, 
 for it was founded by one of the Mowbrays, " a gentleman " 
 (as Hals says) "who was tainted with the disease." * Most of 
 the revenue for its endowment seems to have been obtained 
 by a general subscription throughout the country. Hals and 
 Polwhele agree that it was at this period (Stephen and 
 Henry II) that leprosy " generally spread itself over this king- 
 dom/' and it was therefore natural enough that the decree 
 De Lepro&'O Amovendo should be then issued for the removal of 
 lepers to the various hospitals. Leprosy disabled the subject 
 of it from suing any action, either real or personal, as, first, 
 that he was a leper, and that by the writ De Leproso Amovendo 
 was "propter contagionem morhi predicti," as the writ said, 
 
 ' 'History of Epidemics in Britain,' C. Creighton, M-D-j 1891, p. 91. 
 
 - Tanner, loc. cit. ; HUls, 'History of Cornwall,' part ii, 1750, p. 160; 
 Sir "W. Dugdale, loc. cit., p. 632 ; Nichols, 'Leicestershire,' 1795. 
 
 3 Polwhele, ' Hist, of Cornwall,' p. 88. 
 
 •^ Eoger de Mowbray, Richard Orenge, Manser Biset, the son of the Earl 
 of Leicester, Henry III, Henry IV, Baldwin IV, Eobert the Bruce, and the 
 Duchess of Brittany were amongst celebrities who were said to be lepers.
 
 HISTOEICAL NOTES. 19 
 
 " et propter corporis deformitatevi " to be removed from the 
 society of men to some solitary place, and therefore as 
 Bracton^ said, " talis placitare non pi-otest ; nee hereditatem 
 petere." And herewith agreed John Breton^ and also Fleta/ 
 'saying: " competit etiamfit exceptis propter lepram manifestum 
 ut si petens leprosus suerit et tavi deformis qiiod a communione 
 gentium merito debet separari talis enim morbus petentevi 
 repellit ab agendo," which was grounded upon laws in 
 Leviticus and Numbers (Nichols). 
 
 It was decreed in the Council of Lateran (1179) : "That 
 whereas numbers of leprous people are gathered together in 
 the community, they shall be permitted to enjoy to themselves 
 a church, a churchyard of their own ; but they must take 
 care that this be in no way injurious or prejudicial to the 
 rights of the parish churches ; yet shall not the leper or 
 lazar-houses be compelled to pay tithes for the increase of 
 their own cattle " (Nichols). 
 
 The hospital was destroyed by fire in the fourteenth cen- 
 tury, through the carelessness of a plumber. Its charter was 
 confirmed many times — by John, Henry II, and Edward III. 
 
 Exeter * was one of the first founded in the south-west of 
 England. The hospital was dedicated to St. Mary Magdalene. 
 Lysons thought it the most ancient institution of its kind in 
 England, and says it was in existence 'Mong before 1163," 
 when certain privileges were granted to it by Bishop Bartholo- 
 mew Iscanus, who occupied the See, 1 161 — 1 184. Oliver^ says 
 that " St. Mary Magdalene (lying beyond the south gate and 
 adjoining the parish of Holy Trinity) was not improbably 
 erected before the Crusades " — a conjecture sanctioned by ex- 
 pressions in the charter of Bishop Bartholomew with reference 
 to their long possession, ancient custom, remote times. '^ Pro- 
 bably " (he adds) 'Hhe establishment was increased in conse- 
 quence of the Crusades, when we know leprosy became very 
 common in Europe. In this diocese there was in the suburbs of 
 most towns an hospital for the reception of persons afflicted 
 
 ' Bi'acton, lib. v, fol. 421. 
 
 * Breton, vol. xxxix. 
 
 ^ Fleta, lib. vi, cap. 39. 
 
 * Lysons, ' Britannica,' vol. vi ; Izachus, 'Exeter,' p. il. 
 
 * ' Monasticon Diocesis Exoniensis,' G. Oliver, D.D., 1846.
 
 20 HISTORICAL NOTES. 
 
 with this disorder/' Bishop Bartholomew gi'anted five merks 
 yearly, one tenth of the rents at Morchard and the profits 
 arising from the bark of Chudleigh wood, and with his appro- 
 bation the cathedral chapter allowed them " fourteen loaves 
 weekly for ever/' Oliver states that Bartholomew's charter 
 ordered that none of the lepers should enter the city of 
 Exeter, but he did arrange for a Proctor to collect alms. In 
 1437, ^^® Bishop of the diocese pronounced excommunication 
 on certain persons who had stolen documents from the leper 
 house unless returned within fifteen days. The number of 
 lepers therein was confined to thirteen, and amongst other 
 restrictions they were prevented from going into the city 
 (Lysons). This is denied by Hals,^ who affirms that they 
 were not sufiiciently provided for, since on every market day 
 they went into the market (whether that was within or with- 
 out the city wall, it is clear they must have more or less 
 mingled with the public) with a clap-dish, and went from 
 one to another to beg corn and all other victuals there 
 brought to be sold. They claimed this liberty it seems from 
 the aforesaid will of Bishop Iscanus, who granted them a toll 
 of all corn and bi'ead sold in the several markets and fairs 
 of the city ; also that they should collect the citizens' alms 
 on certain days of the week. They accordingly came into 
 the city with their clap-dishes demanding the said toll, etc., 
 but Hals states that they found little relief. This occasioned 
 a permutation to be made between the mayor of the city and 
 the bishop, viz., that the bishop should become patron of 
 St. John's and the mayor of St. Magdalene's Hospital. 
 (Brice affirms^ that there were several leper hospitals at 
 Exeter). In addition to this systematic begging, it appears 
 that the hospital was also supported by means of funds 
 accruing thereto from a fair,* which was held at the festival of 
 St. Mary Magdalene. In 1463 it was granted to the corpora- 
 tion of Exeter, either to use on behalf of the lepers or to 
 withhold, as seemed desirable. In 1454 the mayor himself, 
 Richard Orenge, " although of noble parentage " (lie came 
 from a foreign stock of nobility), became infected with 
 
 > Hals' ' MSS. in Roche,' Brice, p. 548. 
 
 " Brice, loc. cit. 
 
 ^ Lysons, loc. cit., vol. vi.
 
 HISTOEICAL NOTES. 21 
 
 leprosy. Thereupon he submitted to be removed to dwell 
 in the said lazaretto, and there ending his days he lies 
 buried in the chancel of the chapel belonging to the hospital. 
 (This chapel was a ruin at the end of the seventeenth cen- 
 tury, but was repaired in 1750). '^ A mayor of the city so 
 patiently yielding to be set apart " was considered a piece 
 of superlative goodness and piety. That leprosy prevailed 
 widely in the diocese of Exeter we know on a high authority.^ 
 The will of Thomas Button, Bishop of Exeter, dated 1307, 
 contained thirty -nine legacies to the lepers in his diocese at 
 the following places : 
 
 " Exeter, Okehampton, Tavistock, Sutton, Plymouth, 
 Cleve, Modburi, Chadelyntone, Dertermuth, Tottene, Honi- 
 ton, Teignmouth, Nijweton-Ferrars, Toppesham, Deveneburi, 
 Barnum and Pylton, Launceston, Treweton Setus Gerraanus, 
 Lis Kyret, Dyn-mur, Bodmin, Lanford, Tony, Ponsmur, 
 Schiepstalle, Resuregby, Coygon, Truru, Argel, Helleston, 
 Glas, Moushole, Madern, S. Sancred Redruth, S. Brioc, 
 Oldestowe, Medeschole." Lepers existed at Courtney and 
 Bohun also.^ 
 
 At Carlisle,^ in the southern suburbs near Botchard- 
 gate, stood a hospital for twelve (Lysons) or thirteen men 
 (Simpson), dedicated to St. Nicholas before 1180. It was 
 supposed to be of royal foundation, and John, in 1201, sent 
 letters of protection. Indeed, in 1336, Thomas de Goldyngton, 
 then master of the hospital, brought a prohibition against 
 the bishop, who was about to visit this house, on a suggestion 
 that it was a royal foundation, and therefore visitable only 
 by the king's commissioners; and in 1341 the said bishop 
 was commissioned by the king to visit this hospital.* 
 
 It is said that when the Newcastle and Carlisle Railway 
 was being made, a considerable number of human bones and 
 urns were found on the site of the old leper hospital. 
 
 It was last destroyed during the Civil War,^ 1646. It 
 
 » ' Lancet,' 1890 ; T. C. Button, of Exeter. 
 ^ 'Journal Archseolog. Association,' vol. ix, 1854. 
 ^ Tanner, loc. cit. ; Sir W. Dugdale, loc. cit., p. 757 ; Lysons, vol. iv. 
 ■* Nicolson and Burn, ' Hist, of Westmoreland and Cumberland,' vol. ii, 
 p. 250. 
 
 * Jefferson, ' Hist, of Carlisle.'
 
 22 HISTORICAL NOTES. 
 
 had been destroyed frequently before, in 1296 and again by 
 the Scots in 1326. It was burnt in 1337. 
 
 The earliest reference discoverable is 1180, but by whom 
 it was founded it is not known (probably William II). In 
 Edward the First's time an ''inquest" was held. Edward 
 claimed the patronage of St. Nicholas against the Bishop 
 of Carlisle, and secured his desire by the decision of a 
 jury. 
 
 Things went quietly for a time, then in 137 1, on a 
 complaint being made by the Master that the house was 
 cheated and defrauded of a great part of their sustenance, 
 the Bishop (Thomas Appleby) issued an order that all unjust 
 " deteiners of thraves '' of corn and other goods belonging 
 to the hospital should make full payment within ten days 
 on pain of excommunication. 
 
 Sherburn Hospital, near Durham, was one of the richest 
 endowed charities in the North of England, and certainly 
 the largest leper establishment in the county. It was 
 founded by the opulent Hugh Pudsey, Bishop of Durham, 
 for the reception of sixty-five lepers, with a master and 
 other officers, about the year 1184, just when leprosy was 
 so prevalent in England.^ " The old hospital stands on 
 the west side of a square area of one acre, and consists of a 
 neat but low building having a hall in the centre and a 
 wing at each end ; on the east side of the area is the 
 master's house, the chaplain's apartments, and a house for 
 a chief farmer ; on the north side stands the chapel and the 
 rooms of a new hospital built in 1820." 
 
 Such is the description by Dugdale. The square area 
 above referred to was situated about one and a half miles 
 south-east of Durham, and to the east of Sherburn Water. 
 There were early in its history many lands and donations 
 granted to the hospital, probably through the wide influence 
 of Pudsey, " the joly Byshop of Durham." We have the 
 record of many interesting details of the inner life of a leper 
 hospital such as this, in Surtees' ' History ' (vol. i, pp. 1 27 — 138) 
 and Allan's ' Collections.' From these sources we learn that 
 
 ' Dugdale, ' England and Wales,' vol. vii. Simpson, loc. cit. Sir W. 
 Dugdale, loc. cit., p. 668. Surtees, ' Hist, and Antiq. of Co. Palatine of 
 Durham,' 1S16, vol. i, p. 127.
 
 HISTORICAL NOTES. 23 
 
 the daily allowance of the lepers was a loaf weighing five 
 marks and a gallon of ale each ; and between every two leper? 
 one mess or commons of flesh three days in the week, and if 
 fish, then cheese or butter on the remaining four days : on 
 high festivals a double mess ; and in particular on the Feast 
 of St. Cuthbert in Lent, fresh salmon if it could be had, if 
 not then other fresh fish, and on Michaelmas Day four lepers 
 messed on one goose. With fresh fish, flesh or eggs, a 
 measure of salt was delivered (the twentieth part of a 
 razor). When fresh fish could not be had, red hei'rings 
 were served thi-ee to a single mess, or cheese and butter by 
 weight, or three eg'gs. During Lent each had a razor of 
 wheat " to make furmenty,'^ and two razors of beans to 
 boil ; sometimes greens or onions ; and every day, except 
 Sunday, the seventh part of a razor of bean meal, but on 
 Sunday a measure and a half of pulse to make gruel. Eed 
 herrings were prohibited from Pentecost to Michaelmas ; at 
 the latter each received two razors of apples. 
 
 The lepers shared a common kitchen, a common cook, 
 and utensils and firing for cooking &c., viz. a lead, tAvo 
 brazen pots, a table, a large wooden vessel for washing or 
 making wine, a laver, two ale pots, and two bathing pots. 
 The sick (t. e. those unable to get about at all) had fire 
 and candle and all necessaries, donee meUoretur vel moviatur, 
 and one of the chaplains was assigned to hear the confessions 
 of the sick, and read the gospel to them on Sundays and 
 holy days, and to read the burial service for the dead. The 
 old woman who nursed the sick and the grave-digger were 
 botli fed extra when extra work had to be done. Each 
 leper had a yearl}^ allowance for his clothing of three yards 
 of woollen cloth, white or russet, six yards of linen, six 
 yards of canvas; and on the day on which the '^ tayler " 
 came to cut the clothes he had his meat and drink. Four 
 fires were allowed for the whole community. From 
 Michaelmas to All Saints they had two baskets of peat on 
 the mess days, and four baskets daily from All Saints to 
 Easter. On Christmas Eve they had four yule clogs, each 
 a cartload, with four trusses of straw ; four trusses of straw 
 on All Saints' Eve and Easter Eve, and four bundles of 
 rushes on the eves of Pentecost, St. John the Baptist, and
 
 24 HISTORICAL NOTES. 
 
 St. Magdalene, and on the anniversary of Martin de Sancte 
 Cruce every leper received 5s. ^d. in money. 
 
 The lepers had the liberty of seeing their friends ; and 
 strangers who came from a distance were suffered to rest in 
 the hospital all night, but visitors from the neighbourhood 
 departed in the evening, and when the bell sounded for 
 supper the gates were closed.^ 
 
 Disobedient members were punished at the discretion of 
 their prior and prioress by corporal correction, ^je?- fernlam 
 modo scholarium, and offenders who refused to submit to the 
 usual discipline were reduced to bread and water, and after 
 the third offence were liable to be ejected. All these con- 
 stitutions Bishop Richard Kellaw confirmed by his charter 
 and ordered to be ever thereafter inviolably observed." 
 
 Yet before the lapse of a century abuses were complained 
 of, the lepers neglected, and the whole hospital hastening to 
 decay. Hence Bishop Langley's interposition and after ap- 
 plication to the Pope, Eugenius IV., Langley made new 
 regulations and ordinances for the better government of the 
 hospital {Nova ordinatio sine Reformatio Hosintalis de 
 Shirehurne per Thomas Langley Ej^iscopium ex Gommissione 
 Eugenii Papse 4ti, 22 Inti., 1434). " On account of the 
 reduced state of the revenues (of the causes of which reduc- 
 tion no account is given) the Master was only charged with 
 the maintenance of thirteen poor brethren and of two lepers, 
 in memoriam primarise fundationis si in partihus reperiri 
 possunt" (Surtees). 
 
 The hospital continued under the Langley statutes till 
 1557, when further complaints were made that the Master (Sir 
 Thomas Leigh) had leased the whole possession to his own 
 connections and had reduced the number to be maintained to 
 eight. (Thus as the funds increased " the poor brethren '* 
 diminished in number from sixty-five to thirteen and then 
 to eight.) 
 
 In 1593, there was appointed a general Commission to 
 
 ' Many other details respecting the domestic life of the hospital may be 
 found in Surtees' ' History of Durham,' and other records ; much interesting 
 matter of this nature appeared in the ' Nineteenth Centuiy,' September, 1884, 
 p. 475, efsej. 
 
 ^ ' Constitutiones Domus de Shu'ebume.'
 
 HISTORICAL NOTES. 25 
 
 inquire into all the charities in the diocese of Durham. In 
 that report the Brethren of Shireburne are stated '' to be 
 chosen of one sex only^ viz. men, but of sick or whole 
 lepers or wayfaring there is no distinction in the same 
 foundation. ^^ Surtees aflfirms that " long ago it would have 
 been difficult to find a real leper in England/' and so far 
 the change in the original institution was satisfactory and 
 entirely necessary. 
 
 With regard to leprosy in Wales, it is not easy to gather 
 together much information, partly because there is but 
 little in the way of chronicle extant, and partly because 
 Wales was a wild country with a population less numerous 
 even than England. But there are various references besides 
 the Leper Laws of Hywel Dda which leave no doubt that 
 leprosy existed and prevailed proportionately there much 
 as it did in England. Evidence is forthcoming from a 
 number of laws that were made relative to it. In Cy- 
 vreithiau Amryval the law states that '' if a person became 
 a surety, and before the termination of the suit he should 
 become leprous, and should suppose he is no longer re- 
 sponsible in the law, we say that he must fulfil his promise 
 while he lives ;" ^ and though lepers were kept to such 
 pledges more or less, they were never allowed to accept 
 any new responsibilities or positions. Thus amongst the 
 objections to a pleader were those of having violated his 
 religious profession, or having become a leper (p. 516, and 
 also Law xxiv, p. 764) . Again : " Three sons who are not to 
 have patrimony, the son of a priest, the son of a leper, and 
 the son of a man who had paid his patrimony as blood- 
 land : the son of a leper is not to have it because God has 
 separated him from worldly kin, that is, such a son as a leper 
 may have after being adjudged to a lazar-house " (p. 556), 
 which seems to brand even the offspring of lepers as debarred 
 from the rights and privileges of other men ; and in another 
 place (p. 603) we are told that the one reason for excluding 
 a leper from patrimony was "that he is not of the world.'' 
 Finally, Law cxii (p. 656) states that the " three persons to 
 whom saraad is not due are a leper, a natural fool, and an 
 
 ' 'Welsh Laws : ' Record Edition by Aneurin Owen, 1841, p. 403.
 
 26 HISTORICAL NOTES. 
 
 alltud ;" and in Law ccxiv. (p. 671) lepers are under no cir- 
 cumstances to be invested with " judicial function." 
 
 Various old Welsh records may be found on the treat- 
 ment of leprosy. In the ' Book of Prescriptions of the 
 Physicians of Myddvai/^ which was written, I believe, in 
 the thirteenth century," directions are given for compounding 
 medicines for leprosy, e. g. that of pounding together 
 various vegetable roots with salted butter and heating this 
 to the boiling-point, then strain through fine linen and add 
 flour of brimstone. This was assured as a certain cure for 
 leprosy (p. 401). Another prescription was for the juice of 
 cleavers or goose-grass (p. 444). 
 
 By the kind permission of Professor John Edward Lloyd 
 of Bangor I may add here a note on the matter which 
 I have received from him. Speaking of leprosy he says it 
 was '' undoubtedly well known in Wales in the Middle 
 Ages. The mediaeval name for it was clefri (clafr = a leper), 
 the modern term gwahan-glwyf (= separation sickness) being 
 a compound which we owe, I fancy, to the translators of the 
 Welsh Bible. The evidence for its existence is — 
 
 1. The ancient Welsh Laws (referred to above). Ac- 
 cording to these a person adjudged a leper retired to a 
 lazar-house, ceased to be of the world, might be divorced 
 by his wife, might not act as a judge or advocate, might 
 not inherit patrimony (nor might any son of his born after 
 his separation from the world), could not avenge or be 
 avenged upon in any family feud, and could not be the 
 subject of "sarhad^^ or legal insult. "VYhen he retired 
 from the world he paid an ebediw, or death due, to the lord 
 as in the case of a death. 
 
 2. The proverb '^ Ni bydd adglaf o glaf wr " ^ (' glafwr ' 
 is for ' glafr,' which means leper, not leprosy) = You will 
 find no convalescent leper. 
 
 ' ' The Physicians of Myddvai : Meddygon Myddfai,' by John Pughe, 
 F.Pt.C.S., and J. W. Ab Ithel, M.A. 
 
 - Professor J. E. Lloyd thinks the MSS. " need not be older in substance 
 than the sixteenth century. In the first passage the malady is called ' Tardd 
 gwnhanol [i. e. separation = outbreak] a clwir, (which is called) y gwahan- 
 glwyf.' In the second the word translated is different, viz. 'y ddarwyden 
 fawr,' which is later on glossed ' a clwir yn Lladin lepra.' " 
 
 ^ ' Diareb' (Myv. Arch., iii, 166).
 
 HISTORICAL NOTES. 27 
 
 3. The following place names — Nant y Clauiorion (in 
 modei'n Welsh, Nant y Claforion ^), mentioned in the Liber 
 Landavensis (ed. gwenogfryn, Evans, 126), and possibly the 
 same as the vallis leprosorum " (which is a correct Latin 
 translation), mentioned in the same book (p. 227). Bhydy- 
 clawrdy, three miles west of Pwllheli, Carnarvonshire, which 
 was no doubt Rhyd y Clafrdy = the ford of the lazar- 
 house. I can recall no historical reference to any Welsh 
 '^ lazar-house.'^ My attention has also been called by Professor 
 Lloyd to the different terms used for lepi-osy appearing in 
 Dr. John Davies' Dictionary (1632), which I add below.'^ 
 
 Just about the time that Baldwin, King of Jerusalem, was 
 compelled to resign his crown owing to disablement from 
 leprosy, there were about 2000 leper-houses in France, 
 and two Popes, Lucius III and Clement III, made decrees 
 concerning the disease. Approximately it was the time of 
 the appearance of leprosy in Iceland ; and, though not for 
 the first time by any means (Belcher), a hospital was 
 founded in Ireland at Waterford. Belcher * believes leprosy 
 was prevalent in Ireland in a.d. 432,^ and from that date 
 it existed more or less (endemically) till 1775, when Water- 
 ford Hospital had its last case. A hundred years after 
 its ''first notice " it seems that there w^as (what was termed) 
 a pestilence of leprosy (550) .^ " The rickets are of late 
 very rife in Ireland," said Dr. Boate ^ in 1652, " where a few 
 years ago unknown : so on the contrary it hath been almost 
 quite freed from another disease, one of the very worst and 
 miserablest in the world, viz. the leprosie, which in former 
 
 1 Was probably in Dyfed (roi;ghly, our Pembrokesbire). 
 
 - In Glamorgan. 
 
 ^ Brech yr luddewon ^ the Jews' pox. 
 
 Y gwaban-glwyf =: the separation sickness. 
 y clwy gwahanol or ") -, 
 
 Clawr (= clafr) gwahanol ) 
 
 Y clwyf mawr ^ the great sickness. 
 
 Y tardd gwahanol := the separation outbreak. 
 
 ■* ' Hebrew, Mediseval, and Modern Leprosies compared,' J. W. Belcher, 
 M.D., 1864. 
 
 * Colgan's 'Acta Sanctorum.' 
 
 " ' Chronicon Scotorum.' 
 
 ^ ' Natural History of Ireland.'
 
 28 HISTORICAL NOTES. 
 
 times was very common there, especially in the province of 
 Munster : the which, therefore, was fitted with hospitals 
 expressly built for to receive and keep the leprous persons. 
 But many years since Ireland hath been almost quite freed 
 from this horrible and loathsome disease, and as few leprous 
 persons are found there as in any other countrie in the 
 world ; so that the hospitals erected for their use having stood 
 empty a long time, are quite decayed and come to nothing." 
 
 The earliest notice of a leper hospital in Ireland was in 
 86g, when the hospital flourishing at Armagh was demolished 
 and sacked during Arlaf's invasion. 
 
 The hospital at Waterford was established before 1185.^ 
 The Leper Hospital of St. Stephen was its name, and it stood 
 by St. Stephen Street and was first endowed by the wealthy 
 and influential family of Bowers. They gave it land (called 
 Leper Town) in the parish of St. Killea, about five miles 
 from Waterford. The hospital was under the direction of 
 a master, " who was appointed during the pleasure of the 
 mayor, sheriffs, and commons at a small salary, and has a 
 clerk as an assistant. Formerly about fifty poor used to 
 receive a yearly allowance by the master's hands. But as 
 it was thought that a public infirmary would best answer the 
 intent of the pious benefactor, since leprosy is not now 
 (1740) a disease much complained of,''~ hence endowments, 
 &c., went to establish an infirmary.^ In 1663, William 
 Boyne, Esq., left ten barrels of wheat yearly for ever to 
 the lepers. 
 
 Kilbrixy in co. West Meath followed, according to Arch- 
 dale, in 1 192. 
 
 Then came Dublin with its hospital on Lazar Hill. 
 Several others followed there in the thirteenth and fourteenth 
 centuries. There was one at Lepertowne between Dublin 
 and Bray, another in Dublin at St. Stephen's, a fourth near 
 Kilmainham, a fifth where old Mercer's Hospital now stands. 
 There were hospitals also at Kilchief (co. Down) and at 
 
 1 'Monasticon Hibernicom,' Mervyn Archdale, M.A., 1786. Smith's 
 'Waterford,' p. 123. ' Dubl. Quart. Med. Journ.,' 1868 (Belcher). 
 
 - 'Ancient and Present State of Waterford,' p. 183, Charles Smith, M.D., 
 
 1745. 
 
 3 'Dubl. Quart. Med. Journ.,' 1868, Belcher.
 
 HISTORICAL NOTES. 29 
 
 Camckfergus^ and Downpatrick. The majority of them 
 were, however^ established in Munster (at Waterford, Wex- 
 ford, Cork, Cloyne, Duugannon, and Lismore) ; Lismore Hos- 
 pital had considerable wealth in lands, and paid an annual 
 rent to all the other lazar-houses in Ireland." The words 
 lour, lower, lowre, indicate leprosy in names of places thus — 
 Knockaunalour, Ballylowre, &c. Boate said that ill diet 
 caused leprosy in Ireland, and it stopped when the English 
 changed the diet by protecting the salmon fisheries. There 
 was pi'actically no leprosy after the seventeenth century. 
 
 There were many other leper hospitals also founded in 
 England or already in existence before the end of the 
 twelfth century, i. e. before they returned in sufficient 
 number to increase disease.^ Leprosy was at this period 
 prevalent in England, but in all probability upon the decline. 
 
 " In the border counties of Scotland beyond the year 1200 
 tliere existed various hospitals for the exclusive reception 
 of lepers, and in the immediately adjoining English counties 
 of Northumberland, Cumberland, and Durham, Three alone 
 o£ these hospitals contained as many as ninety-one lepers in 
 all.* One of these was of course the famous hospital at 
 Durham (sixty-five), the second at Carlisle with thirteen, 
 and the third at Bolton in Northumberland, also with capa- 
 city for thirteen lepers. It was founded by Robert de Roos 
 to support " Sb master, three brethren, three chaplains, and 
 thirteen leprous laymen.'" ^ 
 
 The only settlement of the knights of St. Lazarus in 
 Scotland was at Linlithgow (Simpson). This was founded 
 during the reign of Alexander II, and restored under James 
 I. (of Scotland). It was endowed, and had also a fair to 
 augment its income.^ But it may be assumed that leprosy 
 did not in any case become prevalent in Scotland (using the 
 word in comparison with leprosy in England) till the four- 
 teenth century. 
 
 ' ' Hist, and Antiq. of Carrickfergus,' MacSkimin. 
 
 - ' Waterford,' Smith, p. 22. 
 
 ^ Of course Crusaders had returned since 1098. 
 
 ■• 'Edin. Med. and Surg. Journ.,' Sir J. Y. Simpson, 1841. 
 
 ° ' England and Wales,' Thomas Dugdale, vol. ii, 231. 
 
 ® ' Leper Hospitals in Scotland at the Reformation,' Spottiswood, vol. ii, 
 p. 874.
 
 30 HISTORICAL NOTES. 
 
 There -svere in England in the thirteenth century a 
 number of leper hospitals founded, of which detailed mention 
 is not necessary, as it would closely resemble what has been 
 already said. (For the full list of thirteenth century hos- 
 pitals, see list of dates.) 
 
 The Earl of Chester founded the Sponne Hospital, Mary 
 Magdalene, at Coventry in Henry II's reign with half a 
 carucate of land for any lepers in or around Coventry. 
 Dugdale states that shortly afterwards it was appropriated 
 by the monks. 
 
 The Stourbridge Hospital in Cambridge was founded by 
 King John, the one king in England who cared greatly about 
 his leprous subjects. The Bishop of Ely seized it later 
 and used its income apparently for his own purposes. 
 
 Thetford in Norfolk ^ seems to have been quite a centre 
 for lepers, for it possessed four different hospitals. Taylor 
 believes that there were other hospitals in the diocese with 
 chapels attached of which there is no record.^ 
 
 St. John the Baptist Hospital (before 12 16) was found 
 to be insufficient for the need, and hence during Henry the 
 Third's reign, the Earl of Warren built St. Mary Magdalene 
 and bestowed lands, houses, and liberties as endowment. 
 Like others mentioned it also had a fair. 
 
 St. John's, some authorities believe, was in existence 
 before the Norman Conquest as a kind of charitable institu- 
 tion, but in the time of Richard II. it was changed into a 
 leper hospital,^ and it continued as such till the Dissolution. 
 The same sort of experience befell the hospital of St. 
 Margaret.^ Amongst its privileges was an Indulgence 
 allowed by the Bishop of Ely (J. Fordham) to all people 
 who assisted the lepers by donations. 
 
 It has been said that St. Margaret's was converted into 
 a leper hospital in the time of Edward III. (when more 
 leper accommodation was necessary), and then transferred 
 into a chapel again at a later date.^ 
 
 ' * History of Norfolk,' F. Blomefield, 1739. 'Index Monasticus of Diocese 
 of Norwich,' E. Taylor. 
 - Ibid., p. 14. 
 =» ' History of Thetford,' Thos. :\Iartin, F.R.S. 
 
 * 'Register,' Fordham, fol. 175. 
 
 * ' MSS.,' North, fol. 6.
 
 HISTORICAL NOTES. 31 
 
 During the fourteenth century various mandates and 
 regulations were made. In 1346/ Edward III. ordei-ed 
 " that all persons Avho have such blemish (of leprosy) shall 
 within fifteen days from the date of these presents quit the 
 city and suburbs aforesaid^' to solitary country life. The 
 mandate also ordered '^ that no persons shall permit such 
 leprous persons to dwell in their houses " on pain of for- 
 feiture of house and property. In the same document 
 there are references to the prevalence of lepers and the 
 mixing of diseased people with the healthy, and that this 
 should be prevented and fewer errors made and the 
 diagnosis of leprosy placed in more skilled hands, " certain 
 discreet and lawful men who have the best knowledge of the 
 disease " shall make careful and diligent examination of 
 suspicious persons. 
 
 Some twenty-five years later we hear of a case in point. 
 " John Mayer, baker,^ smitten with the blemish of leprosy 
 was sworn before the mayor and aldermen at the husting- 
 holden on the said Monday that he would depart forthwith 
 from the city and would make no longer stay within the 
 same." ^ And many other cases might be brought forward 
 to illustrate not only the prevalence of the disease of 
 " leprosy " but also the difficulty that the municipal 
 authorities had in controlling lepers coming in and going 
 out of the city. It was only three yeai's after the case of 
 Mayer that the porters at the city gates of Aldgate^ 
 Bishopesgate, Cripulgate, Aldwichesgate, Newgate, Ludgate, 
 Bridgegate, and the Postern (near the Tower) were sworn 
 before the Mayor and Recorder 'Hhat they will not allow 
 lepers to enter the city or to stay in the same or in the 
 suburbs thereof." * 
 
 In 1389, a curious revelation is brought to light of the 
 method of management of misconducting lepers in the city 
 
 ' 20 Edw. Ill, Letter-book F, fol. cxvi. 
 
 - It seems that no special trades were more infected by leprosy than any 
 others. Simpson states in his 'Archaeological Essay ' that "ropemakers" 
 were frequently attacked. This was because of their extract and social 
 position. Generally speaking, it was the " villeins " amongst whom the 
 leprosy spread, and next to them the " bordarii " (e. g. in Norwich). 
 
 ^ 46 Edw. Ill, Letter-book G, fol. cclxxxix. 
 
 * 49 Edw. Ill, Letter-book H, fol. xx.
 
 32 HISTORICAL NOTES. 
 
 hospitals^ viz. a royal exemption of '^ our dear and well- 
 beloved Robert Yvyuglioo and Gilbert Eotliyng, keepers 
 and overseers of the lazars," from various municipal duties 
 like inquests, juries, summonses, &c,, because it is their 
 duty " to chastise and punish offenders (lepers) against their 
 rule " and " in doing these things the said Robert and 
 Gilbert are oftentimes occupied and hard-worked" and 
 " cannot occupy themselves about their trades and business 
 so much as they find themselves occupied in their said 
 duties," therefore considering " their meritorious labour, 
 their unpleasant and onerous occupation," &c., they are to 
 be exempted as above. ^ By which it would appear that the 
 lepers were disorderly and also that their " overseers " were 
 traders and business men giving some of their time to 
 attendance and supervision of lepers' hospitals. All of 
 which would confirm me in my belief that the general 
 arrangements of the affairs of the leper-houses were in 
 almost every way lax and irregular. 
 
 The separation of lepers above referred to was in no way 
 a new regulation. Leprosy " being highly contagious," the 
 lepers were separated from all human society.^ (Carlisle 
 believes that is why thei'e was no leprosy in England in the 
 seventeenth century.^) A like arrangement had been an 
 established rule from the earliest antiquity. But to what 
 extent this separation was enforced one may learn from the 
 method of enforcement of the writ De Leproso Amovendo, 
 which applied to a man who was a leper dwelling in any 
 town who persisted in coming into the church or amongst 
 his neighbours where they were assembled, to their annoy- 
 ance and disturbance. Then he or she of the assembly 
 might sue forth that writ for to remove him from their com- 
 pany. The writ arranged for examination and removal 
 to a solitary place. But it seems if a leper kept himself 
 within his house and did not converse or mix with his 
 neighbours, that then he was not to be moved out of his 
 house.^ 
 
 This at once shows how very lax, careless, and therefore 
 useless the " segregation " was. Besides, if leprosy were 
 
 ' 13 Richard, 1389, Letter-book H, folio ccxlii. 
 
 " ' Historical account of the origin of the Commission,' N. Carlisle, 1828.
 
 HISTOEICAL NOTES. 33 
 
 ■^* contagious/^ would not this arrangement have been a most 
 definite assistance to the spread of the disease by contagion ? 
 for as it is certain that many lepers were confined in the 
 hospitals, it is just as certain that more were not. 
 
 They were kept out of the churches also. In the year 
 1200 at the Provincial Synod holden at Westminster^ Hubert, 
 Archbishop of Canterbury, decreed : when so many leprous 
 persons were assembled that might be able to build a church 
 with a churchyard to themselves and to have one especial 
 priest of their own, that they should be permitted to have 
 the same without contradiction ; and in this manner they 
 would be no longer injurious to the old churches. This 
 arrangement was an almost exact counterpart of the Lateran 
 Council, 1 1 79. This same canon dispensed such communi- 
 ties of lepers from payment of tithes. But this part fell 
 into disuse^ for we are told by Strype ^ that in 1562, while 
 Bobling Leper House was " not charged with any tenth " the 
 leper hospital of St. Lawrence at Canterbury is taxed and 
 payeth the perpetual tenths. 
 
 In many places this was done, and the lepers not only 
 formed in such places a social colony, but also an ecclesias- 
 tical one ; and this in addition to the before-mentioned fact 
 that most of the " hospitals " in England were ecclesias- 
 tical institutions. 
 
 But in most places of course this special church and 
 graveyard were quite impossible through lack of funds and 
 lack of lepers. In many of these places arrangements were 
 made by which the lepers were enabled to take some share 
 in the church services by means of the leper window or 
 squint-window or hagioscope. The exact reason for the 
 squint-window is not quite clear. It was established at the 
 wish of the public, either because they feared the contagion 
 of leprosy or because they disliked the sight and presence of 
 the lepers, whose poverty and disease caused them to be 
 generally unsightly, and hence shunned. The first reason is 
 the more likely, but probably both played a part in the 
 custom. 
 
 The hagioscope consisted of " an opening or aperture 
 obliquely disposed, carried through the thickness of the wall 
 ' Strype's ' Life and Acts of Matthew Parker.' 
 
 3
 
 34 HISTORICAL NOTES. 
 
 at the north-east angle of the south aisle and the south- 
 east angle of the north aisle of the church, or of the chapels 
 eastward of the aisles, and which oblique apertures opened 
 into the chancel. Thus at high mass the elevation of the 
 host at the high altar and other ceremonies might be viewed 
 from the chantr}' or other chapel or outside at the east 
 end of each aisle or contiguous to the chancel. In general 
 these apertures are mere plain, narrow oblong slits ; some- 
 times, however, they partake of a more ornamental cha- 
 racter, as in a chantry chapel on the south side of Irthling- 
 borough Church, Northamptonshire, where the head of the 
 aperture of this kind is arched, cinquefoiled within, and 
 finished above with an embattled moulding. On the north 
 and south transepts of Minster Lovell Church in Oxford- 
 shire are oblique openings, arch-headed and foliated, and in 
 the north of Chipping Norton Church in the same county is 
 a singular hagioscope obliquely disposed not unlike a square- 
 headed window of three foliated arched lights, with a quatre- 
 foil beneath each light. ^' ^ An aperture of this description 
 is to be met with in a north chapel on the north side of 
 Standground Church, near Peterborough. A number of leper 
 windows existed in churches along the sea-coast.^ These 
 apertures, though not general, are by no means uncommon in 
 our churches. Many exist along the east coast in Norfolk, 
 Essex, Kent, as well as in Oxfordshire, Bucks, &c. The 
 following are a few I have come across : 
 
 Ludlow (Salop). Christchurch (Hants). 
 
 Irthlingborough (Northamp- Northamptonshire (several) . 
 
 ton). Mulliou Church (Cornwall). 
 
 Chipping Norton (Oxford- Kirkhampton (Cumberland). 
 
 shire) . Beaumont „ 
 
 Minster Lovell (Oxfordshire). Standground (near Peter- 
 Burford „ borough). 
 
 Oxford „ Studland (near Swauage). 
 
 Dorchester ,, Bridgwater (Somerset) . 
 
 Lynn (Norfolk) . Minster (Isle of Thanet) . 
 
 York. Dunchurch (Warwick). 
 
 ' ' Principles of Gothic Ecclesiastical Architecture,' M. H. Bloxaiu, ii, 147. 
 ^ ' Pathological Soc. Transactions,' 1S90, p. 1067.
 
 HISTOEICAL NOTES. 35 
 
 Bidborough (Kent). Packwood (Warwick). 
 
 Send (Surrey). Tenby (South Wales) 
 
 Donnington (Salop). (several). 
 
 Not only was there the hagioscope, but other churches 
 possessed a stone slab let into the sill of the window, and so 
 placed that the leper could receive without actual contact 
 with the administrator of the Sacrament.^ 
 
 By the Provincial Synod of 1200, lepers were not com- 
 pelled to give any tithes of their gardens or increase of 
 cattle. Nor had they any rights or claims in a common law 
 court. Nor were they ever called upon to fulfil any public, 
 judicial, or responsible post.^ They were disqualified for 
 making a will ^ or inheriting property. This latter law had 
 been known for two centuries, for according to the Vene- 
 dotian code, " should her husband be leprous and she leave 
 her husband, the wife is to have the whole of the property,'' 
 i. e. it should not pass into the hands of a leper. They were 
 dead in the eye of the law. 
 
 The leper was not looked upon in the eye of the law alone 
 as defunct, for he was also cut off from the church and 
 not allowed to share in some of its chief services, and in 
 many cases the solemn ceremonial for the burial of the dead 
 was performed over him on the day in which he was sepa- 
 rated from his fellow-men and consigned to the leper hos- 
 pital.* In short, he was from that moment regarded as a 
 man dead amongst the living and legally buried, though still 
 breathing and alive. The ritual of the French Church 
 retained until a late period all the various ceremonies and 
 forms to which the lepers were subjected. 
 
 Although not in chronological order, I may refer here to 
 some of the old laws of Scotland regarding leprosy. 
 
 These are curiously contrary and extravagant, some 
 being so mild and indefinite as to be useless, others sa 
 strict and severe as to be cruel and impossible to keep. 
 
 ^ In the Appendix will be found quotations anent leprosy from several 
 poets, wliicli are further interesting testimony to the disease (note 3). 
 
 2 ' Ancient Laws of Wales ; Dimetian Code and Venedotian Code.' 
 
 ' A case is on record of a York leper (from the Markbridge Hospital) 
 making a will which was proved valid (' Test. Ebor.,' 414). 
 
 * ' Leprosy,' C. N. Macnamara, 1892.
 
 36 HISTORICAL NOTES. 
 
 The more one reads of the quaint arrangements, so much 
 the more does one feel convinced that " strict segregation," 
 as understood and practised now-a-days, never entered the 
 minds of those desiring to separate lepers from the healthy. 
 
 Sir James Y. Simpson (in his ' Archfeological Essays,' 
 vol. ii) mentions several old laws or municipal bye-laws 
 relative to the banishment of lepers from society, one of 
 which I give : — " Na lipper man sail enter within the portes 
 of our burgh. And gif any lipper man uses commonly 
 contrair this our discharge, to come within our burgh, his 
 claiths quherwith he is cled sail be taken fra him and sail 
 be brunt : and he being naked sail be ejected forth of the 
 burgh." 1 
 
 I have also been able to find the followinq- amongst 
 others : 
 
 '' No lepers are to be permitted to enter the borough " 
 in the neighbourhood of which was the hospital." But this 
 was paid so little attention to that vei*y shortly afterwards, 
 " the Chamberlain at his ay re is to enquire whether the 
 Bailies thrice a year hold a visitation to put lepers out of 
 the burgh." " Which curious regulation naturally enough en- 
 couraged a species of smuggling and deceit at the times of 
 the " visitation " of the bailies, and in the intermediate 
 periods secret and sometimes open disobedience to the regu- 
 lation.* These laws dated from the beginning of the fif- 
 teenth century, and twenty-five years afterwards it was 
 found necessary to make less stringent arrangements, seeing 
 that previously the stricter law had been openly transgressed. 
 Hence the following : '' Lepers are not to come into burghs 
 except on Mondays, Wednesdays, and Fridays, from lo to 
 2 o'clock ; when a market falls on these days they shall delay 
 coming till the following day ; lepers are to beg only at 
 their own hospital, and at the town gate and at other places 
 outside the burgh. "^ 
 
 This is very significant, and surely cannot be described 
 
 ' Skene, ' Regiani Majestatem.' 
 - ' Stat. Gild.,' c. i8, i, 343. 
 ' ' Art. Ing.,' i, 680, a. 
 
 * Ibid., i, 681. 
 
 * 1427, c. 8, ii, 16.
 
 HISTORICAL NOTES. 37 
 
 as '^strict segregation." It is difficult to understaud why 
 the lepers in Enghind might attend markets and in Scotland 
 they might not. The same law continues : " Bishops, 
 officials, and deans, at their visitations are to enquire if 
 there be any lepers, and to denounce or report them if lay- 
 men to the King, and if clerks to their bishops ; this statute 
 to be observed under pains." ^ 
 
 By another law a century later, a provision was made for 
 the removal of wandering beggars to their own parishes, 
 but in the case of lepers this was cancelled on two separate 
 occasions,^ by which they were allowed to go where 
 they chose and beg what they could, or reside in any leper 
 hospital to which they could get admittance. A regulation 
 in support of hospitals all over the land is a quaint revela- 
 tion of the kind of care bestowed on the lepers, for it states 
 that '' tainted salmon or pork to be sent to the leper house "^ 
 in the neighbourhood, and " if there was not one, then 
 destroyed " — and again, " when a wild beast be found dead 
 or wounded in the forest, its flesh shall be sent to the nearest 
 leper house." ^ 
 
 At the beginning of the fourteenth century, leprosy was 
 still sufficiently common to call for further hospitals. This 
 was less so in England and more so in Scotland. In Eng- 
 land, probably before the commencement of the century, a 
 hospital of some importance existed at Chester." In the 
 records pertaining thereto we find various items which add 
 to our information of leper customs at this time in Eugland. 
 Ormerod^ tells us that the hospital was situated at the east end 
 of Forest Street, in a small extra-parochial district. It was 
 founded by Earl Randle Blundeville,and was further confirmed 
 and supported by Hugh Kevelioc and Edward III. During 
 the siege of Chester it was completely destroyed. In the 
 Harleian MSS.'^ may be found some account of the method 
 
 ' 1427, c. 8, ii, 16, 
 
 ■ 1574- 1579' c. 12, iii, 88, 141. 
 
 3 ' Frag. Collect,' c. 48. 
 
 * ' Leg. For.,' c. 22, i, 692. 
 
 * ' Notitia Monastica,' Thos. Tanner, M.A., 1787. 
 ® ' History of Chester.' 
 
 ' ' Harl. MSS., 2115, fol. 195.
 
 38 HISTOEICAL NOTES. 
 
 of augmentation of income by means of tolls. " Certain toll 
 fi'om everything carried to sale at Chester market : one 
 handful from every sack of wheat, vetches, or barley ; two 
 handfuls from every sack of oats or malt cai'ried either on 
 a horse or cart or in any other way ; and wheat, vetches, 
 barley, oats, salt fish, and produce of any other kind, and 
 particularly salt, one handful from a sack and two from a 
 cart ; one cheese from every horse-load or cartload of 
 cheese ; one salmon from every horse- or cart-load ; and 
 in other fish such as sparklings, flukes, eels, &c., five from 
 every horse's pannier, and one from every man's load. 
 From fruits of trees, one double handful from each horse- 
 load, and three double handfuls from each cart-load. From 
 fruits of the earth, whether horse-loads or cart-loads, one 
 handful. From all packages of earthenware, one piece of 
 the same ; to have one horse from the horse-fair ; and from 
 all carts drawn by oxen or horses carrying wood or brick, 
 one piece of the same. To have also one boat with a fisher- 
 man above or below Dee bridge, with stallnette, flotuette, 
 or dragnette, or any other kind of nette, night and day ; 
 and three stalls in Dee, called single lyne stalls ; and not to 
 be amenable to the justice, sheriff, or any other ofl[icers of the 
 prince, except in the court of the hospital aforesaid.'' (In 
 this plea are recited two charters of Randle Blundeville, 15 
 Henry VII, Harl. MSS., 21 15, folio 195). 
 
 Many hospitals were supported by voluntary or com- 
 pulsory tolls at markets. Proctors secured funds for some. 
 The munificence of benefactors sufficiently endowed many 
 others, and yet other like establishments were financed 
 by means of Fairs. Perhaps the most famous of these was 
 held at Stourbridge in the interest of the hospital at Cam- 
 bridge. It was held in a field bounded by the Cam in the 
 north and Sture in the east. The origin of it is involved in 
 uncertainty, but it appears to have been granted by King 
 John (1199 — 1216). Heni'y VIII. ultimately granted it to 
 the Corporation of Cambridge. Its legal dui'ation was a 
 fortnight, and the chief articles for sale were wool, hops, 
 leather, hardware, and on one day, horses ; and the busi- 
 ness transacted was extensive.^ Other authorities say it 
 ^ Dugdale, loc. cit., vol. ii, p. 71.
 
 HISTORICAL NOTES. 39 
 
 lasted four weeks, and owed its success to the near ports 
 of Lynn and Blakeney — lience there were many foreign 
 goods sold there and many foreigners present. ^ English 
 people came from all parts of the country and mixed freely 
 together, and hence the fair became a centre for lepers and 
 their interests. 
 
 Some regular amount, either proportionate or actual, went 
 from this fair to the hospitals at Cambridge (St. Anthony 
 and St. Eligius), which were in existence sometime previous 
 to the fourteenth centuiy. One of these Stourbridge-endowed 
 hospitals was unjustly seized some thirty years before Edward 
 the First^s time by Hugh Northwold, Bishop of Ely, whose 
 successor retained it, having placed in it certain officers and 
 others, to the exclusion of the lepers who ought to have 
 been, as in the past, supported there." 
 
 At Lynn, Langwade,and Hard wick in Norfolk, and Beccles 
 and Eye in Suffolk, leper hospitals were established as late 
 as 1330. But there can be no doubt that leprosy was 
 very much on the decline in England even in the Eastern 
 counties. 
 
 The two localities where it seems to have flourished many 
 years after it had died out in other places, were in Scotland 
 and in Cornwall. Dui'ing the fourteenth century various 
 leper institutions and leper laws, both ecclesiastical and 
 political, were established over the Tweed. 
 
 As far back as the twelfth century the disease was not 
 only known there, but hospitals were by that time actually 
 erected for the seclusion of its victims.^ 
 
 At Kingcase, or Kilcais (as it was formerly called),* Ayr 
 was one of the few wealthy leper hospitals in Scotland 
 (Simpson). 
 
 Kingcase, on the coast of Kyle, was in the parish of 
 Prestwick, and the hospital was dedicated to St. Ninian.^ 
 
 ^ Gibbins, ' Industrial History of England.' 
 - Lysons, ' Britannia,' 153. 
 
 ^ If Liberton (near Edinburgh) means, as some believe, lejier-town, it is 
 interesting to know that the earliest mention we have of tlie place is 1 153. 
 
 * ' Historic Ayrshire,' Robertson ; 'Caledonia,' G. Chalmers, F.R.S. ; 
 ^ Statistics, Sir John Sinclair, 1 798 ; ' Statistical Account of Scotland,' v, 1 73. 
 
 * Ninian, b. 360 in the country of the Novantes near the Leucophobia
 
 40 HISTORICAL NOTES. 
 
 Tradition relates that the founder of this establishment was 
 King Robert Bruce, who was, so it is said, himself afflicted 
 with leprosy, " the result of hard fare, hard living, and hard 
 work." The hospital was endowed with various lands in 
 Dundonald parish and other places. Mackenzie Walcott 
 also states that it was dedicated to St. Ninian, was half a 
 mile from Ayr, and was endowed by Robert I. under a 
 chaplain, for eight lepers. Like the leper hospital at Aber- 
 deen, it was in 1654, subdivided into huts (tuguria).^ 
 
 As the foundation charter of this hospital does not exist, 
 it cannot be ascertained what number of persons were 
 originally maintained in it. It appears, however, to have 
 been governed by a guardian and a prior, and it also had a 
 chaplain. In the reign of James II. the lands and hereditary 
 office of governor were acquired by Wallace, of Newton, 
 and it passed through various hands by auctions. Later it 
 and its funds were used for any incurable disease, and in 
 1790 it was purchased for the borough of Ayr, which still 
 holds the patronage. 
 
 Spottiswood" states that the Kingcase Hospital had eight 
 lepers in it " who are each to have eight bolls of meal and 
 eight merks yearly ; and if there is but one he has the whole." 
 As late as 1693, according to Simpson, there were lepers still 
 at Kingcase. In March, 1693, a complaint, it seems, was 
 lodged by the Procurator-Fiscal '' anent the intruding of the 
 lepers of Kingcase upon the priviledges only propper to the 
 Burgers and freemen (of Prestwick) by there resorting to the 
 shoar and taking up certain timber and other wrack, and 
 casting greater quantities of peats and turf off the common, 
 and moss, &c., which being seriously pondered by the magis- 
 trates, they ordained that none of the said lepers of Kingcase 
 do so under the penalty of ane hundredth pund, toties quoties, 
 to be paid by ilk ane of them in caise of failyie."^ 
 
 of Ptolemy ; ordained at Rome ; instructed in monasticism by Maiiin of 
 Toui-s, and returning before the year 397, be freed bis countrymen from 
 superstitious eiTors, and taugbt tbem tbe most important tinitbs. He 
 founded a Monastery at Wbitborn, and erected a cburcb wbicb Bede declares 
 to be the first built of stone. D. 432. 
 
 1 ' Ancient Cburcb of Scotland,' Walcott, p. 336, et seq. 
 
 ' ' Leper Hospitals in Scotland,' Spottiswood, 476. 
 
 ^ • Records of Prestwick,' 342.
 
 HISTORICAL NOTES. 41 
 
 It is singular to note what a large nnmloer of hospitals 
 there were in Scotland at a very early date.^ OdIj ^ very 
 limited number o£ these were set apart for the reception of 
 lepers. At the same time leprosy seems to have " continued 
 prevalent in the northern islands of Scotland long after it 
 had disappeared from the mainland, and indeed all other 
 parts of Great Britain. ^^" 
 
 " It had been known in the north as well as in Ireland 
 for centuries. It was at Lerwick as late as the early part 
 of the sixteenth century,'^ ^ Leprosy was certainly existent 
 in some parts of the Shetlands as late as the eighteenth 
 century — in the island of Papa Stour till 1740.* Then it 
 appears to have gone still further north to the Faroe and 
 Iceland. (Iceland in 1768 had 280 hospital lepers, and 
 accounts record lepers there up to the present day.) 
 
 The well-known entry in the Session Records of Walls 
 (Papastour) regarding the " disappearance " of leprosy in 
 1742 is as follows : 
 
 " The Moderator proposed to the Session that, considering 
 that a gracious Providence had not only delivered the island 
 and country from the burden and necessity of maintaining 
 and otherwise providing for the poor lepers formerly in this 
 island, but had also put a stop to the spreading of that 
 unclean and infectious disease, so that there is no appearance 
 of the symptoms thereof in any person now in this place, 
 the Session should therefore ordain a day to be set apart for 
 solemn thanksgiving for so great a deliverance throughout 
 this ministry, excepting Fowla, which we can have no access 
 to inform. The Session having heard the Moderator's pro- 
 posal, was cordially satisfied therewith, and did agree unani- 
 mously that a day be set apart for solemn thanksgiving on 
 the above account throughout the bounds of the ministry, 
 excepting Fowla, as above said.'^^ 
 
 Several cases of leprosy did appear in 1772 and 1776. 
 In 1778 there were further cases — some of which were sent 
 
 ^ Spottiswood, loc. cit. 
 
 - Simpson, ' Arch. Essays,' vol. ii. 
 
 ^ Simpson, loc. cit. 
 
 '' ' Statistical Account of Scotland,' Sir J. Sinclair. 
 
 * 'MSS. Session Register of Walls,' March 17th, 1742, vol. xx, p. loi.
 
 •42 HISTORICAL NOTES. 
 
 to the hospital at Edinburgh.^ The last actually reported 
 case of endemic leprosy in the Shetlands was in 1798, and 
 lay for some time in the infirmary wards at Edinburgh. 
 
 It is recorded that in i8og '' scarcely an instance of it is 
 to be met with " in Shetland, though but a very little 
 time before " obscure degrees " of it had occurred. " For- 
 merly when this affection was prevalent the unfortunate 
 individuals who were seized with it were removed to small 
 huts erected for the purpose, and here received a scanty 
 allowance of provisions daily until the disease put a period 
 to their miserable existence. The parish of Walls and the 
 island of Papastour, on the west side of the country, appear 
 to have been among the places in which it raged with the 
 greatest malignity. ^^^ 
 
 We shall learn of the progress aud decline of the disease 
 in Scotland by some short notice of the various leper 
 hospitals in the country. 
 
 The famous Greenside Hospital at Edinburgh according 
 to some authorities started in the fourteenth century as a 
 leper-house, others think as an ordinary hospital and it 
 became a leper-house as the need arose at a later date." It 
 is recorded as existent in 1584.* Probably it was built in 
 conjunction with the Act of the Magistrates of Edinburgh. 
 Sir James Simpson points at " an awld fundation of the 
 Lipperhous besyde Dyngwall,'^ which formerly stood near 
 Shakespeare Square. In 1591 all authorities agree that it 
 had at least five lepers in it.^ Spottiswood is of opinion 
 that it was established in the fourteenth or fifteenth century 
 {1479 ?).^ It did not, apparently, last very long, for in 1652 
 it was demolished by the magistrates. 
 
 The lepers, it seems, wei'e kept in awe by the gallows, as 
 the latter was the penalty for opening the gate between 
 dawn and sundown. In turn each leper sat at the door 
 
 ' Rannie, Session Clerk at Papastour. 
 
 - ' Ancient and Present State of Zetland Islands,' A. Edmondstone, M.D., 
 Tol. ii, p. 102. 
 
 ^ Chalmers, 'Dom. Ann.,' i, 227 ; Chalmers, 'Caledonia,' ii. 760 ; Wilson, 
 ^Eccles. History,' ii, 191 ; Arnot, 257. 
 
 "* City Council Records, 1584. 
 
 ^ Simpson, loc. cit., ii, 13, et seq. 
 
 '' ' Leper Houses in Scotland at the Reformation,' Spottiswood.
 
 HISTORICAL NOTES. 43 
 
 ringing his clapper and asking alms^ wliicli were dropped 
 into his cup. Their allowance was only 4s. (Scotch) a week 
 to each inmate. John Robertson, a merchant, was the 
 founder. The regulations, though apparently strict as 
 regards entering and leaving the hospital, were not so in 
 all respects, for we are told that sometimes the lepers' wives 
 lived with them. The begging, too, was differently arranged 
 in comparison with the hospital in the sister city of Glasgow, 
 where the lepers were allowed to go about the city and 
 district with a cloth over their faces, drawing attention by 
 means of the clapper and asking alms.^ 
 
 At Glasgow, according to Simpson, there was a hospital 
 as early as the middle of the fourteenth century." It was 
 dedicated to St. Ninian,'^ was founded by the Lady of 
 Lochow during the reign of David II, and was fairly well 
 endowed with lands.* In 1589 there were six lepers in the 
 house. ^ Walcott believes that it was founded in the middle 
 of the fifteenth century.^ He tells us, further,^ that the 
 characteristics of a leper hospital in Scotland were as 
 follows : 
 
 A lazar house was composed of separate cells {domus, 
 hosjntia) ranged round a quadrangle, and contained a well, 
 a chapel, a common hall, kitchen, and dormitory ; and a 
 mansion for the ' sound. ^ " The lepers were not in commu- 
 nity [non sociati). Dr. Robertson tells us^ that in 1528, 
 James Houston, sub-Dean of Glasgow, ordered twelve pennies 
 to be distributed yearly to lepers beside the bridge at 
 Glasgow. The town kirk was on the north side of the 
 Clyde and in the burgh, and therefore in 1582, lepers were 
 allowed in the burgh. The feeling towards lepers, however, 
 was not the same in 1593, when all lepers were banished 
 from Glasgow by Kirk-session.^ 
 
 ' ' Ancient Church of Scotland,' Walcott, 336. 
 
 - Simpson, loc. cit. 
 
 ^ ' Rec. Eccle.s.,'489. Chalmers, Maclure, Spottiswood, and Walcott agree. 
 
 ■* Spottiswood, loc. cit. 
 
 " Simpson, loc. cit. 
 
 ^ Walcott, loc. cit. 
 
 7 Ibid, p. 384. 
 
 ^ Appendix to 'Arch. Essays,' vol. ii, J. Robertson, LL.D., 162. 
 
 ^ ' Acta Parliamentorum Scotise,' vol. i.
 
 44 HISTORICAL NOTES. 
 
 It was in 1584 that the magistrates of Edinburgh issued 
 orders for finding a place for lepers, and just about the same 
 time the Kirk-session of Glasgow ordered that '' the lepper 
 folks house or spittal beyond the bridge should be visited to 
 see how the same should be reformed.'^ This was done in 
 1587, and repairs were undertaken in 1588. In 1589, six 
 lepers were in the hospital.^ It was just at this period that 
 there seems to have been an increase of leprosy in Scotland. 
 In 1593 all the lepers were cleared out of the town of 
 Glasgow for fear of infection, and, in addition, the admit- 
 tance into the hospital was limited to townspeople only." In 
 1593, the rental of the leper house amounted to £7 '^and 
 eighteen bolls of meal." 
 
 Aberdeen. — A leper hospital (St. Anne's) existed here 
 previously to 15 19. It was supported by public funds of 
 the city, and consisted of several separate houses." Dr. 
 Robertson states that the hospital existed before 1363, and 
 was subdivided.** The Regent and Priory Council interposed 
 for the repair and restoration of the hospital in 1574. In 
 1578, it was placed under the charge of a master, and there 
 were still patients in it in 1591.^ If there really was an 
 increase of leprosy in Scotland (1580 — 1590) it speedily 
 abated, at least in Aberdeen, for the hospital was empty in 
 1604,^ In the same Aberdeen Records we are told that two 
 marks were to be given " to lepper woman laitlie put in the 
 lepper-hous, becaus she will not gett any of the rent of said 
 hous till Martenes next." In 1612, another leper appeared 
 on the scene in the shape of an alien, not an Aberdonian, 
 and in 1661 the last scene of endemic leprosy seems to have 
 occurred in the razing to the ground of the hospital.^ 
 
 Other leper hospitals were at Aldnestun^ as early as the 
 twelfth centui-y, under the jurisdiction of Melrose ; Ald- 
 cambus, in Berwickshire, also in the twelfth century ; 
 
 ' Wodi'ow's ' Biogvapliical Collections,' vol. ii, pt. ii, p. 40. 
 
 - Wodrow, loc. cit. 
 
 •^ Simpson, loc. cit. 
 
 ■• ' Reg. Episcopatus Aberdonensis,' vol. ii, 283. 
 
 * ' Eccles. Rec. of Aberdeen,' pp. 20 — 23, et seq. 
 
 * Heutzner, ' Promptorium Pavolorum,' p. 298. 
 ' Simjison, Walcot.
 
 HISTOEICAL NOTES. 45 
 
 Ligerswood/ in Lauderdale (St. Mary Magdaleae), founded 
 by William, son of Alan; Govan" (St. Ninian's), founded 
 in the fourteentH century by the Lady Lochaw ; Dingwall 
 Castle/ a leper house under the Provost of Trinit}^ College ; 
 Rothfan/ in Elgin (St. Peter's), founded by John Byseth (or 
 Biset) for a prior, chaplain, and seven lepers. ^ Simpson 
 believed it was founded early in the thirteenth century, in 
 the reign of Alexander II (son of William the Lion). By 
 way of endowment it had the patronage of the Kirk of 
 Kyltalargy.'' 
 
 Dr. Robertson, speaking of the Rothfan Hospital, says its 
 first charter was granted, 1224 — 1226. He affirms that 
 the founder Bissett was a kinsman of Mauser Bisset, Avho 
 aided various leper establishments in England in the time of 
 Henry II. It appears that in 1296, Friar William Corbet 
 (master) had letters for the restitution of his lands directed 
 to the sheriff of Edinburgh from Edward I. of England as 
 over-lord of Scotland.^ In 1376 a charter was granted by 
 Robert II. with regard to lands belonging to the lepers at 
 Harehope.^ In 1563, the hospital was worth £35; in 
 1798, £3. 
 
 Stirling possessed a lazaretto also at the end of the town, 
 founded in 1463,^ and there were lepers there as late as 
 1512. 
 
 At Perth a leper hospital existed on '' Leper-Croft," ^° 
 and in the records pertaining thereto we are told that it was 
 a '' public leper hospital," and that " such hospitals were 
 maintained beyond the walls of every considerable burgh in 
 Scotland." 
 
 At Harehope, in the south-west of Eldueston parish, in 
 
 ^ Simpson, Walcott. 
 
 2 Chalmers, ' Caledonia.' 
 
 3 Walcott. 
 " Walcott. 
 
 ^ ' Antiquities of Aberdeen,' ii, p. 142 ; Walcott, loc. cit. 
 
 *" Spottiswood, loc. cit. 
 
 ^ ' Rot. Scotiffi,' vol. i, p. 25. 
 
 >* ' Reg. Magni Sigilli. Reg. Scot.,' p. 132. 
 
 ' Walcott, loc. cit.; 'Rot. Scaccarii Reg.,' Scotorum MSS., in General 
 Register House. 
 
 J« ' Reg. Sheriff Court, Perth ; ' ' Eccles. Annals, Perth,' R. S. Fittis.
 
 46 HISTORICAL NOTES. 
 
 PeebleshirGj there was a leper hospital founded by David I, 
 who endowed them with certain land for maintenance.^ 
 
 The fourteenth and fifteenth centuries were an important 
 period in the decline of endemic leprosy in England. 
 Edward IV. (1461 — 1483) appears to have made various 
 attempts, all of which were more or less successful, to make 
 manifest to the public the satisfactory and progressive decline 
 of leprosy. In 1468, he ordered his three court physicians 
 to report concerning a case of alleged leprosy, and their 
 certificate herewith appended is one of the few English 
 medical reports concerning the disease still left to us. 
 
 At the end of the Middle Ages leprosy was almost extinct 
 in Italy, and very shortly thereafter Pope Innocent VIII. 
 suppressed the Leper Order of St. Lazurus on account of the 
 marked decrease in the disease. It was the time of an 
 immense development of new life in Europe. Printing had 
 been introduced, and also gardening. Discovery and coloni- 
 sation had widened the world and men^s thoughts, and it is 
 noticeable that just as this period (the end of the fifteenth 
 and the beginning of the sixteenth century) was the end of 
 what may suitably be called the Dark Ages in England,, 
 so also, with two significant exceptions (Scotland and 
 Cornwall), it was the end of the ravages of endemic leprosy 
 in these islands. 
 
 Between the years 1530 and 1540 occurred (by the order of 
 Henry VIII) the Suppression of the Monasteries, including" 
 many of the existing leper houses. Carlisle's" enumeration 
 of the objects suppressed is as follows : — 645 convents, 90 
 colleges, 2734 chantries, and no hospitals. Speed^ also 
 gives these same figures ; Tanner* differs. He gives more 
 than 200 general hospitals in England up to the time of 
 Henry VIII, when, as he says, " that deluge arose which at 
 once swept away what the mistaken zeal and piety of many 
 ages had raised." 
 
 He described these hospitals as places " originally designed 
 for relief and entertainment of travellers upon the roads, 
 
 ^ Spottiswood. 
 
 - ' Hist. Account of the Commission to enquire into Charities,' N. Carlisle. 
 
 3 ' Hist, of Great Britain ' (1632). 
 
 ^ 'Notitia Monastica,' preface, pp. v — viii.
 
 HISTORICAL NOTES. 47 
 
 and particularly of pilgrims." Even kings lodged at them 
 in their journeyings.^ These statements throw considerable 
 light on the exact part these so-called hospitals fulfilled ; 
 they were apparently but little more than wayside inns. He 
 does seem to agree with other authorities that the leper 
 "hospitals'^ were places set apart for lepers, of whom he says 
 there were many, partly as a relief for them and partly as 
 protection to the public health. 
 
 The suggested causes of the Dissolution are various : 
 
 1. It is believed by many that one cause was the disorderly 
 state of affairs prevailing at many of these places. The 
 management in many cases was superlatively bad, and the 
 privileges grossly abused. It is probable that if they had 
 not been suppressed, it would have been absolutely necessary 
 to radically reform them. 
 
 2. It was the time of the Reformation and Martin Luther, 
 and this was in some measure the active cause of the throw- 
 ing off by England of the supremacy of the Pope of Rome, 
 and with that naturally came the throwing off of the great 
 influence of the monastic orders. As has been seen, many 
 of these hospitals were in the hands of the Friars. " The 
 work of the Friars was physical as well as moral. The 
 rapid progress of population within the boroughs had out- 
 stripped the sanitary regulations of the Middle Ages, and 
 fever and plague or the more terrible scourge of leprosy 
 festered in the wretched hovels of the suburbs. Their first 
 work lay in the noisome lazar-houses ; it was amongst the 
 lepers that they commonly chose the site of their homes. 
 At London they settled in the shambles of Newgate ; at 
 Oxford they made their way to the swampy ground between 
 the walls and the stream of Thames.'^ " So that it is 
 easy to understand that if the monks' influence abated, then 
 the monastic institutions in the country would practically 
 lose their power and support. 
 
 3. Some authorities think that the act of Henry VIII. 
 was a good and pious deed ; that he wished (a) to prevent 
 the monastic revenues from being squandered and mis-spent, 
 
 ' Blomefield, loc. cit., ii, p, 126. 
 
 " 'History of the English People,' J. E. Green.
 
 48 HISTORICAL NOTES. 
 
 as doubtless they had been ; (6) and to put down the 
 wickedness and immorality that occurred.^ 
 
 4. A far more likely cause is that Henry wanted the 
 money, and as the people were anxious to save their own 
 pockets any additional taxation, the suppression of the 
 monasteries was to all concerned the easiest way out of the 
 difficulty. 
 
 " The monasteries suggested themselves to him as an easy 
 prey, and he knew that an attack upon them would not 
 displease the growing Protestant party in the country. 
 These institutions were in many cases not fulfilling their 
 ancient functions properly, and were often far from being 
 the homes of religious virtue. '^^ 
 
 This case is all the more likely to be the correct one, for 
 we possess confirmation of it in the fact that Heniy bestowed 
 many of the lauds and monastic inheritances upon favourites 
 at his court. At least £32,000 came annually to the Crown" 
 (Gibbins says £161,000 was the annual income of the sup- 
 pressed houses ; not a little of this Henry spent in founding 
 some schools and bishoprics to deceive the people.) 
 
 5. There can, I think, be no doubt at all that many of 
 the leper hospitals which were suppressed at this time Avere 
 closed simply because there was no further need for them to 
 be open. Dr. Steele believes that " though the suppression 
 of the monasteries in this country put a stop to the infirmaries 
 connected with them, the leper-houses continued their opera- 
 tion till the disease itself gradually disappeai'ed from the 
 kingdom." " There were," he adds, " two if not three leper 
 establishments affiliated with St. Bartholomew's Hospital (in 
 London) so late as the seventeenth century." * In this view 
 I largely share, only I think that there is evidence to show 
 that in 1539 the majority of the leper-houses were empty. 
 We cannot accept the suppression of monasteries as in any 
 sense caused by the diminution of leprosy, though there were, 
 and had been, in some cases for a long period, empty leper- 
 houses which were then closed. Endemic leprosy in the time 
 
 ' ' Hist, of Great Britain,' Henry, vol. vi, p. 434. 
 
 - Gibbins, ' Industrial Hist, of England,' p. 83. 
 
 ^ Tanner, loc. cit. 
 
 * Statistical Society, 1878, Dr. Steel.
 
 HISTORICAL NOTES. 49 
 
 of Henry VIII. was far too rare to call for more than a very 
 few hospitals in the whole length of the land. Indeed, it 
 was only a very few years after, that Edward VI. appointed 
 a Royal Commission to enquire into the state of the leper 
 hospitals not suppressed, and it reported (in 1547) that most 
 of the leper-houses in England were empty. 
 
 By slow gradations the disease had greatly abated, 
 although it had not entirely disappeared among the lower 
 orders ; but in the event of any contagion spreading — which 
 was more or less believed in and feared — lepers were not 
 compelled (by the Act in the first year of Edward VI.) to 
 leave their domicile, like the monastics on the suppression 
 of religious houses : 
 
 Act I. Edward VI, c. 3, s. 19: ''All leprous and bed- 
 rid creatures whatsoever may at their own libertie be 
 allowed to continue in such houses appointed for lepers 
 or bed-rid people, and shall not be compelled to repair 
 into other countries or places appointed by this Act." 
 And it was " made lawful for all lepers to appoint proctors 
 for each house, not more than two to gather alms of all 
 such inhabitants who were within four miles of the said 
 house.'' ^ This permission was speedily abused. Sturdy 
 beggars went about with a clap-dish, and pretending they 
 were Proctors to a leper-house, terrified people into con- 
 tributing. (Proctors were put down by Act 39. Elizabeth, 
 c. 4.) 
 
 Soon after the middle of the sixteenth century, it is sig- 
 nificant to note an inexplicable increase of leprosy almost 
 solely confined to Cornwall and the surrounding district. 
 
 The hospital of St. Margaret, about half a mile from 
 Honiton" on the road to Exeter, was founded according to 
 Lysous in 1530^ for lepers, by Thomas Chard, the last Abbot 
 of Ford. Oliver, in his notes from Bishop Brantingham's 
 Register, declared that it existed as early as 1374, which I 
 think is very likely. After the dissolution of colleges and 
 hospitals, the representatives of Chard became possessed of 
 this Hospital by an Act of Henry VIII. to be trustees 
 
 1 Dunkin, 'Hist, of Dartford.' 
 
 2 Sir W. Uui^dale, loc. cit., p. 759; Lysons, vol. vi, p. 283. 
 ^ L3'sons, vol. vi, p. 283. 
 
 4
 
 60 HISTORICAL NOTES. 
 
 thereof on behalf of the foui' lepers then in residence. In 
 1642, it was ordered that the hospital should be thenceforth 
 under tlie management of the Rector of Houiton, who should 
 appoint the governor and four lepers (this appeared to be the 
 capacity)^ or in default of such objects^ other poor persons. 
 The lands belonging to the hospital were then valued at 
 more than £25 per annum. 
 
 Plympton, Plymouth, and Pilton were also centres of 
 leprosy, founded, according to Sir W. Dugdale^ and Lysons," 
 in 1370, 1374, 1197-^ That at Pilton, Lysons thinks, may 
 have been in existence in 1190, and was for both sexes; it 
 flourished up till a recent date, but was quite empty and 
 obsolete in 1800. 
 
 At Totnes, in Devon, the hospital of St. Mary Magdalene 
 was founded for eleven lepers. In 1547 at the time of the 
 commission there were eight, and it also was empty for 
 many years before 1800. 
 
 Bodmin.* — About one mile east from the town, which 
 is situated between two hills, stood the Lowres Hospital 
 (from loure, lower, a British term meaning a leper) for 
 lepers, dedicated to St. Laurence. It is not known when 
 the hospital was established, but in 1395, Bishop Stafford 
 granted an Indulgence which was repeated in 1435.* Queen 
 Elizabeth granted a charter in which it is stated that there 
 were and had been " a great company " of lepers in this 
 hospital. A few months after his accession, James I. granted 
 them — there were then, according to Lysons, thirty-nine 
 lepers — a weekly market on Wednesdays, and " an annual 
 fair with a court of piepowder on the festival of St. Luke." 
 *' In the time of Elizabeth," says Polwhele, " leprosy seems 
 to have been frequent in Cornwall." He believes that the 
 disease first spread in England about 1 100, and was largely due 
 in Cornwall to traders. It would appear that at the Bodmin 
 Hospital — even though the leproso amovendo was in action — 
 
 ' Loc. cit., p. 759. 
 - Loc. cit., vol. vi. 
 
 ^ Soc. of Antiquities, 1795, Iiicledon of Pilton. 
 
 ■• 'Monastic. Exon.,' G. Oliver, D.D. ; Lysons, vol. iii ; Polwhele,' Hist, 
 of Cornwall,' 1806. 
 
 ^ ' Monastic. Exon,' Oliver, loc. cit.
 
 HISTORICAL NOTES. 51 
 
 the custom was that none were to be admitted by the gover- 
 nors " unless the leper so brought in payd them £5, a pot for 
 dressing his meat, a purse (and a penny in it) to receive 
 alms." In 1800 there were no lepers in the hospital, '^ nor 
 indeed any one person touched with the disease in the whole 
 €Ounty of Cornwall/' although the " chappel " adjoining 
 was frequently used. Elizabeth not only granted a fresh 
 charter and thus took the Bodmin lepers under her authority, 
 but she augmented the lands and privileges with the juris- 
 diction of a Court-leet within the precincts of its manor of 
 Ponte-by (a white rod to be erected yearly while the Coui^t 
 sat) ; she also assisted it materially in revenue.^ 
 
 Launceston? — St. Leonards was founded at an early period, 
 but the site was removed, towards the middle of the thir- 
 teenth century, to Gillemartin, at or near the junction of the 
 rivers Kensey and Tamar. At one time there were constant 
 complaints of the lepers that they were defrauded of their 
 rights. 
 
 The close of the sixteenth century witnessed further 
 eSorts on behalf of Queen Elizabeth to amend the position of, 
 and attention paid to, the lepers. In 1597, she had an Act 
 passed for the suppression of Proctors. The system of 
 Proctors was established to overcome the difficulty of allow- 
 ing the lepers to parade the cities and mix with the public 
 on the plea of obtaining alms, — so great was the fear of con- 
 tagion, which was fully and widely believed in till the 
 seventeenth century, when Fernelius and Forestus first 
 called it in question. But one can readily believe that such a 
 system of Proctors would very soon be abused ; thus it hap- 
 pened, and the proctor system was put down by legislation." 
 Two years later it is recorded that Heutzner, travelling 
 through England, was struck with the frequency of leprosy. 
 
 Salads, carrots, turuips, potatoes, tobacco, tea, hops, and 
 watches, became common in England during this century, 
 and it is not to be doubted that the whole social life and 
 diet had materially altered since the fourteenth century. 
 But, in addition, the opening of the seventeenth century 
 
 ' 'Hist, of Cornwall,' William Hals, 1750. 
 
 ^ Lysons; Sir W. Dugdale, loc. cit., p. 757 ; Carew, ' Cornwall,' p. 186. 
 
 ^ 39 Elizabeth, c. iv.
 
 52 HISTORICAL NOTES. 
 
 witnessed the rise of modern science. Leprosy was at that 
 time of very rare occurrence in England, and may be con- 
 sidered to be extinct as an endemic disease, with the excep- 
 tion of the northern islands, Shetland, Orkney, Faroe, and 
 St. Kilda (the Hebrides). 
 
 In this lonely island, the most westerly of the Hebrides, 
 leprosy apparently ''broke out" in 1684^ or later." In the 
 middle of the eighteenth century there were two families 
 labouring under the disease. 
 
 ^ Simpson, loc. cit. 
 
 - Martin, 'Voyage to St. Kilda,' 1753, p. 41.
 
 EEGAEDING THE DECREASE IN LEPERS 
 IN ENGLAND. 
 
 After a careful investigation covering a very large mass 
 of literature^ I am decidedly of the opinion that leprosy 
 commenced to show material and perceptible signs of decline 
 during the thirteenth and fourteenth centuries. There are, 
 it is true, some references and authorities which place the 
 commencing decline a century earlier, but the vast majority 
 declare the end of the fourteenth ceutury to be the period 
 of decline.^ It is, of course, impossible to produce any 
 exact evidence on the point. Statistics are almost wholly 
 lacking. 
 
 The disease probably reached its zenith during the thir- 
 teenth century. 
 
 One of the earliest records dealing with any decline in 
 lepers or leprosy in England may be found in an old statute 
 of the St. Albans Hospital drawn up in 1350, in which 
 decrease is noted in the words : " In general there are now 
 not above three, sometimes only two, and occasionally one." 
 This, of course, may have had relation to the locality only, 
 or may have been due to many other lesser causes besides 
 decrease of the disease. In 1344 the Women's Leper Hos- 
 pital at Tannington was empty. 
 
 ' Simpson, loc. cit. ; Hunstanton, 40, 41, Henry III ; Kaposi, Hebra, 
 * Skin Diseases ' ; Green, ' Hist, of England ' ; Jessop, ' Six Hundred Years 
 Ago'; ' Hist. Commission,' report iii, p. 271; Leland, ' Itinerj ; ' Thin, 
 'Leprosy'; Hirsch, ' Geog. and Hist. Pathology'; White, 'Nat. Hist. 
 Selborne ' ; Denton, ' England in the Fifteenth Century ' ; Rose, ' Leprosy 
 and its Prevention ' ; Macnamara, ' Hygiene and Warm Climates ' ; 
 Hutchinson, ' Brit. Med. Journ.,' 1890, p. 665 ; &c.
 
 54 DECREASE IN LEPERS IN ENGLAND. 
 
 Still tliere can be no doubt, I think, that long before this 
 lepers were disappearing or getting displaced from bouses 
 specially founded for them.^ And I am quite prepared to 
 agree generally with the statement of Dr. Creigbton tbat 
 tbe amount of true leprosy would not be much higher than 
 the leprosy percentage in India (for example, in Burdwan) at 
 the present time. But I think his figures are, if anything, too 
 low (viz. 2*26 per 1000). Mr. Trail" declares tbat tbe leper- 
 bouses were never numerous, " not more than fifty,'^ and 
 " only a small fraction of all tbe charitable bouses in England, 
 perhaps one sixth or one eighth." This calculation seems 
 to me to be entirely below the mark. His total number of 
 " beds '^ in all tbe British hospitals amounted to under 100. 
 But in three of tbe northern hospitals alone, there were 
 ninety " beds." Certainly these calculations, if the records 
 of history are to be trusted in tbe least degree, are not 
 altogether correct. That the Oxford Hospital was nearly 
 empty in the time of Edward II. was due, apparently, not to 
 the decrease in the disease, but to the fact that the hos- 
 pital was bankrupt through disorderly management and 
 thieving; and even then, it was not, as he says, "empty," but 
 contained six. Mr. Trail assures us also that tbe Cambridge 
 hospital was " alienated from the lepers " by the Bishop of 
 Ely. Undoubtedly it was, and by him banded by treachery 
 to bis successors in the bishopric. Tbat was not because it 
 had no lepers, for it was well supplied, but because it bad a 
 handsome revenue from the Sturbridge Fair ! Mr. Trail is 
 correct in stating that in 1349 (the middle, be it noted, of tbe 
 fourteenth century) St. Albans had not sufficient leprosy for 
 its endowments and revenues. But no authority that I can 
 discover attributes the decrease of inmates at Sherburn in 
 1434 to a decrease of national leprosy. The cause of the 
 new regulations for the great Durham hospital is stated to be 
 " on account of the reduced state of the revenues," ^ (of tbe 
 causes of the reduction Langley gives no account, for a very 
 obvious reason), and hence "si in partibus " two lepers 
 might be found^ they were to be admitted, which, after the 
 
 ' ' Hist, of Epidemics in Britain,' C. Creighton, M.A., M.D., 1891. 
 - 'Social England,' H. D. Trail, D.C.L., 1893, vol. i, pp. 367—370. 
 
 ^ ' Nova Ordinatio sine.Keformatio,' Bishop Langley, loc. cit.
 
 UKOREASE IN LEPERS IN ENGLAND. 55 
 
 incessant persecution and maltreatment that the lepers had 
 received there for seventy years, was not to be expected. 
 I think there can be no doubt that in 1434 leprosy was 
 decreasing, but it is in no way proved so because certain 
 hospitals were nearly or entirely empty. The religious 
 fervour of the Friars was dying out, and the wealthy revenue 
 of many of their institutions was a temptation to avaricious 
 neighbours too great to be resisted. From the middle of 
 the thirteenth to the end of the fifteenth centuries these 
 endowments were plundered all over England. 
 
 In his second volume Mr. Trail remarks : " We may be 
 sure there was no longer leprosy in the country " in the 
 fourteenth century. But we have already seen that there 
 is evidence to the contrary. Again : " The disappearance of 
 leprosy from England," he says, '' in the fifteenth century 
 may be taken as absolute." Comparatively with the 
 eleventh and twelfth centuries it probably was so, but 
 leprosy flourished in Cornwall (and Scotland) in the six- 
 teenth century. 
 
 Mr. Denton^ declares that leprosy was exceedingly com- 
 mon in England ; that endowed houses for the reception of 
 lepers existed up and down the country " at the entrance of 
 almost all our towns. The number of these lazar-houses, 
 however great, was insufficient to accommodate more than 
 a small 'proportion of those suffering from the disease.'* 
 Many writers seem to judge the increase or decrease of 
 leper-houses as a fair criterion of the increase or decrease 
 of leprosy. But it is not so. Many lepers, without doubt, 
 could not get admittance, and wandered on the high roads. 
 In London it was possible to prevent, in a generally lax 
 manner, the entrance of lepers, and the detention of such, 
 who entered the hospitals.^ But in the country it was 
 not possible to do so, nor could the lepers be prevented from 
 soliciting alms and mixing at choice with the public. " It 
 was long before this disease ceased to be common amongst 
 the poor in this country. It lingered far beyond the Middle 
 Ages, especially in Cornwall and other places." '^ In this 
 
 1 'England in the Fifteenth Century,' W. Denton,M.A.,l888,p. 206, et seq. 
 
 ' Riley's ' Memorials of London,' p. 384. 
 
 ^ Denton, loc. cit. ; ' Evelyn's Diary,' p. 150 ; ' Roy. Coll. Phys. Rep.,' 1867.
 
 56 DECREASE IN LEPERS IN ENGLAND. 
 
 view I fully share, but it apparently began to decline in the 
 heginning of the fourteenth century, or somewhat earlier. 
 
 The commission of Edward VI. recorded a very definite 
 decrease in leprosy all over the country, and cited viirious 
 examples. Referring to the Ilford Hospital (instituted in 
 the reign of Henry II.), the commissioners declared that, 
 though established for sixteen men, " there is at this day 
 (1547) but one pryest and two pore men,^' It must not be 
 forgotten that Edward's commission was only an inquiry 
 into the leper hospitals, not an inquiry into the progress 
 or otherwise of leprosy. Ilford is a very fair example of 
 the general state of the leper-houses. The lazar-house 
 at Newton Bushell was founded about this time (1540), 
 in the deed of which, its object was recorded as follows : 
 " For the releff of power lazar people whereof grete nomber 
 with that diseas be now iufectid of moche people to whom 
 they use to resort and be conversant with all, for lacke of 
 convenyent hospitals in the county of Devon for them." ^ 
 
 In 1547 the Herbaldowne Hospital was providing relief 
 for fifteen " brethren " and fifteen '' sisters," and out-door 
 relief for as many more (Creighton). 
 
 Heutzner, in 1 598, travelled throuoh England, and ob- 
 served in his ' Itinerary ' : " Angli lahorant frequenter lepra, 
 albct vulgo dicta." " And it is not infrequent to find refer- 
 ences to the existence of leprosy as an endemic disease as 
 late as the time of James I,^ and even down to 17 12,* 1737,^ 
 1786.* 
 
 " A few cases of indigenous origin have been met with 
 in the British Islands during the pi-esent (nineteenth) 
 century," but it is probable that all or most of these were 
 not strictly indigenous or endemic.*' 
 
 It must be borne in mind that these various dates may 
 depend upon an imperfect or incorrect diagnosis. Very 
 much of the diagnosis of leprosy was left to the untrained 
 
 ' Carta, 'Barthol. Episcopi. pro Leprosis, St. M. Magd.,' 402 ; Camden, 
 'Leicestershire ; ' Hokers, MSS., foL 502, p. 402. 
 
 - Heutzner, ' Itin.,' p. 156. 
 
 ^ Carew, • Cornwall,' loc. cit. 
 
 ■• ' Old Bath Legacies and Wills,' Strode. 
 
 * Berry's ' Cure of Leprosy ' (Bath). 
 
 « 'Hoy. Coll. Phys. Rep.,' 1867, Ixxii.
 
 • DECREASE IN LEPERS IN ENGLAND. 57 
 
 and even uneducated. Diseases far removed from leprosy 
 were doubtless frequently classified with it. Gate porters, 
 policemen, priests, and monks, were frequently the judges in 
 suspected cases. Even nowadays such people would not 
 be able to correctly form an opinion on such matters, nor 
 would it be expected of them. Much less were they able to 
 do so in the ignorance of the Middle Ages. We shall never 
 know exactly what diseases were classified under the term 
 '' leprosy,^' but we do know that they were many, and that 
 many different skin diseases found refuge in the lazar-houses. 
 Some authorities go so far as to say that '' lazar-house " was 
 a term equivalent to " poor-house.'^ This is probably not so. 
 There were '' poor-houses " in addition to " lazar-houses,^' 
 and we may feel assured that the lazar-houses were especially 
 the refuges of the leprous. At the same time there can be 
 no doubt that " diseases having no affinity with true leprosy 
 or with one another, have been confounded together by want 
 of precision in their nomenclature. The confusion has been 
 increased by the twofold meaning of the term ' lazaret.' 
 Originally it denoted exclusively an asylum for lepers, but 
 subsequently it was applied to all places for the deten- 
 tion of persons labouring under infectious distempers." ^ 
 
 " The distinction between a Bede-house and a Maladerie 
 was in some places," says Dr. Cooksou, " well observed ; 
 the former being for the sick and infirm — the latter for 
 lepers." In the case of Brown's Hospital at Stamford 
 (Lincolnshire), the regulations as compiled in Henry VII's 
 time ordained that " no leper be admitted into the said 
 almshouse lest he should affect his sound fellows.' " Many 
 such regulations were " compiled," but few were syste- 
 matically enforced. 
 
 1 ' Eoj. Coll. Phys. Rep.,' 1S67, p. Ixxiv.
 
 THE KIND OF LEPROSY IN THE 
 MIDDLE AGES. 
 
 Ceeighton is strongly of the opinion " that leprosy as 
 correctly diagnosed was a disease of Eui-ope and Britain in 
 the Middle Ages,"^ and with this view Trail and Denton agree. 
 The former says : " "It is clear that the medical writers about 
 the beginning of the fourteenth century knew true leprosy 
 when they saw it, and that they described it from actual 
 observation/^ Simpson believes also that the incurable 
 disease which was known in the lazar-house charters and 
 oldest histories of this country under the same name as on 
 the Continent, and which prevailed here during the same 
 periods as on the Continent^ was entirely the same disease 
 as that described by the medical authors of the Middle Ages. 
 His classical and clear statement I will give in full.^ He 
 states from much given evidence : 
 
 " (i) That the leprosy of the Middle Ages, as the disease 
 prevailed upon the continent of Europe, was identical with 
 the Elephantiasis grascorum ; and 
 
 " (2) That it was for the victims of this specific malady 
 that the numerous leper-houses were established, they alone 
 being the individuals who were intended to be adjudged, 
 separated from the people, and consigned to the lazar-houses 
 {" judicati" — "a populo sequestrandi " — "in Malenteria 
 ducendi"). 
 
 " (3) Various authors who personally witnessed the leprosy 
 
 ' ' History of Epidemics in Britain,' Chas. Creighton, M.A , M.D., p. 71. 
 » ' Social England,' H. D. Trail, D.C.L. 
 ^ ' Archaeolog. Essays,' vol. ii, p. 71.
 
 LEPROSY IN THE MIDDLE AGES. 59 
 
 of the Middle Ages upon the continent of Europe, in de- 
 scribing it have described a disease having all the most 
 characteristic syraptoms of Greek elephantiasis. 
 
 " (4) In England, a cutaneous disorder prevailed at the 
 same period bearing the same name, presenting the same 
 chronic incurable character, having its victims subjected to 
 the same civil laws and restrictions, marked (as we know 
 from Gilbert, Gaddesdon, and Glanville's observations and 
 writings) by the same train of nosological symptoms, and 
 hence identical with the Continental disease and with the 
 elephantiasis of the Greeks. 
 
 " (5) In Scotland we find a malady having the same 
 similarity in its general date, in its name, in its course, and 
 in the civil regulations regarding it, in its symptoms as they 
 are incidentally described by Henryson in the sixteenth 
 century, identical with the Greek elephantiasis. 
 
 " (6) In a part of the country where the disease has con- 
 tinued to prevail down to a later period, the infected, as 
 described by eye-witnesses in the earlier part of the century, 
 presented the most unequivocal signs of the affection 
 alluded to. 
 
 '^ (7) ^^ have high medical evidence (William Thomson) 
 for asserting that the malady was seen in members of a 
 Shetland family in which it had been hereditarily trans- 
 mitted, — and hence one of the last, if not the very last, 
 Scotch leper was decidedly marked by the true and genuine 
 marks of the Elephantiasis grsecorum.'^ 
 
 Many other authorities might be mentioned as agreeing 
 with this view. The following will act as confirmation of 
 the general authentic belief that Elephantiasis grsecorum 
 (true leprosy) prevailed in England : — Gilbert (1270),^ John 
 of Gaddesden," Professor of Medicine at Oxford (1307-1325), 
 Kogerius, Rolandus, Ledwich,^ Vontroil,"* Chevalier Back,* 
 Maitland," Theoderic, Bachuone, Lanfranc (the last three 
 contemporary physicians with Gilbert), Gordon,^ Guy de 
 ^ ' Compendium Medicinse.' 
 ^ ' Rose Anglica.' 
 ' ' Antiquities of Ireland,' 1804. 
 
 * ' History of London.' 
 
 » ' Nat. Hist, of Ireland.' 
 
 * ' De Lepra.'
 
 60 LEPROSY IN THE MIDDLE AGES. 
 
 Chauliac, A^italis de Furno, Petrus de Angelata (all of them 
 authorities in the fourteenth centui-}^), aud they had claimed 
 as fellow-believers men who had lived so loug before as 
 -^tius (541), Marcellus, Oribazius (360) and Constautius of 
 Carthage, school of Salerno (1087). In our own times the 
 weight of the greatest authority has also been on the side 
 of the same belief; including Simpson, Wilson, Virchow, 
 Hutchinson, and many others. 
 
 Both Willan and Shapter, while agreeing with the gene- 
 ral view thus held, are inclined to the idea that a very 
 gross amount of " leprosy " in England was not of this type 
 at all. " In consequence of the general application of the 
 term " leprosy " to the elephantiasis, to the leprosy of the 
 Jews, to the proper scah' lepra (gr^ecorum), and even to 
 other cutaneous affections Avhich have no affinity to either 
 of the diseases just mentioned, almost every person afflicted 
 with any severe eruption or ulceration of the skin was 
 deemed leprous and was received into the lazarettos."^ 
 
 In addition to Sir James Young Simpson^s conclusions, I 
 think it is desirable to record very shortly a few of the 
 earliest descriptions of the disease as it occurred in Europe 
 and England and compai-e them with the most modern 
 views for the diagnosis of leprosy. 
 
 The Salernian School of Medicine was undoubtedly the 
 guide to the medical men of the eleventh, twelfth, and 
 thirteenth centuries. Coustantius of Carthage, the founder 
 of the School, who flourished in the middle of the eleventh 
 century, divided leprosy into four varieties : — Est autem 
 quadrifaria. Vel enim de corruptione est sanguinis et 
 vocatur Alopecia ; alia de cholera rubra, et dicitur Leonina ; 
 alia de cholera nigra, et dicitur Elej)hantiasis ; quarta de 
 phlegmatae provenit (qua3) Tijria (apellatur). 
 
 Then we come to the descriptions recorded of the disease 
 at the end of the thirteenth and beginning of the fourteenth 
 century, of which three may be taken. Guy de Chauliac 
 records six leading characteristics, viz. rotundity of the 
 eyes and ears ; thickening and tuberosity of the eyebrows 
 with falling off of hair; dilatation aud disfigurement of 
 the nostrils externally, with stricture of them within and 
 ' ' Diseases of tlie Skin,' Willan, p. 418.
 
 LEPROSY IN THE MIDDLE AGES. 6] 
 
 foetidity of the lips; the voice raucous and nasal; foetidity 
 of breath and whole person ; fixed and horrible satyr-like 
 aspect/'' 
 
 Gilbert made many personal observations of leprosy as 
 it existed around hitn, and they are recorded (' Compendium 
 Medicinas'). He divided the disease into five different 
 forms, viz. alopecia, elephantine, leonine, tyrie, and a 
 general form, and drew to a very large extent his own 
 conclusions. 
 
 Bernhard Gordon also wrote extensively on the subject,^ 
 and discoursed on the signs of leprosy as he found it around 
 him. His views are practically the same as those of Guy 
 de Chauliac. 
 
 Passing over a long period, during part of which leprosy 
 and syphilis were so widely confused, we may quote a few 
 words from Cullen (1772). ''Elephantiasis,^' he says, ''is 
 a contagious disease with (i) 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 harse and nasal.''" 
 
 At the beginning of the present century Good describes 
 the disease thus : (a) Skin thick, livid, rugose, tuberculated, 
 (b) insensibility to feeling, (c) eyes fierce and staring, [d) 
 perspiration highly offensive."^ 
 
 In our own day there have been many descriptions of 
 the pathology and symptoms of the disease.* Kaposi sums 
 them up for all practical purposes in the following words : 
 " Lepra is used as the generic term, and Elephantina, 
 Leonina, Tyria and Alopecia are only its varieties. It is 
 characterised by the formation of red and livid spots, 
 smaller and larger hard tubercles of a dark colour, iusensi- 
 tiveness of the skin, shedding and whitening of the hairs, 
 especially the eyebrows, atrophy of the muscles, deformity 
 of the limbs in consequence of contraction of the joints, 
 granular and ulcerative destruction of the phalanges, 
 
 ' ' De Lepra,' c. xxii, pp. 95, 711. 
 2 ' Synopsis Nosologise Methodica),' p. 369. 
 •'' ' Physiological System of Medicine,' 1817, pp. 257, 258. 
 * Liveing, Neisser, Babes, Danielssen, Boeck, V. Carter, Cunningham, 
 Hillis, Thin, Rake, and many others.
 
 62 LEPROSY IN THE MIDDLE AGES. 
 
 granular nodules ou the mucous membrane of the mouth 
 and pharynx, hoarseness, destruction of the mucous mem- 
 brane of the nose, and general marasmus."^ 
 
 Surely there can be no doubt that these various descrip- 
 tions are of one and the same general disease. They differ 
 only in terms of expression, owing to the great changes and 
 advance inade in the knowledge of leprosy and to the more 
 accurate scientific diagnosis and description. 
 
 Dr. Shapter of Exeter, who wrote in the beginning of 
 the present century, is of opinion that there was a good deal 
 of exaggeration anent the disease. He draws various con- 
 clusions which may be culled from various parts of his book. 
 They are as follows : 
 
 (i) That leprosy was an established European disease 
 anterior to the Crusades. 
 
 (2) That institutions of refuge for the afflicted were 
 numerously provided. 
 
 (3) That the lepers themselves were under the especial 
 care of the Church, and that the movement on their behalf 
 was largely an ecclesiastical movement. 
 
 (4) That from their very first establishment these insti- 
 tutions were not founded as ''separating " houses or houses of 
 pestilential seclusion, but that they were solely the charitable 
 resorts of those afflicted with a peculiarly distressing and 
 loathso!iie disease. These immense charities were at length 
 administered under great abuses, and afford no accurate 
 ground upon which to calculate the extent or prevalence of 
 the disease. 
 
 (5) That from the ignorance and superstition of the 
 Middle Ages, and from the European authors of these early 
 times owing their medical knowledge to the writings of 
 the Arabian physicians and not to their own observations, 
 the common leprosies and cutaneous defoedations were in- 
 vested with all the horrors of the Elephantiasis grsecorum. 
 And thus that the word " leprosy " included many cutaneous 
 diseases similar in character to cutaneous diseases now 
 occurring. Much of the horror entertained with regard to 
 " leprosy " is due to the above mistake ; also to the general 
 
 ^ Hebra's ' Diseases of the Skin,' " Lepra," Dr. Kaposi of Vienna, %-ol. iv, 
 p. 124-
 
 LEPROSY IN THE MIDDLE AGES. 63 
 
 ■deficiency of medical skill ; to the supposed highly con- 
 tagious nature of the complaint ; to the supei'stitious 
 ignorance of the times, and to the exaggerated histories of 
 the returning Crusaders filling the ears of greedy listeners 
 with tales of dread. ^ 
 
 Indeed, so strong was the belief that leprosy was super- 
 natural and beyond all assistance, that in a trial for witch- 
 craft at Edinburgh so late as 1597, a person is actually ac- 
 cused that " she afiirmit she could haill leprosie, quhilk the 
 maist expert men in medicine are not abil to do.^^ ' 
 
 With these general conclusions I entirely agree as regards 
 the first four. Respecting the fifth, it does not seem to me 
 that authorities of the Middle Ages were so much under 
 Arabian influence that their accounts of the medical aspects 
 of the leprosy are worthless. And we may, I think, feel 
 assured that the " leprosy " existent in England was for the 
 most part True Leprosy. 
 
 ^ ' Leprosy in the Middle Ages,' Shapter, p. 72. 
 
 2 Pitcairn's ' Criminal Trials in Scotland,' vol. ii, p. 2g,
 
 LEPEOSY AND SYPHILIS. 
 
 During the sixteenth century and a little before that 
 time there was much discussion as to whether sj'philis was 
 not in reality the offspring of leprosy. Some went so far 
 as to declare that the diseases were one and the same. 
 There can be no doubt that when leprosy disappeared, 
 secondary cases of the new disease — syphilis — were admitted 
 into the leper hospitals (what few then existed) as cases 
 of leprosy or as cases of the lues veriera, in consequence 
 of the emptiness of the leper hospitals. "When physi- 
 cians came to be better acquainted with the distinctive 
 characters of syphilis at the time of its wide diffusion in 
 Europe (about 1490 — 1500) the number of lepers diminished 
 considerably within a very short period. That fact is 
 explained, not by any such sudden extinction of the disease, 
 nor, as some have concluded, by transformation of leprosy 
 into syphilis, but according" to the more natural jtssumption 
 that a correct diagnosis of each disease had taught men to 
 restrict the number of leprous cases within proper limits.^' ^ 
 There is no doubt, I think, that this is true and that syphilis 
 was common at this period (an " epidemic ^^ of syphilis 
 occurred in England in 1498 and Scotland in 1497), ^^^ ^^ 
 does not alter the general fact that even though many 
 diseases — tuberculosis in many forms, smallpox, leucoderma, 
 lichen, eczema, psoriasis, and syphilis — were misdiagnosed as 
 "leprosy,^'" at the same time Elephantiasis grascorum was 
 
 ' Hirsch, ' Geographical and Historical Pathology.' 
 
 ^ Some think ergotism was also misdiagnosed as leprosy. This was not 
 so, as the first undoubted case of ergotism did not occur till the eighteenth 
 century (C. Creighton, loc. cit.). Vide ' Phil. Trans. Roy. Soc.,' xxxi, 58.
 
 LEPROSY AND SYPHILIS. 65 
 
 from all authoritative accounts the disease rightly called 
 leprosy and exceedingly prevalent in England during the 
 eleventh, twelfth, and thirteenth centuries.^ The reason 
 for the belief that syphilis was a form of leprosy was the 
 fact that syphilis followed (chronologically) immediately 
 after leprosy. The evidence that we have in history against 
 such belief is the denial of such interrelation between the 
 two diseases by the contemporary physicians. Also lepers 
 refused to admit syphilitics into the leper-houses.^ And we 
 may consider that the two diseases were on the whole but 
 little confused with, and had little relation to each other. 
 
 ' Vide Bernard, Gilbert, Hunstanton, &c., loc. cit. At the present 
 day some believe that syphilis is intimately related to leprosy, and may be 
 an early stage of the disease. Dr. Fitch believes that " leprosy invariably 
 follows " the introduction of syphilis into virgin races. There can be no 
 doubt that there are pathological similarities between the two diseases, but 
 that is not sufficient evidence to prove that leprosy is a phase of inherited 
 syphilis (Sir W. J. Moore's Theory). 
 
 ^ R. Virchow, ' Krankhafte Geschwiilste,' pp. 500, 501.
 
 THE 
 
 FUNCTION OF THE LEPEE HOSPITALS 
 
 WAS SEGREGATION CARRIED OUT 1 
 
 I HAVE already pointed out that witli half-a-dozen excep- 
 tions, the houses, pest-houses, lazar-houses, lazarettos, 
 leper '' hospitals/' were in no strict sense to be described as 
 hospitals. They were ecclesiastical, not medical, institu- 
 tions ; refuges, not places for treatment ; palliative, not 
 radical. It is true there were divers laws and regulations 
 enacted, and more or less enforced, with regard to detention 
 of lepers and preventing them obtaining access to the city 
 of London ; but that any system of proper segregation 
 existed, I have been able to find absolutely no evidence at 
 all. Indeed, all the evidence points in the other direction. 
 The lepers were allowed to go into the markets and fairs ; 
 and friends and wayfarers were constantly allowed to reside 
 in the leper hospitals. The mixed character of the hospitals 
 is well illustrated in the case of Lynn (1145), which pro- 
 vided for twelve brethren or sisters, nine of whom should 
 be whole and three leprous. St. Leonard's, at Lancaster, also 
 provided for nine poor persons, three of whom might be 
 leprous. Even the detection of leprosy was left to the laity 
 and inferior officers, who were almost wholly ignorant of this 
 disease. Undoubtedly the general public had a strong dis- 
 like to meeting or communicating with a leper, — partly 
 because of his unsightliness, partly because of superstition,
 
 FUNCTION OP THE LEPEE HOSPITALS. 67 
 
 partly because of supposed infection, &c. ; undoubtedly, 
 therefore, the lepers were much shunned, and lived much in 
 solitude, — but that there was in any sense a strict separation 
 of the diseased from the healthy, or that the De Leproso 
 Aviovendo^ was strictly and constantly enforced, I can find 
 no substantial evidence. But I have found a vei'y large 
 mass of evidence wholly to the contrary. A recent writer 
 states : " The great object (of the leper hospitals) in view 
 was not the cure of leprosy, for then as now leprosy was 
 deemed incurable, but to arrest the spread of it, to prevent 
 the contamination of the sound by contact with the infected."" 
 This presupposes at the outset that leprosy was infectious 
 or contagious, a point I shall have occasion to refer to later 
 on. And certainly no one can carefully read the detailed 
 accounts of the various leper hospitals in England and feel 
 assured that they acted as "arresters" of the spread of the 
 disease. Unless segregation is carried out strictly and in 
 toto, the point and principle of it is obviously lost. I do 
 not doubt that segregation was one of ' the objects in view,^ 
 but I can find no proof that it was in any case satisfactorily 
 carried out. It has been pointed out that two or three 
 generations of segregation (like that of the Middle Ages in 
 England) , if enforced in India, would practically exterminate 
 the disease of leprosy in that country. If so, why is it that 
 it took six or seven centuries to accomplish that in England ? 
 Many authors apparently share the view above expressed 
 that " isolation '' and " strict segregation " was carried out 
 rigorously in the leper hospitals, and was the cause of the 
 decline of leprosy.'^ Let me repeat the well-founded con- 
 clusion of Shapter (see p. 52) that these institutions were 
 nothing more than "charitable resorts" — and in many 
 cases that were too good a name for them, for it is not 
 difficult to discern the avaricious abuse that went on in 
 connection with these places. With the view of Shapter, 
 Sir James Y. Simpson wholly agrees.* Mr. Hutchinson 
 
 ' Vide p. 25. 
 
 - 'Nineteenth Century,' 1884, Agnes Lambert. 
 
 ^ C. N. Macnamara, ' Hygiene and Diseases of Warm Climates ; ' Robson 
 Roose, ' Leprosy ; ' Munro, ' Ed. Med. Journ.,' 1877 ; Thin, ' Leprosy,' 1891. 
 •* ' Arch. Essays,' vol. ii.
 
 68 FUNCTION OF THE LEPER HOSPITALS. 
 
 also is of opinion that it is " an utter mistake to believe that 
 efficient segregation was practised."^ 
 
 There is much evidence relative to this question of segre- 
 gation scattered throughout this paper, and from it as well 
 as from the above we may^ I think, safely conclude that the 
 isolation enforced was so slight, irregular, and intermittent, 
 that its effect upon the decline of leprosy is too little to 
 take into account, and that the chief function of the nume- 
 rous leper hospitals was charitable and protective rather 
 than a strictly medical isolation and segregation. 
 
 ' ' British Medical Journal,' 1890, p. 655. 
 
 I
 
 OBSERVATIONS 
 
 ON THE 
 
 CAUSE OF THE DECLINE OE LEPROSY AS 
 AN ENDEMIC DISEASE IN ENGLAND. 
 
 Up to this point we have been dealing with facts, the 
 chief of which are indisputable. But the cause of leprosy 
 and the cause of its decline and final extinction in England 
 opens a very wide region of history, ancient and modern. 
 Not a little of this is speculative and hypothetical. 
 
 In his famous essay on leprosy in this country. Sir J. Y. 
 Simpson has laid it down as a primary axiom that the whole 
 question of the cause of the disease in England in former 
 times must be thoroughly investigated in connection with 
 two other questions, viz. : 
 
 (i) The allied physical circumstances of the inhabitants 
 of those countries in which the disease in the same way 
 formerly raged, and — 
 
 (2) Of those districts of the world in which it is still 
 prevalent ; and thus " by a kind of reasoning by exclusion 
 the exact physical conditions of a people that are capable of 
 originating or of spreading this particular species of disease.^' 
 
 I have endeavoured in my investigation to bear these 
 two points in mind.
 
 PHYSICAL AND SOCIAL CONDITIONS IN 
 ENGLAND DUEING THE LEPEOSY 
 PEEIOD. 
 
 At tlie outset it may be as well to consider something of 
 the physical and social condition of England itself at tlie 
 time when leprosy was endemic. 
 
 The condition of Europe during the Middle Ages is not 
 readily conceived. The last two or three centuries have 
 radically and completely altered the whole life of Europeans, 
 and even down to physical matters^ the conditions now are 
 immensely different from what they were then. From the 
 fifth century, when the Empire at length fell under the 
 repeated assaults of the northern invaders, to the tenth 
 century, the finest parts of Europe lay in a state of devasta- 
 tion ; little cultivation was practised ; all the arts were ne- 
 glected or lost and the clothing, habitations, and food Avere 
 alike insufficient and unwholesome. For three centuries 
 more this devastation continued, being largely caused by the 
 incessant wars and invasions that wei'e waged. 
 
 In the fourteenth century there were fourteen European 
 plagues, with intervals of about six years between each. In 
 England the food consisted during that time, and later, 
 of much salted provisions, especially in winter, and of a 
 hard black bread, chiefly rye. There was practically 
 no corn^ and much of that which was grown was so 
 diseased that it was scarcely usable. The cultivation of 
 vegetables and gardening was not understood or taken up 
 until the sixteenth century.^ In all the towns of Europe 
 the streets were unpaved and ill-constructed, every sort of 
 filth was permitted to be thrown into the streets and remain 
 ' ' Histoiy of London,' Northouck, Bk. i, chap. 7.
 
 CONDITIONS IN ENGLAND DURING THE LEPROSY PERIOD. 71 
 
 there ; vaults and common sewers were seldom adopted, 
 and the drains ran above ground ; tlie office and duty of 
 scavenger was imperfectly executed or neglected ; the 
 supply of water was deficient, and the narrowness of the 
 streets prevented any free circulation of air. In all the large 
 towns, under such circumstances, it is not to be wondered 
 at that pestilence and plague raged every year. The general 
 prevalence of such maladies was also greatly increased by 
 the internal domestic arrangements of the houses, which 
 were also injudiciously placed and overcrowded, and having 
 no cleanliness or ventilation^ afforded the most favorable 
 nidus for the propagation of disease. From the thirteenth 
 to the sixteenth century, most of the towns of England and 
 Europe were in the condition above described. The streets 
 of London were filled with common lay-stalls of all manner 
 of filth and garbage, which the people were in vain ordered 
 to remove from their own doors ; the sewers, the few which 
 existed, were much more harm than good, and large drains 
 ran above the ground ; the access of air into the narrow 
 streets was prevented by the projecting houses, which almost 
 met at the top, and the intervening space below was filled 
 up with enormous sign-boards.^ In 1349, the streets were so 
 abused with common lay-stalls that a proclamation was made 
 " that no person whatever should presume to lay any dung, 
 guts, garbage, offal, or any other ordure in any street, ditch, 
 river, &c., upon penalty of £20" (Rees). ''The homes of 
 the people were wooden or mud houses, small and dirty, 
 without drainage or ventilation -/'^ the floors of earth or clay 
 were covered with rushes, straw, and other rubbish, which 
 were " occasionally renewed ; but underneath lay unmolested 
 an ancient collection of beer, grease, fragments of fish, 
 spittle, the excrements of dogs and cats, and everything 
 that is nasty. "^ Close by the door stood " the raixen," a 
 collection of every abomination, streams of filth from which 
 polluted the houses and neighbourhood, including any river 
 at hand.* 
 
 * Rees, ' CyclopsBdia.' 
 
 2 Sir J. Payrer, M.D., K.C.S.I., Piesid. Address, VII Congress, 1891. 
 ' Letter, Erasmus to Wolsey. 
 
 * ' Six Centuries of Work and Wage?,' Rogers.
 
 72 PHYSICAL AND SOCIAL CONDITIONS IN 
 
 In addition to these conditions the people in the towns 
 lived in a crowded state and knew little of decency, clean- 
 liness, and order. 
 
 Soap, in the fourteenth and fifteenth centuries, was 
 scarcely used at all, and certainly to the labourer was a 
 luxury he could rarely afford to buy. Hence a life of dirt 
 in consequence. He slept upon heaps of decayed vegetable 
 matter, and yet there were no fresh vegetables to eat. The 
 contents of the gardens were very different from the vege- 
 tables we see now ; there were pei'haps a few cabbages, 
 onions, parsnips, and carrots, and apparently some kind of 
 beet or turnip. The potato had never been heard of (thir- 
 teenth) . Meat was scarce, and during whole months of the 
 year little beyond salted meat and fish was eaten, much of 
 which had suffered from keeping. Before 1349 labourers 
 frequently received damaged corn instead of wages. ^ 
 
 By way of example of the deplorable method of storing 
 food, I may quote from the kitchen accounts of Humphrey, 
 Duke of Buckinghamshire (1443 ^^ 1444). Mention is there 
 made of the purchase and storage of "10 barrels salt her- 
 rings, 1 1 cades fresh herrings, 6 cades sprats, 3379 salt fish, 
 3060 stock-fish, 6 barrels salt salmon, i barrel cod, i barrel 
 and 13 salt eels, i barrel sturgeons, 12 lampreys, i pair of 
 porpoises."^ In 1466, at the feast to commemorate the 
 instalment of George Nevile as Archbishop of York, 608 
 pikes and 12 porpoises were used. At a similar ceremony 
 in 1504, when Warham was made Archbishop of Canterbury, 
 the following quantity of fish was used : — 300 ling, 600 cod, 
 7 barrels salted salmon, 40 fresh salmon, 14 barrels white 
 herrings, 20 cades red herrings (600 herrings in each cade), 
 5 barrels salted sturgeons, 2 barrels salted eels, 600 fresh 
 eels, 8000 whelks, 500 pikes, 400 tenches, 100 carp, 800 
 bream, 2 barrels salted lampreys, 1400 fresh lampreys, 134 
 salted congers, 200 great roaches, and a quantity of seals, 
 porpoises, and other fish. This feast occurred, as it is 
 stated, on a " fish day.^'^ 
 
 These examples, I think it will be agreed, are appreciable 
 
 1 Denton, * History of the Fifteenth Century,' 206. 
 
 * ' Compota Domestica; Duke of Buckingham Kitchen Accounts,' 14, 15. 
 
 * ' Domestic Mannere in England in the Middle Ages,' Wright.
 
 ENGLAND DURING THE LEPROSY PERIOD. 73 
 
 evidence of two important oft-disputed facts, viz. that mucli 
 storage of salt food occurred in Mediasval England, and 
 that even in the Midlands away from the coast a very large 
 amount of fish was eaten. 
 
 There is much more evidence to prove the latter, of 
 which I will take two examples. Sir William Dugdale 
 affirms that there was in the Middle Ages a great trade in 
 oysters and other shell-fish at Colchester, which trade 
 also extended far into the Midlands, where stale oysters 
 were much sold,^ Another writer states that in pre-Norman 
 times in England " various kinds of fish ^' were eaten 
 throughout the county, but chiefly and most largely, eels. 
 *' They used eels,'' says Turner,^ " as abundantly as swine." 
 Two grants are mentioned, each yielding looo eels, and by 
 another, 2000 were received as an annual rent ; 4000 eels 
 were a yearly present from the monks of Ramsay to those of 
 Peterborough. In one charter twenty fishermen are noticed 
 who furnished every year 60,000 eels to the monastery. 
 Eel-dykes are often mentioned in the boundaries of their 
 lands.^ " Fish," says Wright, " was a great article of con- 
 sumption in the Middle Ages.''* Many cases might be 
 quoted where enormous quantities of fish were left as lega- 
 cies to the poor in certain parishes, especially in East 
 Anglia. In the fourteenth, fifteenth, and sixteenth cen- 
 turies many laws were made with regard to protecting the 
 fishing interests. A prevalent smuggling system on the 
 shores of the Wash was stopped. It had been customary 
 there for the people on the shores to live by robbing the 
 fish from the boats that landed fish cargo along that coast ; 
 and we are assured that large quantities of fish for the 
 Sturbridge and Ely Fairs never got there at all. Much fish 
 had been dried, salted, and secretly stored previously to an 
 Act of Edward III.* Dr. Cookson declares that " pro- 
 visions long salted were a common article of diet from the 
 noble to the peasant. Fish was largely consumed, some- 
 times pickled, sometimes preserved in a dry state ; it was 
 
 ^ ' Monasticon Anglicanum,' Sir W. Dugdale. 
 
 ^ Sharon Turner, ' Hist, of Anglo-Saxons,' vol. iii, b. vii, c. iii. 
 
 ' ' Domestic Manners in the Middle Ages,' 149. 
 
 ■• 31 Edward III, St. i, c. i, and c. i, ii, iii, et seq.
 
 74 PHYSICAL AND SOCIAL CONDITIONS IN 
 
 then called ' stock-fisli/ because it Lad to be beaten in a stocky 
 or wooden anvil, with a mallet before it could be employed 
 for culinary purposes. '^^ 
 
 I add a further note respecting the fish trade of the 
 Middle Ages, as it has been not infrequently stated that 
 there was none of any account. As a matter of fact there was 
 a great deal. Fish was sent, from a number of fishing ports, 
 all over the populated parts of the country (East Anglia, 
 Northampton, Yorks, Derbyshire, Durham, &c.). This trade,, 
 which declined very much in the sixteenth century, was 
 due to two causes : (a) exportation of fish in much increased 
 quantities ;^ (b) the rise in the price of fish which followed 
 the Black Death in 1349.^ 
 
 It is strange — if not significant — that the decline of 
 leprosy and the decline of excessive eating of salt and bad, 
 as well as fresh fish, should occur at the same period. Also 
 that the endemic leprosy areas and the fish areas were 
 largely identical. 
 
 So much did fish-eating of all kinds decrease, that two 
 centuries afterwards a number of statutes were made 
 enforcing more frequent fish diet. A curious example of 
 these w^as one in the time of Elizabeth (1562) compelling 
 the eating of fish on Wednesdays as well as on Saturdays, 
 except to those persons possessing a special licence to eat 
 flesh.* So long as there were three dishes of fish to one of 
 flesh, the letter and spirit of the law was being fulfilled. 
 One of the methods for assisting the legal and palatable 
 inclinations of the people in this little matter was a statute 
 forbidding the sale of flesh on fish days ; and in order to 
 drive the subject still further home, those who transgressed 
 suffered after their meal the pain of a penalty of £3.^ 
 Another statute made illegal the selling of fish which was 
 badly salted or putrid ;* or the selling of meat on fish- 
 days.'^ 
 
 ' Lincohi Topographical Soc, 1841, Cookson. 
 
 " 27 Elizabeth, c. xv. 
 
 ' ' Industrial Hist, of England,' Gibbins. 
 
 * 5 Elizabeth, c. v, xi. 
 
 * 5 Elizabeth, c. v — xii, and xiii. 
 
 * 23 Elizabeth, c. vii. 
 ^27 Eliaabeth, cc. x, xi.
 
 ENGLAND DURING THE LEPROSY PERIOD. 75 
 
 As Mr. Hutchinson has frequently pointed out that for 
 nearly one hundred days in the year only fish could be used be- 
 cause of the numerous fasts^ so salt fish must have gone prac- 
 tically all over populated England ; and it is quite certain 
 (from various laws to the contrary in Edward IIPs time) that 
 a good deal of storage went on ; and doubtless fish was used 
 frequently besides on fast days. It is equally certain, as 
 has been pointed out, that an oyster shell-fish and " stock- 
 fish " trade was carried on between the seaports on the 
 Wash and East Anglian coast and the Midlands. 
 
 Fishing came in very much with the Scoto- Saxons, 
 though there was none previously with the Celts. ■^ 
 
 Salting down the animals for the winter consumption was a 
 very serious expense, for a couple of bushels of salt often 
 cost as much as a sheep. This must have compelled the 
 people to spare salt as much as possible, and it must have 
 been only too common to find the bacon more than rancid, 
 and the ham alive with maggots.^ White bread was a 
 rare delicacy. 
 
 Little wonder, therefore, that " the sediment of the town 
 population in the Middle Ages was a dense slough of 
 stagnant misery, squalor, famine, loathsome disease and 
 dull despair such as the worst slums of London, Liverpool, 
 or Paris know nothing of."'^ It is perfectly obvious that 
 such a life would soon result in disease. 
 
 " The whole of London, especially the city, was polluted 
 by the dead and the living. Smallpox and typhus were 
 perpetual epidemics. The deaths in London were greatly 
 in excess of the births '' (Kogers) . 
 
 The absence of vegetable, and insufficiency of ordinary 
 food, the dirty skins, the sleeping at night in the clothes 
 worn during the day, and the total neglect of all hygienic 
 or sanitary laws, made cutaneous diseases frightfully common. 
 This was worst, of course, in the towns, but it was bad also 
 in the villages, for the surrounding uncultivated country 
 was not infrequently covered with marshes and stagnant 
 water. According to Defoe, " one fifteenth part of England 
 
 * 'Caledonia,' Chalmers, p. 1807. 
 
 ' ' The Coming of the Friars,' Augustus Jessop, D.D., pp. 88, 90. 
 
 ' Ibid.
 
 76 PHISICAL AND SOCIAL CONDITIONS IN 
 
 consisted ol: unreclaimed marshy land."^ This was as late 
 as the time of Elizabetbj when various laws were made for 
 reclaiming land in East Anglia, Sussex, Kent, Northampton- 
 shire, and Huntingdon. 
 
 During the twelfth and thirteenth centuries the cities 
 had grown not a little outside their gates. In the crowded 
 courts under the walls, or else in the marshes of the river, 
 there herded together masses of men and women neglected 
 and outcast. " Amid those multitudes the foul plague of 
 leprosy stalked like a remorseless demon, and there the 
 Friars from the first sought and found their work. All 
 Franciscan novices were made to undergo a period of train- 
 ing in the leper hospitals.'^" 
 
 The terrible scourge of 1349 is supposed to have destroyed 
 ''not much less than one half of the population."'' Rogers 
 also believes that it had the effect of doubling the wages,* 
 and of completely changing the farming system in conse- 
 quence. The modern system of letting was introduced, and 
 the permanent distinction between the farmer and labourer 
 established.^ But it was not till 1666 that radical changes 
 occurred in London, nearly three hundred years after the 
 first Sanitary Act (1388). In many ways the fire of London 
 was beneficial. The streets were made wider in the new 
 London, the lay-stalls were officially controlled, sign-posts 
 were affixed against the balconies, and did not project over 
 the street as before, the street itself was levelled and paved, 
 and no rubbish might be deposited thereon. The people 
 lived in a less crowded manner, and in 1766 the drains were 
 all covered, scavengers appointed, and a freer use of water 
 exercised.^ 
 
 Concomitant with these conditions we must also remember 
 that the standard of existence and morality was very low. 
 Immorality ran freely wild in the Mediaeval world. The 
 whole tone in the reign of William II. was decidedly low, 
 
 ' Sir J. Fayrer, loc. cit. 
 
 2 H. D. Trail, loc. cit. 
 
 ' ' Hist, of Prices,' Eogei"s, i, p. 60. 
 
 * Ibid. 
 
 • Wm. Stubbs, ' Constitutional Hist, of England,' vol. ii. 
 ® Eees, ' Cyclopaedia.'
 
 ENGLAND DURING THE LEPROSY PERIOD. 77 
 
 and one is forcibly struck with the regulations made in lazar 
 hospitals to prevent any gross immorality going on.^ It is 
 quite clear, from the statements of Mediaeval physicians as 
 well as from the regulations in the leper hospitals, that the 
 disease had, in their opinion, some intimate connection, with 
 the prevalent immorality ; heredity, as well as contagion, was 
 held responsible. It is quaint to discover that the penalty 
 for immorality in these strictly " segregated " leper hospitals 
 was expulsion ! 
 
 Gilbert White, in one of his letters,^ gives various interest- 
 ing details about the leprosy and diet of the people. He 
 says that the decrease in the disease was due to the ''much 
 smaller quantity of salted meat and fish now eaten in these 
 kingdoms, from the use of linen next the skin, from the plenty 
 of better bread, and from the profusion of fruits, roots, 
 legumens, and greens, so common in every family. Three or 
 four centuries before there were any enclosures, sown grasses, 
 field turnips, or field carrots, or hay, all the cattle which had 
 grown fat in the summer and were not killed for winter use 
 were turned out soon after Michaelmas to shift as they could 
 through the dead months, so that no fresh meat could be had 
 in winter or spring. Hence the marvellous accounts of the 
 vast stores ^ of salted flesh found in the larder of the eldest 
 Spencer in the days of Edward II, and even so late in the 
 spring as May 3rd. It was from magazines like these that the 
 turbulent barons supported in idleness their riotous swarms of 
 retainers ready for any disorder or mischief. But our agri- 
 culture is now arrived at such a pitch of perfection that our 
 best and fatted meats are killed in the winter, and no man 
 need eat salted flesh, unless he prefers it, that has money to 
 buy fresh. One cause of this distemper might be, no doubt, 
 the quantity of wretched fresh and salt fish consumed by the 
 commonalty at all seasons as well as in Lent, which our poor 
 now would hardly be persuaded to touch. 
 
 " The use of linen changes, shirts or shifts, in the room of 
 sordid and filthy woollen, long worn next the skin, is a matter 
 of neatness, and comparatively modern, but must prove a 
 
 ' Freeman, ' Reign of William Rufus,' Appendix, vol. ii, pp. 498, 499. 
 * 'Natural Hist, of Selborne,' Gilbert White, letter xxxvii, 1798. 
 ' 600 bacons, 80 beef carcases, 600 muttons.
 
 78 PBYSICAL AND SOCIAL CONDITIONS JN 
 
 great means of preventing cutaneous ails. At this very time 
 (1778) woollen instead of linen prevails among the poorer 
 Welch who are subject to foul eruptions. The plenty of good 
 meat and bread that is now found among all ranks of people 
 in the south, instead of that misei'able sort which used in the 
 old days to be made of barley or beans, may contribute not a 
 little, sweetening their blood and correcting tlieir juices, for 
 the inhabitants of mountainous districts to this day are still 
 liable to the itch and other cutaneous disorders, from a 
 wretchedness and poverty of diet. As to the products of 
 a garden, every middle-age person of observation may per- 
 ceive, within his own memory, both in town and country, how 
 vastly the consumption of vegetables is increased. Green 
 stalls in cities now support multitudes in a comfortable 
 state, while gardeners get fortunes. . , . Potatoes 
 have prevailed in this little district, by means of premiums, 
 within these twenty years only, and are much esteemed here 
 by the poor, who would scarce have ventured to taste them 
 in the last reign. Our Saxon ancestors certainly had some 
 sort of cabbage, because they call the month of February 
 " Sprout-cale," but long after their days the cultivation 
 of gardens was little attended to." 
 
 Even in 1509, King Henry^s Queen, Catharine, could not 
 procure a salad, till Henry sent to the Netherlands and 
 engaged a gardener to come over and raise the necessary 
 articles here.^ How totally destitute of such diet must the 
 people in general have been at a much later period. 
 
 We learn something more of the progress of civilisation 
 from noting the appearance in England of various commo- 
 dities of necessity or luxury. 
 
 Straw was first used for the King's bed in 1242. Fine 
 linen was first made or sold in England ten years later. 
 Gunpowder came in 1320, and the first Sanitary Act was 
 enforced (more or less) sixty years later. 
 
 The population of England was, roughly, about three 
 millions in the sixteenth century. Norwich claimed about 
 6000 people (so that it is not probable or possible that 
 '' 58,000 people died of the plague at Norwich in 1349"). 
 
 ' 'Hist, of London,' Xorthouck, Bk. i, c. vii ; Nicholas Carlisle, F.R.S., 
 loc. cit.
 
 ENGLAND DURING THE LEPROSY PERIOD. 79 
 
 London only contained 35,000 people, and there was no town 
 in Lancashire worthy of a separate return.^ At Domesday 
 the population of England was about two and a half millions, 
 mostly in the south and south-east parts of the country. 
 Just exactly 300 years after, it was two millions. At each of 
 the two periods there were only six towns with a population 
 of 5000 or over 5000. The ' Census ' (the first proper Census 
 was not till 1801) of the eleventh century was calculated 
 at the compilation of Domesday Book, and is probably fairly 
 correct. The estimation of the population in the fourteenth 
 century was most carefully drawn up by Professor Thorold 
 Rogers (' Industrial and Commercial History of England,' 
 p. 48), on the basis of a poll-tax of 4d. a head on all lay 
 persons over fourteen years of age, which tax was granted 
 by Parliament to Edward III, in the last year of his reign. 
 In both cases there can be little doubt that the calculations 
 were roughly correct. The population was five millions in 
 the sixteenth century (Froude), ten iu the seventeenth, and 
 more than eighteen in the eighteenth (Rogers). Printing 
 commenced in the middle of the fifteenth century, and before 
 the close of the Middle Ages [i. e. end of fifteenth century) 
 colonisation and discovery had advanced. 
 
 The art of gardening was introduced in 1509, just one hun- 
 dred years after it had been necessai-y for England to send 
 to the Baltic for corn. 
 
 In the sixteenth century there was considerable develop- 
 ment in the conditions of life in England. Hops, salads, 
 carrots, turnips, potatoes, tobacco, tea and watches were 
 grown or introduced. The seventeenth century witnessed 
 the rise of science. The eighteenth century saw the 
 marvellous growth of the British Empire (India, &c.). 
 Brindley, Watt, Arkwright, &c., flourished, and the factory 
 system and gas came into use. 
 
 Such is a rough and sketchy outline of the conditions of 
 life in England during the leprosy epoch. 
 
 ^ ' Industrial and Commercial Hist, of England,' Rogers.
 
 GENERAL PHYSICAL AND SOCIAL CONDITION 
 IN CHINA, INDIA, AND ICELAND. 
 
 In a few paragraphs I propose to mention characteristics 
 of other countries where leprosy is now or has been 
 endemic. 
 
 First, two or three examples of countries in which leprosy 
 now exists endemically : China, India, and Iceland. 
 
 China.^ — Here is every variety of climate, but the 
 average temperature is lower than in other countries of the 
 same latitude. 
 
 The Chinese are an agricultural people, somewhat similar to 
 the Mediaeval English, and this has been the case from time 
 immemorial. Comparatively little beef is eaten ; not so 
 much because of the prevalence of Buddhism, but because 
 of a feeling of gratitude to the animal most used as a tiller 
 of the soil. Pork is much used ; and quantities of excellent 
 fish and shell-fish, (the fishing is mostly done by trained 
 diving cormorants). 
 
 Regarding clothing, silk has been used in China from the 
 twenty-third century before Christ, and the people use cotton 
 and linen abundantly. The houses are built of wood or 
 stone, and though not picturesque are serviceable. The 
 streets are narrow, and crowded with people — especially in 
 the south. They are badly drained, and the heat and stench 
 are exceedingly disagreeable to passers-by. Since the feudal 
 times, separation of the sexes till marriage has been a 
 feature of the social life. But polygamy has been a long- 
 standing evil to the nation. Leprosy is legal ground 
 
 ^ A. S. Ashmead, M.D., ' Leprosy in China ;' Doolittle, * Social Life of 
 the Chinese ;' Prof. I/egge, in ' Chambers' Encyclopaedia.'
 
 PHYSICAL AND SOCIAL CONDITION IN CHINA, ETC. 81 
 
 for divorce. There was orderly governraent in China and 
 selection of best man as ruler two thousand three hundred 
 years before Christ. 
 
 Coming now to the consideration of leprosy in China, we 
 learn that it has been existent there from the very earliest 
 times ; but a cursory glance at the history of leprosy in the 
 parts of China where it has been prevalent, will at once 
 detect marked similarities between the endemic disease in 
 England and China — e. g. the governraent believe it to be 
 contagious ; the people share this belief in theory, but not 
 in practice (just as they did in England), lepers go about 
 and mix with the public. " Nobody thinks of refusing to 
 buy from a leprous huckster ; and provisions are bought 
 fearlessly in the store of a leper" (Ashmead). He begs 
 his alms, and in some places they even have the Mediaeval 
 much-abused system of Proctors. Even in the matter of 
 leper hospitals there is a marked resemblance to the old 
 English methods. So cogent are the remarks of Doolittle^ 
 on the leper hospital at Tientsin, that I quote them fully. 
 
 *^ There are two large asylums, or places of refuge and of 
 residence, at Tientsin, for the wretches who are taken with 
 leprosy, located on the outside of the city near the east and 
 west gates. Two or three hundred lepers live at each of 
 these asylums. A certain number at each asylum have a 
 small stipend allotted them regularly from the government. 
 When one of those who receives the government aid dies, 
 his place on the list is supplied by the name of another. It 
 is reported that each leper at the west asylum only receives 
 from looo to 1500 cash (about 3s. 4d. and 5s.) per quarter 
 from the Imperial benefaction. 
 
 " Each asylum is under the control of a head man, who 
 must reside at the institution, and who is nominally or really 
 one of the lepers. It is the duty of this head man to report 
 at stated times to the district magistrate the number of 
 deaths, accessions, &c., and to manage the general affairs 
 of the asylum. Matters which he cannot settle must be 
 promptly reported to the proper magistrate. He has great 
 power over the unfortunates connected with his establish- 
 ment. The rules are very rigid, and it is said that if one 
 ' ' Social Life of the Chinese,' pp. 524 — 527. 
 
 6
 
 82 GENERAL PHrSICAL AND SOCIAL CONDITION 
 
 of the inmates should manifest a decidedly insubordinate 
 disposition, and repeatedly and wilfully violate them, and 
 the head man should beat him so severely as to result in 
 death, no notice would be taken of it by the authorities. 
 These head men have the reputation of being rich, and of 
 having money at interest. 
 
 " Different sections of the asylum are allotted to the 
 different sexes. Husbands and wives are, however, allowed 
 to live together. In case of their husbands being taken 
 with the leprosy and required to live in the asylum, some 
 -wives prefer to accompany them rather than live at their 
 owm houses. These asylums present the appearance of a 
 walled village, having streets, a few small shops, and a 
 school. A wealtliy leper can hire a respectable house within 
 the compound, and live well by paying extra for what he' 
 enjoys. Lepers at the asylums may marry and raise families. 
 It is a popular saying that if either a man or his wife has 
 the disease, the other party will not take it ; and that a 
 male leper cannot impart the leprosy to a woman, while a 
 female leper can give the leprosy to a man who is not her 
 
 husband 
 
 " When one breaks out with the leprosy, no matter what 
 his social standing or his wealth, established custom re- 
 quires that he should be conveyed to one of these asylums, 
 have his name entered upon the list of inmates, and remain 
 there for a longer or shorter time. His neighbours, if they 
 know it, will not allow a person taken with the leprosy to 
 remain at his home. On entering an asylum, the leper 
 must give to the head man a sum of ready money, regulated 
 somewhat by the wealth of the individual. In case of a 
 poor man becoming leprous, his neighbours are glad to help 
 him in raising the sum demanded by the head man in order 
 to facilitate his departure. The sum demanded by the head 
 man as an entrance fee is said to vary from a few to thirty or 
 forty dollars. 
 
 '' Sometimes rich and influential families endeavour to 
 prevent a knowledge of the circumstances becoming public, 
 in case a relative is taken with the leprosy, by confining him 
 at home, and keeping away from him those who they think 
 would communicate the news to the street lepers or their head
 
 IN CHINA, INDIA, AND ICELAND. 83 
 
 man. Sliould the neighbours become aware of the fact, they 
 generally would inform the street lepers, who would report 
 to the chief ; and the neighbours themselves would insist 
 on the observance of the established custom. When the 
 fact becomes known, the matter is sometimes, though very 
 rarely, compromised with the head leper by giving him a 
 large bribe. Some twenty years ago a very rich man, 
 living in the suburbs of this city, having been attacked with 
 this disease, secretly bribed the head man by a present of 
 I GOO taels of silver to allow him to remain in his own house. 
 In this instance the family was so influential and respected 
 that the neighbours did not insist on his entering the asylum 
 as a poor man would have been obliged to do. He remained 
 at home, and subsequently died of the leprosy. 
 
 ''The poor leper leads an unhappy and hopeless life. 
 Obliged to beg in the streets in order to supplement the 
 insufficiency of the Imperial benefaction, in health his lot is 
 a most unenviable one, and sickness would seem to render 
 his misery complete. A physician is connected with each 
 of the asylums, residing without the compound. But money 
 is requisite to secure the attention and medicines which a 
 sick leper needs. At death the corpse is burned, not buried. 
 Fire is believed to destroy the insects which are supposed 
 to cause the leprosy, and which, unless the corpse was 
 burned, might naturally be expected to infest the neighbour- 
 hood and affect travellers 
 
 ''We were told that out of 400 inmates of the asylum, 
 one fourth were females. We saw thirty or forty children 
 of both sexes who were affirmed to have been born there. 
 A number of the larger boys and gii'ls were out begging. 
 We were informed in reply to our inquiries, that sometimes 
 the leprosy did not make its appearance on the children of 
 leprous parents in early life, and that the relatives of the 
 children living outside the asylum sometimes took home 
 to bring up those who seemed to be unaffected by the 
 disease. ^^ 
 
 India} — The most excellent and almost exhaustive 
 
 ^ India, ' Imperial Gazetteer,' Sir W. W. Hunter; ' Chambers' Encyclo- 
 pedia,' Sir R. Temple, and other works of his ; various Histories of 
 India ; ' Fauna of British India,' Blandford.
 
 84 GENERAL PHYSICAL AND SOCIAL CONDITION 
 
 Report of the Leprosy Commissioners leaves but little to 
 add. But I will state shortly a few notes relative to the 
 matter under discussion : — The climate runs to the extreme 
 in both directions — a torrid zone and a cold zone ; in 
 some parts very dry, in others (Bengal, Behar, &c.) very 
 damp. 
 
 One third of the country is cultivated or grazed. '^ As 
 a point of comparison a native has hardly half the strength 
 or nervous force of a European, perhaps not more than 
 one third ; his work comparatively would be in the same 
 proportion. In consequence of this, and of the cheapness 
 of living, his wages are not more than one sixth of the 
 British rate " (Temple). The mass of the people are 
 monogamist. 
 
 The Empire is over-populated, and a large percentage of 
 the agricultural population is not sufficiently employed. 
 " The cultivation of the soil forms the occupation of the 
 Indian people in a sense which it is difficult to realise in 
 England" (Hunter). It has been estimated that go 
 per cent, of the rural population live by tillage of the soil. 
 " The natural drainage (of Bengal, ■?'. e. the chief leprous 
 district) is extremely deficient " (Blandford). '' Insanitary 
 conditions abound throughout Bengal. The dwellings of 
 the poor, sessile on damp ground, are crowded, and if per- 
 chance clean within, are surrounded by dirt heaps and 
 dirt pools. Clothing is deficient, often dirty " (Blandford) . 
 The same may be said for Rungpore, another leprous dis- 
 trict. '' The masses (of India) are poor, and live in defective 
 hygienic conditions, far below the level of the Western 
 European nations, and apparently have lived in such sur- 
 roundings for centuries. '^ ^ " In the smaller towns and 
 villages little or no attempt at organising conservancy 
 arrangements are made." ^ To take Bengal as an example, 
 the soil is damp and marshy, and filthy tanks, ponds, pools, 
 and wells (the reservoirs of the usable water) abound in 
 every village.'^ Overcrowding, exposure to hardships, ill- 
 ventilation, filthy dwellings, water-pollution, unsatisfactory 
 
 ' ' Leprosy Commission Report,' 1893, p. 98. 
 
 2 Ibid., p. 300, et seq. 
 
 3 ' Medical Reporter of Calcutta,' 1894, Dr. Judunah Ganguli.
 
 IN CHINA, INDIA, AND ICELAND. 85 
 
 drainage, and personal uncleanliness seem to be the general 
 rule.^ 
 
 Indeed, the account of the deplorable state of affairs as 
 regards public health in some parts of India given by Surgeon- 
 Major Patrick Hehir seems almost incredible," and one can 
 only express the hope that the last six years have seen con- 
 siderable improvement. Dr. Roy ^ believes that Burdwau 
 (the area of endemic leprosy and fever) is unhealthy 
 because of (a) the dampness and marshiness of the soil ; 
 (6) the rise of the ground water ; (c) the unproductiveness 
 of the land ; this last being due to the fact that inun- 
 dations throw up large quantities of sand, which lies as a 
 new stratum on the surface of the soil. According to 
 Petteukofer, the chief mischief arising from the alteration 
 in the ground water is not so much its high level as its 
 extensive and frequent fluctuations. Sir James Annesley * 
 and Dr. Temple Wright ^ believed much of the unhealthiness 
 of the soil was due to animal remains and animal substances 
 in a state of decomposition, mingled with the products re- 
 sulting from the decay of vegetable matter. However that 
 may be, there can be no doubt at all that the conditions of 
 soil in India are as unfavorable to the maintenance of the 
 public health as the soil was in mediaeval England. 
 
 Conservancy is advanced and comparatively satisfactory 
 in the large towns, but much the reverse in the villages and 
 country districts.^ The drinking-water is frequently impure 
 and inadequate to the needs.'^ 
 
 The ordinary diet of the natives of India is rice. The 
 poor eat it with herbs gathered out of the fields ; the middle 
 classes eat it with split peas, greens, fish, &c. The rich add 
 spices, potatoes, cabbages, cucumbers, and other fruits and 
 vegetables, frequently fried in clarified butter.^ 
 
 ^ 'Lep. Com. Rep.,' 1893, p. 300, et seq. 
 
 ^ 'Indian Medical Gazette,' November, 1889, Patrick Hehir, M.D., D.P.H. ; 
 also see ' Brit. Med. Journ.,' Aug. 3rd, 1895, p. 287 ; Ernest Hart, D.C.L. 
 5 ' Epidemic Fever in Bengal,' G. C. Roy, M.D. 
 ■• ' Researches into Diseases of India,' Sir J. Annesley, F.R.C.S., F.R.S. 
 
 * 'Indian Medical Record,' June, 1894, R. T. Wright, M.D., F.R.C.S. 
 " ' Report Sanitary Measures in India,' 1892, 167. 
 
 7 ' Rep. Sanit. Meas. India,' 1887-8 ; Indian Fam. Comm. Rep.,' 108. 
 
 * 'Indian Medical Record,' 1894.
 
 86 GENERAL PHYSICAL AND SOCIAL CONDITION 
 
 As regards fisli, mucli is cured by the natives for their 
 own or European consumption. The fishing in the streams 
 is good^ but in the rivers of the champaign the fish, though 
 abundant in quautity, is not esteemed for quality (Blandford). 
 " Both sea and fresh-water fish are largely consumed wherever 
 they can be caught. Dried fish is used all round the coast, 
 especially in the Madras Presidency and Burma. In the 
 latter country dried fish more or less in a state of de- 
 composition is almost universally eaten, but in small quan- 
 tities, and more as a condiment than as a food " {' Lep. 
 Com. E,ep.,' 1893, p. 308). As a matter of fact, although 
 much has been said to the contrary, fish is eaten by a very 
 large proportion of the Indian people. Along the coast it 
 is consumed habitually except by a small minority ; " all up 
 the larger rivers fish is found in every market, over two and 
 a halt millions of people live by the provision of this article 
 of food, and probably another half- million should be added 
 from amongst the boatmen."^ ('The Indian Famine Com- 
 mission Report,' 1880, states the same.) Dr. Vincent 
 Richards held the opinion that in Bengal (where leprosy 
 was most prevalent) no fish could be procured f but Dr. Loos, 
 writing in 1893, states that " all the waters of Bengal abound 
 in fish, and this forms the main article of diet ;" ^ and of this 
 same district (the delta of the Ganges and Brahmapootra) 
 Sir James Caird says, " The rivers here swarm with fish, 
 which must be salted to preserve them for transport, but the 
 cost of salt is three times that of fish." ^ Further evidence 
 could be produced ° to show that a fish diet in India, inland 
 or on the coast, is not a rare diet, but enough has been said. 
 
 Regarding leprosy in India, very much the same general 
 remarks apply as for China. Leprosy has been existent in 
 India for at least 3000 years. In the earliest times it was 
 called Kushtha. Many centuries before Christ (exact date 
 
 1 'Third Decennial Rep.,' 1892, p. 426. 
 
 -' 'Ind. Med. Gazette,' 1889. 
 yf ' ' Ceylon Med. Journ.,' " Leprosy in India," Jas. Loos, M.D., 1893. 
 
 ' ' India, Land and People,' Sir Jas. Caird, K.C.B., F.E.S. 
 
 ■^ ' Roy. Coll. of Phys. Report,' 1867, Ixvii ; ' India in 1880,' Sir Richard 
 Temple, G.C.S.I., &c. ; 'Leprosy Commission Report,' 1893, p. 308; 
 ' Climate and Diseases of British India,' 1880, p. 209.
 
 IN CHINA, INDIA, AND ICELAND. 87 
 
 unknown) Atreya refers to tlie seven varieties of Kushtba. 
 There can be no doubt that leprosy was common in India 600 
 years before Christ (Susruta). Some writers believed it had 
 its source in Cliiua and spread eastwards, others believed it 
 came from Thibet, and others again from Egypt (Lucre- 
 tius). The probability is that the disease has been indigenous 
 and endemic in certain parts of India from time immemorial. 
 And even the scanty records which are extant deal more 
 with the disease as a religious curse, or as a fit opportunity 
 for benevolence, than from a scientific standpoint. The 
 first authentic records of the disease begin with the present 
 century. This is largely owing to the lack of chronological 
 reference to the disease, and also to the fact that until a 
 census was taken exact figures and facts were not obtain- 
 able. It is estimated that there are in India, at the 
 present time, 100,000 lepers.^ There are a number of 
 hospitals set apart for them, where they are well fed 
 and cared for — much better than in China or mediaeval 
 England. There is no compulsory detention of lepers in 
 these asylums. Some of them are semi-religious, and in 
 some medical skill is obtainable, and in others a medical man 
 resides. Some are situated in the middle of the bazaar, 
 surrounded b}' all the other houses ; others are situated out- 
 side the city. At Subathu and other places lepers are 
 " allowed to go outside the asylum on certain days of the 
 week,^' and " in addition to lepers, other patients are re- 
 ceived from charity. In more than one case the hospital 
 lepers were engaged in selling food in the bazaar." 
 
 Iceland ^ is more than a third larger than Scotland ; a 
 table-land about 2000 feet high. 
 
 The climate of the south of Iceland is like that of the 
 north of Scotland — wet, and colder. In the north of the 
 island the climate is drier, and colder still. 
 
 The only cereal is the metur (a kind of wild oats). 
 Turnips, carrots, cabbages, and potatoes are now culti- 
 
 ' ' Lep. Com. Rep.,' p. 53. 
 
 2 Ibid., pp. 9—35. 
 
 ^ Jon A. Hjaltalin, 'Chambers' Encyclopaedia;' von Troll, ' Letters on 
 Iceland' (1772) ; 'Journal of Dermatology,' Ehlers of Copenhagen, 1894 ; 
 " Iceland," Dr. E. Henderson, ' Quarterly Review,' 1818.
 
 88 PHYSICAL AND SOCIAL CONDITION IN CHINA, ETC. 
 
 vated to some extent. Ponies, slieep, and dogs are expoi'ted 
 to Scotland. " The sea around the coast is very rich in 
 fish, especially cod and herrings ; the cod fisheries have 
 been carried on a long time by the Icelanders" (Hjaltaliu). 
 ^' Their continual occupation is fishing; they are night 
 and day exposed to wet and cold, frequently fed upon 
 corrupted rotten fish, fish livers and roe, fat and train 
 of whale and sea-dogs, as likewise congealed and stale 
 sour milk ; they often wear wet clothes, and are com- 
 monly exposed to all the hardships of poverty " (Vontroil) . 
 Their houses and villages are small, ill-drained, and crowded. 
 " The diet of the Icelanders consisting almost solely of 
 animal food, chiefly fish, and the want of cleanliness in 
 their habits, produce cutaneous diseases under their worst 
 forms and render leprosy common ; nine-tenths of them 
 know not the luxury of bread or vegetables" (Henderson). 
 
 As to leprosy, it would seem that it first became common 
 in the twelfth century, and still exists there. In 1555 
 the disease was so prevalent that the government decided 
 to build hospitals; four were constructed about 100 years 
 later. The spread of the disease was checked by epidemic 
 diseases which occasionally swept over the island. A small- 
 pox epidemic, in 1707, '^killed 18,000 persons, including 
 nearly all the lepers alive at that time " (Ehlers) . There 
 are now (1894) 141 lepers in Iceland.^ In the beginning 
 of the present century (1800— 1837) the yearly average 
 mortality was 19. Leprosy is at the present time de- 
 creasing in Iceland. (Ehlers states that it is increasing.) 
 Thei'e has been no segregation, no isolation, no treatment. 
 Its zenith w^as probably in the sixteenth or seventeenth 
 century. The present population is about 70,000. 
 
 As an example of a country where leprosy has been, 
 and is now almost or quite extinct, we may take New 
 Zealand. The climate of New Zealand is one of the 
 healthiest in the world (death-rate 9*04 per 1000), the 
 average temperature equable. The white population is 
 626,000, besides 41,000 Maoris. The date of the Maorian 
 emigration to New Zealand is unknown. In Cook's time 
 they numbered 100,000. 
 
 ' 'La Seinaine medicale,' Nov., 1894 (Ehlers).
 
 CONCLUSIONS AND APPLICATIONS OP 
 THE POREGOING. 
 
 Let these few sentences on tliese three leprous countries 
 suffice. 
 
 Now here we have four different peoples, viz. : 
 
 Mediaeval England . (tenth to fifteenth centuries). 
 
 China . . .as at present. 
 
 India •.-,,,, 
 
 Iceland '•}>}) 
 
 Climate. — All four countries are widely different ; yet the 
 disease attacks all regions — cold, temperate, torrid. 
 
 Physical conditions. — All vary ; the disease exists on 
 mountains, table-lands, plains, and valleys ; no generalisation 
 can be made. England (Media3val) was probably as damp 
 and marshy as Iceland is now, and it would seem that in 
 India, '' the smallest proportion of lepers are found in the 
 driest areas." ^ That is quite my view in regard to England, 
 e. g. Norfolk, Suffolk, Essex, Kent, Cornwall, Cambridgeshire 
 were the leper areas, and they were undoubtedly the damp 
 parts of England. " Of course it is not maintained that the 
 degrees of the climate is the sole or even chief factor in the 
 numerical distribution of the disease, yet it must always 
 remain a significant and suggestive fact that the leper ratios 
 (in England, India, China, and Iceland) vary inversely with 
 the degrees of the climate." ^ 
 
 ''^Density of population. — It seems to me that in some 
 measure the more crowded the population the more does 
 
 ' 'Leprosy Com. Rep.,' 1893, p. 58. 
 " Ibid.
 
 90 CONCLUSIONS AND APPLICATIONS OF THE FOREGOING. 
 
 leprosy flourish. All these four countries have crowded 
 populations. Leprosy was more common iu the cities in 
 England tlian elsewhere. So also in Iceland, where it is 
 almost limited to the more thickly populated south coast. 
 The 'Leprosy Commission Report/ 1893, states that leprosy 
 has not increased in India in proportion to increase of popu- 
 lation since 188 1, and concludes that therefore the density 
 of population has no effect on the spread of leprosy 'per se. 
 It w^ould be very serious if it did, for at the nineteenth 
 century rate of increase of population, leprosy would now be 
 the most prevalent disease. 
 
 As regards agriciiJture, all four countries are similar, 
 though they differ in degree. Tillage of the soil has been 
 the chief employment in three out of the four, and the 
 fourth, Iceland, from its insular position has reaped the 
 harvest of the sea. Agriculture of itself is not likely to 
 cause disease. 
 
 Respecting social conditions — poverty, sanitation, diet, 
 &c. — we have at least some remarkably common features. 
 The poverty is m all four extreme, the sanitation little or 
 nothing, the diet insufficient. 
 
 It has sui-ely been amply proved, here and elsewhere, that 
 this is the only common feature in all leprous areas all 
 over the world, viz. what I have classed under " social 
 conditions." 
 
 On the question of the vera causa of leprosy, I may quote 
 Neisser,^ whose propositions have the general acceptance of 
 scientific men of the present day, viz. : 
 
 1. Leprosy is a pure bacterial disease produced by a 
 specific bacillus.- 
 
 2. These bacilli are introduced into the organism either 
 as such, or more probably as spores, and remain during* a 
 period of incubation of varying duration. 
 
 3. From the parts of the body in which the spores have 
 been deposited, invasion of the system takes place. 
 
 Granting the specific cause of the disease to be, and 
 always to have been, bacillary, it follows that the spread and 
 decline of the disease in England had a definite and exact 
 
 ^ ' Bacteria in Relation to Disease,' New Sydenham Society. ^ 
 2 The Bacillus leprx, Hansen, 1874.
 
 CONCLUSIONS AND APPLICATIONS OF THE FOREGOING. 91 
 
 relation to conditions which favoured or prohibited the 
 introduction or action of the Bacillus leprae. 
 
 The following modes of introduction are open to us : 
 
 1. By touch through an itnhrohen surface of skin = 
 Contagion. 
 
 2. By introduction of the specific poison through a broken 
 surface of skin = Inoculation. 
 
 3. By actual foetal transmission = Pure heredity. 
 
 4. By air = infectious ^ ^. -in 
 -r, „ T T , ,• r = Communicable. 
 
 5. By food = dietetic ) 
 
 Applying these possibilities to leprosy in England, one 
 may say : 
 
 I. The whole weight of historic evidence is opposed to 
 the supposition that contagion was the cause of the spread 
 of the disease, and that segregation was therefore the cause 
 of its decline. It is true that the people believed, in a rough 
 and general way, that the disease ivas contagious ; it is equally 
 true that many medical and other authorities declared it to 
 be contagious. 
 
 " The leprosy is not infectious (some say), neither is it 
 ever communicated by carnal copulation. But surely 
 whoever looks into the history of the distemper, will find 
 that the ancients had quite another notion of it ; ^tius 
 (Lib. Iv, i, 120) expressly says it is contagious, and upon 
 this very account thinks it unsafe to go near a leper." 
 
 Avicenna (Lib. Iv, 3, 3) tells us " that the very air is 
 corrupted as it is in the plague or smallpox, and if contagion 
 can be propagated this way, i. e. by medium of the atmo- 
 sphere, in a leprosy, how much more active must the venom 
 be in a close and immediate contact. •'^^ 
 
 In a certain restricted sense every bacillary disease is 
 " contagious," but the point is not the abstract theory of 
 contagion, but as to whether or not the disease was spread in 
 England hy contagion, and its sequel, viz. whether segre- 
 gation was the cause of its decline. If the disease was 
 spread by contagion, how was it, considering the oppor- 
 tunities, that it spread so little ? There can, I think, be 
 no doubt that it never assumed a greater frequency than 
 
 ' ' History of Physic from time of Galen to the Sixteenth Century,' by 
 J. Friend, M.D., 1758.
 
 92 CONCLUSIONS AND APPLICATIONS OF THE FOEEGOING. 
 
 40 per 1 0,000 ; yet, as has been proved, the lepers mixed with 
 the public, and healthy paupers lived in many cases with the 
 lepers. 
 
 This is not the place to enter into a full discussion for 
 and against contagion, but it may be taken for granted that 
 contagion is not a chief cause of the propagation of leprosy 
 in modern times. ^ In China, India, and Iceland the disease 
 has not spread at such a rate or proportion as to make it 
 the least probable that contagion has caused the spread. 
 Indeed, the evidence from the three different countries 
 favours a decrease in the leper population, although in not 
 one of the three countries is segregation enforced. Some 
 writers argue that Norway is proof that segregation causes 
 decline, and that therefore contagion spreads the disease. It 
 is interesting to discover that so little and so irregular is 
 the " segregation" in Norway, that in 1885, out of a regis- 
 tered leper population of 1377, only 522 were in hospital 
 at all, i.e. not nearly half. In 1890, out of 960 lepers 
 (484 men, 476 women), 507 were in leper establishments. 
 
 Another example : at Aqua di Dios, the leper village in 
 Columbia, containing 520 lepers (one third of the popula- 
 tion) they live in intimacy and mix freely with healthy 
 people, yet there is no spread of the disease. And many 
 other examples might be adduced. On the other hand, it 
 is easy to mention places where it would appear that con- 
 tagion played a large part in spreading the disease. But 
 in these cases I believe it will be found that the diet and 
 mode of life are the responsible agents. Be that as it may, 
 I feel confident that the whole mass of historial evidence 
 regarding leprosy in England will support the statement 
 that any spread of the disease in the British Islands in the 
 Middle Ages w^as not chiefly caused by contagion. If that 
 were a chief cause " we should expect a rapid increase all 
 over the world, for segregation is not absolute anywhere." " 
 
 ' Fliigge (Leipsic) ; Yirchow (' Krankhaf te Geschwiilste,' vol. ii, p. 507) ; 
 ' Times of India,' Xov. iSth, 1890 ; ' Lep. Com, Rep.,' 1893 ; ' E. C. Phjs. 
 Eep.,' 1867; Erasmus Wilson, 'Lancet,' 1856; Hutchinson, 'Brit. Med. 
 Journ.,' 1889; von Troil ; Chevalier Back; Harrebar ; Fitch (Molokai) ; 
 Olavide (Madrid) ; Ross (Cape). » 
 
 ■^ ' Tiinidad Leper Asyhnn Report,' 1S92, Bevan Rake.
 
 CONCLUSIONS AND APPLICATIONS OF THE FOREGOING. 93 
 
 2. There can, it seems, be no doubt at all that inocxilation 
 is possible in the abstract. Practically, inoculation has 
 failed,^ and we may be absolutely certain that the disease 
 does not spread through a nation by inoculation. Upon 
 this point I may not unsuitably quote Mr. Hutchinson. 
 " There was a time/' he says, " prior to Hansen's discovery 
 of the bacillus, in which I was inclined to call leprosy ' fish- 
 eaters' gout,' but I should now prefer to name it ' fish-eaters' 
 lupus,' or, perhaps better, ' fish-eaters' tuberculosis.' The 
 differences between the bacillus of leprosy and that of tuber- 
 culosis are, although definite, very slight, and may possibly 
 be only acquired and temporary. It is well known tuber- 
 cular affections of the lungs are a common cause of death in 
 lepers. We must not rely too confidently on the permanent 
 specificity of species in bacilli .... Mr. C. Macnamara 
 disavows any belief in aerial infection, but says that it 
 is necessary that the discharge from a leper sore should 
 enter the blood of the healthy person. The question, how- 
 ever, is hoiv does it get into the blood. Obviously Mr, 
 Macnamara presupposes a local sore, but I repeat neither 
 he, nor anyone else, has ever observed such." {' Brit. Med. 
 Journ.,' i8go.) 
 
 3. Foetal transviission, or true heredity. — Bacillary trans- 
 mission in the maternal blood in this manner is unknown. 
 
 4. Communicahility : hj air =: infectious ; hy food = dietetic . 
 By air = infectious. — There can be no doubt that the 
 
 Bacillus leprse has frequently been breathed into the respi- 
 ratory tract. Of course it is impossible to make any exact 
 statement historically with regard to such a method of propa- 
 gation ; it is equally cei'tain that one can find scores of ex- 
 amples of nurses, physicians, and attendants upon lepers, 
 who must have inspired leprous-infected air and yet have 
 not suffered from the disease,^ from which it may be argued 
 
 ' ' Lep. Com. Rep,,' 1893, Appendix, p. 432, et seq. 
 
 2 E. g. physicians in Norway leper hospitals who have never taken the 
 disease ; or the nine nurses on Sheldrake Island, at the mouth of St. 
 Lawrence River, who lived in the same lazaretto with a number of lepers, 
 washing their ulcers and caring for them as long as life lasts, and have 
 been at it for twenty-one years, while not a single case has contracted 
 the disease (Fitch).
 
 94 CONCLUSIONS AND APPLICATIONS OF THE FOREGOING. 
 
 (a) that the lepra bacillus never gained access to the respi- 
 ratory ti"act, or {h) that, having gained access, the tissues 
 were too healthy and resistent for its growth. In the 
 former position the idea of spread by infection falls to the 
 ground. The latter position (immunity, diathesis, &c.) will 
 be referred to habit. 
 
 Dietetics. — This is the only possible active cause left by the 
 elimination and exclusion of tlie others. (Questions of sanita- 
 tion, poverty, dampness, over-crowding, will be referred to 
 later ; not one or all can by any possibility be an active 
 cause if the previous propositions, relating to contagion and 
 infection, are valid.) 
 
 Larry ascribes the leprosy from which the French suf- 
 fered in Egypt to the unwholesome character of the pork.^ 
 Forrestus, Plater, and Raymond believed the leprosy of the 
 Middle Ages in England was due to the salt, putrid, indi- 
 gestible food which was eaten ; and the frequent scarcity of 
 even that, owing to the disorder of the times." 
 
 " To the change from the use of salted, to that of fresh 
 meat, joined to the advantage of vegetable productions now 
 common throughout the year, is principally to be ascribed 
 the almost total extirpation of the leprosy, which formerly 
 made such dreadful havoc." ^ He then goes on to add that 
 linen and other comforts elevated the whole social life of 
 the comumnit}^, and contributed towards the expulsion of 
 leprosy. " The general history of civilization teaches us 
 that skin diseases were very prevalent, and that leper- 
 houses were ordinary institutions in all the countries of 
 Europe as long as the lower classes continued impoverished, 
 ill-fed, and ill-clothed. Referring to the history of our own 
 country, the age of the Plantagenets and Tudors presented 
 similar scenes, which most probably originated in like 
 causes, and mainly in a deficiency and very irregular supply 
 of a mixed diet of fresh animal and vegetable food.'"* 
 
 Exactly the same view was promulgated by the Royal College 
 of Physicians in 1867. "The experience of the past appears 
 
 ' Willan, ' Cutaneous Diseases,' p. 42. - Rees, 'Cyclopsedia.' 
 
 ^ 'Historical Account of the Commission to Inquire into Charities,' 
 N. Carlisle, F.K.S., 1828. 
 
 ' ' Navy Report,' W. R. E. Smart, M.D., R.N. ,
 
 CONCLUSIONS AND APPLICATIONS OP THE FOREGOING. 95 
 
 to point in an unmistakable manner to an improved diet as 
 one of the principal factors in its (leprosy) gradual decline, 
 and eventual cessation in all parts of Europe. During the 
 Middle Ages, and down to within the last one hundred and 
 fifty years, the food of the mass of the people was generally 
 unwholesome and unnutritious. The scarcity of fresh meat 
 and the ordinary consumption of highly salted meats, scanty 
 supply of vegetables and fruits, and the inferior and often 
 unsound character of the bread in common use, together 
 with extremely filthy habits, could not fail to act injuriously 
 upon the general health, and predispose them to endemic 
 chi'onic maladies as well as to the occasional ravages of 
 epidemic disease. It seems indisputable that as the agri- 
 cultural and horticultural condition advanced, and the diet 
 of the working class was bettered by the more frequent and 
 abundant use of fresh animal and vegetable aliments, and 
 of more wholesome cereals, leprosy became less and less 
 common, until it almost altogether disappeared, except in 
 scattered and occasional instances.''^ And again : — " The 
 food of the class chiefly affected with leprosy is almost 
 invariably described as being poor, unnutritious, generally 
 unwholesome, and often insufficient in quantity, and in the 
 reports sent in from all over the world, the frequent 
 or constant use of fish, much salted and often tainted or 
 semi-putrid, is perhaps more frequently referred to as a 
 cause of the disease, than that of any other other article of 
 food." 
 
 '' In Ireland, too, notwithstanding the frequent destitution 
 of the people in many districts, the general cessation of the 
 malady since the seventeenth century seemed to show that 
 mere poverty of food, provided this be fresh and wholesome, 
 is insufficient to produce or to perpetuate the disease."" 
 Villannova asserted that leprosy was provoked by unnatural 
 food, and believed that was the reason of its prevalence 
 among the French and Burgundese.'^ 
 
 Evidence is also forthcoming from different quarters of 
 the British Islands, to the dietetic causation of endemic 
 
 ' 'Roy. Coll. Phys. Rep.,' 1867. 
 
 ' Ibid., p. 75. 
 
 ^ Villannova, ' Breviarii,' Lib. II, c. lii.
 
 96 CONCLUSIONS AND APPLICATIONS OF THE FOEEGOTNG. 
 
 leprosy. In St. Kilda it was " ascribed to their gross 
 feeding, and that on those fat fowls, as the Fulmar and 
 Solan geese ; the latter of which they keep for a whole year 
 without any salt or pepper to preserve them.^^^ Uncooked 
 meat, and " other gross aliments," are said to have caused 
 the '' very common " leprosy in Ireland." '' The prevailing 
 notion," says Polwhele, speaking for Cornwall, '' is that 
 leprosy was generated by eating salmon too frequently, and 
 at unseasonable times. That our forefathers thought so is 
 evident from covenants which I have seen in this country 
 and in Devon, stipulating that no apprentice or servant shall 
 be obliged to dine on salmon more than once or twice a 
 week. And we are told that, in consequence of a due 
 abstinence from salmon, leper-houses were no longer 
 necessary,^' '^ The disease, we are told, was due especially 
 to the liver of the fish being not well prepared."* Speaking 
 of Cornwall only about one hundred and fifty years ago, an 
 anonymous writer to the ' St. Jameses Chronicle ' says : — 
 '' The labourers bring up their families with only potatoes or 
 turnips, or leeks rolled up in black barley crust, baked 
 under the ashes, with now and then a little milk. Perhaps 
 they do not take a bit of flesh meat in three months." 
 
 An interesting analogy with leprosy is to be found in 
 the pellagra in Italy, a disease caused by bread-eating, from 
 bad or damaged maize. " It is in pellagra," says Dr. 
 Creighton, " that we find the key to the ancient problem of 
 leprosy. The two diseases are closely allied, . . . and 
 may be reasonably suspected of having analogous causes. 
 The most general expression (dietetically) for leprosy, is a 
 semi-putrid and toxic character of animal food, just as for 
 the pellagra it is a semi-putrid or toxic character of bread." ^ 
 
 The view that diet is one of the chief causes of the spread of 
 leprosy is not by any means a new idea. Avicen thought 
 that ill-cooked or unhealthy cow-flesh engendered leprosy,^ 
 
 ' ' Voyage to St. Kilda,' Martin, 1793, p. 41. 
 - Ledwich, ' Antiquities of Ireland,' p. 370. 
 3 Polwhele, ' Hist, of Cornwall,' 1806, p. 88. 
 
 * Nichols, 'Leicestershire,' vol. ii, pt. i, p. 272. 
 
 * ' Epidemics in Britain,' Creighton, vol. i. 
 ® 'Regimen Sanitas Salerni,' 1649.
 
 CONCLUSIONS AND APPLICATIONS OF THE FOREGOING. 97 
 
 and in this old book not a few references are made to the 
 effect of diet upon the disease. Debe put down the preva- 
 lence of the disease in the Faroe Islands to the food of the 
 poorer people being half-rotten flesh or fish.^ Leprosy was 
 prevalent in the Faroes when it was extinct in Great Britain. 
 '' We learn/' saj^s Dr. Hjort/ '' from the Faroes, that the 
 disease there has diminished, and is now almost unknown, 
 since the great sea-fishings were relinquished, and more 
 attention has been paid to agriculture." It was believed in 
 many parts of England that salmon was responsible for the 
 disease.'^ Indeed, for centuries in England the common 
 opinion has ascribed to food the chief place amongst etio- 
 logical factors ; ^ and the increased use of vegetables and 
 good food as the active cause in the decline. 
 
 Some interesting evidence relating to the effect of diet 
 upon the disease is obtainable from several foreign quarters. 
 
 Iceland. — Here the disease, in the opinion of various 
 writers, first appeared "not so much owing to the climate 
 as to the manner of life and diet.'" " Since fishing has 
 declined among the inhabitants of the islands of Ferro, 
 and the inhabitants have cultivated corn and live upon 
 other food, instead of whale flesh and bacon, the elephan- 
 tiasis has entirely ceased among them " (Peterson^). Banks,^ 
 Vontroil,^ Holland,^ Schleisner,^ share the same view, 
 and believe that " since fruits and vegetables have become 
 fashionable, '^ leprosy has greatly diminished in Iceland. ^^ 
 " It is probable," conclude Drs. Ihre and Bach,^^ " that the 
 elephantiasis quitted southern countries from similar causes, 
 and have on the contrary maintained themselves where a suffi- 
 cient quantity of bread cannot be provided for the natives 
 and where the lower sort of people do not eat any vegetable." 
 
 ^ Debe, 'Account of Faroe Island,' 1676. 
 
 ^ Liveiug, Gulstonian Lectures, 1873. 
 
 3 MufEet, 1655. 
 
 '' ' Chambers' Encyclopjedia,' Willis and others. 
 
 * ' Letters on Iceland,' Banks. 
 
 « Ibid. 7 Ibid. 
 
 ^ Sir Geo. Mackenzie, 'Travels,' 1812. 
 
 s 'Roy. Coll. Phys. Rep.,' 1867, p. xliii. 
 
 ^" Sir J. Pringle, ' Observations of the Diseases of an Army.' 
 
 " ' Letters on Iceland,' Banks 
 
 7
 
 98 CONCLUSIONS AND APPLICATIONS OF THE FOKEGOING. 
 
 Neiv Zealand. — " When the English first began to 
 colonize New Zealand they found leprosy prevalent amongst 
 the natives. In a few isolated cases English colonists 
 themselves became the subjects of it. Now, as is well 
 proven by its fauna, &c., New Zealand had for long ages 
 been separated from all intercourse with other parts of the 
 world. Its diseases were therefore its own. Its natives 
 were living on very restricted supplies of food. They had 
 no quadrupeds, and but few edible vegetables. They lived 
 near the sea-shore, and very largely on what the sea pi'O- 
 duced. The English introduced corn, sheep and cattle, and 
 Maories took to farming, went to live inland, and to a large 
 extent abandoned fish for mutton and Indian corn. The 
 result had been, that without the slightest attempt at 
 isolation, leprosy had within quite a short period almost 
 wholly disappeared. 
 
 " As regards the Englishmen who became lepers (very few 
 indeed) it is probable that they got it from eating the same 
 food as the Maories, and not from contagion. It did not 
 spread in their families, nor did their children inherit it.^'^ 
 In 1890 there were believed to be no cases of leprosy in 
 New Zealand. Here is very conclusive evidence as to the 
 influence of diet, and it is confirmed by Dr. Myles," who 
 states, that even so far back as the time of Captain Cook, 
 leprosy prevailed in New Zealand, but only on the shores of an 
 inland lake where fish diet was used, and nowhere else. 
 
 Jajjan. — Quite recently a gentleman well acquainted with 
 Japan, speaking of the diet, quite apart from any thoughts 
 of leprosy, said, " The seas round Japan as well as its 
 rivers swarm with innumerable fish of the most varied kinds, 
 and the diet of the people, especially the lower orders, 
 largely consists of fish, often raw. Neither sheep nor 
 cattle thrive in Japan, and such as there are in the country 
 are almost entirely for the use of the European community. '* 
 It is so well known that leprosy exists extensively in Japan 
 that it is hardly necessary to enter into the matter fully. 
 Only a few months ago considerable effort was being made 
 in Japan to procure further housing for the lepers. 
 
 ^ Abtheilung xvi, ' Med. Geog. und Klimat.,' Hutchinson. 
 - Roy. Acad. Med., Dublin, 1S89.
 
 CONCLUSIONS AND APPLICATIONS OF THE FOEEGOING. 99 
 
 One more example may be taken^ viz. : 
 
 The Sandwich Islands. — And here again I must quote 
 from Mr. Hutchinson, who said : — " In all probability the 
 lepra bacillus or its representative was always and invariably 
 received into the human body in connection with fish. It 
 was true that as yet the bacillus had not been found in fish, 
 but on this point we must not be discouraged, but persevere. 
 No doubt it would be found. Probably it is not very 
 common. If it were so, leprosy would prevail far more 
 widely than it does. 
 
 " Although he had said that he believed that leprosy was 
 not new to the Sandwich Islands, but had always been 
 present, he was quite prepared to adjnit that there had been 
 of late years, a very remarkable increase. He explained 
 that by the immigration of Chinese, who, wherever they 
 went, became fishermen, food-providers, and cooks, for the 
 rest of the community. An eighth of the population of the 
 Sandwich Islands were at the present time Chinese. No 
 doubt they had taught the natives to eat fish in novel 
 forms. This was the explanation which he had suggested 
 ever since the Sandwich Islands outbreak had been under 
 discussion. He had been delighted to have it confirmed by 
 what Dr. Arning had told him yesterday. Dr. Arning had 
 said that although the use of fish as food had always been 
 common, it was only quite recently that it had been salted. 
 Probably it was this recent use of salted fish which had 
 caused the outbreak. Exactly the same was, he believed, 
 now occurring at the Cape of Good Hope. Here also 
 leprosy was increasing, and here a colony of Malay fisher- 
 men and fish-salters had settled. Their salt fish was now 
 sent far inland, and much eaten, and where it went there- 
 leprosy made its appearance. The speaker had recently 
 seen two Europeans, who, living inland in Cape Colony, had 
 become lepers. One of them was an Englishman, and the 
 other a Dutchman. Neither could possibly have inherited 
 that disease. Both had been large consumers of the Malay 
 salt fish.'^^ 
 
 It has been afiirmed that as fish has no effect upon 
 lepers, therefore it cannot be intimately associated with the- 
 
 1 Ibid.
 
 100 CONOLUSTOXS AND APPLICATrONS OF THE FOREGOING. 
 
 disease. But we have evidence to prove that, under certain 
 cii'cumstances, fish does cause an exacerbation. Speaking of 
 the food supply in the Leper Hospital on Robbin Island, near 
 the Cape of Good Hope, Dr. W. H. Ross says : — " We obtain 
 our meat from Cape Town, and it does not ai'rive till late on 
 Tuesdays and Fridays ; for those two days dried fish is 
 issued instead. The lepers objected strongly to this ration 
 of dried fish. They said that after eating fish they became 
 feverish, and then after the third day a rash broke out ; 
 the fever then gradually passed away. I noticed these sym- 
 ptoms myself (the rash occurring in patches of flattened 
 tubercles or shining red blotches), and since we stopped the 
 issue of salt fish the number of such cases has decreased.''^ 
 
 Speaking of leprosy at the Cape, Dr. Wright^ says: — "Any- 
 thing that tends to lower the system would render the sub- 
 ject more liable to take the disease. It is due more to over- 
 crowded dwellings in which people live like pigs. I think 
 that not the fish diet, but the decomposing fish around them, 
 is the more probable cause. Decomposing fish is more 
 injurious than any other decaying matter.'^ 
 
 So much, then, by way of evidence on the influence oi 
 diet upon leprosy in England, and confirmatory evidence 
 from other countries. 
 
 It will at once be pointed out that the argument is en- 
 tirely overthrown because in many countries where as poor 
 a diet, and a fish diet too, is used, there is no leprosy ; and 
 in some countries where there is leprosy it is difficult or 
 impossible to discover a fish diet. 
 
 With regard to the former statement our contention is, 
 not that wholesome cooked fish is the cause of leprosy ; but 
 bad, putrid, uncooked fish may be so under predisposing 
 circumstances. Before cases of other countries where much 
 fish is eaten and little leprosy appears are emphasized, it 
 must be shown that the cases are actually parallel and com- 
 parable ill predisposing and general conditions. 
 
 India is not infrequently quoted as an example of the latter. 
 But it must be remembered that India is the one country that 
 
 > Dr. W. H. Ross, Surg. Robben Island Lep. Hosp., 1889. 
 
 - Abtheilung xvi. Dr. Donnet attributes leprosy in Portugal to New- 
 foundland salted fish ('Brit. Med. Journ.,' 1889, p. 304). Dr. Hjort says 
 the same of the Faroe Islands.
 
 CONCLUSrONS AND APPLICATIONS OF THE FOREGOING. 101 
 
 is mostly opposed to the fish-theory. Besides, continued evi- 
 dence appeal's, making it more and more probable that a fish 
 diet is much more widely used in India than is commonly 
 supposed.^ 
 
 I would venture to point out that even in the ' Report of 
 the Leprosy Commission/ 1891, in India (see p. 308), there 
 is not a little evidence in favour of the fish hypothesis. 
 
 Central China is also quoted as a leprotic but not fish- 
 eating region. But is that so ? Professor Legge says 
 that fish may be obtained all over the empire." 
 
 There can be no doubt that the chief predisposition to 
 any disease is due to the weak resistance the human tissues, 
 under certain circumstance, are capable of offering. The 
 Bacillus leprse is (i) either contained in the food, or (2) 
 raised into activity in the tissues by the use of certain foods. 
 No other way seems possible. In either of these ways there 
 are doubtless certain conditions of the tissues and general 
 bodily health which will affect the accession, progress, and 
 decline of the disease. 
 
 Therefore I propose to shortly consider some general 
 conditions which in Mediaeval England probably played an 
 active part in the spread and decline of leprosy. 
 
 Before passing to this topic, let me draw attention to the 
 mass of evidence previously given under the " Social Condi- 
 tions of England," relative to the widespread custom of fish- 
 eating in the Middle Ages. If fish be really the specific 
 medium of bacillary introductiou, there was abundant use of 
 the specific medium throughout the leprosy period in 
 England. Mr. Hutchinson has declared : — " I believe the 
 advance of Christianity, with its salt-fish fasts, was mainly 
 conducive to the prevalence of the disease in Europe during 
 the Middle Ages, and that its spreading is always due to food, 
 and never to contagion, and its disappearance to an improved 
 dietary and not in the least to enforced isolation."^ 
 
 ^ Vide ' St. James's Gazette,' Sept. 13th, 1893. C. D. Terrell, a missionary 
 in the Central Provinces of India, writes to me (Sept. 29th, 1894) and says 
 that leprosy cannot be caused by fish, because it is such a common diet among 
 the lower castes of Hindoos. He believes leprosy in India stationary or 
 decreasing. 
 
 ^ 'Chambers' Encyclopfedia,' "China," by Professor Leggo. 
 
 ^ ' Quarterly Examiner,' 1890, " The Leprosy Problem."
 
 102 CONCLUSIONS AND APPLICATIONS OF THE FOREGOING. 
 
 Although for a specific disease there is one specific cause, 
 still to produce an epidemic or endemic prevalence of a 
 disease the co-operation of many causes is necessary. So 
 cogent and to the point are the remarks on this subject in 
 the ' Eeport of the Leprosy Commission/ 1893, that they 
 may be quoted. " In leprosy, as in tuberculosis, a special 
 individual disposition is necessary for the acquisition of the 
 disease. There seem to be certain factors, partly connected 
 with the climatiCj economic, social, and hygienic conditions, 
 which establish the endemic nature of this affection. A 
 disease can only be endemic in an area where all the conditions 
 leading to its acquisition exist. Leprosy is an infectious 
 disease, but besides the contagium vivuvi, a certain disposi- 
 tion of the individual is necessary to produce the disease in 
 the latter. Therefore it can only be endemic in areas 
 where, besides the virus, those factors also exist which are 
 held responsible for the special disposition in the indi- 
 vidual 
 
 *' An endemic area, then, would be one where (a) the 
 virus in some form or other is present, and where also (&) 
 such conditions exist as are calculated to receive a special 
 predisposing influence on the population, thus enabling the 
 parasite not only to enter the body, but also to grow and 
 thrive in the same."^ General causes, such as poverty, 
 famine, hereditary transmission, precarious living, in sanita- 
 tion, over-population, &c., are cited as examples of predis- 
 posing agents. At present no one denies the necessity of 
 a special predisposition in the case of tuberculosis ; there 
 must exist a certain ensemble of unhygienic and bad or 
 poor conditions of life, often perhaps transmitted (t. e. the 
 conditions transmitted) from the ancestors.^ This point is 
 of importance, and is at once brought into relation to the 
 subject by Kocl/s dictum : "The two diseases (tuberculosis 
 and leprosy) resemble each other etiologically.^'" 
 
 I now therefore turn to the predisposing conditions of 
 endemic leprosy in Mediaeval England. 
 
 ^ ' Lep. Com. Rep.,' 1893, chap, iii, pp. 98 — loi. 
 
 - ' The Bacillus of Tuberculosis,' New Sydenham Soc.
 
 PEEDISPOSING CONDITIONS OP ENDEMIC 
 LEPEOSY IN ENGLAND. 
 
 1. Hereditary transmission. — It is well-uigh. impossible to 
 gauge in historical leprosy to what extent this factor was 
 responsible for the spread of the disease. It may now be 
 safely assumed, according to recent authorities and investi- 
 gations, that it played an almost inappreciable part in the 
 disease. If the disease had depended for its spread upon this 
 factor, it would not have lasted long.^ For alongside the 
 fact that the leprosy diathesis is a very small and doubtful 
 quantity, the marked sterility of lepers and the separation 
 of sexes (in many English leper hospitals) must also be 
 borne in mind. 
 
 2. Physical circumstances. — " As the importance of in- 
 heritance as an etiological factor vanishes, so that of external 
 conditions must rise into importance."^ A glance at the 
 appended list of the leper-houses will — if the leper-houses 
 are any criterion at all of the local prevalence or otherwise 
 of the disease — at once show that there were leprous and 
 
 ^ Proof of this may be obtained from various quarters : (a) Hansen's 
 investigations into the descendants of i6o Norwegian lepers who emigrated 
 to the United States of America revealed that all the offspring had 
 remained free from the disease to the third generation ; " Of all the descend- 
 ants not a single one has become leprous" (' Virchow's Archives,' 1888). 
 (b) In Maracaibo Island (Venezuela leper colony) marriages are permitted 
 among lepers ; during the last fifteen yeai-s only two births occurred, both 
 children being healthy (' Trinidad Leper Rep.,' Koch, 1890). (c) In Hawaiian 
 settlement 2864 lepers had twenty-six children, of whom only two developed 
 leprosy ('Brit. Med. Journ.,' July, 1892). 
 
 2 'Indian Lep. Com. Rep.,' 1893, p. 217.
 
 104 PREDISPOSING CONDITIONS OF ENDEMIC LEPROSY 
 
 non-leprous areas. As examples of the former, we may 
 take East Anglia, Kent, Cambridgeshire, and surrounding 
 counties along the Thames, Ouse, &c., and Cornwall and 
 the Lowlands of Scotland ; of the latter, note the almost 
 entire absence of such institutions in Wales, the Highlands, 
 and with an exception or two, the high laud of the English 
 Lake District. In short, speaking generally we may notice 
 that the number of these hospitals holds a relative and 
 inverse proportion to the high and dry land of the country. 
 Forrestus^ and Liveing^ maintained that " the uncultivated 
 marshy condition of the soil " was thus a " cause '' of 
 leprosy.^ Surely it could not be a vera causa, but I think it 
 cannot be denied that it did exercise considerable influence 
 upon the general condition of the people. 
 
 But, it will be objected, the Highlands enumerated above, 
 contained few leper hospitals, not because of lack of leprosy 
 owing to physical causes, but because of lack of people. 
 Undoubtedly ; but the whole of England was exceedingly 
 sparsely populated, and in the twelfth and. thirteenth 
 centuries did not contain two and a half millions of people. 
 Certainly Cornwall had no greater population than mid- 
 Derbyshire or North Yorkshire, yet it contained " a great 
 company " of lepers. 
 
 " In short, in whatever country an uncultivated soil, a 
 marshy surface, and a humid atmosphere has been found, 
 together with a diet generally consisting of a salted, semi- 
 putrid, insufficient or indigestible aliment, and composed 
 chiefly of animal flesh or fish, with a small proportion of 
 nutritious vegetable matter — there from the earliest times 
 human life has been shortened by the multiplication of 
 pestilential fevers and cachexias of a leprous and scorbutic 
 nature. Therefore, as Raymond observes, even if ecclesias- 
 tical writers of the Middle Ages had left us no records of 
 the history of such maladies, the history of the soil, of the 
 circumstances of the times, and of the food generally used, 
 would afford an incontestable monument of the existence 
 
 ' Rees, ' Cyclopredia,' vol. xx. 
 
 2 Gulstonian Lectures, Royal Coll. Phys., 1873. 
 
 ' Defoe says one-fifteenth part of England was marsh-land.
 
 IN ENGLAND. 105 
 
 of the leprosy/'^ Erasmus Wilson" attributes leprosy to 
 miasma from marshy soil. The decrease of leprosy in 
 Europe may be owing partly to the di'ainage and cultiva- 
 tion of the soil and the better conditions of living.^ Kaposi'^ 
 shares the same view^ for in summing up he concludes that 
 " it would for the present seem not unreasonable to suppose 
 that certain physicial and geographical peculiarities of parti- 
 cular countries serve as etiological influences on the produc- 
 tion of the primary disease." 
 
 I am aware that leprosy exists in high altitudes in the 
 north of South America, Mexico, and the Deccan (India), 
 and I do not for a moment wish it to be supposed that I 
 believe the altitude above the sea is an important etiolo- 
 logical factor. I do not. But I believe the endemic 
 leprosy areas in England were, as a matter of fact, in low- 
 lying and marshy districts, with a very damp climate. And 
 I think the evidence of the distribution of the disease in 
 Medieval England, as far as we are able to ascertain it, does 
 support the dictum, " the leper ratios vary inversely with 
 the dryness of the climate,'"'* 
 
 3. The Crusades. — It has been pointed out that leprosy 
 was prevalent in England long before the Crusades, and 
 that the Crusades per se had no effect in " introducing " 
 leprosy into England. At the same time it is not unlikely 
 that the Crusades affected the life of the English people un- 
 favourably. " Those who were not actually engaged in war, 
 were afflicted with famine and deprived of many of the 
 necessities of life" (Kaposi),^ because of draining the land 
 of what little wealth it had for the Crusades, and taking 
 away many, including the best, men from the countr}^ 
 Hence whole districts were either laid waste, or remained 
 uncultivated because of labourers (Kaposi). 
 
 4. Social conditions : insanitation, overcrowding, un- 
 cleanliness, &c. — As has been pointed out, the standard of 
 comfort among the people was very low. '' The Normans 
 
 ^ ' Condition of Europe in the Middle Ages.' 
 
 - ' Epidemics,' RoUo Russell. 
 
 ^ Hebra, ' Diseases of the Skin,' " Lepra." 
 
 ■• ' Lep. Com. Rep.,' 1893, p. 58. 
 
 ^ Loc. cit.
 
 106 PREDISPOSING CONDITIONS OF ENDEMIC LEPROSY 
 
 did not bathe and wash as much as the Saxons/' they 
 lived in close unventilated hovels, the diet was poor, and 
 shameful intempei*ance and immorality prevailed extensively.^ 
 All this lowered very perceptibly the standard of health as 
 well as comfort, so that it is not surprising to hear how 
 slowly population increased, and how frequent were plague, 
 pestilence, and famine. {Vide pp. 70 — 79 for the social and 
 sanitary condition of England.) Much might be said on 
 the influence of poverty and bad social surroundings, but it 
 has been so well said elsewhere' that it is here unnecessary to 
 repeat. Although it is true that cases of leprosy have occurred 
 among people in good position in life, it is nevertheless a uni- 
 versal feature of leprosy that it attacks most frequently those 
 who are low in the social scale, and who by one or more 
 disadvantageous conditions are unable to resist the disease. 
 
 5. Individiial idiosyncrasy , family diathesis, previous or 
 concomitant disease. — It is not probable that either of these 
 three conditions had any great effect upon Mediaeval leprosy. 
 Undoubtedly cases did occur, as they occur in these days 
 in tuberculosis, where the above conditions were predis- 
 posing to leprosy. Many cases also occurred where a leper 
 had other diseases as well. 
 
 6. Tendency to die out. — An old Chinese law states^ that 
 every child of a leper has an inheritance of the disease, but 
 diminished, and that after the fourth generation, if no 
 healthy hlood intervenes, the disease is entirely extinguished 
 and the person is immune. Thus some believe that the 
 " exhaustion of the pathological principle after the course of 
 four generations " has caused leprosy to die out in Europe. 
 Obviously, if this had been so it is probable something 
 would have been recorded in the laws of England as well 
 as China, which record has not yet been found. Also if 
 this had been carried out in the East, the disease should 
 have been as extinct there as here, which it is not. There- 
 fore the law is probably fallacious. 
 
 There can, however, be no doubt that under favourable 
 
 ^ Simpson, loc. cit. 
 
 2 *Lep. Com. Rep.,' 1893; Li veing, Gulstonian Lectures ; Voltaire, ' Essai 
 sur les McBurs,' torn, i, p. 429 ; Heeven, ' Sur I'influence des Croisades,' p. 424, 
 
 3 ' Immunity from Leprosy,' A. S. Ashmead, M.D.
 
 IN ENGLAND. 107 
 
 circumstances (e. g. removal from the West Indies to England 
 and complete change of conditions) the leprosy has a 
 tendency to come to an end.^ (Hutchinson and W. Cottle.) 
 Those favourable circumstances did not exist universally in 
 England during the leprosy period. 
 
 7. There are two factors that may have played — and 
 probably actually did so — an important part in the exter- 
 mination of leprosy in England, viz. the famine in 13 15 to 
 13 16, and the Black Death, 1349. Both these events to- 
 gether probably killed more than half of the population, 
 including doubtless the lower classes (villeins, sei'vi, &c.) 
 and many lepers. Not only would this bring about a great 
 diminution in the number of lepers in the country, but the 
 after-effects of these events and similar events in the four- 
 teenth century, did much to improve the social and hygienic 
 condition of England. 
 
 1 ' British MedicalJovirnal,' 1889.
 
 CONCLUSIONS. 
 
 1. That the disease designated "leprosy" which was 
 prevalent in England during the Middle Ages Avas true 
 leprosy (Elephantiasis grjBCorum), though it is evident that 
 many other diseases were not infrequently misdiagnosed as 
 lepros3\ 
 
 2. That leprosy was existent in England many years 
 anterior to the Crusades {i.e. before 1095). 
 
 3. That the Crusades had little or no effect per se in 
 spreading the disease in England. 
 
 4. That it was generally supposed from the eleventh 
 century that leprosy was a contagious and hereditary disease, 
 and that it depended very largely upon these two character- 
 istics for its extension in England ; but that it would appear 
 from historical and collateral evidence that such was not 
 the case in any appreciable degree, 
 
 5. That a large number of institutions of a charitable, 
 ecclesiastical, or municipal character, were established in the 
 endemic areas throughout the British Islands, for the more 
 or less exclusive use of lepers. That these institutions were 
 occupied by lepers, voluntarily or involuntarily, {i. e. by more 
 or less compulsory residence — De Leiiroso Amovendo,) and 
 that certainly not less than 200 existed. That in a certain 
 degree they Avere establishments for the purpose and object 
 of segregation, but, whether that was so or not, they in no 
 case and at no date actually did serve as such. " Strict 
 segregation " — if we are to trust historical evidence — never 
 was carried out in England. 
 
 6. That the endemic disease reached its zenith in the
 
 CONCLUSIONS. 109 
 
 tliirteentli century or earlier, and declined till final extinction 
 in the eighteenth. (In England it approximately disappeared 
 in the sixteenth century.) 
 
 6a. That probably the Famine (1315) and Black Death 
 (1349) materially assisted in extermination of lepers in the 
 fourteenth century. 
 
 7, That 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 endemic leprosy was due, not to segregation, but to this 
 general tendency under favouring circumstances, viz. to a 
 general and extensive social improvement in the life of the 
 people, to a complete change in the poor and insufficient 
 diet (which, it is evident, consisted far too largely of bad 
 meat, salt, putrid and dried fish,^ and an almost entire lack 
 of vegetables), and to agricultural advancement, improved 
 sanitation, and land drainage. 
 
 8. That of all the unfavourable circumstances it would 
 appear that the food of the people was largely responsible 
 for the prevalence in the human tissues of the lepra bacillus, 
 either by containing and thus introducing the bacillus, or 
 by assisting in its growth and action in the tissues. 
 
 ' I am not in a position to make any more definite statement regarding 
 the fish hypothesis further than this : The diet of the English people during 
 the leprous period included a large quantity of stale fish, and it would 
 appear that this obnoxious fish diet lessened at or about the same period 
 that leprosy declined. I am not qualified to judge of the etiological relation 
 between the two, nor do I think I have been able to produce evidence 
 sufficient to authorise a decided conclusion in favour of the fish hypothesis 
 as the sole cause of leprosy. I feel no doubt that, in conjunction with other 
 dietaries and conditions, it played some part in the prevalence of the disease.
 
 LEPEOSY IN THE BEITISH ISLANDS. 
 
 A LIST OF CHIEF DATES. 
 
 Peefatory Note. 
 
 This list of the chief dates of the history of Endemic 
 Leprosy in the British Islands has been compiled from a 
 very large number of records. The page on the left hand 
 relates to Leprosy in the British Islands ; and though 
 entitled by the shorter term " England/^ it is to be under- 
 stood that it includes Great Britain, Ireland, and Islands. 
 Where only the name of a place appears, followed by a date, 
 it signifies that at that place and time (approximately) a 
 House or Hospital set apart for lepers was established. 
 Those Hospitals whose date of foundation is not obtainable 
 are printed in the List at the end. The thirteenth century 
 has been supposed by Liveing and othei-s to have witnessed 
 the zenith of Leprosy in this country. It may have been 
 earlier. Even during the twelfth century more Leper-houses 
 were instituted, though this is not a fair criterion of the rise 
 and fall of the disease. By the end of the thirteenth 
 century there can be little doubt that Leprosy was begin- 
 ning to decline (with a few local exceptions, e. g. Devon 
 and Cornwall). 
 
 With a few exceptions, authorities have not been 
 printed, for want of space ; but no date has been inserted 
 for which there is not some more or less reliable authority.
 
 PREFATORY NOTE. ^ 
 
 It will be readily understood that antlieuticity looo years ago 
 is occasionally rather doubtful. 
 
 On the right-hand side have been placed any events 
 which are landmarks in history, or have had, in the opinion 
 of various writers, a direct or indirect effect upon the disease. 
 
 G. N.
 
 112 
 
 LEPROSY. IN THE BRITISH ISLANDS. 
 
 Period. 
 
 LEPKOSY IX ENGLAND. 
 
 B.C. 
 
 60 B.C. Leprosy first " brought to England" (Parton ; 
 Burton) (.>).
 
 LEPROSY IN THE BRITISH ISLANDS. 113 
 
 Chaeacteeistics op Peeiod, and Lepeosy in othee Counteies. 
 
 Before 4000 B.C. Egyptian civilisation ; Memphis founded. In Europe, 
 
 polished Stone Age (Neolithic) begun. 
 3500 B.C. Husapti (?) ; Leprosy in Egypt. 
 2500-2000 B.C. First migration from the Aryan centre : Celts moving 
 
 Westward, Indo-Persic tribes Southward. Chinese civilisation. 
 1600 B.C. Phoenician cities and Damascus flourishing. Colonisation 
 
 round the Mediterranean. Trade for tin with Cornwall. 
 1320 B.C. The Exodus ; probably during Meneptah's time. 
 1000-900 B.C. Celts already in England, with bronze in use. 
 600-400 B.C. Leprosy common in Hindostan (Susruta) and China. 
 
 Leprosy common in Greece, and called Elephantiasis. 
 460 B.C. Hippocrates described Leprosy. 
 260 B.C. Manetho testified to presence of Leprosy among the Jews 
 
 (90,000). 
 200 B.C. Leprosy common in Greece, and designated Elephantiasis 
 
 (Kaposi). 
 too B.C. Leprosy became known in Italy at this period. 
 95 B.C. " There is a disease called Elephas, which has its rise on the 
 
 river Nile, in the middle of Egypt " (Lucretius). 
 60 B.C. Leprosy first in Spain. 
 53 B.C. Celsus wrote on Leprosy.
 
 114 
 
 LEPROSY IN THE BRITISH ISLANDS. 
 
 Period. 
 
 LEPROSY IN ENGLAND. 
 
 A.D. 
 
 First to Ninth Centuries. 
 
 432. First notice of Leprosy in Ireland (Colgan's ' Acta 
 Sanctorum '). 
 
 550. Pestilence of Leprosy in Ireland (' Chronicon 
 
 Scotorum '). 
 603. St. Kentigern, of Glasgow, died ; " mundabat 
 
 leprosos." 
 606. Increase of Leprosy during a Roman invasion in 
 
 the time of Heraclius (Lanigan, 'Eccles. Hist.'). 
 
 654. Death of Fechin of Fore (Co. Westmeath), who 
 saw much Leprosy in Ireland. 
 
 695. Death of St. Finian, a Munster Leper (Lanigan, 
 ' Eccles. Hist.'). 
 
 869. Leper Hospitals existed in Ireland. The Hospital 
 at Armagh burned by Arlaf.
 
 LEPEOSY IN THE BKITISH ISLANDS. 115 
 
 Chaeacteeistics of Centuries, and Leprosy in other Countries. 
 
 First to Ninth Centuries. 
 
 8i. Aretaeus (wrote on Leprosy). 
 
 97. Archigenes (wrote on Leprosy). 
 
 128. Claudius Galen born ; died about 200. 
 
 Aretseus wrote on Leprosy (second century ?). 
 
 Leprosy became prevalent in Europe in second century. 
 
 360. Oribazius (wrote on Leprosy). 
 
 Order of St. Lazarus founded in Palestine (366). 
 
 Theodoret mentions Lazarettos for Lepers in fourth century. 
 
 Christianity introduced into Ireland during fifth century. 
 
 500. Charaka (wrote on Leprosy). 
 
 A plague desolates Europe and Asia dui-ing sixth century. 
 
 Aetius wrote on Leprosy and described it as wide-spread. 
 
 549. Council of Orleans Leprosy Decree.. 
 
 583. Council of Lyons Leprosy Decree. 
 
 597. Conversion of English to Christianity. 
 
 Gregory of Tours speaks of Lazarettos in sixth century. 
 
 Hospital of St. John founded for Lepers in seventh century, on Lake 
 
 Constance. 
 •661-664. ^ pestilence depopulated Britain and L'eland. Leprosy in 
 
 Brittany. 
 Rothar, King of the Lombards, made laws to prevent the marriage of 
 
 Lepers. 
 Leper-houses existed at Verdun, Metz, and Mastricht in the seventh 
 
 century (Virchow). 
 St. Boniface (eighth century) ; " mundabat leprosos." 
 Hospital of St. Lazarus founded at St. Gallen, Lake Constance (720 ?). 
 St. Othmar founded Leper-houses in Germany. He died 758. 
 757. Pepin provided an Act that Leprosy in a husband or wife should 
 
 be sufficient cause for separation or divorce (Parliament at Cam- 
 
 piegne). 
 789. Charlemagne re-enacted similar laws. He also enforced seques- 
 tration. 
 St. Nicolaus, of Corbie, founded Leper-houses in France (eighth 
 
 century). 
 Isidore, of Spain, alludes to Leprosy in Spain in eighth century. 
 868. Council of Worms Leprosy Decree. 
 874. Iceland peopled from Norway. 
 897. Fatal i)lague in England.
 
 116 
 
 LEPEOSY IN THE BRITISH ISLANDS. 
 
 Sovereigns. 
 
 Edward 
 
 succeeded 
 
 Alfred, 
 
 901. 
 
 Athelstan. 
 925- 
 
 Edmund. 
 940. 
 
 Edred. 
 946. 
 
 Eadwig. 
 955- 
 
 Edgar. 
 959- 
 
 Edward. 
 975- 
 
 Ethelred. 
 978. 
 
 LEPROSY IN ENGLAND. 
 
 Tenth Century. 
 
 Leprosy prevalent in England. 
 
 950. Hy wel Dda, or Howell tlie Good (a Welsli king who 
 died about 950), enacted a code of Laws relative to 
 Leprosy ('Celtic General Repository,' vol. iii, 199). 
 
 Venedotian and Dimetian Codes (Leper laws). 
 
 A Law was passed making Leprosy a valid cause for 
 divorce.
 
 LEPROSY IN THE BRITISH ISLANDS. 117 
 
 Chaeacteristics of Centueies, and Lepeost in othee Counteies. 
 
 Tenth Century. 
 
 Leprosy prevalent in Europe. 
 
 923. Truela, son of King Alfonso of Spain, died of Leprosy. 
 The ScLool of Salerno existed in tliis centui-y. 
 
 936. Hospital at York (may have been partly Leprous, probably not) 
 founded by Athelstan; first endowed hospital in England. (206 
 patients.) 
 
 (Leper-houses had existed in Palestine for nearly 1000 years.) 
 Christianity advances in England and also in Northern Europe. 
 The Normans were now established in France. 
 
 The Danes in England. 
 
 Fast Days observed more strictly. 
 
 958. Leprosy mortality excessive ; considerable suffering and misery 
 throughout Europe. 
 
 The year 1000 marks the end of the Dark Ages.
 
 118 
 
 LEPROSY IN THE BRITISH ISLANDS. 
 
 Sovereisrns. 
 
 Ethelred. 
 
 Edmund 
 
 Ironside. 
 
 1016. 
 
 Canute. 
 1017. 
 
 Harold 
 Hardi- 
 canute. 
 
 Edward the 
 
 Confessor. 
 
 1042. 
 
 Harold 
 
 (son of 
 
 Godwin). 
 
 1066. 
 
 William I. 
 1066. 
 
 William II. 
 
 1087. 
 
 LEPROSY IN ENGLAND. 
 
 Eleventh Century. 
 
 Beverley (before the Conquest, Tanner). 
 
 London (Westminster), before the Conquest (Speed, 
 
 Stowe, &c.). 
 Northampton, during reign of William I. 
 1075. Hugh d'Orivalle, Bishop of London, had 
 
 Leprosy. 
 Chatham (St. Bartholomew), 1078. 
 1084. Leper Hospital founded at Canterbury by Lan- 
 
 franc (Archbishop of Canterbury), who died 1089. 
 
 Several Leper-houses founded in England previous to 
 the first Crusade.
 
 LEPROSY IN THE BRITISH ISLANDS. 119 
 
 Chabacteeistics of Centukies, and Leprosy in other Countries. 
 
 Eleventh Century. 
 
 1007. Leprosy prevalent in Spain. 
 
 It was at this time that the first hospitals and pest-houses were built. 
 We must not necessarily assume that Leper-houses implied a new 
 or increasing disease. 
 
 1066. The Norman Conquest. 
 
 1067. First Leper Hospital in Spain — Yaleucia. 
 The Jews arrived in England. 
 
 Hildehrand, Pope Gregory VII, 1073-1085. 
 
 1086. Domesday Book. Population probably under two millions 
 (mostly in Southern and Eastern Counties — very thin north of 
 York) ; six towns with population over 5000. 
 
 1087. Death of Constantius of Carthage, founder of the Salernian 
 School, who studied Leprosy, and originated various theoi'ies 
 regarding it. 
 
 1095. First Ci'usade was begun by Peter the Hei'mit. 
 
 Low condition of English Agriculture ; much misery, famine, and 
 pestilence. 
 
 1098. Return of the first Crusaders. [See Kaposi.]
 
 120 
 
 LEPROSY IN THE BRITISH ISLANDS. 
 
 Sovereisrns. 
 
 Henry I. 
 
 Stephen. 
 II35- 
 
 Henry II. 
 II54- 
 
 Ricliard I. 
 ii8q. 
 
 John. 
 1 199. 
 
 LEPROSY IN ENGLAND. 
 
 Twelfth Century. 
 
 The writ " De Leproso Amovendo " in force at this 
 
 period. 
 The earliest mention of Leper-houses in Scotland. 
 Knights of St. Lazarus acquired a footing in England 
 
 (Stephen). 
 Lincoln (Holy Innocents) founded by Remegius, Bishop 
 
 of London, iioo. Wilton, iioo. Fugglestore 
 
 (Wilts), xii. 
 London (St. Giles), founded by Qaeen Matilda, iioi. 
 York (St. Nicholas), about mo. Newcastle, 11 12. 
 Norwich (St. Mary Magdalene), befoi'e 11 19. 
 Oxford (St. Bartholomew's), during Henry I's reign. 
 Bury St. Edmunds, 1135. 
 Colchester (St. Mary Magdalene), founded by Eudo, 
 
 during Henry I's reign. 
 Aylesbury (St. John's and St. Leonard's), 1135. 
 Gloucester, Tilton, Tweedmouth, Careton (all four in 
 
 twelfth century). 
 Bristol (St. John's and St. Laurence's), 1135 (P). Hare- 
 hope (David I). 
 Maiden Bradley, Wilts, before 1145. 
 St. Alban's (St. Julian's) founded by Jeffrey, Abbot of 
 
 St. Alban's, 1 135. 
 Reading, 1134. Warwick, 1135. Shrewsbury, 1136. 
 
 Canterbury (St. Lawrence), 1137. 
 Burton Lazars, Leicester, during reign of Stephen. 
 
 Ripon, 1 139. 
 Dover, 1 141. Lynn, Norfolk (2), before 11 45. Wymond- 
 
 ham, 1 146. 
 Huntingdon (by David of Scotland), 1165. Aldcambus 
 
 (twelfth century). 
 Ilford (Henry II). Somerton, Norfolk (Henry II). 
 Coventry (Henry II). Derby (Henry II). 
 Havering, 1154. Herbaldowne, 1154. Peterborough, 
 
 1 150. Seatord, 1171. 
 1 163. Will of Bishop Iscanus respecting Market Tolls 
 
 for Lepers in and around Exeter. 
 Exeter, 1163. Aldnestun. 1177. Southampton, 11 79. 
 
 Reading (another), 1180. Carlisle, 1180. 
 1 166. Death of St. Aelred, of Rievaux, who assisted 
 
 Lepers in Galloway. 
 Sherburn. founded by Hugh Pudsey, Bishop of Durham, 
 
 in 1 181. Ilford, 11 83 (?). 
 Waterford, 1185. Tannington, 1189. Racheness, 1189. 
 
 Romney, 1190 (?). Lancaster, 1 190. Badele, 1195. 
 
 Pilton, 1 197. 
 Chichester, 1 1 73. Herting, 1 189. Kilbixy, 1192. Dun- 
 
 wich, 1 199. 
 Chesterfield, 1 199. Leicester, 11 99. Berrington, 1199. 
 Berkhamstead, 1200.
 
 LEPEOSY IN THE BRITISH ISLANDS. 121 
 
 Characteeistics of Centueies, and Leprosy in other Cottntbies. 
 
 Twelfth Century. 
 
 It was a custom during and before this century to burn and otherwise 
 persecute Lepers in Europe. Henry II, in an edict, threatens it in 
 England. 
 
 The Church of Rome gained much power in Enghxnd during Stephen's 
 reign. 
 
 1 154. Amalgamation between English and Normans in commerce, 
 
 social life, and intercourse. 
 
 The Council of Lateran, 1179 : famous Leprosy Decree. 
 The Carthusians settled in England, 1181. 
 
 Leprosy prevalent in Denmark (Gislasen). 
 
 The third Crusade, vmder Richard I. 
 
 Baldwin IV, King of Jerusalem, himself became a Leper, and ten years 
 
 later resigned his ci'own because of disablement (i 184). 
 1 181. Pope Lucius III, Leprous Decree. 
 
 1 190. Pope Clement III, Leprous Decree. 
 
 1 192. Grain very scai'ce in England ; serious famine in 1194. 
 
 Approximate time of appearance of Leprosy in Iceland.
 
 122 
 
 LEPKOST IN THE BEITISH ISLANDS. 
 
 Sovereigns. 
 
 LEPROSY IN ENGLAND. 
 
 Henry III. 
 1216. 
 
 Thirteenth Century. 
 
 John. Leprosy reached its zenith during this century 
 
 (Liveing) (?). 
 1200. Leprosy Decree of Provincial Synod at West- 
 minster ; Hubert, Archbishop of Canterbury. 
 Ipswich (about 1200). Chester (in thirteenth century). 
 Towcester, 1200. Devizes, 1207. Chesterfield, before 
 
 1200. Hexham, 12 10. 
 Sturbridge, 1205. Selwood, 12 12. 
 Linlithgow, 12 14 (?). Banbury, 12 16. Hedon, before 
 
 1216. Windsor, 12 16. 
 Henry III. visited Lepers every Holy Thursday. 
 Thetford (St. John Baptist and St. Mary Magdalene), 
 
 before 1216. 
 Dublin (Lazar's Hill), 1220. Grimsbury (John), 
 
 Bridgnorth. 1224. 
 Bolton (Robert de Roos), 1225 (?). Rothfan, 1226. 
 Wycomb, 1229. Ottford, 1229. 
 Dunstable (in thirteenth century). Rochester 
 
 (Henry III). 
 Catterick (Henry III). Dunstane (Henry III). 
 Conishead (thirteenth century). Cotes, 1230. Ospring, 
 
 1235- 
 1242. Leprosy Canons of Scotch Church, separating 
 
 them from society. 
 Newport Pagnell. 1240. Mere, Lincolnshire, 1246. 
 
 Lechlade, 1246. 
 Crowmarsh, 1248. Kendal (thirteenth century). 
 Norwich (St. Giles), 1249. Stamford, Lincoln, 1250 (?) 
 Baldock (Henry III). Winchester, 1259. Worcester 
 
 (before 1259). 
 1269. Leprosy Segregation Canons of Scotch Church. 
 Pope Alexander IV, sent a Bull to confirm estates and 
 
 statutes of St. Giles' Hospital. Henry III. rebuilt 
 
 St. James' Hospital, Westminster. 
 Edward I. Bebington, 1272. Doncaster, 1272. Chosell, 1272. 
 1272. York (St. Giles), 1274. Taunton, 12S0. Lincoln (St. 
 
 Giles), 1280. 
 Brackley, 1280. Long Blandford, 1282. Berwick-on- 
 
 Tweed, 1283. 
 1283. Statutes of Society of Merchants at Bei-wick 
 
 ordered that Lepers should not come into the burgh. 
 Pontefract, 1286. Brentwood, 1292. Sedburbrook, 1292. 
 Brook. Street, near Brentwood, 1292. Cork, 1295. 
 Ickborough, Norfolk (Edward I). 
 1296. Leprosy in Edinburgh. 
 Leprosy prevalent, but probably declining.
 
 LEPROSY IN THE BRITISH ISLANDS. 123 
 
 ( Characteristics or Centuries, and Leprosy in other Countries. 
 
 Thirteenth Centiiry. 
 
 Period of returning Crusades. 
 Fi-eiich Invasion of England. 
 
 Magna Cbarta, 1215. 
 
 Orders of Dominican (1221) and Franciscan (1224) Friars founded in 
 
 England. 
 Louis VIII's Code of Frencb Leper Ijaws. 2000 Leper Hospitals in 
 
 France ; and, according to Heren, these figures were not smaller in 
 
 the middle of filteenth century. 
 
 1242. Straw first used for the King's bed (Henry III). 
 
 Franciscan missionaries laboured in China. 
 
 1248. Ferdinand III. founded Leper Hospital at Seville. 
 
 1250. Leprosy existed in Japan. 
 
 1253. Fine linen first made in England. 
 
 1257. Severe famine in England. 
 
 1263. Norwegians invaded Scotland (unsuccessfully). 
 
 1266. First mention of Leper-houses at Bergen, in Norway. 
 
 1270. St. Louis of France on the last Crusade. Many of his soldiers 
 became Leprous (Joinville). 
 
 Time of Dante. 
 
 1290. Council of Nogaro exempted Lepers from the jurisdiction of 
 secular justices, prohibited their entrance into markets or towns, 
 and insisted on their wearing some distinguishing badge.
 
 124 
 
 LEPROSY IN THE BRITISH ISLANDS. 
 
 Sovereigns. 
 
 Edward I. 
 
 Edward II. 
 1307- 
 
 Edward III. 
 1327- 
 
 Richard II. 
 1377- 
 
 LEPROSY m ENGLAND, 
 
 Tourteenth Century. 
 
 Chester (before fourteenth century). 
 
 Kingscase, Ayr (before 1306). 
 
 Kendal (before 1307). 
 
 1307. Bishop Button willed Legacies for Lepers in 
 
 Thirty-nine districts in the Diocese of Exeter. 
 Langport, 1310. 
 Boughton, near Chester, 1310. 
 Rochester, 1316. Kingston, Surry, 1316. 
 Langwade, 1320. 
 
 Little Maldon, 1323. Ilchester (fourteenth century). 
 Hardwick, 1327. Otteley, 1327. 
 1329. Death of Robert Bruce from Leprosy (' Chronicou 
 
 de Lanercost,' 264). 
 Ospring, 1325. Beccles, 1327. Eye, 1329. Dartford, 1330. 
 Lynn, Dorset, 1336. 
 Hythe, 1336. 
 Bridgwater (Edward III). Gild Martyn (fourteenth 
 
 century). 
 A Leprosy " visitation " in the West of England 
 
 (Somei'set, &c.). 
 Dublin, i;544- 
 1346. Baldock, Bishop of London, made rules for the 
 
 Leper Hospital at Ilford. 
 1346. Edward Ill's Proclamation issued (Expulsion of 
 
 Lepers from the City of London). 
 Glasgow, 1350 (Robertson says 1494). Govan (fourteenth 
 
 century). 
 Edward III. annexed St. Giles' to Burton Lazars by 
 
 Charter. 
 1350. Lepers getting scarce at St. Albans and Ayles- 
 bury. 
 1365. There were now four Leper-houses at York, and 
 
 they remained for just 100 years (Robertson). 
 Norwich (4), 1370. Plympton, 1370. 
 Gorleston, 1372. Honiton (fourteenth century ?). 
 
 Newbridge, 1373. 
 Plymouth, 1374. Yarmouth, 1374- Thetford 
 
 (Richard II). 
 1375. Regulations against Lepers entering the City of 
 
 London ; the taking of the oath by John Gardener. 
 Bough ton-under-Blean, 13S0. Snoring Parva, 1380. 
 Wisbech, 1380. Kilchief (.Co. Downj, 1387. 
 1389 Special exemptions of Lazar overseers from 
 
 judicial duties. 
 Thetford (St. Margaret), 1390. 
 Hoddesdon, 1391- 
 Cambridge (2), (Richard II ?). 
 1398. John of Gaunt's will, bequeathing to London 
 
 Lepers. Henry IV, a Leper (according to Gas- 
 
 coigne).
 
 LEPROSY IN THE BRITISH ISLANDS. 125 
 
 Chaeacteeistics of Centueies, and Lepeosy in othee Counteies. 
 
 Fourteenth Century. 
 
 Commencing decline of Leprosy throughout Europe during this century. 
 1303. Nogaro Council (xvii) proclaimed excommunication upon any 
 
 who levied taxes upon Lepers. 
 1305. Lilium Medicinse (Gordon). 
 
 1314. Decrees as to examination of Lepers (Milo, Bp. of Orleans). 
 1315-1316. Famine in England ; much disease and general misery. 
 Various " Violent Plagues " ravaged Europe. 
 
 Norfolk the richest county in England after Middlesex (including 
 London). 
 
 The Black Death in Europe; in England, 1349. 
 
 1357. Laws passed in England protecting fislieries and the supply of 
 fresh fish instead of dried (31 Edw. Ill, cc. i, ii, iii) ; also to 
 prevent secret storage of dried fish (31 Edw. Ill, St. iii, c. i.). 
 
 First Sanitary Act in England against water pollution. 
 
 1377. Population of England between two and three millions ; London, 
 35,000; York, 11,000; Bristol, 9000; Coventry, 7000; Norwich, 
 6000 ; Lincoln, 5000. No town in Lancashire worthy of a 
 separate return (Rogers). 
 
 1384. Deatt of Wiclif (born 1324). 
 
 1388. Renewal of persecution ot Lepers in France (Charles VI). 
 
 1389. Royal Proclamation with regard to cleansing the streets of 
 London. 
 
 Guy de Chauliac, Glanville, John of Gaddesdon, Bernard Gordon, and 
 Gilbert wrote on Leprosy.
 
 126 
 
 LEPROSY IN THE BRITISH ISLANDS. 
 
 Sovereigns. 
 
 LEPROSY IN ENGLAND. 
 
 Henry V. 
 1413- 
 
 Henry YI. 
 1422. 
 
 Fifteenth Centviry. 
 
 Henry IV. Liskeai'd (before 1400). 
 
 1399. Wexford, 1408. Downpatrick, 1415. 
 
 Dartford, in Kent (fifteenth century). 
 I Edinburgh (Greenside), fifteenth century (Robertson 
 I says 1589). 
 
 Henry IV. granted the custody of Wexford to son of 
 
 William Rochford 
 1413 St. Mary Magdalene Hospital at Reading closed 
 
 because no Lepers forthcoming. 
 1414. Leper Hospitals in England " for the most part 
 
 decayed, and the goods thereof spent in other use" 
 
 (2 Hy. V, c. i.). 
 1427. Scottish Parliament comi3elled to legislate for 
 
 Lepers (1427, c. 8. II, 16). 
 Classification of Leper Hospitals (Rastall St., fol. 228). 
 1429. A legacy left to Lepers in Newcastle. 
 Lynn, Norfolk (3). 1432. 
 The Leper-house at Sherburu reduced from 65 beds to 
 
 13. and of the latter two are to be kept for Lepers 
 
 "if such can be found." 1434. 
 1454. The Leper Mayor of Exeter (Richard Orenge). 
 1457. LincolnLeperHospitalannexedtoBurtonLazars. 
 Edward IV. 1463. The ''Fair" of St. Mary Magdalene granted to 
 j.gi Exeter Corporation. Stirling, 1463. 
 
 Lismore, Limerick, 1467. 
 1468. The Leprosy certificate of the Court physicians 
 
 of Edward IV. 
 1470. A Royal Commission, appointed by Edward IV, 
 
 reported marked decrease of Leprosy. 
 London (Highgate), 1472. 
 1478. Leprosy at Prestwick. 
 
 Edward V. 
 1483. 
 
 Richard III. 
 
 1483- 
 Henry VII. 
 
 1485. 
 
 1485. Lepers still in London, and a number of legacies 
 left to them (' Calendar of Wills,' vol. ii). 
 
 Walsingham, Norfolk, i486. 
 
 Leprosy by no means rare in Lincolnshire.
 
 LEPEOSY IN THE BRITISH ISLANDS. 127 
 
 Charactkkistics of Centuries, and Leprosy in other Countbiks. 
 
 Fifteenth Century. 
 1400. Impoi-tation of corn into England from the Baltic necessary. 
 
 1407. Great plagae in London. 
 
 Formation of modern " middle classes." 
 
 Numerous Leper-houses were p.'o\'ided in Switzerland and Spain. 
 
 1440. Invention of Printing. 
 1453. Turks take Constantinople. 
 
 Discovery and colonisation advanced. 
 
 1478. Segregation Decree of Ferdinand of Spain (relaxed 1508). 
 1485. First visitation of the Sweating Sickness to England. 
 Leprosy was now almost entirely extinct in Italy. 
 
 1488. An edict ordering all Lepers to leave Paris. 
 
 1490. Suppression of Order of St. Lazarus by Pope Innocent VIII 
 
 because of decrease of Leprosy. 
 1492. Discovery of America (Columbus). 
 
 1496. Epidemic of syphilis in England ; Scotland, 1497. 
 
 1497. Vasco di Gama rounds the Cape. 
 End of the Middle Ages.
 
 128 
 
 LEPROSY IN THE BRITISH ISLANDS. 
 
 Sovereigns. 
 
 LEPROSY IX ENGLAND. 
 
 Henry VIII. 
 1509. 
 
 Sixteenth Century. 
 1512. Lepei-s at Stirling (Robertson). 
 Aberdeen, 1519. (1363 according to ' Regifitir. Episcop. 
 
 Aberdeen,' vol. ii, 283 ; probably csxclusively for 
 
 Lepers, 1519.) 
 1529. Donations granted to the Lepers in Glasgow. 
 
 Honiton, 1530. 
 Newton Busliell, 1538. Chaiter mentions " grete 
 
 nomber " of Lepers in thp district. 
 1536-1540. Suppression of the Monasteries and many 
 
 of the existing Leper-nouses ; but the larger ones 
 
 were spared by i ErNvard VI, c. 3, " to prevent the 
 
 contagion spread' ag." 
 Galway, 1543. 
 A Royal Commission (Edward VI) reported most of the 
 
 Leper Hospitals in England empty, 1547. 
 1547. Eight Lepers in Totnes Hospital. 
 
 Edward VI. 
 1547- 
 
 Mary. 
 
 1553- 
 Elizabeth. 
 
 1558. 
 
 1569. Leprosy still in Norfolk. 
 
 Leprosy was frequent in Cornwall in the time of Eliza- 
 beth (Polwhele). 
 
 Perth, 157 1. 
 
 1574. Herbaldowne Hospital providing relief for more 
 than thirty. Leper Laws made in Scotland ; re- 
 pealed, 1579. 
 
 1582. Refoundation of Bodmin Hospital by Elizabeth 
 " A great company of Lazar people." Glasgow 
 Lepers allowed free access to burgh (Robertson) 
 till 1593. 
 
 1584. Magistrates of Edinburgh issued orders relative 
 to Lepers. 
 
 1586. Similar orders issued in Glasgow. 
 1589. Six Lepers in Hospital at Glasgow; none in the 
 Ilford Hospital. 
 
 1585. Sherburn Leper Hospital diverted from its 
 original purpose (because no Lepers forthcoming), 
 became a general hospital. 
 
 159 1. Five Lepers consigned to Hospital in Edinburgh. 
 
 Lepers still at Aberbeen. Appai-ent outbreak of 
 
 Leprosy in Scotland. 
 Haddington, 1593. 
 1593. Glasgow Lepers banished from the burgh by 
 
 Kirk session. 
 
 1597. An Act for suppression of Lazarite Proctors. 
 
 1598. Heutzner, travelling through England, remarks 
 on the frequency of Leprosy.
 
 LEPROSY IN THE BRITISH ISLANDS. 129 
 
 Chaeacteeistics of Centueies, and Lepbosy in othee Cotjnteies. 
 
 Sixteenth Century. 
 
 Leper Hospitals still being founded in the Netherlands and parts of 
 Germany and Spain. 
 
 1509. Art of gai-dening introduced into England. 
 151 7. The Reformation (Luther). 
 
 Immense development of new life in Europe. 
 Terrible plague in England. 
 
 1525. Hops first brought into England. 
 
 1534. Reformation established in England. 
 
 1539. Greater Monasteries suppressed. 
 
 Salads, carrots, and turnips became more common. Henry YIII, on 
 
 account of decline in the use of fish, passed a law compelling its 
 
 use. 
 1542. Leper Hospital built on Canary Islands. 
 1544. Law passed in England for the protection of fisheries and the 
 
 sale of fish at the fairs of Sturbridge, St. Ives, and Ely. 
 1546. Fracastor enunciated the Doctrine of Contagion. 
 
 1555. Leprosy very prevalent in Iceland (Ehlers). 
 
 One-fifteenth part of England consisted of unreclaimed marshy land 
 (Defoe). 
 
 Many edicts m Elizabeth's time for reclaiming large areas of marsh- 
 land in Durham, East Anglia, Sussex, Kent, Huntingdon, 
 Northampton, &c. 
 
 1560. Lominus said Leprosy spread by contagion and hereditary trans- 
 mission. 
 
 1564. Shakespeare born. 
 
 1565. Protestantism seemed likely to triumph throughout Europe, 
 Spain and Italy excepted. 
 
 1565-85. Antwerp's ruin, London's gain. 
 
 Potatoes introduced into England in this century. Also tobacco, tea, 
 
 watches, carpets, and chimneys. 
 Alpinus wrote on Leprosy. 
 
 Final extinction of Leprosy in Denmark (Gislasen). 
 Population of England five millions (Froude).
 
 130 
 
 LEPROSY IN THE BRITISH ISLANDS. 
 
 Sovereigns. 
 
 Elizabeth. 
 
 James I. 
 1603. 
 
 Cliai'les I. 
 
 1625. 
 Common- 
 wealth. 
 
 Cromwell. 
 1649. 
 
 Charles II. 
 1660. 
 
 James II. 
 
 1685. 
 
 William and 
 
 Mary. 
 
 1689. 
 
 LEPROSY IN ENGLAND. 
 
 Seventeenth Century. 
 
 1604. There was a Leper in the Lazar-house at Aber- 
 deen, and one in Kingcase Hospital. 
 
 Thirty-nine Lepers in Bodmin Hospital in James I's 
 reign, who were largely patronised by the King. 
 
 1 610. A Leper at Aberdeen, in addition to the one in 
 1604; another, 1612. 
 
 1642. One Leper at Honiton (four others up till 1807). 
 
 1652. For " many years Ireland hath been almost quite 
 
 freed " from Leprosy (Boate). 
 1657. An order made to dismantle the Lazar-house at 
 
 Greenside, Edinburgh. 
 1661. Leper-house at Aberdeen razed to the ground. 
 1674. The Ripon Hospital repaired by Richard Hooke. 
 
 St. Kilda, 1684. 
 
 Leprosy was prevalent in the Faroe and Shetland 
 Islands. 
 
 1693. Records of Lepers at Kingcase. 
 
 1699. Leper endowment of St. Mary Magdalene, 
 Southampton, charitably distributed, on account of 
 marked decrease of Leprosy "for many years."
 
 LEPEOSY IN THE BRITISH ISLANDS. 131 
 
 Chaeacteeistics of Centukies, and Lepeosy in othee Counteies. 
 
 Seventeenth Century. 
 
 Rise of modern science and philosophy. Kepler, Galileo, Cervantes, 
 
 Bacon, Spinoza, Pascal, Shakespeare, Milton, Newton. 
 1601. The Poor Law. 
 
 1609. Rise of Holland, foremost trading country of Europe. 
 1 61 8. Harvey discovers circulation of the blood. 
 1620. The Pilgrim Fathers. Bacon's 'Novum Organum.' 
 Settlements made in East, 1620 ; and West Indies and Barbadoes, 1625. 
 1634. The fens of East Anglia reclaimed. 
 
 1650. The Dutch began a colony at the Cape. 
 
 1651. Four Leper Hospitals built in Iceland (Ehlers). 
 
 1656. Leper Hospital built on Madeira. 
 
 1665. Plague in London. 
 
 1666. Fire of London. Great sanitary improvements. 
 
 1676. Leprosy very prevalent in the Faroe Islands. 
 
 Fernelius and Forestus first called in question the contagiousness of 
 Leprosy. 
 
 Population doubled during the century (Rogers) ; ten millions.
 
 132 
 
 LEPROSY IN THE BRITISH ISLANDS. 
 
 Sovereigns. 
 
 LEPROSY IN ENGLAND. 
 
 
 Eighteenth Century. 
 
 Anne. 
 
 1 712. Legacy left to Lepers at Bath. 
 
 1702. 
 
 
 George I. 
 
 
 1714. 
 
 
 George II. 
 
 1730. Leprosy prevalent in Ireland (Von Triol). 
 
 1727. 
 
 1736. Five Lepers (females) at Papastoiir (Robertson). 
 
 
 1737. Leprosy at Bath. 
 
 
 Papastour, Shetland, 1740, wbitber it had been customary 
 
 
 to export Lepers (Liveing). 
 
 
 1742. Public thanksgiving in Shetland on account of 
 
 
 disappearance of Leprosy. A few cases continue to 
 
 
 appear. 
 
 
 1753. Several Lepers in St. Kilda. 
 
 George III. 
 
 
 1760. 
 
 « 
 
 
 1775. Last endemic case of Leprosy in Ireland at 
 
 
 Waterford. 
 
 
 1778. A Leper existed in the Shetlands. 
 
 
 1778. "A Leper is now a rare sight" (White of 
 
 
 Selborne). 
 
 
 1798. A man, John Berns, a Shetland Leper, descended 
 
 
 from a Leprous family, admitted into the Edinburgh 
 
 
 Infirmary.
 
 LEPROSY IN THE BRITISH ISLANDS. 133 
 
 Chaeacteeistics of Centueies, and Lepeost in othee Cottnteies. 
 
 Eighteenth. Century. 
 
 Astounding growth of the British Empire. 
 
 1707. Severe smallpox epidemic in Iceland killed one-third of the 
 
 population, including many Lepers. 
 1643-17 15. Louis XIV. 
 
 First undoubted case of Ergotism belongs to this century (Creighton). 
 Leprosy still in France (Upper Auvergne, &c. ; Bell Isle still used as a 
 
 Leper refuge). 
 
 1757. British Empire in India founded ; Clive at Plassey. 
 
 1759. One hundred and fifty Lepers in Norway (three hospitals). 
 
 Brindley, Watt, and Arkwright. 
 The Factory System begins. 
 
 1768. 280 Lepers in the four Iceland Hospitals (Petersen). 
 
 1769. Captain Cook landed in New Zealand ; Leprosy present. 
 
 1787. Leprosy endemic in Auvergne. 
 1792. Gas first used for lighting. 
 
 Hensler wrote on Leprosy. 
 
 Population nearly doubled during the century (Rogers).
 
 134 
 
 LEPROSY IN THE BRITISH ISLANDS. 
 
 Sovereigns. 
 
 LEPROSY IN ENGLAND. 
 
 George III. 
 
 George IV. 
 
 1820, 
 
 William IV. 
 1830. 
 
 Victoria. 
 1837- 
 
 Nineteenth Century. 
 
 A few isolated cases of supposed indigenous Leprosy 
 occur in the present century in tlie British Islands. 
 
 1809. Supposed case of indigenous Leprosy in Edin- 
 burgh ; another in the Shetlands (Edmonston). 
 
 1810. Leprosy endowment in Cornwall transferred to 
 general infirmary because no Lepers needing assist- 
 ance (Brown's ' Cases in Chancei'y,' 166, n.). 
 
 The Truro Infirmary received the revenues of the Leper 
 Hospital formerly there, and bound itself to take in 
 Lepers should such be forthcoming. 
 
 1855. Supposed indigenous case in the Hebrides 
 
 (Broadbent). 
 1877. Supposed case of Leprosy in Ireland. 
 
 Leprosy unknown as an indigenous disease throughout 
 the British Islands. 
 
 1889. Since 1882 twenty cases of Leprosy have been 
 brought before the Dermatological Society (pro- 
 bably none indigenous). 
 
 1 89 1. Supposed indigenous case of Leprosy in Ulster.
 
 LEPROSY IN THE BRITISH ISLANDS. 135 
 
 Chabacteeistics of Centuries, and Lepeost in othee Counteies. 
 
 Nineteenth. Century. 
 
 Continued rapid advance of science, inventions, and discoveries. 
 
 1807. Slave trade abolished in British Empire. 
 
 1811. First Leper Hospital at Calcutta. 
 
 1 8 15. Waterloo. 
 
 Population of United Kingdom nineteen to twenty millions. 
 
 1836. Many Lepers still in Noi-way and Iceland; some in Portugal, 
 Spain, Italy, Sicily, Crete, New Zealand, &c. ; very prevalent in 
 India, China, Japan, and the West Indies. 
 
 1842. Om den SpedahJce Sygdoni Elephantiasis Gh'eecorum, Danielssen 
 and Boeck (" first clear account of leprosy " — Kaposi). 
 
 1848. The Chinese arrive in Hawaiian Islands. 
 
 1853. First case of Leprosy in Hawaiian Islands (?). 
 
 1863. Leprosy still common in Iceland. 
 
 1867. Royal College of Physicians' Report. 
 
 1874. Hansen's Bacillus of Leprosy. 
 
 1885. Norway contained 1377 Lepers. 
 
 1889. Death of Father Damien. Six hundred Lepers at the Cape. 
 
 1890. Leprosy Commission in India (H.R.H. the Prince of Wales). 
 The disease practically extinct in New Zealand. 18,000 Lepers 
 in Columbia. 
 
 1892. Lepers in Spain, 1200 ; in Norway, 1 200 ; from 600 to 700 others 
 elsewhere in Europe (Arning). 
 
 Lepers in India, 100,000; in Japan, 150,000 (?). 
 
 1894. Lepers in Iceland, 140 (Ehlers).
 
 NOTE. 
 
 This list of leper-houses is appended as a matter of 
 interest, and not witli the intention of arguing therefrom 
 the exact prevalency of the disease. It has been drawn up 
 with considerable care, and in order to add to its authenticity, 
 at least one authority has been given for each place. It 
 would have been an easy but unnecessary task to have 
 given more than one standard authority for most of them. 
 Where an authority appears more than once, and the author 
 only is given, it is to be understood that the same woi-k as 
 previously mentioned is indicated. The number placed 
 after the town indicates the number of hospitals ; the 
 figures after the name of the hospital refer to the number 
 of inmates. The word ''Fair " denotes that part or all of 
 the revenues were secured by means of an annual or more 
 frequent Fair. An asterisk distinguishes those which were 
 undoubtedly in possession of Charters, or were supported by 
 the active patronage of Eoyalty. In the fourth column the 
 approximate or actual date has been placed, and if more 
 than one has been discovered, the one supported by appa- 
 rently the highest authority has been printed. 
 
 G. N.
 
 LIST OF LEPER-HOUSES ESTABLISHED IN 
 THE BRITISH ISLANDS DURING THE 
 MIDDLE AGES. 
 
 England and Wales. 
 
 Place. 
 
 Name. 
 
 FOUNDEE. 
 
 Andover,! Hants 
 
 St. Mary Magdalene. 
 
 
 Appleby,'^ Westmore- 
 
 St. Nicholas. 
 
 
 land 
 
 
 
 Athelington,^ Dorset 
 
 St. Mary Magdalene 
 
 Founded by the 
 Chidiocks (Coker). 
 
 Aylesbury,'' Bucks, 2 
 
 St. John's and 
 St. Leonard's 
 
 
 Badele,^ Darlington 
 
 
 
 Baldock,6 Hertford- 
 
 
 
 sbire 
 
 
 
 Bath,7 
 
 
 Richard, xix Bishop 
 of Bath. 
 
 Banbury,^ Oxfordshire 
 
 St. John's 
 
 
 Bebingtou,^ Chesliire 
 
 
 
 Bawtryi" 
 
 St. Mary Magdalene. 
 
 
 Beccles," Suffolk 
 
 St. Mary Magdalene 
 
 
 Berkhainpstead,'- 
 
 St. John the Evangelist 
 
 
 Herts 
 
 St. John the Baptist 
 
 
 Beringtou^-' 
 
 (13 beds). 
 
 
 Brackiey,'^Northai]op- 
 
 
 
 ton 
 
 
 
 Berwick-on-Tweed,i5 
 
 St. Mary Magdalene 
 
 
 Beverley,^* Yorkshire 
 
 St. Giles 
 
 
 BIythe,i7 Notts 
 
 St. Mary Magdalene 
 
 William de Cressi 
 
 *Bodrain,i* Cornwall 
 
 St. Lawrence (39) 
 
 Elizabeth refounded 
 it in 1582. 
 
 II3S- 
 
 ".95- 
 xiii. 
 
 1216. 
 1272. 
 
 1.^27. 
 John. 
 
 1 199. 
 1280. 
 
 1283. 
 
 1066. 
 
 Pope 
 
 Honorius. 
 
 * Indicates Charter or Royal Patronage. 
 
 1 T. W. Shore, ' Hist, of Hampshire.' ^ H. Barnes, ' Leper-houses of 
 Cumberland.' * Tanner, ' Nostitia Monastica.' •* Sir Wm. Dugdale, ' Monas- 
 ticon Anglicorum,' 81. ^ Robertson, ' App. Arch. Essays,' vol. ii. * Sir W. 
 Dugdale, 762. '' Camden Soc, 1863. ^ Thos. Dugdale, ' England and Wales,' 
 voiri. ^ Sir W. Dugdale, 756. '" H. P. Wright, ' Leprosy and Segregation.' 
 11 Sir J. Y. Simpson, 'Archseolog. Essays,' vol. ii. ^'^ Pettigrevv, 'Arch. Assn. 
 Journal,' vol. ii, 95. ^^ Robertson. ^* Baker, ' Hist, of Northampton,' 584. 
 1^ T. Dugdale, vol. i. i"' Tanner, i'' Pettigrew, vol. ii, 95. 1* ' Monastic. 
 Dioc. Exon.' 
 
 Date.
 
 138 
 
 LEPER-HOUSES ESTABLISHED TN THE 
 England and Wales — continued. 
 
 Place. 
 
 Name. 
 
 FOUNDEK. 
 
 Date. 
 
 Boltou,! Nortluunber- 
 
 Holy Trinity (13) 
 
 Robert de Roos. 
 
 1225. 
 
 land 
 
 
 
 
 Bouffliton,- Cheshire 
 
 
 
 13 10. 
 
 *Bristol/ 3 
 
 St. Mary Magdalene, 
 
 
 xii. 
 
 
 St. John's, and 
 
 
 John. 
 
 
 St. Lawrence 
 
 
 
 *Rri(l!;iiorth,^ Salop 
 
 St. James 
 
 
 1224. 
 
 Brid^water,^ Somerset 
 
 St. Giles 
 
 
 xiv. 
 
 Brentwood,^ Essex 
 
 
 
 1292. 
 
 Boughton-nnder- 
 
 St. Nicholas 
 
 Thomas of Hurst 
 
 1380. 
 
 Bleiin,7 Kent 
 
 
 
 
 ♦Burton,'* Leicester- 
 
 
 Roger de Mowbray, 
 
 xii. 
 
 shire 
 
 
 and public sub- 
 scription 
 
 
 Bury St. Edmunds,^ 4 
 
 [St. Saviour ?], 
 St. John, St. Nicholas. 
 St. Stephen, St. Peter 
 
 
 i'35- 
 
 *Carlisle '» 
 
 St. Nicholas (13) 
 
 
 1 180. 
 
 *Colcliester,ii Essex 
 
 St. Mary Magdalene 
 
 Eudo Dapifer 
 
 1 100. 
 
 (Fair) 
 
 
 
 
 Cotes,i2 Nortiiampton 
 
 
 
 1230. 
 
 Care ton 13 
 
 
 
 xii. 
 
 *Cambridge,''' 2 (Fair) 
 
 St. Anthony and 
 St. Anne's 
 
 
 xiv. 
 
 Coventry!* 
 
 St. Mary Magdalene 
 
 
 xii. 
 
 Canterbury,!^ 2 
 
 St. Nicholas, 
 St. Lawrence 
 
 Lanfranc 
 
 II.37- 
 
 Catterick!" 
 
 St. Giles 
 
 
 xiii. 
 
 Cliristeliurch,'" Hants 
 
 
 
 
 *Chatliam,i^ Kent 
 
 St. Bartholomew 
 
 Bishop Gundulph 
 
 1078. 
 
 Chosell,-" Norfolk 
 
 
 
 1272. 
 
 Chicliester/i Sussex 
 
 St. James 
 
 Leodg. de Hampton 
 
 1 1 7.^ 
 
 ♦Chester^- 
 
 St. Giles 
 
 Earl Blaudeville 
 
 xiii. 
 
 Chesterfield,23 Derby- 
 
 St. Leonai'd's 
 
 
 1 1 99. 
 
 shire 
 
 
 
 
 Conisheadj^-' 
 
 
 William de 
 
 xiii. 
 
 Lancashire 
 
 
 Lancastre 
 
 
 Crowmarsh,"* Oxford- 
 
 
 
 1248. 
 
 shire 
 
 
 
 
 Derby,26 2 
 
 Maison Dieu, 
 St. Leonard's 
 
 
 xii. 
 
 * Indicates Charter or Royal Patronage. 
 
 ! Thomas Dugdale. ^ Tanner. ^ Sir W. Dugdale, 670. * Eyton, ' History 
 of Salop.' * Sir W. Dugdale, 773. " Simpson. 7 Pettigrew, vol. ii, 95. 
 ^ Nichol's ' Leicestershire.' ^ Thomas Dugdale, 55. i" Lysons, ' Magna Britan- 
 nica,' vol. iv. " Sir W. Dugdale, 631. i- Pettigrew, vol. ii, 95. ^^ Burton's 
 * Leicestershire.' ^* Lysons, vol. i. 1* Tanner. 1® Somner, ' Autiq. of Canter- 
 bury,' 80. 17 Tanner. ^^ T. \V. Shore. ^^ Tanner, 211. ^ Pettigrew, vol. ii, 
 95. 21 Sussex, 'Arch. Soc.,' vol. xxi. 22 Ormerod, 'Hist, of Chester,' vol. i, 
 352. ^ Tanner's 'Baronage.' ^^ Sir W. Dugdale, 162. -^ Simpson. "^ Sir W. 
 Dugdale, 758.
 
 BRITISH ISLANDS DURING THE MIDDLE AGES. 
 England and Wales — continued. 
 
 139 
 
 PlACE. 
 
 Name, 
 
 Founder. 
 
 Date. 
 
 *Dartford,i Kent, i 
 
 Trinity or 
 St. Mary Magdalene 
 
 Henry VI 
 
 i.^.^o- 
 
 Devizes,* Wilts 
 
 
 
 1207. 
 
 Dorchester^ 
 
 (10 beds) 
 
 
 
 Doncaster/ Yorkshire 
 
 St. James 
 
 
 1272. 
 
 Dunwich,' Suffolk 
 
 St. James 
 
 
 1 199. 
 
 Dunstable/ Bedford- 
 
 
 Prior of Dunstable 
 
 xiii. 
 
 shire 
 
 
 
 
 Dover/ 
 
 St. Bartholomew 
 
 
 1141. 
 
 Dunstane,^ Lincoln- 
 
 
 
 xiii. 
 
 shire 
 
 
 
 
 *tExeter,^ (Fair) 
 
 St. Mary Magdalene 
 (•3) 
 
 
 1 1 63. 
 
 East Harnham,io 
 
 
 
 
 Wilts 
 
 
 
 
 Eye,ii Suffolk 
 
 St. Mary Magdalene 
 
 
 1.^29. 
 
 Fngglestone (Wilts)2s 
 
 
 Adelicia 
 
 xii. 
 
 Gild Martyn,!' Devon- 
 
 St. Leonard 
 
 
 xiv. 
 
 shire 
 
 
 
 
 *Gloucester,i3 2 
 
 St. Margaret, 
 St. Mary Magdalene 
 
 Prior of Llanthony 
 
 xii. 
 
 Grimshury,!'' North- 
 
 St. Leonard's 
 
 
 John. 
 
 ampton 
 
 
 
 
 Gorleston.i* Suffolk 
 
 
 
 '.S72. 
 
 Hardwic'k,!^ Norfolk 
 
 St. Lawrence 
 
 
 1327- 
 
 Hedon,!'' Yorkshire 
 
 St. Sepulchre 
 
 
 1200. 
 
 *Havering,i^ Essex 
 
 
 
 IIS4- 
 
 Hereford,"* 
 
 St. Giles (? Duncomb). 
 
 
 
 Hertin^',^" Sussex 
 
 St. John the Baptist 
 
 
 1 1 89. 
 
 *HerbaIdoune,^^ Kent 
 
 (30 beds) 
 
 Archbishop of 
 Canterbury 
 
 ifS4- 
 
 Hexham,22 Northum- 
 
 
 
 1 2 10. 
 
 berland 
 
 
 
 
 Honiton,"^ Devon- 
 
 St. Martin, 
 
 Thomas Charde 
 
 1530- 
 
 shire, 2 
 
 St. Margaret 
 
 
 
 Hythe,24 Kent, 2 
 
 St. Bartholomew's, 
 St. John's 
 
 
 1336. 
 
 Huntingdon,2-5 
 
 St. Margaret's 
 
 
 1 165. 
 
 Hoddesdon,^^ i 
 
 St. Liindus and 
 St. Anthony 
 
 
 139'- 
 
 Ickborough,27 Norfolk 
 
 St. Mary 
 
 
 xiii. 
 
 * Indicates Charter or Royal Patronage. 
 
 t There were many smaller houses for lepers within the Diocese of Exeter 
 (' Arch. Ass. Journal,' ' Monastic. Dioc. Exon.'). 
 
 1 Sir W. Dugdale, 763. ^ Simpson. 3 Tanner, ■* Miller, ' Hist, of Don- 
 caster,' 40. 5 Thos. Dugdale, vol. iii, ^ Lysons, 76. '' Tanner. ^ Tanner. 
 « Hals, MSS., Brice, 548. 1° Hoares, 'Wiltshire.' " * Index Monas. Dioc. Nor- 
 wich.' '2 Pettigrew, vol. ii, 95. ^^ Bigland, 'Hist, of Gloucester.' i'' Baker, 
 584. 1' Simpson, i^ gi^^pson. '? Sir W. Dugdale, 654. 1^ 'Monastic. Anglican.,' 
 162. 1^ Duncoinb, ' Hist, of Hereford.' '^'^ Simpson, ^igomner, 80. -'■^Tanner. 
 23 Lysons, vol. vi. 283. '-^ Thomas Dugdale, vol. v. 2.5 i£_ \) Xraill, ' Social 
 England,' 367. ^^ Sir W. Dugdale, 762. 2' 'Index Monast. Dioc. Norwich.' 
 2^ ' Notes and Queries,' seventh series, viii, 278.
 
 140 LEPEE-HOUSES ESTABLISHED IN THE 
 
 England and AVales — continued. 
 
 Place, 
 
 Name. 
 
 FOTJNDEE. 
 
 Date. 
 
 Ipswich.i Suffolk 
 
 St. Mary Magdalene 
 
 
 1 199. 
 
 Ilchester,2 
 
 
 
 xiv. 
 
 *Ilford,3 Essex 
 
 St. Thomas (13) 
 
 Adelicia 
 
 xii. 
 
 Kuiglitsbridge,* Mid- 
 
 
 
 
 dlesex 
 
 
 
 
 Kirkby,' Westmore- 
 
 St. Leonard's. 
 
 
 
 land 
 
 
 
 
 Kingston,^ Surrey 
 
 
 
 13 16. 
 
 Kliigswood (Wilts)"-* 
 
 
 
 
 ♦Kendal/ 
 
 
 
 xiii. 
 
 Lancaster/ 
 
 St. Leonard's 
 
 
 1 1 90. 
 
 Langwade/ Norfolk 
 
 
 
 1320. 
 
 Langport,'" Somerset- 
 
 St. Mary Magdalene 
 
 
 1310. 
 
 shire 
 
 
 
 
 Launceston," Corn- 
 
 St. Leonard's, 
 
 
 
 wall, 2 
 
 St. Thomas. 
 
 
 
 Leicester,'* 
 
 St. Leonard's 
 
 William Blanck- 
 mains 
 
 1 199. 
 
 Lecklade/^ Glouces- 
 
 
 
 1246. 
 
 tershire 
 
 
 
 
 *Little Maldon," Essex 
 
 St. Giles 
 
 Edward II. 
 
 1.^23. 
 
 *Lincoln,i^ 2 
 
 Holy Innocents, 
 
 Remegius, Bishop of 
 
 1 100. 
 
 
 St. Giles (10) 
 
 London, and Henry I. 
 
 
 * London,'^ 7 
 
 St. Giles (40) 
 
 Matilda, Queen of 
 Henry I. 
 
 IIOI. 
 
 
 High gate 
 
 
 1472. 
 
 
 Stratford. 
 
 
 
 
 Kingslaud. 
 
 
 
 
 Shoreditch. 
 
 
 
 
 South wark. 
 
 
 
 
 Westminster (14) 
 
 
 1066. 
 
 
 (Fair) 
 
 
 
 Long Blandfordji? 
 
 
 
 1282. 
 
 Dorset 
 
 
 
 
 Lokhay,!^ Derbyshire 
 
 St. Mary Magdalene, 
 
 
 
 Low Cross,!^ Yorkshire 
 
 St. Leonard's. 
 
 
 
 Lynne.^" Dorset 
 
 St. Mary Magdalene 
 
 
 •.^.^6. 
 
 *Lynn,2i Norfolk, 5 
 
 St. Mary Magdalene 
 St. John's. 
 
 Petrus Capellanus 
 
 H45- 
 
 
 West Lynn 
 
 
 1432. 
 
 
 Cowgate 
 
 
 1432. 
 
 
 Stetch-hitlie 
 
 
 1482. 
 
 Mere," Lincolnshire 
 
 
 
 1246. 
 
 Minehead,23 near 
 
 St. Mary Magdalene 
 
 
 1400. 
 
 Liskeard 
 
 
 
 
 * Indicates Charter or Royal Patronage. 
 1 'Index Monast. Dioc. Norwich.' 2 h. D. TraiU. ^ gi,. W. Dugdale, 628. 
 '' Sir W. Dugdale, 766. ^ Simpson. ^ Manning and Bray, ' History and Antiq. 
 of Surrey.' ' Sir W. Dugdale, 162. * Sir W. Dugdale, 765. ^ Simpson, i" Simp- 
 son. 11 Carew, ' Survey of Cornwall,' 186. i^ Sir W. Dugdale, 686. ^^ Tanner. 
 i-* ' Monastic. Anglic.,' vol. iii, pt. i., 93. ^^ Cookson, ' Lincoln Topog. Society.' 
 1^ Parton, ' History of St. Giles ;' Speed, ' History of Great Britain,' &c. '^ Sir W. 
 Dugdale, 759. is Tanner. " Pettigrew, vol. ii, 95. '" Sir W. Dugdale. 759. 
 21 Mackenell, ' History of Lynn.' ~ 'j'^nner. ^3 c^rew. *■*' Notes and Queries,' 
 seventh series, viii, 278.
 
 BRITISH ISLANDS DURING THE MIDDLE AGES. 141 
 
 England and Walks — continued. 
 
 Place. 
 
 Name. 
 
 Founder. 
 
 Date. 
 
 * Maiden Bradley ,i 
 
 Virgin Mary 
 
 Manser Biset 
 
 1145- 
 
 Wiltshire ' 
 
 
 
 
 Nantwich,2 Cliesliire 
 
 St. Lawrence. 
 
 
 
 Newport,^ Hampshire 
 
 St. Augustine. 
 
 
 
 *Norwich,'' 6 (Fair) 
 
 St. Mary Magdalene 
 
 
 II 19. 
 
 
 St. Mary and 
 
 
 1370- 
 
 
 St. Clement 
 
 
 
 
 St. Giles' Gate 
 
 
 1249. 
 
 
 Without St. Magdalen's 
 
 
 1370. 
 
 
 Gate 
 
 
 
 
 Without St. Bonnet's 
 
 
 1370- 
 
 
 Gate 
 
 
 
 
 Without St. Stephen's 
 
 
 1370- 
 
 
 Gate 
 
 
 
 Newport/ near Laiiu- 
 
 St. Thomas. 
 
 
 
 ceston. 
 
 
 
 
 Nortliampton,^ 
 
 St. Leonard's 
 
 
 xi. 
 
 Nottingham,^^ 
 
 " West Barre " 
 
 
 
 *Newtpn Bushell^ 
 
 
 
 '.=;38. 
 
 Newbridge,*^ 
 
 St. Mary and 
 St. Lawrence 
 
 
 1373- 
 
 Newcastle, 
 
 St. Mary Magdalene 
 
 
 1112. 
 
 Newport Pagnell,'" 
 
 
 
 1240. 
 
 Otford," Kent 
 
 
 
 1229. 
 
 Ospringe,!'^ Kent 
 
 Maison Dieu 
 
 
 1335- 
 
 Otley," Yorkshire 
 
 
 
 1327. 
 
 *0xfordi4 
 
 St. Bartholomew, 12 
 
 Henry I. 
 
 xii. 
 
 Ongar ^^ 
 
 St. Oliver. 
 
 
 
 Peterborough, North- 
 
 St. Leonard's 
 
 
 1150. 
 
 ampton 
 
 
 
 
 Pilton,'^ Devon 
 
 St. Margaret 
 
 
 1197. 
 
 Plymouth,!' Devon. 
 
 St. Mary Magdalene 
 
 
 1374- 
 
 Plyinpton.is Devon 
 
 
 
 1370- 
 
 Pontefract," York- 
 
 St. Mary Magdalene 
 
 
 1286. 
 
 shire 
 
 
 
 
 RacheuesSj^" Norfolk 
 
 St. Bartholomew 
 
 
 1189. 
 
 Reading,2i 2 
 
 St. Mary Magdalene 
 
 Aucherius, ii Abbot 
 of Reading 
 
 II34- 
 
 
 " The Leper Hospital " 
 
 Hugh, Bishop of 
 
 1180. 
 
 
 (1.^) 
 
 Reading 
 
 
 *Ripon,22 Yorkshire 
 
 St. Marv Magdalene 
 (18) 
 
 Archbishop Thurston 
 
 H39- 
 
 *Rocbester,23 Kent, 2 
 
 St. Catherine's 
 
 Simon Potyn 
 
 1316. 
 
 
 St. Bartholomew 
 
 
 1216. 
 
 * Indicates Charter or Royal Patronage. 
 
 1 Hoare's ' Wiltshire.' 2 < Lichfield Register.' » t. W. Shore. •• Blomefield, 
 * History of Norfolk.' ^ Sir W. Dugdale, 757. ^ Brigges, 'History of North- 
 ampton.' " Camden, ' Leicestershire.' ^ Pettigrew, vol. ii, 95. ^ Sykes, ' His- 
 torical Register.' ^^ Tanner. ^^ Sir W. Dugdale, 763. i- Philpot, ' History of 
 Ospring.' ^ Simpson. ^* Gardner, ' History of Oxford.' 1* H. P. Wright. 
 1^ ' Soc. of Antiquit.,' Incledon. ^^ Lysons, vol. vi. ^' Lysons, vol. vi. 1^ Sir W. 
 Dugdale, 781. 20 Simpson, [^i Lysons, p. 348. 22 gij. ^_ Dugdale, 620. 
 ^^ Speed. 24 < Notes and Queries,' seventh series, viii, 278.
 
 142 
 
 LEPER-HOUSES ESTABLISHED IN THE 
 
 England and Walks — continved. 
 
 Place. 
 
 Name, 
 
 Founder. 
 
 Date. 
 
 Roiiiiiej',1 Kent 
 
 St. Stephen and 
 
 Adam de Cherryng 
 
 Baldwin, 
 
 
 St. Thomas 
 
 
 Archbishop 
 of Canter- 
 bury, 1 1 90 ? 
 
 Ruddlau,2 South 
 
 
 
 
 Wales. 
 
 
 
 
 Sealorcl,3 Sussex 
 
 St. James 
 
 Rogerus de Fraxeto, 
 Walter de Lucy 
 
 1171. 
 
 Sedburbrook,'' Essex 
 
 St. John the Baptist 
 
 
 1292. 
 
 Sehvood,= Somerset 
 
 The " Domus Lepro- 
 sorum " 
 
 
 I2I2. 
 
 Sudbury'' 
 
 " Jesus Christ and the 
 Virgin " 
 
 
 xiii. 
 
 *Sherburn,'' Durham 
 
 The Virgins (65) 
 
 Hugh Pudsey, 
 Bishop of Durham 
 
 1181. 
 
 Stratton-in-Levino;- 
 
 
 
 
 ton.s 
 
 
 
 
 Sturbridge,' Camb. 
 
 St. Mary Magdalene 
 
 
 1205. 
 
 (Fair) 
 
 
 
 
 *Sbrewsburv '" 
 
 St. Giles 
 
 
 1 136. 
 
 Somerton," Norfolk 
 
 
 
 xii. 
 
 Southampton,!- Hants 
 
 St. Mary Magdalene 
 
 
 II 79. 
 
 *St. Albans,i3 2 
 
 St. Julian's (6) 
 
 Jeffreys, vi Abbot ot 
 St. Albans 
 
 1135- 
 
 
 De la Praye (for 
 
 (Annexed) 
 
 1528. 
 
 
 leprous women) 
 
 
 
 St. Roche, Cornwall. 
 
 
 
 
 Stamford,''' Lincoln- 
 
 
 (Grosteste ?), Bishop 
 
 xiii. 
 
 shire 
 
 
 of Lincoln 
 
 
 Snoring Parva,'^ Nor- 
 
 
 
 i.sSo. 
 
 folk 
 
 
 
 
 Strattan,i6 Norfolk. 
 
 
 
 
 *Tannington,i7 Kent 
 
 St. James (25) 
 
 Henry II. 
 
 1 189. 
 
 Tavistock,!^ Devon 
 
 St. Mary Magdalene. 
 
 
 
 Taunton, '9 Somerset- 
 
 St. Margaret's 
 
 
 1280. 
 
 shire 
 
 
 
 
 Tenby,-o Pembroke- 
 
 St. Mary Magdalene. 
 
 
 
 shire 
 
 
 
 
 Tewkesbury,2i Glou- 
 
 
 
 
 cestershire. 
 
 
 
 
 Totnes,^'^ Devon 
 
 St. Mary Magdalene 
 (II). 
 
 
 
 Tilton,^^ Leicester- 
 
 
 
 xii. 
 
 shire 
 
 
 
 
 * Indicates Charter or Royal Patronage. 
 
 1 ' Archaeolog. Cent.,' vol. xiii, 247. ^ H. P. Wright. ^ Sussex, 'Arch. Soc.,' 
 vol. xxi. ■* Pettigrew, vol. ii, 95. * Simpson. ^ Simpson. ^ Surtees, ' Hist, of 
 Durham,' vol. i, 127. ' Pettigrew, vol. ii, 59. ^ Lysons. i" Owen and Blake- 
 way, ' Hist, of Shrewsbury.' 11 ' Index Monas. Dioc. Norwich.' ^'■^ T. W. Shore. 
 " Speed, 1060. " Sir W. Dugdale. 766. i^ Blomefield. " 'Index Monastic. 
 Dioc. Norwich.' ^^ Somner. ^^ Brice, p. 548. '^ Simpson. ^^ Simpson. 
 ^1 Simpson. 2- Leland, ' Itinerary,' vol. iii, 49. ^' Sir W. Dugdale, 766.
 
 BRITISH ISLANDS DURING THE MIDDLE AGES. 
 England and Wales — continued. 
 
 143 
 
 Place. 
 
 Name. 
 
 Founder. 
 
 Date. 
 
 *Thetford,i Norfolk, 4 
 
 St. John's 
 
 
 xiv. 
 
 
 St. John tlie Baptist 
 
 
 I2l6. 
 
 
 St. Msiry Magdalene 
 
 Earl of Warren 
 
 I2l6. 
 
 
 St. Margaret 
 
 
 1390. 
 
 To\vcester,2 North - 
 
 St. Leonard's 
 
 
 1200. 
 
 iiiupton 
 
 
 
 
 Tweediuoutli,^ Dur- 
 
 St. Bartholomew's 
 
 
 xii. 
 
 ham 
 
 
 
 
 Walsiiiffham,'' Norfolk 
 
 
 
 i486. 
 
 *Wilton> Wiltshire 
 
 St. Giles 
 
 Queen of Henry I. 
 
 1 100. 
 
 Warwick" 
 
 St. Michael 
 
 
 xii. 
 
 Winchester,^ Hants. 
 
 (On Magdalen Hill) 
 
 
 1259. 
 
 Wisbech* 
 
 
 » 
 
 1.380. 
 
 Wigton,^ Cumberland 
 
 St. Leonard's. 
 
 
 
 Wycomb,!" Bucks 
 
 St. Giles 
 
 
 1229. 
 
 Windsor" 
 
 St. Peter 
 
 
 1216. 
 
 Wvmondham,!^ Nor- 
 
 
 
 H46. 
 
 folk 
 
 
 
 
 Yarmouth," Norfolk 
 
 (Outside the North 
 Gate) 
 
 
 1.374- 
 
 *York,i* 4 
 
 St. Giles 
 
 
 1274. 
 
 
 St. Nicholas 
 
 Maud, daughter of 
 Henry I. 
 
 mo. 
 
 
 Moukbridge. 
 
 
 
 * Indicates Charter or Royal Patronage. 
 
 1 Thomas Martin, ' History of Thetford,' Worth MS., fol. vi, * Simpson. 
 ' Eaine, * History of North Durham.' ■* Tanner. ^ Tanner. * Simpson. 
 7 T. W. Shore. " Watson, ' History of Wisbech,' 139. » Sir W. Dugdale, 758. 
 ^" Lipscomb, ' Hist, of Buckinghamshire.' ^^ Pettigrew, ^^ Sir W. Dugdale, 
 749. 1^ Thomas Dugdale, vol. viii. ^■* ' Test. Ebor.,' vols, i, ii.
 
 144 
 
 LEPER-HOUSES ESTABLISHED IN THE 
 
 Scotland. 
 
 M. 
 
 Walcott, ' Anc. Church of Scotland.' Spottiswoode, ' Leper Hospitals in Scot- 
 land at the Reformation.' ' Historic Ayrshire,' William Robertson. Sir James 
 Simpson, ' Arch. Essays,' vol. ii. George Chalmers, F.R.S., ' Caledonia,' 4 vols. 
 Sir John Sinclair, 'Statistics,' 1798. ' Voyage to St. Kilda,' Martin, 41. 
 ' Sheriff's Register, Perth.' ' Antiq. of Aberdeen,' ii, 142, &c. 
 
 Place. 
 
 Name. 
 
 FOUNDEB. 
 
 Date. 
 
 Aberdeen 
 
 
 
 1519- 
 
 Aldcambus, Berwick 
 
 St. Anne's 
 
 Corporation of City 
 
 xii. 
 
 Alduestun, Berwick 
 
 
 
 1 1 70. 
 
 *EdiTiburgh, Mid- 
 
 Greenside 
 
 Corporation of City 
 
 XV. 
 
 lothian 
 
 Dingwall Castle 
 
 
 Previously. 
 
 Govan 
 
 St. Ninian's 
 
 Lady Lochow 
 
 xiv. 
 
 * Glasgow 
 
 St. Ninian's 
 
 W. Steward 
 
 1350- 
 
 Haddington 
 
 
 
 1592. 
 
 *Hareliope, Peebles 
 
 
 David I. 
 
 xii. 
 
 *Kingcase, Ayr 
 
 St. Ninian's (8) 
 
 Robert Bruce (?) 
 
 1306. 
 
 Lerwick, Shetlands 
 
 
 
 
 Ligerswood, Lauder- 
 
 
 William Alan. 
 
 
 dale 
 
 
 
 
 *Linlithgow (Fair) 
 
 St. Mary Magdalene 
 
 
 1 2 14. 
 
 Papastour, Shetlands 
 
 
 
 1740. 
 
 Perth 
 
 
 
 1571- 
 
 Rothfan, Elgin 
 
 (7 beds) 
 
 John Byseth 
 
 1226. 
 
 St. Kilda 
 
 
 
 1684. 
 
 Stirling 
 
 St. James 
 
 
 1463. 
 
 * Indicates Charter or Royal Patronage.
 
 LEPER-HOUSES IN THE BRITISH ISLANDS. 
 
 145 
 
 Ireland. 
 
 Ledwich, ' History of Ireland.' T. W. Belcher, M.D., ' Mediseval Leper 
 Hospitals in Ireland.' Arehdall, ' Monastieon Hibernicon,' 1786. Boate's 
 'Natural History of Ireland.' Simpson, 'Archaeolog. Essays,' vol. ii, &c. 
 ' Waterford, Ancient and Present State,' Charles Smith, 1745. ' History of 
 County Down,' &c. 
 
 PlACE. 
 
 Name. 
 
 FotTNDEE. Date. 
 
 Dublin, 3 
 Armagli 
 *Waterford 
 Kilbixv, West Meath 
 
 St. Stephen's 
 
 St. Stephen's 
 St. Bridffet 
 
 
 •344. 
 869. 
 1185. 
 1 192. 
 
 Dublin 
 
 Lazar's Hill 
 
 
 1220. 
 
 Wexford, 2 
 
 St. Miiry Mngdaleue 
 David Le Latimer's 
 
 
 1408. 
 
 *Lismore, Limerick 
 
 Hospital. 
 St. Bridget 
 
 
 1467. 
 
 Galway 
 
 Dungarvon, Co. 
 Waterford 
 
 St. Bridget 
 St. Bridget. 
 
 
 IS4.S- 
 
 Downpatrick 
 Kilclief, Co. Down 
 
 St. Nicholas 
 St. Peter's 
 
 
 1415- 
 
 1.^87. 
 
 Cork, 4 
 
 St. Stephen's 
 
 St. Mary Magdalene 
 
 St. Dominic. 
 
 St. Brandon. 
 
 
 1295. 
 
 Cloyne 
 Trim 
 
 Leperstowne, near 
 Dublin. 
 
 
 
 1440. 
 
 Palmerstown. 
 
 
 
 
 * Royal Patronage or Charter. 
 
 10
 
 APPENDIX. 
 
 Note i. 
 
 MEDICORUM REGIS SUPER MORBO LEPR^, 
 CERTIFICATIO. (Copied.) 
 
 A.D. 1468. Excellentissimo et serenissimo in Christo Principii 
 Edw. IV. et Domino Edwardo, Dei gratia, Regi Anglige et 
 Franciae et Domino Hiberniae, Nos, liumilium 
 oralores vestri Willielmus Hatteclyffe, Rogerus Marchall 
 ET DoMiNicus DE Seeego Artium et Medicinse Doctores, 
 vestri medici et personse ; vestras lutetam imati debitam 
 revereptiam cum humilitate et honore : Cum nuper in Can- 
 cellaria vestra vobis supplicai'etur de amovendo a communi 
 hominum consortio Johannam Nightyngale de Brentwode in 
 COMITATU EssEXi^E, eo quod praesumeretur per quosdam ex 
 vicinis sius ipsam foeda leprae coutagione infectam et de 
 facto leprosam existere : Propter quod quoddam breve 
 vestram tunc ibid, confectum et superindo vice comiti 
 comitatus proedicti directum fuit in hoec verba : Quia 
 accepimus quod J. N. leprosa existit et inter homines 
 comitatus prsedicta communiter conversatur et cum eio tarn 
 in locis publicis quam privatio communicat et ved ad locum 
 solitarium pront moris est et ad ipsam pertineret, transferre 
 recusat ad grave dampnum hominum predictorum et propter 
 contag. morbi predicti periculum manifestum : Nos hujus- 
 modi periculum pront ad nos pertinet praecavendum et super 
 troemissis quodjustum est et usitatum sieri volentes : tibi 
 proecipimus quod assumptis tecum aliquibus discretio et 
 legalibus hominibus de comitatu predicto non suspecto qui 
 de persona predictas J. et de hujusmodi morbo notitiam
 
 APPENDIX. 147 
 
 habent meliorem et ad ipsam J. accedas et ipsam in prcB- 
 sentia pi'edictorum hominum facias diligenter videri et 
 examinari : Et, si ipsam leprosam esse inveneris et predic- 
 tum est tunc ipsam lionestiori modo quo poteris a communi- 
 catione hominum predictorum amoveri et si ad locum 
 solatiarum ad liabitandum ibid, pront moris est transferre 
 facias in dilate, ne per hujusmodi commun. conversation em 
 suam hominibus predictis dampnum vel periculum eveniet 
 quovismodo : teste meipso apud Westmonasterium decimo 
 die juli ann. reg. nostri octavo, super quo prefata J. ante- 
 quam prefatus vicecomes executionem brevis predictifoecerat, 
 notitiam inde habeus in cancellariam vestram predictam 
 pro remedio et relevio suo in hoc parte habendo veniebat : 
 quo pretextu, rev. in Christo pater et dominus Robertus, 
 Dei gratia, Balhoniensis et Wellensis Episcopus, cancellarius 
 vester anglicee, nos superinde consuliet, eadem que J. nobis 
 decrevit deber presentari ea potissimura intentione, ut, juxta 
 quid ex scientia medicinae precepimus vestram celsitadinum 
 in cancellariam predictum redderemus certiorem an ipsa 
 eadem J. de facto leprosa esset necue : Nos itaque vestras 
 celsitudini morem genere cupientes, ut super isto clarissima 
 Veritas eidem patisieri posset et deberet in hunc modum 
 processimus ; Primum de persona sua consideravimus et 
 juxta quod antiquiores et sapientissimi, mediciuEe auctores 
 in hujusmodi casibus faciendum docuerant, ipsam tractavi- 
 mus et palpavimus, per signa hujusmodi morbi declarativa, 
 discursum fcecimus si in ea reperirentur mature diligenter et 
 pront oportuit inquisivimus, inspectis que et consideratis 
 singulis quag nobis, pro elicienda vera notitia hujus ambiqui, 
 inspicienda et consideranda videbantur debetantque videri 
 invenimus ipsam mulierem nequa quam fuisse aut esse 
 leprosam neque ex ea causa a communis hominum consortio 
 segregandum : Docemur equidaiu ex scientia mediciuati 
 morbuni leprae in communi per plurima vigna, item, 
 unamquamque ejus morbi speciem — quee quatuor sunt 
 Alopecia, Tiria, Leonina, et Elepantia, per aliqua signa 
 debere cognosci et discerni unamqua ab alia specificas dis- 
 tingui : Itaque, in hoc casu mulieris nobis oblati per viginti 
 et ultra signi leprae in communi famosiora discurrentes non 
 invenimus ipsam ex illis anteorundem sufficienti numero posse
 
 148 APPENDIX. 
 
 convinci leprosam : et hoc quidem generaliter proliterando 
 ipsam a dicta prsesumptione sufficeret cum non sit possibile 
 leprae roorbo quern, laborare in quo non milita pars hujusmodo 
 signorum reperiatur : coeterum et ut de singulio speciebus 
 feramus sententiarn per quadraginta et ultra specioreoi lepra 
 signa distinctiva transeuntes non reperimus ipsam mulierem 
 ex aliqua quatuor specierum leprae notandam sed ab omni 
 specie leprae liberam prorsus et immunem quem ad modem 
 et vesfcrse celsitudini vivis vocibus in cancellariam vestram 
 predicta sigui'acavimus paratique sumus idem per processum 
 scientificum si et quando, erit opus eidem vestrae celsitudini 
 plenius declarare certificamus itaque vobis in cancellariam 
 vestram predictam quod mulier sepedicta J. N., nobis pre- 
 sentata per nos inspecta visitata et in hoc casu juxta rei 
 exegentiam, in omnibus ut congruum erat, tractata, inveuta 
 est. Sana, libera nulla penitus specie leprosae contagionis 
 infecta : In quorum omnium fidem et testimonum nos dicti 
 W. Hatteclyff, E,. Marchall, et D, de Serego, manibus 
 nostris proprius nos ipsos presentibus inscripsimus et sigilla 
 nostra alternatim apposuimus ; 
 
 Dat, primo, die novenibris, anno regni, Regis Edward 
 QcARTi post conquestucn angliae octavo : 
 
 Et memorandum quod predict!, W. Hatteclyff, Rogerus 
 Marchall et Dominicds dk Serego venerunt in Cancellarium 
 regis, apud Westmonasterium, septimo dei novembris, 
 amno presenti et recognoverunt scriptum predictum et omnia 
 contenta in eodem in forma predicta. 
 
 Note 2. 
 Episcopal Register of Lincoln. 
 
 " Vacante ecclesia de Seyton per remocionem Thoma de 
 Bella fago nuper Rectoris Ejusdem ab administracionis 
 oflficio quod gerebat in ea contra eum eo quod lepre macula 
 adeo respersus extitit et infectus quod communioni fidelium 
 seu conspectui se presentare nequivit pi'opter scandalum et 
 horrorem per Espiscopum diffinitive servato processu qui 
 requiritur promulgatam cujus tenor iuferius Continetur
 
 APPENDIX. 149 
 
 Johannes de Bella fago Magistrum Willelmum de Bella 
 fago ad dictam ecclesiam Episcopo presentavit, &c., iii Non. 
 Aprilis A.D. M.CCC. Decimo apud Nettelham." 
 
 Note 3. 
 
 " He looked on her ngly lepers face, 
 The which before was white as lely floure, 
 Wringing his hands." 
 Chaucer (1348-1400), ' The Complaint of Creseide,' p. 297. 
 
 " Lying among leper-folke, alas ! " 
 
 Ibid. 
 
 " A leper lady rose, and to her wend." 
 
 Ibid. 
 
 " And soone a leaper-man took off the ring." 
 
 Ibid., p. 298. 
 
 " And he was in his lustie age, 
 
 The lepre caught in his visage." 
 Gower (1330— 1408), ' Confessio Amantis,' bk. ii, p. 69. 
 
 " In the porches of mine eares did poure 
 The leprous distilment." 
 
 Shakespeare (1564— 1616), 'Hamlet,' fol. 258. 
 
 " By thee the silly amorovis sucks his death. 
 By drawing in a leprous harlot's breath." 
 
 Donne (1573— 1631), ' The Perfume,' Elegy 4-
 
 ON THE 
 
 CONDITIONS UNDER WHICH LEPROSY 
 HAS DECLINED IN ICELAND, 
 
 EXTENT OF ITS EOEMER AND 
 PEESENT PEEYALENCE. 
 
 EDWARD EHLERS, M.D, 
 
 COPENHAGEN.
 
 The longitude in the accomjianying reproduction of the 
 map of Iceland, is calculated on the English system, from 
 Greenwich. That alluded to in Dr. Ehler's text is calculated 
 from Copenhagen. To make them agree add 12° 35' to longi- 
 tude sho2vn on the map. 
 
 sM
 
 or Ehlers Expedition 
 
 O Tubej^otLs l^ers 
 ^Aneesthjetijc lepers 
 
 DTEhJjer's Itinerary
 
 The longitude m the accomj^anying reproduction of the 
 map of Iceland is calculated on the English systetn, from 
 Greenwich. That alluded to in Dr. Ehler's text is calculated 
 from Copenhagen. To make them agree add 12° 35' to longi- 
 tude shoivn on the map.
 
 ^..i^
 
 CONDITIONS UNDER WHICH LEPROSY 
 HAS DECLINED IN ICELAND. 
 
 History. 
 
 In the Icelandic language leprosy has received various 
 names, among which Holdsveiki, i. e. disease of the flesh, 
 seems to be the most recent. The older names are likthrar 
 {derived from lik, a corpse, and thrar, rancid), employed for 
 the tuberous form, and limafallssyki (the limbs-falling-ofE 
 disease), which expresses the anesthetic form. 
 
 It cannot be decided with certainty at what period leprosy 
 first made its appearance in the island. The vice-superinten- 
 dent Eggert-Olafsen, and the physician Bjarne Povelsen,^ 
 who, during the years 1752—57, as students traversed Iceland, 
 were of the opinion that the disease " was as old as the 
 inhabitants themselves, who probably had brought it from 
 Norway.'^ 
 
 Dr. Gislasen, an Icelander, who was physician at Drammen 
 (Norway), and as such wrote his thesis for the diploma of 
 doctor, upon leprosy,^ was, however, of the opinion that the 
 disease was first brought to Norway about the end of the 
 thirteenth century, probably from the Crusades. 
 
 Gislasen did not think that any positive proof could be 
 given of the existence of the disease previous to a Testa- 
 mentum by King Magnus Lagabaster in the year 1277," in 
 
 ' ' Voyage through Iceland,' vol. ii, Soroe, 1772, p. 325 (Danish). 
 - ' De ElepLantiasi Norvegica,' Haunise, 1785. 
 ^ Ed. HafniiB, 1719, p. 14.
 
 154 EHLERS UN LEPROSY IN ICELAND. 
 
 whicli it is said : *' Item ad Ospitale CatliarinaB Leprosorum 
 Bergis centum marcas sterlingorum contulimus." Hjaltelin,^ 
 on the contraiy, adopts the opinion of Olafsen and Povelseu, 
 and declares that the disease is mentioned here and thei'e in 
 the old legends. He points out some such cases, to which 
 I, with the help of the dictionaries of the old Norse lan- 
 guage, am able to add a few. 
 
 We are only concerned with the word likthrar ; the other 
 expressions, holdsveiki and limafallssyki, are not to be 
 found in the legends, and no trace of the disease exists 
 before the twelfth and thirteenth centuries. 
 
 No doubt, in the legend concerning Olaf Tryggvasou," the 
 action of which takes place before the year looo, a story 
 about a man, by name Thorhal Knapp, from Knapstad in 
 Fljot, is mentioned: "he was a man of good and pure 
 morals, though a heathen, but much suffering and afflicted 
 by leprosy.^' One night he dreamed that King Olaf stood 
 before him, and counselled him to build a church, and 
 construct it of the timber of his old sacrificial temple, then 
 he would be cured. Of course the man did it ; and the old 
 gods, who now were homeless, became so angry, that they, in 
 moving away, killed a jade belonging to a woman, who, 
 though quite innocent, " was very active and versed in 
 witchcraft." But the leprous man " day by day got better, 
 and recovered his strength." Next year he adopted the 
 Christian faith, "and then he first was perfectly cured, on 
 the day he was baptised." It is a matter of course that 
 this myth never can prove that leprosy was known before 
 the battle of Svold, year looo, but only that the writer knew 
 the name of the disease. 
 
 Gislasen is inclined to believe that Gunnlog, a monk, who 
 wrote this legend two hundred years afterwards, " in ac- 
 cordance with monastic custom, adorned the life of the 
 sainted king with this miracle, rather than tell the truth." 
 
 In the Ljos-vetninga saga" another leprous patient is 
 mentioned ; but he has nothing to do with the story. 
 
 ' ' Leprosy, with Special Reference to its Appearance in Iceland,' 
 Copenhagen, 1843 (Danish). 
 
 - ' Fornmanna sugar,' vol. ii, Copenh., 1826, chap. 227, p. 229 
 (Icelandic) 
 
 ^ ' Ljos vetninga Saga,' Copenh., 1830, p. q8 (Icelandic).
 
 ITS EARLY HISTORY. 155 
 
 This saga, which refers to Iceland, was most probably 
 written in the last half of the twelfth century, " after Ketill 
 had been created a bishop/^ He was bishop from 1122 to 
 
 II45- 
 
 In ' Konge spejlet'^ (speculum regale-konungs skug-gsja), 
 a philosophico-didactical treatise which appeared in Norway 
 towards the end of the twelfth, or at least not later than the 
 beginning- of the thirteenth century, the word likthrar is 
 used at page 37 referring to the disease of Job, and at 
 page 32 it is mentioned that the sperm of a whale called 
 red whale (probably spermaceti), " is good for the cure of 
 disease of the eyes, leprosy, tremor, headaches, and all sick- 
 ness that may befall men/^" 
 
 The earlier Gulathingslov, 298/5^ freed all lepers from 
 war contribution, Conrad Maurer'^ dates the origin of this 
 law to the beginning of the thirteenth century. 
 
 Finally the disease is mentioned in the legend of 
 " Sturlog " the industrious : a person named Fraraar 
 demands and gets from three sorcerers the power to make 
 himself leprous and well again whenever he pleased. Kafn ^ 
 (in his preface to the edition) supposes this legend to have 
 been composed in the thirteenth and fourteenth centuries. 
 
 Neither as regards Norway, Denmark, nor Iceland can 
 leprosy thus be traced with certainty further back than the 
 end of the twelfth century. 
 
 The supposition of Olafseu, Povelsen and Hjaltelin, that 
 
 ^ The Christiania edition, 1848. 
 
 - The therapeutic value of spermaceti against leprosy gives very 
 favourable evidence regarding the knowledge of the writer of the 
 ' Kongespejl.,' as it is much to be preferred to the ignorant and 
 "miraculous" treatment employed during the fourteenth century. 
 Thanks to the assistant librarian, Dr. Verner Dahlerup, who has given 
 me several useful hints and much good advice, I am able to cite the 
 following example :— In a Danish medical book of the fourteenth 
 century (the ' Arnamagnaianic Manuscript,' No. 187, Svo, edited by 
 Saaby) it is recommended to smear persons attacked with " spyta^ls 
 sot" with the blood of a male goat. At another place it is said : " If 
 you have got the disease (leprosy), take some ants and the ant-hill, put 
 it in your bath, and you will be cured." 
 
 ^ ' Old Laws of Norway up to 1837,' '^^^- h P- 97 (Icelandic). 
 
 * ' The History of the Original Texts of North German Laws ' (Danish). 
 
 * 'Fornaldar sogur,' vol. iii, p. 642, chap, xsv (Icelandic).
 
 156 EHLERS ON LEPROSY IN ICELAND. 
 
 leprosy was known in Iceland before tlie commencement of 
 the Crusades, must therefore be said to want any solid 
 foundation. 
 
 Iceland got its first inhabitants from Norway, and most 
 probably its first case of leprosy from the same place : that 
 is all that can be said ; the exact time cannot be fixed, with 
 regard specially to Iceland. The greatest probability points 
 to the end of the twelfth century. 
 
 Towards the middle of the sixteenth century, leprosy 
 seems to have obtained more hold of the island, and to have 
 become so extensive that a dread was created in the hearts 
 of the Icelanders, which is so touchingly manifested in the 
 report of Gislasen about this period. He says that they 
 never mentioned the name of the disease without at the 
 same time adding, " May God in His mercy save us ! '^ 
 
 As early as in the year 1555, the authorities of the island, 
 together with the chief officer, Knud Steensen, made pre- 
 parations^ for the erection of four leper asylums, but the 
 proposal was first realised by a royal edict of the loth of 
 May, 1 65 1, which decided upon the erection of an hospital 
 in each quarter of the island. 
 
 These hospitals were supported in the following way : — 
 All the fishermen round the country were appointed to meet 
 on a certain day during the fishing season, on which day 
 they had to give up a certain pi'oportion of their catch, 
 unless it amounted to less than five good-sized cod, or their 
 equivalent, the hospitals then receiving their share next day. 
 Following this rule, the catch was divided into eight parts 
 instead of the usual seven, and one of these was due to the 
 hospitals. The bishop and the superintendents of each 
 county were inspectors, while well-known and honourable 
 men were elected superintendents of the hospitals. They 
 lived on adjacent farms, and had to provide the patients 
 with what was necessary, and to render an account of the 
 income. 
 
 The four hospitals were : in the western division, Hallb- 
 
 jarnareyra, in Oresvejten (a farm in the district of Snefjell) ; 
 
 in the northern division, on Madrefell, in the district of 
 
 Ofjord j for the eastern part, on Horgsland ; that for the 
 
 ^ ' The Voyage of Olafsen and Povelsen,' vol. i, p. 325.
 
 THE HOSPITAL ACCOMMODATION. 157 
 
 southern part was situated at Klosterhole in Grimsnes, until 
 the year 1750, when it was moved to Kaldadernaes, at Floen, 
 a short distance from the harbour of Orebakke. 
 
 This installation of the hospitals, with everything neces- 
 sary for their support, their '' inspectors " and " honourable 
 men,^' looks certainly very nice on paper, but if we follow 
 the reports of Hjaltelin,^ the impression left is not so 
 favourable. 
 
 He visited the two largest of them, those of Kaldadernees 
 and Hallbjarnareyra, and he was bound to admit " that 
 these miserable huts were more like pigsties and cow- 
 houses, to say the least of them, than sick-chambers. The 
 stink and filth were so abominable, that only those accustomed 
 to such dirt could stand a prolonged stay there without 
 being themselv^es sick, and these hospitals were only a sad 
 example of how the Icelanders stood as regards their 
 medical institutions, and of how patiently they suffered in 
 their passion for tradition, endeavouring in this instance to 
 maintain the institutions of the Middle Ages.^' 
 
 The great smallpox epidemic in Iceland in 1707, which 
 destroyed more than one third of the population, made 
 away with the greater part of the leprous families. How 
 many there were in the eighteenth century I have not been 
 able to discover; but as regards the year 1768 their total is, 
 in a letter to Johs. Petersen," calculated to be upwards of 280. 
 This number was further diminished by the very sensible 
 law of the 28th of March, 1776, which put a stop to mar- 
 riage between lepers.' 
 
 Lepers in Iceland, as elsewhere, appear at this time to 
 have been isolated from intercourse with the rest of the 
 population. Thus Johannes Petersen (1. c, page 42), who 
 considers the disease contagious, says : " it is not sufficient 
 that these miserable beings are tormented by the disease, 
 but, like the impure of the Old Testament, they are shunned 
 and abhorred by most people, and this isolation of course 
 makes them still more wretched." 
 
 1 Log. cit., p. 43. 
 
 2 ' The so-called Icelandic scorbutus,' Soro, 1769, p. 9 (Danish). 
 
 ^ Further enjoined by a law of December 7th, 1827, and by a circular 
 from the Department of Justice, May 30th, 1848.
 
 158 EHLERS ON LEPiiOSY IN ICELAND. 
 
 It is only since tlie beginning of this century that a re- 
 gister of mortality has been kept in Iceland, thus enabling 
 one to ascertain the number of lepers. Hjalteliu,^ with 
 regard to the years 1802—37, calculated the number of 
 deaths from leprosy and scorbutus together, because these 
 two maladies, following the doctrine of Boerhaave as to 
 leprosy being the last phase of scorbutus, were amal- 
 gamated. Hjaltelin was of the opinion that there is much 
 reason to believe that the greater number of those re- 
 gistered as having died from scorbutus really died from 
 leprosy. 
 
 The total number of lepers who died during the years 
 1800—37 inclusive would then amount to 707, which for these 
 thirty-seven years (there is no report for the year 1824) gives 
 a yearly average of I9'3; and as hardly any Icelander, 
 according to Hjaltelin, could be deceived with regard to 
 the disease in its last stage, he guarantees that the mor- 
 tality has been nowhere calculated too high. 
 
 The number of deaths from leprosy and scorbutus to- 
 gether during the same period amounts to 943 ; this gives 
 an average of 26' 19. 
 
 In 1837 ^^^ Bishop St. Johnsen ordered his clergy to 
 make a report of the number of lepers found in their re- 
 spective parishes J the result was 128 (68 men and 60 
 women). But Hjaltelin justly criticises this summing-up 
 as being very deficient and imperfect, as, firstly, it is not 
 to be expected that clergymen " not skilled in medicine, 
 should be able to recognise the disease before its more ad- 
 vanced stage ; and, secondly, in consonance with Icelandic 
 usage, it is only customary to call those persons lepers who 
 are suffering from Lepra nodosa, while those afflicted with 
 Lepra squamosa or Psoriasis leprodes seldom, or at least 
 only at a few places, are regarded as leprous." As a fact 
 he found this report so defective, that in one parish where 
 the number of lepers according to the report was stated to 
 be 13, he met with 22 leprous patients, all of whom had 
 been affected when the clergyman was collecting his sta- 
 tistics. 
 
 He (Hjaltelin) estimated the number of lepers on the 
 
 • Loc. cit., p. 39.
 
 ITS PEEVALENCE AND DISTEIBUTION IN 1870. 159 
 
 island to be 289, at wliicli uumber lie arrived by multiplying 
 the average of the yearly number of deceased by 8, which 
 last number he considers the average duration of the 
 leprous disease. Hjaltelin supposed the disease to be in- 
 creasing in this time. 
 
 During the great measles epidemic in 1846, great numbers 
 of lepers died, and the number of survivors was calculated 
 to be only 66, of whom one third lived in the district of 
 Gullbringe (see 'The Voyage of Schleisner ^).^ 
 
 As leprosy was considered now to be decreasing all over 
 the country, the miserable hospitals were abolished, according 
 to a royal mandate of the 23rd of August, 1848. 
 
 During the year 1872, the lepers were again counted by 
 the clergy^ in 151 parishes (the whole island consists of 
 184 parishes). Altogether 43 leprous patients were found, 
 out of whom 36 presented the tuberous form, 7 the ansBS- 
 thetic. These last-mentioned, with one exception, all belonged 
 to the district of Gullbringe. 
 
 The apportionment was : in the southern division 19, in 
 the western division 13, in the northern division 11, in the 
 eastern division o. 
 
 The population of Iceland in 1870 was 69,763 inhabit- 
 ants. With regard to these statistics, the same objection, 
 no doubt, may be urged as Hjaltelin pleaded against Bishop 
 St. Johnson's. 
 
 Finsen'^ in nine years observed 22 cases in his own 
 districts (those of Ofjord and Thingo), where Schleisner (1847) 
 only counted 2. It is, however, evident from his notes 
 that a comparatively great number of these cases originated 
 in other districts; thus 6 out of 14 cases he observed during 
 the period 1857-61 (both years inclusive) ; nevertheless 
 sufficient remain to make one believe that the reckoning of 
 Schleisner was incorrect, or, as Finsen expresses himself, 
 " that the disease at this time was more frequent than at the 
 time when Schleisner made his observations.^' 
 
 ' 'Iceland from a Medical View' (Danish), Copenhagen, 1847. 
 
 2 'The Annual Repoi't of the Board of Health,' 1873, p. 374 
 (Danish). 
 
 2 ' Observations regarding Maladies in Iceland : ' a thesis for the 
 diploma of M.D. Copenhagen, 1874, p. 53 (Danish).
 
 160 
 
 EHLERS ON LEPROSY IN ICELAND. 
 
 Finally, in 1869 the number of lepers was stated to be 48, 
 in a report from the land physician. 
 
 The Apportionment of Lepers on Iceland according to 
 Districts. 
 
 East Skaptafell 
 
 West 
 
 RangaiTalla 
 
 (Westmannaeyar) 
 
 Arnses 
 
 Gullbringe 
 
 Kjosar 
 
 Reikiavik . 
 
 Borgarfjord 
 
 Myra 
 
 Hnappadal 
 
 Snajfellsnses 
 
 Dala 
 
 Bardestrand 
 
 Nortb Isafjord 
 
 South „ 
 
 Strande 
 
 Huuavatn . 
 
 Skagefjord 
 
 Ofjord 
 
 South Thingo 
 
 North „ 
 
 North Mule 
 
 South „ 
 
 1746 
 
 1847 
 
 1872 
 
 188 
 
 = } 
 
 -> 
 
 8 
 
 
 1 
 
 = } 
 
 16 
 
 
 I 
 3 
 
 — 
 
 — 
 
 - 19 
 
 7 
 
 — 
 
 22 
 
 
 — 
 
 — 
 
 — 
 
 
 14 
 
 ^■5 ^ 
 
 
 
 2 
 
 — 1 
 z > 
 
 
 
 — 
 
 9 
 
 
 9 
 
 
 ^ 13 
 
 J 
 
 — > 
 
 10 
 
 
 4 
 
 — 
 
 . 
 
 
 
 
 I 
 
 I 1 
 
 
 I 
 
 
 I 
 2 
 
 > II 
 
 I 
 
 — 
 
 - J 
 
 
 3 
 
 As leprosy according to the above schema is now 
 apportioned on Iceland, so probably was it also in olden 
 days. 
 
 A glance at the map of Iceland shows that out of forty- 
 seven cases, thirty-five (consequently almost three-fourths 
 of all the cases) are met with on the south-western coast 
 of the island, where Snefjellsnaes in the north and the 
 peninsula of Gullbringe with the adjoining Arnjes in the 
 south enclose the Gulf of Faxo, whose coast consists of the 
 two districts, Kjosar and Borgarfjord. 
 
 In the frequently mentioned travels of Eggert Olafsen 
 and Bjarne Povelsen, I have found the following statements : 
 
 (Page 176. The District of Borgarfjord.) — '^Leprosy is 
 not nearly so common here as in the southern districts ; nay,
 
 OLAFSEN AND POVELSEN's REPORT. 161 
 
 it is even rarely met with among persons born at the place. 
 Upon the whole, one does not see so much of it up country 
 as near the shore. ■'^ 
 
 (Page 323. The District of Snefjseldsnges.) — '' Leprosy 
 is here more common than at Borgarfjord, and is said to 
 have been formerly still more frequent." 
 
 (Page 449. The Districts of Dala, Bardestrand, Isafjord 
 and Strande.) — '^ One would think that leprosy was mostly 
 found along the Westfjords ; nevertheless only very few are 
 seriously affected with this disease. Scorbutus, on the 
 contrary, attacks the feet of all persons more than forty 
 years old. The head, too, is affected with eruptions, and 
 swellings of the gum are common ; the teeth rarely become 
 loose, and very seldom real toothache accompanies the 
 disease." 
 
 " Loss of sensation is very frequent, and is noticed by 
 those who are operated upon ; as they tell you, they only 
 feel very little pain." 
 
 " They generally complain of heaviness throughout the 
 body, and quick movements do not at all agree with 
 them." 
 
 (Page 695. The Northern Districts of Iceland.) — " Neither 
 leprosy nor scorbutus is nearly so common as on the south 
 and west sides of the island. The hospital for lepers on 
 the Northland is situated at Madrefjell, in the district of 
 Of jord, and for many years only one, or at most two patients 
 have been found there at a time ; sometimes there are none 
 at all." 
 
 (Page 820. The Eastern Districts of Iceland.) — "Leprosy 
 is by no means frequent here, as the hospital at Horgsland 
 in 1756 contained only two patients. The disease is, how- 
 ever, more frequently met with in the northern part of the 
 District of Mule. The patients are very seldom sent to the 
 hospital, as it lies so far away, and the road is very im- 
 passable." 
 
 (Page 961. The Districts of Rangaarvalle, Aarnaes, and 
 Gullbringe.) — '' Leprosy is here very frequent, and even 
 persons of quality are not exempted from the disease." 
 
 The reason why the south-western part of the country is that 
 most frequently attacked seems to me without doubt to be that 
 
 11
 
 162 EHLEES ON LEPEOSY IN ICELAND. 
 
 it is the district into whicli the disease was imported,^ and has 
 been able to take firm root among the poor population, consist- 
 ing of fisher-folks. This part of the island, the richest and 
 most thickly populated of Iceland, is of course at the 
 same time its weak point — its locus minoris resistentise. 
 
 Against this weak point, all the plagues that at different 
 times have assailed this unfortunate island have directed 
 their chief force. Here is the greatest traffic with foreigners, 
 as well as almost all commercial communication with other 
 countries. 
 
 It was on the Westman Isles that barbarous pirates in 
 1627 ravaged the coast ; partly murdered, partly carried off 
 to slavery the poor fishermen from their barren cliffs, and 
 killed their minister. Ion Thorstensen, who so far met 
 with the happier fate, that he after his death was considered 
 a saint. 
 
 In the southern part, too, it was that " the great epidemic " 
 in 1493 began, by which most probably is meant the 
 " plague." 
 
 The two great measles epidemics, the first in 1644, which 
 was imported by the Orebakke ship (lying at Arnses), and 
 the second, which commenced the 3rd of April, 1846, and 
 at the same time spread from Havnefjord in the southern, 
 and Skagestrand in the northern part of the island, also 
 chose this way. 
 
 The great scarlet fever epidemic of 1797 began on West- 
 man Island; the next, in 1827, in the southern districts. 
 
 Whooping-cough attacked the southern part in 1825 and 
 1839. The dreadful smallpox epidemic of 1707 made its 
 first appearance at Orebakke. As this epidemic, which 
 killed 18,000 out of the population, possesses a special 
 importance for leprosy on Iceland, I shall report what 
 Schleisner" says about it. 
 
 An Icelander had been abroad, and died during the 
 winter from smallpox. In spring his clothes were brought 
 on shore at Orebakke, and among these a chest filled with 
 linen. His sister put on one of his shirts, and contracted 
 
 * Most likely the reason why leprosy is so much more frequent in 
 the vicinity of Bergen in Norway. 
 2 Loc. cit., p. 61.
 
 ITS DIFFERENT FORMS. 163 
 
 smallpox J in this way the disease spread all over the 
 country. Thirty-four years had elapsed since the previous 
 smallpox epidemic. Several old people who in former days 
 had suffered from the disease caught it again, while most 
 of the young persons, especially men, were attacked. 
 Women were occasionally obliged to cai-ry their dead to the 
 church. The bishop had to saddle his horse himself, and 
 to ride out alone. Twelve thousand persons are said to have 
 died in the diocese of Skalholt, and 6000 in the northern 
 districts, making altogether 18,000, thus leaving only about 
 34,000 inhabitants. The majority of the lepers died on this 
 occasion, and, besides these, most of the old persons and the 
 pregnant women. 
 
 Syphilis, which, as well as other venereal diseases, is not 
 endemic in Iceland, has a few times got on shore at 
 Reykiavik ; the epidemic which in 1528 was called sarasott 
 is most probably to be explained as syphilis ; at all events, 
 the epidemic in 1 756, which started in the wool manufactory in 
 Reykiavik, gave rise to that place being called the " Franzos 
 manufactory." 
 
 Thus the south-western corner of Iceland has always been 
 the locality which was first and most severely attacked by 
 epidemics. 
 
 It has been very difficult for me to get information about 
 the relative proportions between the different forms of 
 leprosy — the smooth and the tuberous — in Iceland. Of 
 course both forms are known there, Limafallssyki being the 
 anaesthetic form, Likprar the tuberous. 
 
 Thorstensen ^ describes three forms : 
 
 (i) Lepra genuina scorbutica, which seems to be essen- 
 tially a tuberous form ; 
 
 (2) Lepra decidua seu rheumatica = Limafallssyki, the 
 anaesthetic form, as is to be perceived from the description ;^ 
 and — 
 
 ' "Tractatus de Morbis in Islandia frequentissimis, aiictore Job. 
 Thorstensen," 1837. 'Mem. del' Acad. Royale de Med.,' Paris, 1840, p. 47. 
 
 - Incipit talis morbus cum insensibilitate ultimaB extremitatis, sine 
 ullo tumore, sed dolore ardente, supra membrum insensibile, quo loco 
 ulcus aperitur et ultimum os ejusdem membri vma cum adjacentibus 
 partibus exsolvitur. Gradus insensibilitatis tantus est, ut si necesse
 
 164 EHLEES ON LEPROSY IN ICELAND. 
 
 (3) Lepra arabica seu elephantina, of wliicli Thorstensen 
 only saw two cases in Iceland, and one in Denmark in 18 19. 
 
 Hjaltelin, who gives a good description of what he calls 
 lepra squamosa, says (p. 103) that almost one half of the 
 lepers in Iceland suffer from this form of the disease. 
 
 Out of those examined by Schleisner, eleven men and ten 
 women, twelve suffered from the tuberous form, six from 
 the anaesthetic, three from a combination of the two. 
 
 Finsen (1. c, p. 54), who saw twenty-two cases on Iceland, 
 never observed a single case belonging to the smooth form 
 (the districts of Ofjord and Thingo). In the official report 
 of 1872, thirty cases of tuberous form and seven of the 
 anaesthetic are recorded, but of these last mentioned not less 
 than six were found in the district of Gullbringe, where the 
 whole number of lepers was twenty-two. 
 
 My Personal Researches. 
 
 On the 16th of July we arrived at Eeykiavik, and already 
 on the 1 8th of July we began to traverse Faxebugten (the 
 bay of Faxe). The expedition consisted, besides myself, of 
 the assistant physician to the Garnison's hospital in Copen- 
 hagen, C. T. Hansen, who particularly took charge of the 
 photographic work ; the medical student Gudmundur 
 Gudmundsson, who acted as an interpreter, and the fishing 
 sorter Amundi Amundsson as a guide. 
 
 The excursions of the first eight days were made on the 
 steamer " Elin,^' which surely is not adapted to lodge 
 passengers ; but, thanks to the owners, our stay there was 
 made as comfortable as possible, the steamer being also given 
 up to our disposal for extra trips. 
 
 On the 24th of July the expedition started for the interior 
 of the Southland, whence we returned on August 5th ; 
 August 15th we went on the " Thyra ^' round the whole 
 island. 
 
 The plan of our journey was devised by the renowned 
 polar explorator. Captain Hovgaard, and Doctor Bjorn Olsen, 
 
 esset extremitatem adfectam amputare, aut os fere solutum omnino 
 exscindere talem operationen segroti non, aut tIx non percipiunt. 
 Haec species rarior est quam lepra genuina.
 
 THE AUTHOR S RESEARCHES. 
 
 165 
 
 who lent us perfectly invaluable assistance. The Icelandic 
 press had announced our arrival at the different places ; and 
 the governor of the province, Stephenson^ who kindly lent 
 us all help possible, had, by a circular to our Icelandic 
 colleagues, recommended them to assist us. I cannot 
 sufficiently extol the amiability and obligingness which our 
 Icelandic colleagues showed ; several of them met us on 
 horseback at the bound of their district, and also accom- 
 panied us out of it again. 
 
 By working in common we succeeded in finding and exa- 
 mining altogether 102 leprous patients, of whom we wrote 
 minute stories of their illness, and we photographed the most 
 interesting of them. Besides we obtained detailed informa- 
 tions of about forty-two patients whom we could not visit on 
 account of the enormous distances. 
 
 District. 
 
 Men. 
 
 Women. 
 
 Altogether.! 
 
 
 
 
 
 
 
 
 Tuberous 
 
 Mixed 
 
 Anaesthe- 
 
 Tuberous 
 
 Mixed 
 
 Anaesthe- 
 
 
 
 form. 
 
 form. 
 
 tic form. 
 
 form. 
 
 forai. 
 
 tic form. 
 
 
 Myra . 
 
 I 
 
 I 
 
 
 _ 
 
 
 
 2 (0) 
 
 Borgarfjord . 
 
 3 
 
 2 
 
 2 
 
 — 
 
 I 
 
 I 
 
 9 (2) 
 
 Gullbringe-Kjosar 
 Reykiavik 
 
 2 
 I 
 
 2 
 
 I 
 
 3 
 
 2 
 
 3 
 
 I 
 
 2 
 I 
 
 12 , s 
 
 6J(i4) 
 
 Arnses . 
 
 4 
 
 — 
 
 2 
 
 3 
 
 I 
 
 I 
 
 II (7) 
 
 Rangarvalla . 
 
 4 
 
 3 
 
 4 
 
 5 
 
 3 
 
 2 
 
 21 (4) 
 
 V. Skaptafell 
 
 I 
 
 
 — 
 
 I 
 
 I 
 
 — 
 
 3 (0) 
 
 Sngefellsnses . 
 
 4 
 
 — 
 
 3 
 
 6 
 
 — 
 
 I 
 
 14 (9) 
 
 Bardestrand . 
 
 3 
 
 2 
 
 
 I 
 
 I 
 
 2 
 
 9 (I) 
 
 Isafjord 
 
 2 
 
 — 
 
 2 
 
 — 
 
 — 
 
 3 
 
 7 (4) 
 
 Dala 
 
 2 
 
 — 
 
 — 
 
 I 
 
 — 
 
 
 3 (0) 
 
 Hunavatn 
 
 I 
 
 — 
 
 I 
 
 I 
 
 — 
 
 — 
 
 3 (I) 
 
 Skagefjovd . 
 
 2 
 
 — 
 
 I 
 
 2 
 
 I 
 
 2 
 
 8 (0) 
 
 Ofjord . 
 
 5 
 
 6 
 
 4 
 
 6 
 
 2 
 
 2 
 
 25 (I) 
 
 Thingo . 
 
 3 
 
 I 
 
 2 
 
 I 
 
 I 
 
 I 
 
 9 (3) 
 
 Norder Mule 
 
 
 — 
 
 — 
 
 I 
 
 — 
 
 — 
 
 I (0) 
 
 0. Skaptafell - 
 
 I 
 
 — 
 
 — 
 
 — 
 
 — 
 
 — 
 
 I (I) 
 
 39 
 
 18 
 
 24 
 
 34 
 
 II 
 
 18 
 
 144 
 
 
 1. 
 
 
 
 I. 
 
 
 J 1 
 
 
 81 
 
 63 
 
 
 ' The numbers in parentheses ai"e taken from the ofl&cial accounts of 
 1889. 
 ' The coasts of Ofjord.
 
 166 EHLERS ON LEPROSY IN ICELAND. 
 
 From this follows — 
 
 1. That the number of leprous patients on Iceland is at 
 least three times as great as heretofore presumed. That the 
 real number is far, far greater than that which I have found 
 is a matter of course. My journey has been a mere journe}" 
 of reconnoitring; going about in pursuit of patients was out 
 of the question on account of the enormous distances. I was 
 obliged to confine myself to examine those patients who 
 presented themselves, and in some cases I had to ask my 
 way from farm to farm. That in some places the patients 
 shunned me is a fact ; this was, for instance, particularly the 
 case in the province of Bardestrand, where it is considered 
 a disgi'ace to be leprous, and where the disease is looked 
 upon as infectious. This, again, is the consequence of there 
 being provinces (Dala, Myra, East and West Skaptafell) 
 where I have not set foot, and with regard to which I have 
 been obliged to be content either with the official numbers 
 (Dala, Myra), or I have only counted those patients who did 
 not shun the journey of three to four days to meet me in the 
 neighbouring province (the provinces of Skaptafell). Finally 
 it is due to the circumstance that I scarcely saw any cases of 
 the disease but those strongly marked, those of which there 
 could no longer be any doubt. So in iniy enurtieraiion nearly 
 all the beginning cases of the disease are wanting. 
 
 2. That the relation between the tuberous, the amesthetic, 
 and the mixed form is about the same on Iceland as in other 
 countries. In the enumerations of the clergymen the anaes- 
 thetic forms (Icelandic, Limafallssyki) have hitherto mostly 
 been left unnoticed, as the circular which the head physician 
 has sent round does not require informations, except of the 
 tuberous forms (Icelandic, Holdsveiki). 
 
 3. While in certain districts of the country the disease 
 is on the decline, as is especially the case in the whole of 
 the west country, where formerly leprosy was enormously 
 wide-spread, it is just as sure that in the ^provinces of Bangar- 
 valla and Ofjord it is on the increase. I must particularly 
 direct the attention to the last-mentioned ''fjord '^ as the most 
 dangerous seat for the leprosy. The western coast (the pro- 
 vince of Ofjord) has in my enumerations twenty-five patients, 
 and the eastern coast of the fjord has nine patients (the pro-
 
 EVIDENCE AS TO PEESENT PREVALENCE. 
 
 167 
 
 vince of Thmgo)^ which makes altogether thirty- five patients 
 on both sides of the '^ fjord. '^ These cases are dispersed in 
 small foci in Olufsfjord, Svarfadardal, GrytuhakTce, and round 
 about Akureyri, which gives evidence to the local epidemic 
 character of the disease. 
 
 Most of the cases I observed about Ofjord were only- 
 some years old. As to the point of time at which my now 
 living patients in these two districts have been attacked by 
 the disease, the state of the matter is this : 
 
 he province of 
 
 Province of 
 
 The patients were 
 
 Rangarvalla. 
 
 Ofjord-Thingo. 
 
 attacked 
 
 3 
 
 
 
 before the year 1 88o. 
 
 o 
 
 I 
 
 in , 
 
 i88o. 
 
 o 
 
 O 
 
 ,, , 
 
 i88i. 
 
 I 
 
 2 
 
 ,, , 
 
 1882. 
 
 I 
 
 I 
 
 ,, , 
 
 , 1883. 
 
 3 
 
 3 
 
 !, > 
 
 1884. 
 
 I 
 
 I 
 
 »> ) 
 
 , 1885. 
 
 o 
 
 I 
 
 )> ) 
 
 1886. 
 
 o 
 
 o 
 
 ,, , 
 
 1887. 
 
 I 
 
 2 
 
 ,, , 
 
 1888. 
 
 2 
 
 3 
 
 »! » 
 
 1889. 
 
 3 
 
 3 
 
 „ . 
 
 , 1890. 
 
 I 
 
 4 
 
 )) ) 
 
 1891. 
 
 o 
 
 6 
 
 J> 5 
 
 1892. 
 
 4 
 
 6 
 
 J> > 
 
 , 1893- 
 
 I 
 
 I 
 
 9) > 
 
 1894. 
 
 34 
 
 This survey tells its own story : if one would have a trust- 
 worthy picture of the movement of the disease, one must 
 needs have trustworthy lists of mortality ; but as things are, 
 such ones are not to be procured. While in other places, in 
 Isafjord, for instance, our consultations were actually be- 
 sieged by healthy children (in Isafjord 40 — 50) of diseased 
 leprous parents, there was in Ofjord at the very utmost a 
 dozen children present — the best evidence that the increase 
 of the disease is not more than one generation old. 
 
 East of 30° of longitude I have only met with two 
 patients, one in Seydisfjord, the other in Bjarnarnses at 
 Hornafjord. Both these patients had immigrated from the 
 Eastland, and they also acquired their illness there. The
 
 168 EHLEES ON LEPROSY IN ICELAND. 
 
 constantly increasing traffic between the provinces, as well as 
 the great traffic between the Faroe Islands and the eastern 
 coast of Iceland, make these circumstances very critical. Of 
 course one single case is sufficient to rouse a local epidemic. 
 
 Since the four miserable hospitals for leprosy on Iceland 
 were abolished, according to the bill of the justice depart- 
 ment of August 23rd, 1848, literally nothing has been done 
 against this dreadful disease. The lepers were by this 
 arrangement deprived of their tending and maintenance, and 
 afterwards they have been left to take care of themselves 
 and given up to the care of the pauperism. After a couple 
 of years, the patients who suffer from this generally incurable 
 disease, without any means to earn their own living, fall to 
 the pauperism, and then they are sent to some private farm for 
 a payment which varies from 70 to 150 kroner a year (four 
 to eight £ sterl.). For this sum, which necessarily is quite 
 insufficient, and which is only accepted because the popula- 
 tion want ready money, the people concerned keep him only 
 about a year. When it appears that it will not answer keep- 
 ing him any longer, he is sent to another house, and thus 
 the infection creeps from farm to farm. While nearly all 
 my colleagues on Iceland are zealous contagionists, the 
 opinion of the population differs very much : in those districts 
 where the disease is on the decline it is considered contagious 
 and inheritable ; in those districts where it is on the increase 
 the population appears to be thoughtless in the presence of 
 the imminent peril. 
 
 So this disease, which one almost considers as prehistoric, 
 can strike root there where Hansen's bacillus refinds its 
 favourite soil of uncleanliness, bad nourishment, andfilthiness, 
 under hygienic circumstances which have not altered in many 
 respects since the Middle Ages. 
 
 I shall now describe a little further the poor Icelander's 
 mode of living, and the observations I have made as to 
 the evidence of infection. With regard to any more 
 details than I have space to give here I am obliged to 
 direct the reader's attention to the masterly observations of 
 Schleisner.^ 
 
 The Habitation. — The Icelandic habitation is in its typical 
 ' • Iceland from a Medical Point of Yiew,' Copenhagen, 1847.
 
 THE Icelander's home. 169 
 
 form a sod-hut of green turf. It is built without a founda- 
 tion, resting upon some large stones or the bare ground. 
 The farm consists of four or five huts, of which each makes 
 one room ; one hut is crammed closely against the other, and 
 all the fa9ades face the road. The front is covered with a 
 thin layer of boards, some few of the rooms are boarded, and 
 from the boards drips the moisture in big drops, even in fine 
 weather, for the sod absorbs the dampness like a sponge. 
 When we had been out in the rain our clothes could never 
 be dried in the interior of these houses. In the facade there 
 are some few windows, which are all, however, nailed up for 
 fear of the winter cold, so that the rooms are only and entirely 
 ventilated through the T-shaped passage which connects 
 each of the rooms with the air outside, but the passage 
 itself is dark and narrow. For the Icelanders are still proved 
 to be on that low hygienic point of civilisation which holds 
 the fresh air to be a more ruinous enemy than the corrupted 
 air. One of the rooms always serves as a separate bedroom 
 for the peasant and his wife ; but ivith the poor this room is 
 dropped, and all the people of the farm — men, women, and 
 children — sleep in the same room, the so-called " Badstofa'^ 
 (bath-room). In this room every one at the farm lives during 
 the long rainy days and the long winter evenings ; here the 
 meals are eaten, generally in bed, for there are no tables. At 
 the utmost they have a couple of boxes which you can sit 
 on. The Badstofa has six to eight fixed bedsteads, or rather 
 large wooden boxes, each box intended for two or three 
 persons, who usually sleep head against feet and feet against 
 head. 
 
 If you enter this Badstofa when thirteen to fourteen persons 
 lie sleeping there, first of all you feel a temperature which cer- 
 tainly both summer and winter reminds you of the tepidarium 
 of a Roman bath, but surely here the likeness ceases. A 
 suffocating stink and an unwholesome smell meets you. It 
 is the smell of the mouldy hay, of the sheepskin quilts that 
 are never dried or aired ; it is the smell of the dirt which is 
 dragged into the house on the clumsy Icelandic skin shoes that 
 want double soles, and are quite unqualified to keep out the 
 dampness. In this dirt a confused mixture of cats, dogs, and 
 children lie reeking on the floor, exchanging caresses and
 
 170 EHLERS ON LEPROSY IN ICELAND. 
 
 echinococci ; it is tlie smell of tlie wet stockings and the 
 woollen sliirts which hang to dry next to a slice of dried 
 halibut (" Eekling ") or the dried cod's head — this dreadful 
 irrational favourite dish, for which the Icelander pays four 
 kroner (4s. 6d.) a hundred. And if you poke yournose into 
 the corners of the Badstofa, you will find a bucket in which 
 the urine of the whole party is gathered ; it is considered 
 good for wool-washing. 
 
 I shall never succeed in picturing all the details of such 
 an interior, which, in addition, you may imagine as being 
 heated in the winter, at the places where they have no turfs, 
 with the sheep's dried excrements, a kind of fuel which 
 spreads a penetrating smell of nitre and burnt wool. 
 
 One must have seen and smelt it all to be able to under- 
 stand that the leprous disease is due neither to the rancid 
 butter nor to the dry fish. Just as well as rousing accusations 
 against these articles of food which certain leprologists do, 
 one might complain of the want of brooms to sweep the floor 
 with, or insist that the leprosy is owing to the want of window- 
 hooks, or to the stagnant water they drink. It is neither one 
 nor the other of these moments, but the whole ensemble ; it is 
 the absolute want of cleanliness plus Armauer Hansen's 
 bacillus, which in such an interior finds its true paradise. 
 
 The Nourishment. — The adherents of the theory of the 
 rancid butter and the rancid oil as the causes of the leprosy 
 must not imagine that a house where they prefer or are content 
 with the rancid butter is more careful with the other arti- 
 cles of food. The rancid butter or oil is only a symptom of 
 the general filthiness which manures the soil in which the 
 disease thrives. And then the poor fishes : the adherents 
 of the theory of the fat fish will, no doubt, be content to 
 hear that on Iceland it is especially the inhabitants of the 
 coast who are affected with leprosy. But the explanation 
 of this is quite simple, the interior of the island being almost 
 uninhabited and uninhabitable, and covered with glaciers. 
 Also on Iceland they know the tradition about the leprous 
 disease being due to far too exclusive an eating of fat fish. 
 In Gullbringe it was the halibut, round the Lake of Thing- 
 valla it was the trout which was accused of causing this 
 horrible disease. It is a well-known fact that too mono-
 
 THE Icelander's food. 171 
 
 tonous a diet breaks down the resisting power of tlie 
 organism as to diseases of every kind, but it can never 
 create a specific and infectious disease. We also notice 
 that the leprous disease has decreased considerably in the 
 province of GuUbringe, and it has almost disappeared round 
 the Lake of Thingvalla (I only found one single patient in 
 this district). But it still teems with halibut and trout. 
 All these theories may soon befittingly be buried beside 
 that of Hjaltelin, who believed that the decrease of the leprous 
 disease in Iceland was owing to the introduction of the 
 potato. He considered the leprous disease as being founded 
 upon the want of potassic salts in the blood. At the present 
 time the potato has found its way to most of the Icelanders' 
 tables, but unfortunately the leprous disease is on the 
 increase. Is now this, may be, the potato's fault ? 
 
 The essential nourishment of the Icelanders consists of 
 dried fish, which is eaten cold with rancid butter ; they even 
 prefer the rancid butter that is kept for years, and to which 
 the poor add a little (train) oil of whales or seals. The 
 sour milk which they call " Skjr" forms a conspicuous part 
 of their food, and can likewise be kept for years. Bread is 
 a rare food, and does not form a prominent part, as Iceland 
 does not produce any corn itself. The bread is prepared 
 without any yeast or leaven, generally under the form of pan- 
 cakes. That meat which bears the prominent part is the 
 rfiutton, which is eaten new-killed in the months of Sep- 
 tember and October ; smoked, salted, or preserved during 
 the other months of the years. The Icelandic mode of 
 cooking is almost destitute of salts, spices, and vegetables. As 
 the chief grievance of their living the scarcity of carbonic 
 hydrates must undoubtedly be stated. But the want of 
 carbonic hydrates only does certainly not cause leprosy. 
 
 The Leprous Disease is an Infectious Disease. 
 
 Is it really necessary in our day to heap proof upon 
 proof of this simple fact before it prevails ? Why, we 
 have seen the heroic Pater Daraien die at the hospital for 
 lepers on Molokai. We know the grafting which Dr.
 
 172 EHLERS ON LEPROSY IN ICELAND. 
 
 Arning from Hamburgh undertook on a criminal sentenced 
 to death from the Sandwich Islands ; his name was Keanu. 
 This criminal became two years after attacked by leprosy, 
 which started at the point of inoculation. Certainly Dr. 
 Swift insists that this last proof is not perfectly valid, as 
 the son, the nephew, and the cousin of the experimental 
 object were all leprous. The late Dr. Danielssen made in 
 1844, 1846, 1856, and 1858 repeated inoculations" on him- 
 self and upon several of the hospital nurses, inoculations 
 which all remained resultless. Profeta has made similar ex- 
 periments, and always with negative results. However, all 
 these negative results do not, of course, prove so much as 
 one positive result. How often does it not happen that the 
 plain vaccination fails for us ? Let us, opposite to these 
 negative results, place Gairdner's two children,'^ who became 
 leprous by the vaccination. Onetti has also observed a case 
 of leprosy transmitted by the vaccination.^ Ortmann and 
 Melcher^ have perhaps inoculated leprosy in rabbits. 
 
 And there are not a few clinical proofs of infection. 
 Johannes Petersen, an Icelandic physician from the eigh- 
 teenth century, quotes as an instance a peasant who became 
 leprous by weariug another patient's boots. At the present 
 times, Hawtrey Benson^ (from Dublin) has in 1872 presented 
 a man who had never left Ireland, but who, after having 
 used his brother's clothes, became leprous, and died from his 
 illness. He had contracted the leprosy in the East Indies, 
 and brought it home to his native country. Small epidemics 
 have been noticed in Cape Breton^ and in Louisiaua,^ which 
 with greater precision point at contagion. And Halm^ cites 
 a case where a nun-nurse became leprous by pricking her 
 
 ^ 'Archives of Dermat. and Syphilis,' 21 Ergiinzungshefte, No. 9. 
 
 ^ ' A Commemorative Writing at the Fifty Years' Jubilee of Daniels- 
 sen/ Bergen, 1891, p. 15. 
 
 ^ 'British Medical Journal,' June nth, 18S7. 
 
 ^ ' Gazzetta medica di Milano,' 1846 (cited from Leloir). 
 
 ' 'Berl. klin. Wochenschr.,' 1885, No. 13. 
 
 * ' Dublin Journal of Medical Science,' Jime, 1877. 
 
 ^ ' Canadian Journal of Medical Sciences,' September, 1881 (cit. from 
 Leloir). 
 
 ^ ' Annales de Dermat.,' November 25th, 1S85. 
 
 ' ' These de Nancy,' 1882 (cit. from Besnier).
 
 EVIDENCE AS TO CONTAGION. 173 
 
 finger when she was patching the clothes of a leprous patient. 
 Our Norwegian colleagues, who have always distinguished 
 themselves in the first rank among those who have studied 
 this dreadful scourge of their country, Drs. Armauer 
 Hansen and Kaurin, as well as Leloir, who visited the leper 
 asylums in Norway, quote numei'ous instances,^ which leave 
 no room for doubt as to the possibility of contagiousness. I 
 have lately received a small very instructive essay by 
 Loi'and (Carlsbad)," in which are collected some hitherto 
 unpublished observations of our Swedish colleagues, 
 Langgren, Stappelmohr, Oehrn, and Sederholm. These 
 physicians, who live in close relations with lepers, are out- 
 spoken adherents of the theory of contagiousness, quite as 
 are our Icelandic colleagues. 
 
 My personal researches have given the following result. 
 
 I have classified the 102 patients whom I have examined 
 myself into two groups : 
 
 1. Patients in whose family cases of leprosy /mre occurred 
 (fifty-one patients). 
 
 2. Patients in whose family cases of leprosy have never 
 occurred (fifty-one patients). 
 
 To be able to understand the significance of these infor- 
 mations, one must know that most of the Icelanders possess 
 exact genealogical tables of lineage, which even permit some 
 of them to trace their descent back to 874, to the first 
 colonists. 
 
 I should feel inclined to believe that nowhere else an 
 examiner could produce any so reliable and complete 
 material for etiological and epidemiological examinations as 
 in Iceland. Besides, I must add that the majority of my 
 patients have proved to be very stationary with regard to 
 their residence. There are, may be, a dozen persons who 
 have left, for a shorter or longer time, the district where 
 they were born ; but the greater part of the Icelanders are 
 born, live, and die in the same parish, a circumstance which 
 is peculiarly favourable for epidemiological researches, so 
 that the aetiology of leprosy would be quite clear were it not 
 
 ' ' Norsk Magasiu for Lasgevidenskaben/ diflferent years ; and Leloir, 
 ' Traite de la Lopre,' Paris, 1886. 
 
 " ' Wiener med. Wochenschr.,' 1894, Nos. 26 to 28.
 
 174 EHLERS OX LEPROSV IN ICELAND. 
 
 foi* this confounded period of incubation, the duration of 
 which is utterly unknown, which we have to combat with. 
 And, histly, I must add that as a rule my patients have 
 enjoyed perfectly good health before the leprous disease 
 broke out with them. 
 
 First Group. 
 
 Cases of leprosy in the family (fifty-one patients). 
 
 A. Father and mother both leprous. 
 
 This group comprises three patients. With all the three 
 persons concerned the leprous disease did not break out 
 until a very long time after the children's birth ; and the 
 chances are here that these cases are those of contagion 
 rather than of heredity, ail the patients having brothers and 
 sisters who have remained perfectly sound. 
 
 No. 56. A boy of eleven with lepra maculosa — was not 
 known to be affected. Is a son of my patients Nos. 54 and 
 55. No. 54, the mother, has lepra ansesthetica, probably 
 five or six years old. 
 
 No. 55, the father, has been tuberous for eight years. 
 During the first two years of his life the boy shared the bed 
 of his parents, but not afterwards. He has a half-sister and 
 a half-brother, who are both sound. 
 
 No. 64. A member of the family at Sydrigrof, which 
 place he left only three years ago (this family will be 
 mentioned later on). He is a man of twenty-eight, with 
 lepra mixta six years old. The father died eight years ago 
 from leprosy after eight years of illness. The mother is my 
 patient No. 26, who suffers from anaesthetic leprosy ; she 
 has been ill for nine years. The other brothers and sisters 
 will be mentioned under No. 26. 
 
 No. 25. A sister of the above-mentioned ; she has lepra 
 mixta eleven years old. 
 
 B I. The father only leprous {fourteen patients) . 
 
 Also here the question is about cases where the parents 
 became leprous after the children's birth. 
 
 No. 2. Man of thirty-one, lepra tuberosa two and a 
 half years old. The patient's father, fifty-five years of age
 
 FAMILY PREVALENCE. 175 
 
 (No. lo), has during six years been suffering from tuberous 
 leprosy. 
 
 No. 3. Man of forty-three, lepra tuberosa eight years 
 old. The patient's father died fifteen years ago from lepra 
 tuberosa. During five (5) generations a man of his family 
 has been leprous. 
 
 No. 17. Man of thirty, with lepra mixta five years old. 
 The father died fifteen years ago from L. tuberosa. 
 
 No. 18. Woman of forty-two, with L. angesthetica three 
 years old. The father died sixteen to seventeen years ago, 
 after five or six years of illness from L. tuberosa. A sister 
 died from L. tuberosa in 1892. 
 
 No. 28. Man of eighteen, L. tuberosa ten years old. The 
 father died twelve years ago after two years of illness from 
 L. tuberosa. He is thovght to have infected the son, who was 
 then four years old. 
 
 No. 31. Woman of fifteen, L. mixta four years old. A 
 sister of above-mentioned No. 28, hy whom she has probably 
 been infected. Four other sisters and brothers are alive and 
 in good health. 
 
 No. 35. Man of twenty-one, L. tuberosa one and a half 
 years old. The father died eleven years ago from L. tube- 
 rosa after two years of illness. 
 
 No. 42. Man of forty-one, L. aneesthetica seven weeks old. 
 The father died forty years ago fi'om L. anaesthetica. 
 
 No. 48, Man of sixty-four, L. anaesthetica six years old. 
 The father died sixty years ago from L. anaesthetica. 
 
 The Family Einarsson. 
 
 No. 59. Woman of forty, L. anaesthetica seven years old. 
 
 No. 60. Woman of twenty-six, L. tuberosa seven years old. 
 
 No. 61. Woman of thirty-six, L. angesthetica ten years old. 
 
 No. 62. Man of twenty -nine, L. angesthetica mixta nine 
 years old. 
 
 These four are sisters and brother, besides one sister of 
 thirty-five, not examined ; she has been suffering from 
 tuberous leprosy for twelve years. These five children's 
 father, Einar J — , died nine to ten years ago, sixty years 
 old, of L. tuberosa. His sister's daughter was leprous. 
 Besides the above-mentioned five, there are, out of eleven
 
 176 EHLERS ON LEPROSY IN ICELAND. 
 
 sisters and brothers, yet two other healthy sisters alive, who 
 left their home quite early, before the outbreak of the 
 father's illness, one in her second year of life (she has 
 never since visited her parents), the other in her sixth year 
 of life. The Jive above-mentioned sisters and brothers, who 
 did not break off the connection, have all become lepers. 
 
 No. 96. The patient has most probably been infected in 
 marriage. Man of fifty-eight, L. ansesthetica twelve years old. 
 The patient's father was leprous, but died two years after 
 the son's birth. The patient's wife died fourteen years ago 
 from L. tubei'osa, after thirteen years of marriage, eight to 
 nine years of illness. Two years after her death the disease 
 broke out with the patient. 
 
 B 2. Only the mother leprous (4 patients). 
 
 Also here the mothers have become leprous after the 
 birth of the children. 
 
 No. 24. Man of thirty-two, L. tuberosa eight to nine 
 years old. The mother died nine years ago after two years of 
 L. tuberosa. Out of thirteen children five have died as 
 babies, eight are alive, and patient only ill. 
 
 No. 44. Man of thirty-seven, L. tuberosa four years old. 
 The mother, who is seventy-one years old, lives and has kept 
 her bed during nine years, suffering from L. tuberosa. A 
 sister of No. 44 died five years ago after two years of 
 L. tuberosa. 
 
 No. 75. Man of twenty-five, L. mixta three years old. 
 The mother died twenty-one years ago of L. tuberosa. One 
 brother died at the age of twenty-eight, seven years ago, 
 after having suffered for four yeai's from L. tuberosa. 
 
 No. 76. Boy of nine, L. maculosa ; outset uncertain. The 
 son of No. 77, who has L. tuberosa. The father has only an 
 ordinary psoriasis. There have been six brothers and sisters, 
 two of whom have died from children's diseases, four are 
 alive, the youngest is eleven weeks old and is nursed by 
 his mother, No. 77, who suffers from a strong tub erculo- ulce- 
 rative leprosy. The two midmost children do not ail anything. 
 
 I particularly call the attention to this case, because it 
 so strikingly shows that leprous women may give birth to 
 healthy children even at the terminal stage of their illness, a 
 fact which does not exactly speak in favour of the theorj
 
 FAMILY PREVALENCE. 177 
 
 of heredity, though, on the other hand, it does not absohitely 
 contradict it. But this observation cries loudly about the 
 filthiness which thrives in leprous houses. 
 
 C. Father and mother not leprous, hut leprous brothers 
 and sisters ; nineteen patients. 
 
 In most of these cases such patients are concerned who 
 have been infected by their brothers and sisters. It is a 
 matter of course that the danger of infection is nowhere so 
 great as in the intimacy of home life, and naturally the younger 
 children will have to suffer. Of two of my patients it is 
 kuown for certain that for a long time they have shared the 
 bed of lepers ; a third patient has lived for several years 
 under one roof with a leper. 
 
 No. 7. Woman of 46, L. tuberosa. The patient^s eldest 
 brother died in 1887 from L. tuberosa, which had lasted for 
 eight years (1879 — 1887). They were together until her 
 thirteenth year (he was then twenty-one), but he was not 
 attacked before he was almost forty. 
 
 No. 27. Man of 52, L. anjBsthetica twenty-two years old. 
 A half-brother died ten years ago, fifty years old, from L. 
 anaesthetica. The patient has during about three months 
 slept tvith a patient suffering from L. tuberosa, three to four 
 years before the outbreak of his own disease. 
 
 No. 34. Woman of 59, L. mixta two years old. Two 
 sisters both died from leprosy : one, whose age she does not 
 remember, died ten or twelve years ago ; the other, forty years 
 old, two or three years ago. If she has been infected by them, 
 she can only think it being because she kissed them when slie 
 'met with them. 
 
 No. 38. Woman of 26, L. tuberosa three years old. A 
 sister of No. 34 lived until the age of twenty in Holtaman- 
 narhepp, the district in Rangarvalla where leprosy has spread 
 very much during the last ten years. The farm where she 
 lived 10 as frequently visited by lepers. 
 
 No. 39. Woman of 60, L. tuberosa twelve to thirteen 
 years old. A sister of 50 died three to four years ago after 
 two to three years of illness, several days^ journey from the 
 patient's residence. 
 
 No. 40. Man of 35, L. tuberosa (look under No. 41). 
 
 No. 43. Woman of 22, L. angesthetica since October, 1893. 
 
 12
 
 178 EHLERS ON LEPROSY IN ICELAND. 
 
 A half-bi'otlier died iu the summer, 1883, thirty-uiue 3'ears 
 old, after ten years of L. tuberosa. He stayed till his death 
 at the same farm as the patient. 
 
 No. 45. Woman of 63, L. an^esthetica, began thirty- 
 three yeai's ago. The disease broke out with her before 
 either of her two brothers Avho died from L. tuberosa. A 
 brother of 42 died, twenty years' illness. Four brothers 
 and sisters out of sixteen live beside the patient, and they 
 are all well. 
 
 No. 55. Man of 37, L. tuberosa, eight years old ; his 
 grandmother's sister and her daughter have had leprosy. 
 A sister died in the year 1894 from leprosy after three to 
 four years' illness ; she lived in the same parish. The 
 patient himself slept one winter, twenty years ago, together 
 with a leprous patient. 
 
 No. 58. Man of 45, L. mixta, five years old. The 
 patient's father died from leprosy. A brother, older by one 
 year, died twelve years ago from the measles with L. tuberosa ; 
 he had been ill for four years : he lived in the same parish. A 
 half-brother died seventeen years ago in the same parish, 
 after eight years of L. tuberosa. 
 
 No. 68. Woman of 53, L. tuberosa mixta, thirty-five 
 years old. A sister died thirty-five years ago in her nine- 
 teenth year from L. tuberosa, another one forty years 
 ago in her thirtieth year from the same disease. The patient 
 herself was together ivith these sisters at their i:)arents' till 
 her tiventy -sixth year. 
 
 No. 73. Woman ofc' 64, L. tuberosa mixta, two years old. 
 Her father's sister and this latter's two children were leprous. 
 The patient's sister of sixty-nine is suffering from six years' 
 advanced L. tuberosa at the terminal stadium ; the patient 
 has constantly kept company with this sister, who lives in a 
 neighbouring farm. The patient has two daughters, one 
 married and w^ell, the other married to No. 74 (L. anaes- 
 thetica) . 
 
 No. 78. Man of 53, L. tuberosa, five years old. A half- 
 sister, who lived close by, died seven and a half years ago 
 from L. tuberosa, after seven to eight years' illness. 
 
 No. 82. Man of 40, L. tuberosa, one year old. A sister of 
 thirty to forty died five years ago from leprosy ; they kept
 
 FAMILY PEE VALENCE. 179 
 
 company, but not intimately. Four years ago the 'patient 
 lodged a lej'rous yawper for a year in his farm {for 60 kroner 
 — £3 IS. 2d., the lowest price I ever heard of in Iceland). 
 
 No. 86. Woman of 31, L, tuberosa, two years old. A 
 sister of No. 88. 
 
 No. 88. Man of 30, L. tuberosa, one year old. Brother of 
 No. 86 ; has lived in the same farm as she, who became ill a 
 year before. 
 
 No. 90. Woman of 38, L. mixta, ten years old. A half- 
 brother died half a year ago after six years^ illness about 
 forty years of age. They were together one winter, but the 
 patient No. 90 was then already attacked. A half-sister 
 suffers from L. anaesthetica (No. 92), but she too was 
 attacked before. 
 
 No. 92. Woman of 53, L. anaesthetica, ten years old. A 
 half-sister of the above-mentioned No. 90 ; she has lived at 
 a farm together with a widow who died at the farm from 
 L. tuberosa. 
 
 D. The parents not leprous, hut a remoter relation ; eleven 
 patients. 
 
 No. I. Man of 33, L. tuberosa since May, 1894. The 
 patient's father's father became leprous at a more advanced 
 age. 
 
 No. 13. Man of 46, L. anaesthetica twenty-three years 
 old. At least three generations backward there has been a 
 great deal of lepers, but neither parents nor grandparents 
 were leprous. 
 
 No. 15. Woman of 30, L. mixta fifteen years old. Her 
 mother's brother died five years before the patient's birth 
 from L. tuberosa ; two daughter's sons of another of her 
 mother's brothei-s have died from leprosy. 
 
 No. 23. Woman of 34, L. tuberosa three years old. 
 Her father's brother was leprous ; he is now dead, and did 
 not live at the same farm. At the neighbouring farm lived 
 a leprous patient with whom she denies to have had any 
 intercourse. Dr. G. Gudmundsson, on the other hand, 
 says that she has had a leprous man-servant at her farm 
 for about a year. The lepers conceal such points, lest they 
 shall rouse the inhabitants' apprehension of having any com- 
 munion with them. This woman came to me on horseback
 
 180 EHLERS ON LEPEOSY TN ICELAND. 
 
 accompanied by a dead-drunk attendant. Need I to add 
 that they both employed the same pocket flask with brandy, 
 regardless of the large ulcerated lepromata in the woman's 
 throat; on her lips, and on her tongue. 
 
 No. 30. Man of 37, L. tuberosa mixta five years old. 
 His mother's brother died from leprosy. 
 
 No. 47. Woman of 67, L. anaesthetica forty-five years 
 old. She has two leprous nephews, one of whom is dead, 
 the other (No. 40) is alive. 
 
 No. 72. Woman of 30, L. tuberosa. Her father's mother 
 died from leprosy. Her own disease began last year hardly 
 one year ago, and for more than one year she has served at a 
 farm where a tuberous leprous patient, a sister of No. 73, 
 and mother-in-law of No. 74, lives. The patient lies in the 
 same " Badstofa" (room), next to the leprous patient. We 
 are informed that until four years ago one of the children 
 at the farm shared the bed of the leper for one year and a 
 half. 
 
 No. 74. Man of 40, L. angesthetica. His mother's 
 brother has been leprous, but he has never known him. 
 His mother-in-law is leprous (No. 73), and the sister of his 
 mother-in-law, being also leprous, was frequently together 
 with him, and became ill before him,, but they did not live at 
 the same farm. 
 
 No. 83. Man of 32, L. anaesthetica mixta three and a 
 half years old. His father's brother died from leprosy 
 before the patient was born. 
 
 No. 84. Woman of 37, L. tuberosa two years old. Her 
 father's brother, who died nine years ago, was leprous, but 
 she did not live together with him. Her late husband's 
 brother's son suffers from L. tuberosa. 
 
 No. 87. Woman of 34, L. tuberosa three years old. Her 
 father's brother died from leprosy many years ago. A 
 brother of 20 died two years ago from leprosy after six 
 years of illness. He rambled about to different places in 
 the district ; the last year of his life he lived at the patient's 
 farm.
 
 OASES WITHOUT FAMILY PREVALENCE. 181 
 
 Second Group. 
 
 No cases of le])rosy in the family ; fifty-one 'patients. 
 
 Again I call attention to the fact that these negative 
 informations are most likely as reliable as is altogether 
 possible to pi'ocure them. Most of the Icelanders keep^ as 
 before mentioned, genealogical records. What are they to 
 do during the long winter evenings ? Again and again it 
 happened at the consultations that the genealogical tables 
 were fetched out of the pocket, and that the patients 
 referred to them and gave us information from them. 
 There is, therefore, hardly any other examiner who has 
 disposed of a material as trustworthy as mine, which appears 
 from such details as those I have already stated, where, for 
 instance, a patient is able to tell us that in five generations 
 of his family one man has been leprous. 
 
 A. No leprosy in the family, neither can any contagion 
 he stated; thirty -three patients. 
 
 For regularity's sake I cite their running numbers, but 
 considering the space I give no further information. The 
 minute histories of the diseases shall be published later 
 with the same running numbers. 
 
 Eunning numbers : 4, 5, 8, 9, 10, 11, 14, 16, ig, 20, 29, 
 46, 50.' 51. 53. 57; 63, 65, 66, 69, 70, 77, 79, 81, 85, 89, 93, 
 94. 95. 97. ioo> ioi> 102. 
 
 B. No leprosy in the family, the patient probably infected 
 by marriage ; two patients. 
 
 (Besides there is one case without a number, which 
 belongs to this : it is due to oral communication, and further 
 the stories No. 41 and 52, in which the patients have been 
 infected in concubinage without marriage, and No. 96 who 
 is included in the first group.) 
 
 The Family at Sydrigrof. 
 
 No. 26. Widow of 54 ; the mother of this family, L. 
 ansesthetica nine years old. The patient herself was 
 perfectly well until in 1885 she was affected by the disease. 
 She was married in 1859-60: 1878, after eighteen years of 
 married life, her husband became leprous and died in 1886, 
 fifty-seven years old. The husband's grandfather, whom he 
 had never seen or known, was leprous ; on the other hand.
 
 182 EHLERS ON LEPROSY IN ICELAND. 
 
 his father was not; but his blind brother, who died in 1870, 
 was leprous, and accompanied his brother (the husband of 
 No. 26) all over. The parents of No. 26 were healthy ; 
 they had only two childi'en ; the other sister is alive and 
 sound. The patient has had eleven children, out of whom 
 three, the midmost of the lot, died as babies. The youngest 
 child was born in 1879, the year after the outbreak of the 
 father's leprosy ; he was examined by me ; he was now fifteen 
 years old. He suffered from fainting fits, angemia, his eye- 
 brows had fallen off, but there was no angesthesia nor other 
 signs of leprosy. Two other sons and two daughters were 
 examined by me, among those the youngest but one, a son 
 of nineteen ; they did not ail anything. Two other sons 
 were absent ; afterwards I met No. 64, who three years ago 
 left his parents' house, and who now suffered from L. mixta 
 six years old. A daughter of thirty-one (No. 25), who lived 
 at another farm as a pauper, suffered from L. mixta eleven 
 years old. 
 
 No. 54. Fifty-three years old, suffers from L. ansesthetica 
 and is married to peasant No. 55, who suffers from L. tuberosa. 
 She does not know that she is ill, still she remembers that 
 five to six years ago she suffered from giddiness and 
 shivering fits. The gout, which had plagued her head, 
 wrist, and arms during twenty to thirty years, grew worse. 
 Scarcely one year ago she had an itching* eruption 011 her 
 arms after having washed her husband's clothes; when she 
 scratched it she observed on her left a,Ym,just above the wrist 
 on the ulnar side, an ansesthetic patch of the size of a child's 
 palm. In this patch there is analgesia up to 250 
 (Friedenreich's angesthesiomefcer), but no anaesthesia. The 
 skin is, in one half of the speck, rugged, erythematous. 
 The hair is falling off, and there is a beginning contraction 
 of both the small fingers (without inspissations of fascia 
 palmaris), but otherwise no signs of leprosy. No sensible 
 inspissation of the ulnar nerve on the left arm. 
 
 Without a number. — Woman married to my patient 
 No. 95, who is a man of 46 with L. mixta. During five 
 years the woman has been suffering from neuralgia in the 
 whole of her body, and she has anaesthetic specks on her 
 thighs (not examined).
 
 CASES WITHOUT FAMILY PREVALENCE. 183 
 
 C. No leiirosy in the family, prohahly infection; sixteen 
 j)atients (plus one 23Citient witJiout a number). 
 
 No. 6. Man of 36, L. tuberosa five years old. He 
 has had leprous associates. 
 
 No. 12. Mau of 51, L. aiifesthetica ten years old. Has 
 daring his youth kept companj^ with many leprous people. 
 
 No. 21. Woman of 31^ L. tuberosa five years old. She 
 has for one year served at a farm where a leper lived in the 
 terminal stacje of the disease ; he died the folloiving year. 
 
 No. 22. Woman of 24, L. tuberosa four years old. In 
 1884 a leprous fisherman stayed at the farm where she was 
 in the fishing season. Besides, a leprous patient whom she 
 served frequently came there. 
 
 No. 29. Man of 63, L. tuberosa ten years old. Lepers 
 have often stayed the night over at this farm ; he is the 
 richest farmer of the parish, and consequently is very much 
 visited by people. 
 
 No. 32. Man of fifty, L. tuberosa ten to twelve years old. 
 Lived for a couple of years together with a lep)rous patient at 
 the same farm. 
 
 No. 33. Woman of 31, L. tuberosa six years old. For 
 about one year she shared the bed of a leprous patient, and 
 during this time she went through a cure for the itch. 
 
 No. 36. Mau of 56, L. tuberosa mixta four years old. 
 When fifteen years old he served together with a leprous 
 boy. 
 
 No. 41. Woman of 34, L. tuberosa half a year old. Lives 
 together with patient No. 40, and belongs to : 
 
 The Family at Moshvol in Rangarvalla. 
 
 The family at Moshvol consisted of three brothers, one 
 of whom (he seems to have dragged the infection into the 
 family) died last winter of L. mutilans. He was fifty years 
 old, and had been ill for ten years. This brother travelled 
 about twenty-five years ago together with a leprous patient, 
 slept in the same bed as he, and is supposed to have been 
 infected by him. The other brother (No. 40) is suffering- 
 from fresh L. tuberosa. The third brother, with whom No. 
 41 lives together, is not yet affected, though. The brothers' 
 mother's sister (No. 47) is sixty-seven years of age ; she
 
 184- EHLERS OX LEPROSY IX If'ELAXD. 
 
 lives at a more distant farm and suffers from L. anaes- 
 thetica, which lias lasted for forty-five years. For the rest 
 there is no leprosy in the family. The father of these three 
 brothers died in the winter 1893—4 at the age of eighty! 
 The mother is alive and sound, eighty-five years old. 
 
 The day after the death of the above-mentioned brother, 
 Dr. Olafr Gudmundsson was sent for to No. 41 to deliver 
 her (she suffered from narrowness of the pelvis) of the third 
 illegitimate child with the brother who is not leprous. The 
 woman in labour lay m the same heel icith the same bedclothes 
 wJiich the leprous corpse had left the day before, and there 
 she was getting ready for the delivery in these very little 
 comfortable surroundings, which was fortunately prevented by 
 the physician. The same luinter the ivoman in labour u-as 
 attached by tuberous leprosy. At my arrival she had no sus- 
 picion of this, for she had regarded the prodromes as " pains 
 of gout,'' and the first protuberances (tubercles) as " warts." 
 
 No. 49. Man of 35, with L. tuberosa two years old. He 
 served fifteen years ago together with a leprous patient. 
 
 No. 52. Widow of 51, L. tuberosa three years old. A 
 leprous man died two years ago after two years of illness at 
 the same farm as the patient [most liJcely he lived in cohabi- 
 tatiomuith the patient), and he is by the patient considered to 
 have infected her. She herself is a midwife, and until May, 
 1894, she still practised as one. She suffers from far ad- 
 vanced leprosy with large scattered tubercles, covering also 
 her hands and forearms. 
 
 No. 67. Man of 67, L. anaesthetica eleven years old. Once 
 he lodged a pauper for three years; tlie latter vjas suffering 
 from L. tuberosa. He left him fourteen years ago. Three 
 years after he was himself attaclced by the disease. 
 
 No. 71. Man of 50, L. anaesthetica five years old. 
 Twenty years ago he served at a farm where a leprous 
 patient came on a visit. This patient was rambling about, 
 and died at this farm in a bed opposite the patient. 
 
 No. 80. Man of 35, L. anjesthetica three years old. For 
 two years he has been living under one roof vnth his sister-in- 
 law, No. 70, who was not known to be leprous, but now she 
 has been ill for three years. 
 
 No. 98. A fisher of 35, L. mixta two years old. Five
 
 CONDITIONS UNDEE WHICH IT HAS DECLINED. 185 
 
 years ago lie shared the room of a leprous ^5ah'e?i^ and ate 
 together toith him for six weehs. 
 
 No. 99. Boy of 14, L. maculosa two years old. A 
 sister's son of his father was leprous. When the boy vjas 
 ten years old he slept for half a year with a woman (No. 86) 
 of luhovi it was not known that she was ill, hut two years 
 after tuberous leprosy broke out with her. 
 
 Finally I add an oral communication from Dr. Thoroddseu 
 in GuUbringe about a patient whom I did not see. 
 
 Without a number. — "A girl of 18, L, angestlietica begun 
 this year. Her father's sister, who is now dead, had lepra 
 nodosa, and stayed four years ago with the patient's father. 
 The child of fourteen shared the bed of the leper during the 
 ivhole winter. Three years after she became ill herself. 
 Her father's sister has since the outbreak of her illness 
 borne a child, who is now six years old ; I have examined it, 
 and it does not ail anything." 
 
 Answer to the Peize Question. 
 
 Conditions under which leprosy has declined. — From the 
 historical view I have given in the first part of my work it 
 appears that the leprous disease in all probability has beev 
 introduced into Iceland after the Crusades, probably from 
 Norway. 
 
 1. Four hospitals. — It spread very much on the island, 
 and increased most likely very strongly' during the sixteenth 
 century. In 1651 four Jtosjntals were erected as a defence 
 against the disease ; they never got to contain many of the 
 leprous patients, hardly more than 5 per cent, of the whole 
 number. Their power of combating with the progress of 
 the disease was not great ; they were dirty, small, and 
 unclean. Nevertheless I suppose they were of some 
 use by isolating the worst patients and those who were 
 most dangerous of infection, whom no one else had a mind 
 to house. Undoubtedly it has had a far better and more 
 preventive influence that the population itself dreaded the 
 infection. 
 
 2. Popular dread of contagion. — The leprous disease
 
 186 EHLEES ON LEPROSY IN ICELAND. 
 
 was in the Middle Ages all Europe over held to be an 
 eminently contagious disease. For a long time the Ice- 
 landers stuck to this view, and not before the nineteenth 
 century did this opinion waver, and they begin to listen to 
 the statements as to its being an inheritable disease. 
 
 3. The great devastating ej)idemics. — Better than all public 
 measures against the disease, though, was the effect of the 
 great devastating epidemics, especially the smallpox epidemic 
 in 1707, which swept away one third of the population of 
 the whole island, and the epidemic of the measles in 1846. It 
 is particularly mentioned in the history of Iceland that 
 in the first instance the lepers had ahcays to suffer from these 
 epidemics. Yet after each epidemic the number increased 
 again, sheltered by the bad hygienic circumstances. 
 
 4. Forhiddance of viarriage. — In 1776 the lepers were 
 forhidden to enter into marriage. Naturally this inhibition 
 has also been conducive to diminish the disease, the leprous 
 patient being as a rule most dangerous for his own family. 
 
 But, on the other hand, the inhibition was not strictly 
 carried into effect, repeatedly it had to be enforced anew, 
 and besides, the beginning lepers probably hurried on to 
 marry before their illness had become manifest to their sur- 
 roundings. 
 
 5. Advcmcing civilisation. — Thanks to these different cir- 
 cumstances, the disease decreased by-and-by in Iceland, 
 to which fact, of course, the advancing civilisation assisted 
 somewhat, although its hygienic progress on Iceland has 
 been exceedingly small with regard to the poor. There- 
 fore in 1848 the Government closed the four miserable 
 leproseries. 
 
 No doubt this arrangement has been to the injury of the 
 country. Surely the hospitals played but a slight part in 
 the combat against the disease, but it must not be left out 
 of consideration that their existence indicated that the 
 disease was still to be feai*ed. On the contrary, the abolish- 
 ing of the hospitals and the administration's throwing up 
 the game could not help giving the population the idea, 
 which Iceland's superior physicians persistently maintained, 
 that the disease was on the point of becoming extinct 
 spontaneously, and that it did no longer deserve any interest.
 
 ESTIMATE OP PRESENT PEEVALENCE. 187 
 
 Thanks to the impi'oved means of communication (steam- 
 ship traffic) the leprous patients have been able to make 
 their way to parts of the country which formerly the 
 disease had not taken hold of, and where, therefore, the 
 population at the present day did not entertain any fear of 
 it. Thus in two districts the disease has spread. Still, it 
 is not to be settled definitely how much it has increased, 
 for the Icelandic Government have not had their eyes suffi- 
 ciently open for the imminent peril ; they have been content 
 with quite superficial enumerations performed by the clergy- 
 men, and which therefore almost solely concerned the 
 tuberous lepers. Thus the official enumeration of 1889 
 reports but 47 patients, while without any special searching 
 I found 144. 
 
 Post-scriptiim. — Dr. Ehlers^ second voyage in Iceland 
 during the summer 1895, has brought to light 15 new 
 patients, so that their total number is now 159. It cannot 
 be an exaggeration to say that there are at present at least 
 200 lepers in Iceland.
 
 LEPROSY IN SOUTH AFRICA : 
 
 A REPORT ON THE FACTS AS TO THE RECENT INCREASE 
 
 OF LEPROSY AT THE CAPE, AND ITS PREVALENCE 
 
 IN SOUTH AFRICA. 
 
 S. P. IMPEY, M.D., M.C., 
 
 CHIEF AND MEDICAL SUPERINTENDENT, ROBBEN ISLAND LEPER AND 
 LUNATIC ASYLUMS.
 
 LEPHOSY IN SOUTH ArEICA. 
 
 The archives of tlie Cape Colony do not contain much 
 information about leprosy, and until the middle of the last 
 century no mention is made of this loathsome disease, so 
 that it is reasonable to conclude that until that time the 
 disease was not prevalent in the European settlement. 
 
 The coloured races then inhabiting the colony were, how- 
 ever, afflicted with the disease, and native tradition cleai'ly 
 proves that leprosy was known amongst the aborigines long 
 before they had any intercourse with the strangers. 
 
 At the time of the European occupation of the Cape there 
 were living in the colony two distinct races, — the Bantu, or 
 black men, and the Hottentot and Bushmen tribes, who were 
 more or less off-coloured. The former, roughly speaking, 
 lived east and north of a line drawn from Walfish Bay on 
 the west coast to Port Elizabeth on the east coast ; the 
 Hottentots and Bushmen occupied the country to the west 
 and south of this line. 
 
 It is not definitely stated tliat lepi'osy existed among the 
 Bushmen, but it certainly did to a great extent amongst the 
 Hottentots, and to a less extent among the Bantu races. 
 
 In the north, among the natives of the interior, and in 
 fact among all tlie native tribes of the colony, it existed 
 before the advent of the white man, so that it is reasonable 
 to conclude that it was not introduced into the colony by 
 the new-comers, but that it had been spread by direct com- 
 munication from the north, or by visitors to the country in 
 the distant past. 
 
 During the reign of the East India Company, however.
 
 192 IMFEY ON LEPROSY IX SOUTH AFRICA. 
 
 there was free iutercourse between the Cape Colony and 
 the East and West Indies, where the disease was rife, so 
 that probably the number of cases in South Africa w^as 
 augmented by importations from these colonies. 
 
 It is not; however, until the middle of the last century 
 that leprosy was specially mentioned by the Dutch writers 
 and authorities. 
 
 On the loth of May, 1756, the Landrost and Heemraden 
 of Stellenbosch, a village situated about eighteen miles due 
 east from Cape Town, which was founded in 1680 by 
 Governor Van der Stell, sent in a report to the then Governor 
 of the Colony, Ryk Tulbngh, and the Political Council, 
 asking that steps should be taken to deal with the lepers in 
 that district. 
 
 Two medical men were appointed to examine the cases 
 and report upon their condition, which they did on the 20th 
 of July, 1756, in the following terms : 
 
 " I. In the family of the farmer John M — , of French 
 Hoek, we fonnd the said J. M — aifected in the worst form. 
 He is stated to have had the disease for eighteen years. 
 His family consists of his wife, four daughters, and two 
 sons, all apparently healthy with the exception of the eldest 
 daughter, who had taken the greatest share in nursing her 
 father, and shows at present indubitable symptoms of the 
 disease. 
 
 '' 2. In the family of the farmer James M — , of Wagon- 
 makers, Vlei, J. M — , who has had the disease for nine 
 years, is so bad that the extremities of his fingers and toes 
 are mortified. His wife, four sons, and three daughters do 
 not show any symptoms of leprosy. But, as it has appeared 
 to us that the two J. M — 's after having become diseased 
 became the fathers of many children by their wives, we 
 would respectfully suggest that a careful eye should from 
 time to time be kept on those children, so that if any signs 
 of the disease should show on them, steps might be taken 
 in time." 
 
 On August the 24th, 1756, the Landrost and Heemraden 
 again wrote to the Governor, saying that the persons 
 suffering from leprosy should be entirely separated from the 
 healthy people. Their report ran as follows :
 
 EARLY HISTORY OP THE DISEASE AT THE CAPE. 193 
 
 " We have the honour most obediently to report, that in 
 our opinion the surest method would be to entirely separate 
 from intercourse with healthy people the persons proved to 
 be leprous ; but as there is some difficulty in this course with 
 regard to the hitherto healthy members of their families, 
 we would suggest for the present to recommend the families 
 affected with leprosy to know their own duty in this matter, 
 and to refrain from such intercourse by which others might 
 become infected. Further, by affixing notices to inform all 
 the inhabitants in what family the disease has to a certainty 
 hitherto been discovered ; also that as from time to time it 
 has been observed that manj'^ of the inhabitants do not think 
 much of the disease, and have even less notion of its dan- 
 gerous and contagious character, to warn them that every 
 one should most carefully beware of those families, so as to 
 avoid exposing themselves to the dreadful results which it 
 would be afterwards useless to reject.''^ 
 
 The Governor approved of these suggestions, but stated 
 that as the two families by the adoption of these measures 
 would be plunged into extreme poverty, the Landrost and 
 Heemraden should provide for their maintenance. 
 
 This is the history of the first two lepers mentioned in 
 Cape history. The history is interesting for two reasons : 
 (i) because the fuss made over the cases shows clearly 
 that at that time leprosy was not a common disease in the 
 colony ; probably the two cases mentioned were the only 
 lepers in the colony at that time. (2) Because even at that 
 early date the contagious nature of the disease was recognised. 
 The patients and their families were practically ostracised, 
 as the regulations under which they lived prohibited all 
 intercourse with the healthy outside world. 
 
 These extreme measures seemed to have the desired 
 effect, for nothing more is heard of the families. 
 
 No mention is again made of leprosy until the beginning 
 of the present century, so that it is reasonable to conclude 
 that during the next fifty years the disease, though probably 
 still existing, did not make much progress. 
 
 In 18 1 7, on the i ith of February, Lord Charles Somerset, 
 then Governor of the colony, issued a proclamation, direct- 
 ing that all the lepers in the Cape Colony should be sent 
 
 lb
 
 194 IMPEY ON LEPROSY IN SOUTH AFRICA. 
 
 to Hemel-en-Aarde, in the Caledon District, a place which 
 had been granted to the Government for this purpose by 
 the Landrost and Heemraden of Svvellendani. 
 
 Leprosy had by this time considerably increased in the 
 colony, especially amongst the Hottentots. The Moravian 
 missionaries had for five years previously been collecting 
 these outcasts among men at this spot by offering them a 
 home, and by ministering to their wants. 
 
 This Hemel-en-Aarde is situated among the Caledon 
 Mountains, a few miles away from the village of Caledon. 
 It is a most isolated spot — a small valley buried among 
 the high hills and almost impassable rocks, over which only 
 a glimpse of the sky can be seen. The valley is well shel- 
 tered from the winds, the soil is fertile, water plentiful, and 
 the climate warm and equable, so that the patients and 
 their friends, under the supervision of the missionaries, soou 
 turned the barren waste into a veritable heaven on earth, 
 as the name implies. 
 
 Into this lonely spot patients were drafted from all parts 
 of the Cape Colony. At Graaff Rienet and at Port Elizabeth 
 temporary lazarettos were erected for the reception of 
 these unfortunate cases prior to their transmission to Hemel- 
 en-Aarde. This was absolutely necessary, as ti'avelling in 
 those days was slow, and the distance being great, a 
 journey was not undertaken unless the number of pas- 
 sengers justified it. When a sufficient number of lepers 
 had been collected at these stations to form a waggon-load, 
 the waggon drawn by oxen would start on its long and 
 tedious journey of some hundreds of miles with its freight 
 of human sufferers, to land them after a month or six weeks 
 at this home among the mountains. 
 
 From 1816 to 1845 over 400 lepers were admitted into 
 this asylum. The regulations, however, were not very 
 strict, and the patients were allowed to have their friends 
 with them, and were allowed to come and go as they wished. 
 Their detention was only a voluntary one. 
 
 Soon it was found that Hemel-en-Aarde was not a satis- 
 factory place for a leper hospital ; it was too far from the 
 seat of government, and the patients could not get the 
 medical attendance they required. Within five years of its
 
 ITS RECENT INCREASE. 195 
 
 formation it was decided to remove the patients to a more 
 suitable locality, but it was not until 1845 that the change 
 was made. At that time the colonial Government, requir- 
 ing additional accommodation for lunatics and paupers, had 
 made use of the old military buildings and convict stations 
 at Robben Island for the reception of these patients. A 
 portion of this establishment was also fitted up for the 
 reception of the leper patients from Hemel-en-Aarde, who 
 were brought hither in 1845 ^^^ 1846. Ever since 1845 
 the leper asylum on Robben Island has given accommo- 
 dation to some lepers, chiefly of the pauper class. 
 
 Segregation was by no means complete, for the patients 
 were allowed to do pretty well what they wished. They 
 were allowed to leave the island when they wished. Many 
 of those who left the island did not return, others after 
 paying a visit to the mainland and their friends returned 
 to the island. As only those lepers who were unable to take 
 care of themselves availed tliemselves of the Robben Island 
 asylum, the number of admissions to the asylum is no 
 criterion of the number of lepers in the colony. 
 
 In 1883 the question of leprosy and its spread was the 
 subject of a special inquiry by a Parliamentary Commis- 
 sion, who, from the evidence of a number of witnesses 
 examined by them, came to the conclusion that leprosy was 
 decidedly on the increase in the colony, and they recom- 
 mended that some steps should be taken to check its spread. 
 
 The report of the Leprosy Commission is as follows : 
 
 *' I. That leprosy prevails extensively in the colony, and 
 is steadily spreading amongst both white and coloured 
 classes. 
 
 "2. That no efiicient steps have been taken hitherto to 
 prevent the spread of this loathsome disease, and to avert 
 the terrible evils which threaten society through heredity, 
 and in other ways, from the indiscriminate intercourse and 
 intermarriage of lepers witli other classes of the commu- 
 nity. 
 
 " 3. That it has been conclusively proved to your com- 
 mittee that by proper measures, energetically and efficiently 
 carried out, it is possible to arrest the further progress of 
 the disease, and ultimately to stamp it out altogether.
 
 196 IMPEY ON LEPROSY IN SOUTH AFRICA. 
 
 " 4. That for the accomph'shraent of this object an act 
 for the compulsory segregation of all lepers is necessary, 
 and the establishment of leper institutions in suitable 
 localities where perfect isolation can be secured. 
 
 " Your committee, therefore, recommend for the protection 
 of the public and in the interests of humanity, as well as 
 for the sufferers themselves, that the Government should, so 
 early as possible, take steps to secure the passing of a com- 
 pulsory Leper Act, and the commencement of a system of 
 isolation.'^ 
 
 In the following year the Leprosy Repression Act was 
 passed, but for some reason it was not promulgated. 
 
 In 1889 the matter was again brought before Parliament, 
 and the fact was established that leprosy was making vast 
 strides, and that there was urgent need of segregation. A 
 select committee was appointed to inquire into the matter, 
 and the result of their inquiries was that they reported, 
 inter alia — 
 
 " Leprosy is on the increase in the colony. Many of the 
 district surgeons say that in their particular districts there 
 is no such increase, and others again are unable to express 
 any opinion upon the question, but in the more populous dis- 
 tricts of the colony, such as the Cape and the Paarl, and 
 even in some outlying and less popular districts, such as 
 Alexandria and Stockenstrom, the district surgeons report 
 a marked increase in the number. 
 
 " Your committee estimate the number of lepers in the 
 colony to be upwards of six hundred.'^ 
 
 As the result of this inquiry steps were at once taken to 
 put the Leprosy Repression Act of 1884 into force. Hospi- 
 tals had to be built for the patients, as the buildings on 
 Robben Island hitherto used by the patients were not only 
 unsuitable for an asylum, but were too small for the recep- 
 tion of all the lepers in the colony. The foundation stone 
 of the first leper pavilion was laid by Sir Henry Loch, the 
 Governor of the colony, in April, 1891, since which time six 
 pavilions for male lepers and five pavilions for female lepers 
 have been built. 
 
 The Leprosy Repression Act was promulgated in May, 
 1892, when a large number of patients were drafted to the
 
 LEPROSY IN BASUTOLAND. 197 
 
 island from the various districts of the colony, and from the 
 Orange Free State and British Bechuanaland. 
 
 In the subjoined table, I have shown the number of 
 lepers admitted, discharged, and died in the settlement on 
 Robben Island, from the time it was first opened for the 
 reception of patients in October, 1845, until the 30th of 
 June, 1894, The European portion of the Cape Colony- 
 proper is bounded on the east by the native territories, on 
 the north by Basutoland, the Orange Free State, and 
 British Bechuanaland, beyond which are the Transvaal 
 Republic, the colony of Natal, and the native territories of 
 Zululand, Swaziland, and Pondoland — the last recently 
 annexed to the Cape Colony. Leprosy exists in each of 
 these countries to a considerable extent. I have thought it 
 best in dealing with the subject of leprosy in South Africa 
 to take each of these in detail, indicating how the disease 
 was probably introduced into the country, and its prevalence 
 at the present time. 
 
 Leprosy in Basutoland. 
 
 Until 1835 the Basuto nation was a quiet and peaceful 
 race, and, although surrounded on all sides by European and 
 native tribes, the Basutos kept to themselves, and had little if 
 any intercourse with their neighbours. During the year 1 835, 
 however, their chief " Moshesh " took advantage of a native 
 war in the Cape Colony to make a raid upon the native 
 territories adjoining Basutoland ; his armies entered these 
 countries, and devastated the land. This was the beginning 
 of a free intercourse between the Basutos and the neigh- 
 bouring tribes. Hottentots and Bushmen, who were always 
 a more or less nomadic people, soon settled in Basutoland, 
 and with them brought the loathsome disease. The Basuto 
 name for the disease is " Lefer le Bova,^' or Bushman 
 disease, which clearly indicates the manner in which the 
 disease was introduced into the counti-y. After the great 
 wars in which the Basutos were engaged the country became 
 much impoverished, and, by the order of the chief, large 
 numbers of men left the land to work elsewhere. 
 
 In 1872 they visited Kimbevley for that purpose in very
 
 198 IMPEY ON LEPROSY IN SOUTH AFRICA. 
 
 large numbei's, aud the missionaries who live in Basutoland 
 state that from that period leprosy became very prevalent 
 in Basutoland. The late Dr. Casilis, who lived for thirty 
 years in Basutoland, stated that until twenty-five years ago 
 the disease was confined to strangers in the land, and was 
 not known to affect the Basutos aud old inhabitants of the 
 country. I think, therefore, it can fairly be concluded 
 that leprosy was introduced into Basutoland after the great 
 wars of 1835, but ^^'^t it was only during the last twenty-five 
 years that it became common and prevalent in Basutoland. 
 The population of Basutoland is about 225,000 ; of these 
 about 250 are lepers. In the Orange Free State there are a 
 large number of Basutos working as servants, &c. Within 
 the last two years the Orange Free State Volksraad has 
 passed a law making segregation compulsory. To evade 
 this law many of the natives have left the Free State for 
 their own country, so that Basutoland is at present a land of 
 refuge for this unfortunate class of people, and many have 
 gone there who do not really belong to the country. It is, 
 however, impossible to say how many of the lepers in 
 Basutoland are refugees, and how many actually belong to 
 the country. The Basutos themselves state that leprosy is 
 decidedly on the increase in their country. 
 
 Orange Free State. 
 
 The history of leprosy in the Orange Free State is iden- 
 tical with that of the Cape Colony, as the two colonies are 
 inhabited by the same people, and the intercourse between 
 the Orange Free State and the colony has always been free. 
 
 The disease was probably introduced into the Orange Free 
 State at the time of the exodus of the colonial fai-mers into 
 that until then unknown country. It has increased ^ari 
 'passu with the increase of leprosy in the Cape Colony ; at 
 present there are upwards of 150 lepers in or belonging 
 to that republic. When the Leprosy Repression Act of 
 1884 was promulgated in the Cape Colony in 1892, the Free 
 State Government made an arrangement with the colonial 
 Government by which our Government took charge of their 
 coloured lepers ; for that purpose wards for their accommo-
 
 LEPROSY IN GRIQUALAND. 199 
 
 dation were built on Robben Island, and patients have been 
 sent to the island. The European lepers are segregated 
 within the republic. 
 
 Leprosy in Griqualand East and Transheian Territories. 
 
 In 1863, for political reasons, the Griquas, under their 
 chief Adam Kok, were moved from the westei*n portion of 
 what is now the Orange Free State, and from the present 
 disti'ict of Griqualand West, to the southern slopes of the 
 Drakensberg Mountains, where they formed the present 
 colony of Griqualand East. The journey was a long and 
 tedious one, as the country through which the multitude had 
 to pass was in its primitive wild state. The Griquas — a 
 branch of the Hottentot race — sujffered very considerably 
 from leprosy, and in the long journey they left their mark 
 behind them, for they not only introduced leprosy into the 
 new country, but leprosy prevails to a great extent among 
 the people through whom they passed on their way to their 
 new home. 
 
 The head-quarters of the new colony was called Kokstad, 
 after the chief Adam Kok. From this point as a centre 
 leprosy spread far and wide through the neighbouring ter- 
 ritories, though the largest proportion of lepers is still found 
 in the neighbourhood of Kokstad. 
 
 1. The district surgeon of Kokstad reports that the 
 disease was introduced into the colony in 1863, that it is on 
 the increase, and that there are at present 43 known lepers, 
 but that there are it is believed about 80 cases in his 
 district. 
 
 2. The district surgeon of Umzimkulu, the furthest re- 
 moved district from Kokstad, says there are only 3 known 
 lepers in his district, and that the disease is apparently not 
 on the increase. 
 
 3. The district surgeon of Mount Frere says that the dis- 
 ease was first discovered in his district about ten years ago. 
 There is no evidence that it is on the increase, and there are 
 only 6 known cases. 
 
 4. The Resident Magistrate of Qumbu says that leprosy 
 has only lately been introduced into his district, that it
 
 200 IMPEV ON LEPROSY IN SOUTH AFRICA. 
 
 is decidedly on the increase, and there are upwards of 20 
 cases known. 
 
 5. The R. M. of Umtata states that leprosy was intro- 
 duced into his district by the Hottentots about seventy 
 years ago, and that there are at present 50 cases known. 
 
 6. The Er. M. of Butterworth states that the natives of 
 his district were unacquainted with the disease until they 
 came in contact with the Hottentots, that the disease is 
 on the increase, and that there are now 49 known cases in 
 the district. 
 
 7. The R. M. of Ngamatsare states that the disease 
 was introduced into his district by the Headman Mnegania, 
 who contracted it while living with some Hottentots in the 
 Cape Colony about twenty-two years ago, that the disease 
 is not increasing to any serious extent, and that there are 
 50 cases known. 
 
 8. The R. M. of Idutywa states that the disease was in- 
 troduced into his district in about i860, that it is on the 
 increase, and that there are 22 known cases. 
 
 9. The R. M. of Willowdale states that it was only very 
 lately introduced into his district by the Hottentots, that 
 it is spreading, and that there are 37 cases known. 
 
 10. The R. M. of Kentani says that the disease appears to 
 have been introduced by Hottentots from the Cape Colony 
 in about 1836, that there is no evidence that it is on the 
 increase, and that there are 18 cases known. 
 
 11. The R. M. of Elliotdale says that the disease was 
 first introduced into his district in about 1883, that it is on 
 the increase, and that there are now 8 cases known. 
 
 12. The R. M. of Mganduli says that leprosy made its 
 appearance in his district about eight years ago, that it 
 is rapidly on the increase, and that there are now 40 cases 
 known. 
 
 13. The R. M. of Engcobo states that the disease was 
 probably introduced into his district by the Hottentots, 
 that it is on the increase, and that there are 68 cases known. 
 
 14. The R. M. of St. Mark's states that leprosy was in- 
 troduced into his district by the Hottentots about the middle 
 of the present century, that there is no evidence that it is 
 on the increase, and that there are 15 cases known.
 
 LEPROSY IX THE TRANSVAAL. 201 
 
 15. The R. M. of Cala states that the disease was intro- 
 duced into his district by the Hottentots, thiat it is not on 
 the increase, and that there is only one case known in the 
 district. 
 
 16. The R. M. of Tsolo says that leprosy was discovered 
 in his district in 1874 for the first time, and that it is not 
 on the increase. In 1886 there were 11 cases, now there 
 are only 4 known. 
 
 17. The R. M. of Maclear says that leprosy was supposed 
 to have been introduced into his district by the Hottentots 
 (Griquas), that it is not on the increase, and that there are 
 only 5 cases known at present. 
 
 18. The R. M. of Mount Fletcher says that leprosy was 
 introduced into his district about i860 (probably 1863), that 
 it is on the increase, and that there are 14 cases known 
 at present. 
 
 19. The R. M. of Matatiele thinks that leprosy was 
 introduced into the district from Basutoland about thirty 
 years ago, but it was more probably introduced by the 
 Griquas, who passed through a portion of Basutoland in 
 travelling from their old home to the new. The disease is 
 on the increase, and there are about 20 cases in the dis- 
 trict at present. 
 
 The Transvaal Republic. 
 
 This republic was formed in 1835 by the Boers, who, to 
 escape from the trammels of civilisation, were continually 
 moving onwards into the then uncivilised portions of the 
 African continent. A large portion of the country claimed 
 by this republic is still in the hands of the natives, and is 
 almost unknown to Europeans. Leprosy exists among these 
 natives, but to what extent it is impossible to say. Even in 
 the more civilised parts, as no proper census has been 
 taken, it is difiicult to arrive at the truth about leprosy. 
 A small hospital for lepers has long existed close to 
 Pretoria, the chief town of the republic, in which about ten 
 unfortunate lepers find a refuge. 
 
 Now that the leprosy question has been brought promi- 
 nently before the world, each country is awakening to the
 
 202 IMPEY ON LEPROSY IN SOUTH AFRICA. 
 
 fact that the evil is amongst its people, and that it is 
 spreading. 
 
 The Transvaal Government has now enlarged its leper 
 asylum, and the number of lepers which it now accommo- 
 dates is upwards of twenty ; but this cannot be taken as a 
 criterion of the number of lepers existing in the country, 
 for as there is no law making segregation compulsory, only 
 the paupers avail themselves of the shelter and privileges 
 of a home. 
 
 Natal. 
 
 Leprosy appears to have been introduced into this colony 
 at a comparatively recent date, as no mention is made of the 
 disease until the middle of the present century. 
 
 The following account of its introduction is the one on 
 which credence is placed by both the Europeans and natives 
 of Natal. It appears that in about 1840 two native men 
 left the colony of Natal for the Cape Colony, where in 
 Orahamstown they worked for three years. Whilst in 
 Grahamstown they lived with a coloured woman who was 
 suffering from leprosy ; this woman they left behind them 
 when they returned to Natal in 1843. On their return to 
 their native land the two men married healthy native 
 women. Within two years of their return to Natal they 
 developed leprosy, and one of the men died of the disease 
 within three years. 
 
 Thus leprosy was introduced into the kraal where these 
 men resided, and from this point as a centre the disease 
 spread from kraal to kraal and from tribe to tribe, till at 
 the present time there is not a single tribe free from disease. 
 Every tribe in the colony — and there are many of them — is 
 infected to a greater or less extent, but the most cases are 
 still found in the tribe to which the two original lepers 
 belonged. 
 
 In 1886 the disease had become so prevalent that a Com- 
 mission was appointed by the Government to inquire into 
 the matter, and to devise some means to check its spread. 
 Natal, like the other South African states, has a large 
 native population, and as leprosy is at present confined to
 
 NATAL, BEOHTJANALAND, AND ZULULAND. 203 
 
 the blacks, the information obtainable is not very reliable, 
 so that the number of cases reported to the Commission was 
 probably far short of the actual number then existing ; 
 nevertheless the Commission were able to obtain records of 
 upwards of loo lepers, so that in forty-three years the number 
 of lepers Lad increased from 2 to 100 or more. 
 
 The Hon. the Under Secretary of Natal, Mr. Bird, in- 
 forms me that since 1886 there have been 132 additional 
 cases of leprosy reported to the Government, so that there 
 are at present over 200 lepers in that colony, all natives. 
 
 A mild form of segregation is now being enforced, and 
 it is hoped that this will check the spread of the disease. 
 
 British Bechuanaland. 
 
 The authorities in Bechuanaland have made an arrange- 
 ment with the Cape Colonial Government by which all the 
 lepers from Bechuanaland are brought to Robben Island for 
 isolation and treatment. 
 
 The number of cases admitted into this asylum since this 
 arrangement was made is only seven, all coloured people, 
 so that it is evident the disease is not very prevalent in 
 that colony, which may be accounted for by the dryness of 
 the climate, and the consequent sparseness of the population. 
 
 Leprosy was probably introduced into Bechuanaland by 
 nomadic Bushmen from the Orange Free State. 
 
 Pondoland {recently annexed to the Cape Colony), 
 I have learned from the magistrates stationed in Pondo- 
 land that there are no lepers in that country, which can be 
 accounted for by the fact that all suffering from the disease 
 are excluded from the country by the chiefs under penalty 
 of death. 
 
 Zululand and Swaziland. 
 
 No reliable information can be obtained as to the preva- 
 lence of leprosy in these native territories, but that it does 
 exist to a considerable extent is well known ; whether it is 
 on the increase or not is impossible to say, but judging 
 from the habits of the other uncivilised natives I should
 
 204 
 
 IMPEY ON LEPROSY IN SOUTH AFRICA. 
 
 say not, for, as a rule, the natives kill or ostracise all 
 objectionable persons. 
 
 In conclusion I may state that in a country like South 
 Africa, with its large native population, it is almost impos- 
 sible to obtain thoroughly reliable information, especally 
 about a disease like leprosy ; but I have made very careful 
 inquiries, and have obtained the information contained in this 
 paper from reliable sources. 
 
 I am especially indebted to the Hon. J. Rose-Innes, C.M.G., 
 Under Secretary of Native Affairs of the Cape Colony, who 
 obtained the information from the various magistrates in 
 Griqualand East and the Transkeian Territories for me ; and 
 also to ^[r. Bird, Under Secretary of Natal, the State 
 Secretary of the Transvaal Republic, and the British Resident 
 in Basutoland. 
 
 Roughly speaking, the number of lepers at present known 
 in the various South African colonies and states is as 
 follows : 
 
 Cape Colony proper . 
 
 
 
 600 
 
 Griqualand East 
 
 
 
 250 
 
 Transkeian Territories 
 
 
 
 357 
 
 Basutoland 
 
 
 
 250 
 
 Bechuanaland . 
 
 
 
 10 
 
 Natal . 
 
 
 
 200 
 
 Orange Free State . 
 
 
 
 150 
 
 Transvaal Republic . 
 
 
 
 30 
 
 Total number 
 
 • 17.S0 
 
 The facts and figures quoted clearly prove — 
 (i) That leprosy has been known in the Cape Colony 
 since the middle of the last century. 
 
 (2) That the disease has made rapid progress from the 
 beginning of this century, but more especially during the 
 last fifty years. 
 
 (3) That the Hottentots, of whom the Griquas are an 
 offshoot, were, on account of their nomadic nature, the 
 cause of the spread of the disease amongst the Bantu races. 
 
 (4) That the disease is much more prevalent in South 
 Africa than is generally known.
 
 STATISTICS FROM EOBBEN ISLAND. 
 
 205 
 
 The various Governments have awakened to the fact that 
 something- must be done to check the spread of the disease. 
 
 The Cape Colony, the Orange Free State, Bechuanaland, 
 and Natal have each adopted some form of segregation, and 
 it is hoped that by this united action an effectual check will 
 be put upon the spread of the loathsome disease. 
 
 Table shuiriiiy the Number of Lepers admitted, discharged, 
 and died in the Robben Island Leper Asylum each year 
 since its formation in 1845 until the ^oth June, 1894. 
 
 Date. 
 
 Admissions. 
 
 Discharges. 
 
 Deaths. 
 
 1845 
 
 37 
 
 
 
 
 1S46 
 
 35 
 
 — 
 
 — 
 
 1847 
 
 17 
 
 — 
 
 — 
 
 1848 
 
 26 
 
 
 
 — 
 
 1849 
 
 18 
 
 — 
 
 — 
 
 1S5O 
 
 14 
 
 — 
 
 — 
 
 185I 
 
 7 
 
 — 
 
 — 
 
 1852 
 
 13 
 
 — 
 
 — 
 
 1853 
 
 22 
 
 5 
 
 15 
 
 1854 
 
 14 
 
 9 
 
 9 
 
 1855 
 
 17 
 
 10 
 
 12 
 
 1856 
 
 21 
 
 15 
 
 12 
 
 1857 
 
 18 
 
 7 
 
 II 
 
 1858 
 
 18 
 
 6 
 
 II 
 
 1859 
 
 19 
 
 6 
 
 13 
 
 i860 
 
 16 
 
 2 
 
 10 
 
 1861 
 
 30 
 
 15 
 
 15 
 
 1862 
 
 20 
 
 4 
 
 8 
 
 1863 
 
 23 
 
 15 
 
 II 
 
 1864 
 
 13 
 
 3 
 
 9 
 
 1865 
 
 35 
 
 17 
 
 18 
 
 1866 
 
 19 
 
 7 
 
 10 
 
 1867 
 
 20 
 
 6 
 
 14 
 
 1868 
 
 21 
 
 6 
 
 13 
 
 1869 
 
 15 
 
 10 
 
 II 
 
 1870 
 
 25 
 
 II 
 
 15 
 
 1871 
 
 27 
 
 27 
 
 9 
 
 1872 
 
 17 
 
 18 
 
 9 
 
 1873 
 
 17 
 
 6 
 
 7 
 
 1874 
 
 19 
 
 6 
 
 15 
 
 1875 
 
 13 
 
 13 
 
 9 
 
 1876 
 
 17 
 
 9 
 
 5 
 
 1877 
 
 26 
 
 II 
 
 8 
 
 1878 
 
 19 
 
 10 
 
 7 
 
 1879 
 
 13 
 
 10 
 
 7 
 
 1880 
 
 15 
 
 2 
 
 10
 
 206 
 
 IMPEY ON LEPROSY IN SOUTH AFRICA. 
 
 Date. 
 
 Admissions. 
 
 Discliarges. 
 
 Deaths. 
 
 j 
 
 1881 
 
 24 
 
 4 
 
 12 
 
 1882 
 
 21 
 
 15 
 
 17 
 
 1883 
 
 23 
 
 13 
 
 5 
 
 1884 
 
 25 
 
 5 
 
 10 
 
 1885 
 
 14 
 
 
 
 13 
 
 1886 
 
 21 
 
 5 
 
 9 
 
 1887 
 
 51 
 
 13 
 
 12 
 
 1888 
 
 40 
 
 7 
 
 14 
 
 1889 
 
 51 
 
 II 
 
 32 
 
 1890 
 
 21 
 
 8 
 
 23 
 
 1891 
 
 52 
 
 2 
 
 21 
 
 1892 
 
 338 
 
 7 
 
 40 
 
 1893 
 
 250 
 
 12 
 
 114 
 
 1894 
 
 52 
 
 7 
 
 37 
 
 Total 
 
 1697 
 
 375 
 
 776 
 
 RoBBEN Island ; 
 
 November Uth, 1894.
 
 ON SPONTANEOUS RECOVERY FROM 
 LEPROSY. 
 
 S. p. IMPEY, M.D., M.C., 
 
 MEDICAL SUPEEINTENDENT OF THE EOBBEN ISLAND LEPER AND LUNATIC 
 
 ASYLUMS.
 
 ON SPONTANEOUS EECOVEHY EEOM 
 LEPROSY. 
 
 A MEDICAL man in the practice of his profession is very 
 apt to run in a groove, from which it is difficult to escape ; 
 he runs with the crowd in a beaten track, and the longer he 
 runs the more difficult it is for him to leave it. The track 
 may be a fairly broad one, but few men have the temerity 
 to leave it and explore the unknown regions adjoining it : for 
 the track is bright and clear, and the way easy ; but the land 
 is dark, and full of the pitfalls of criticism and controversy. 
 
 It is certainly a very safe course to adopt to drift with 
 the stream, but in my opinion it is the greatest stumbling- 
 block to the progress of medical science. 
 
 If a medical man in the daily routine of work sees in 
 this forbidden region dim and uncertain shadows, let him 
 pursue them, and see what more light they can throw upon 
 the path, and if it is possible by the knowledge thus gained 
 to remove some of the rocks which encumber the road of 
 medical practice. Surely it is the duty of every medical 
 man to try and make this broad path smooth and easy, not 
 only for the sake of those who have to tread after him, but 
 for the unfortunate patients on whose behalf the track has 
 been so well worn. 
 
 A few months ago, at a Medical Congress held in Cape 
 Town, I ventured to state that in my opinion a certain 
 number of lepers were self-cured ; but I was off the beaten 
 track, and my views met with opposition. Some medical 
 men stated that they did not recognise the term ; others, that 
 it was an unhappy term ; others, that it was a contradiction ; 
 
 14
 
 210 IMPEY ON SPONTANEOUS RECOVERY FROM LEPROSY. 
 
 and others, that they were not prepared to acknowledge the 
 fact. 
 
 I had, however, carefully studied the subjects, and by 
 following certain ideas had come to the conclusion that, not- 
 withstanding these adverse criticisms, my observations were 
 correct. 
 
 The matter is such an important one, not only medically 
 but socially and politically, and to the patients themselves, 
 that I have chosen it as the subject of my paper. 
 
 I am of opinion that a certain number of lepers are 
 actually cured, and if I can only prove the correctness of my 
 opinion to the satisfaction of the medical profession, what a 
 world of hope Avill be infused into the heart of every leper 
 in the world ! and with the hope will come contentment and 
 happiness, where now there is misery and despair. 
 
 In discussing the subject I shall first deal with the objec- 
 tions, and then give my reasons for coming to the conclusions 
 that there are self-cured lepers. 
 
 (i) Some medical men do not recognise the term. I dare 
 say not, as the term is a new one ; but the fact of not recog- 
 nising a term is, in my opinion, a mere quibble, and is 
 hardly worthy of consideration. 
 
 (2) Some say it is an unhappy one. This may be true, 
 but in my opinion it is a very expressive one, and provided 
 the term conveys the meaning attached to it the objection 
 is a frivolous one. 
 
 (3) Others say it is a contradiction. I said that leprosy 
 was not amenable to treatment, yet in certain cases the dis- 
 ease was cured. I adhere to that statement. All who have 
 had to treat leprous patients must agree with me that 
 medical treatment, be it ever so skilful, is of little avail. 
 In certain ways the disease may be temporarily arrested, but 
 as a rule it goes on steadily from bad to worse, until death 
 removes the patient from a life that is almost worse than 
 death. 
 
 Many drugs have been tried, and many treatments 
 adopted, but without any permanent benefit to the patients. 
 Some medical men claim to have actually cured the disease, 
 but of this I am extremely sceptical, so that I am still of 
 opinion that medical treatment is useless and powerless, and
 
 MEANING OP THE TERM " CUEED." 211 
 
 of no use for tlie cure of leprosy. In a few cases, however, 
 as I shall presently endeavour to prove, the disease is cured 
 spontaneously, not from the effects of external applications 
 or internal treatment, but from causes at present unknown, 
 which exist within the body itself ; the system throws off 
 the disease — it cures itself ; and therefore I am of opinion 
 that I am justified in calling such cases " self-cured/' 
 
 (4) Some medical men do not acknowledge the facts ; they 
 agree that in certain cases the disease is arrested, but they 
 cannot allow that they are cured. This is naturally a grave 
 objection, and one, moreover, which it is by no means easy to 
 upset. On a point of this nature one may have very strong 
 views, yet be unable to substantiate them by conclusive argu- 
 ments. The term " cure ^' is itself a controvertible one. 
 The meaning of the term is " restoration to health or sound- 
 ness ; " but every medical man knows that, strictly speaking, 
 every " cured " patient cannot be said to have been restored 
 to perfect health. The system is weakened or changed, or 
 the body is left in an unsound state. Remove a tumour from 
 a patient, the scar remains, though the patient is said to be 
 cured ; and so with any disease. It is very seldom that 
 the system is attacked by an acute disease without something 
 remaining behind to the detriment of the system ; thus the 
 cure of a patient does not always mean the restoration of the 
 body to a perfect state, or of absolute health to the system, 
 but it means something much more imperfect and indefinite. 
 Smallpox leaves its indelible mark, and yet it is considered 
 cured though the mark remains ; and yet because leprosy 
 leaves its mark, it is considered arrested only, and not 
 cured. Of these sceptics I should like to ask the following : 
 
 If you have been treating' a disease, and have brought it 
 to such a condition that the active symptoms disappear never 
 to return, would you not consider it cured ? 
 
 If phthisis, arrested in childhood, has not shown itself in 
 adult life, would you not consider it cured ? 
 
 If syphilis, properly treated in youth, does not show sym- 
 ptoms, in age, of recrudescence, would you not be justified 
 in saying that the disease had been eradicated from the 
 system ? 
 
 If, after the removal of a malignant growth, it does not
 
 212 IMPEY ON SPONTANEOUS RECOVERY FROM LEPROSY. 
 
 recur, say witliin ten years, would you not be content to con- 
 sider it a cure ? Yet you, who must consider sucli cases 
 cured, will not allow that leprosy is cured, though it passes into 
 the same stage, — for after a certain period the ulceration in 
 anaesthetic leprosy ceases never to recur ; in fact, the disease 
 is cured as effectually and completely as any cure is ever made 
 in the practice of medicine. Some medical men say, " We 
 acknowledge that such cases exist, but they are only arrested, 
 and if you wait long enough the ulceration will start afresh." 
 But surely there is a limit to everything. Why be Micawbers 
 in dealing with lepers ? Why keep the patients languishing 
 in an asylum until death removes them from your expectant 
 eye, watching for something to turn up — watching for the 
 ulceration to recur ? The ulceration has ceased, and if you 
 keep the patient in the hospital waiting for the ulcers to 
 break out again, he will die probably of old age before you 
 are satisfied. 
 
 When I first took charge of the leper asylum here I was 
 struck with the fact that, as a rule, the disease was much 
 more acute and rapid in its course than was generally sup- 
 posed, and that most of the patients died within a very few 
 years of their admission ; a few, however, after a battle for 
 life, seemed to regain their health, and then lived ou to old 
 age unless their life was cut short by intercurrent affections. 
 
 I at once inquired into this matter, and into the cause of 
 this apparent auomal}', and was forced to the conclusion 
 that, with few exceptions, these long-lived cases were free 
 from disease. 
 
 Leprosy exists here in four forms — the anaesthetic, tuber- 
 cular, mixed, and syphilitic, — each form running a distinct 
 course. Self-cured cases occur only in aujesthetic leprosy, 
 therefore I shall confine my remarks mainl}' to this form of 
 the disease, though in passing I should like to draw your 
 attention to a curious and most interesting fact in connec- 
 tion with the tubercular form of the disease. In anaesthetic 
 leprosy medical treatment is powerless to cure the disease, 
 but in ray opinion the disease is occasionally self-cured ; in 
 tubercular leprosy the disease is never self-cured, but I 
 believe the time is not far distant Avhen this form of the 
 disease will be cured by proper medical treatment. Tuber-
 
 INFLUENCE OF OTHER DISEASES. 213 
 
 cular leprosy is due to the presence of bacilli and their 
 products in the tissues of the body. I have noticed that 
 the course of this form of the disease is often temporarily 
 modified by intercurrent inflammatory affections. An attack 
 of measles arrests the disease^ and causes the tubercles to 
 subside in some cases for years ; smallpox supervening on 
 tubercular leprosy checks the latter disease for a time, if 
 not permanently ; erysipelas always causes the tubercles in 
 the part attacked to subside. These are most interesting 
 facts, and I think they point to the way in which this form 
 of the disease in its early stages will yet be cured. Leprosy, 
 measles, smallpox, and erysipelas are all due to bacilli, and 
 in each the disease manifests itself by preference in the face 
 first ; therefore it is probable that the bacilli themselves are 
 related or are influenced by the same forces. We do not 
 know how these or any other bacilli live in the body ; we do 
 not know, for instance, from which secretions or tissues the 
 bacilli draw their nourishment ; but we do know that certain 
 conditions are necessary for their growth in life, and we do 
 know that each class of bacilli requires its own conditions. 
 It is probable that the bacilli of these diseases are nourished 
 and supported by the same secretions and tissues in the 
 body. We know that in the battle for existence the 
 stronger always pushes the weaker to the wall, be it in man, 
 animal, or plant. Measles, smallpox, and erysipelas are 
 acute diseases, and therefore the bacilli are moi'e active and 
 virulent than those of the slow-growing leprosy ; hence it is 
 probable that the stronger bacilli of the intercurrent affec- 
 tions push the weaker bacilli of leprosy to the wall ; but, be 
 this as it may, the fact remains, that by the introduction of 
 these bacilli into the sj^stem of a leprous patient the disease 
 is checked for a time, i. e. the leprous bacillus is in some 
 way acted upon to its own detriment, but to the benefit of 
 the patient. This being so, would it not be possible, by 
 some system of cultivation of, and vaccination with, these 
 bacilli, not only to check the growth of the leper bacillus, 
 but to entirely destroy it, and thus remove it from the body ? 
 I am of opinion that the solution of the leprosy question will 
 be found in the use of the vaccinator's lance, and I believe 
 that it is only by the introduction of an antagonistic bacillus
 
 214 IMPEY ON SPONTANEOUS RECOVERr FROM LEPROSY. 
 
 into the system of a leprous patient that the disease will be 
 cured. 
 
 In angesthetic leprosy the symptoms are due to disease 
 of the nerves. In a recent case the affected nerves are 
 thickened and soft, due to the sheath being injected and 
 swollen by inflammatory exudations. At this stage the 
 patient, as in ordinary neuritis, suffers acute neuralgic 
 pains extending to the fingers ; the nerve itself is highly 
 sensitive, though sensation in the parts supplied by the 
 nerve may be partially diminished. At a later stage the 
 nerve becomes smaller, firmer, and nodulated, due to the con- 
 traction of the inflammatory products ; the contraction causes 
 pressure upon the nerve-fibres and their subsequent destruc- 
 tion ; the nerve-fibres are at first irritated, thus causing 
 contraction of the fingers and toes ; pari passu with the 
 destruction of the nerve-fibres comes anassthesia of the 
 parts. In the last stage the nerve-fibres are desti'oyed, 
 and all that remains is a fibrous band — a remnant of the 
 original sheath. The nerve-supply to the extremities is 
 thus destroyed and lost ; the bones through these atrophic 
 changes become necrosed, and are removed by absorption 
 or ulceration. 
 
 The symptoms thus described are exactly what would be 
 expected from the nature of the disease ; they are, in fact, 
 identical with the history of the symptoms due to the 
 destruction of a nerve from any cause. In an ordinary 
 typical case of anaesthetic leprosy both hands and both feet 
 are equally affected, and both seventh nerves are para- 
 lysed, — in fact, it is a symmetrical disease. The disease 
 runs a rapid course, and the necrosis and ulceration cause so 
 much irritation, and there is such a drain on the system, 
 that few patients survive it. In a few cases, however, the 
 necrosis ceases, the ulceration stops, and the wounds heal, 
 though of course the lost parts are not restored. 
 
 In these so-called self-cured cases the disease does not 
 break out again ; the anaesthesia may be, and is generally, 
 complete and permanent, but the ulceration has ceased — 
 never to return. We do not know why the ulceration 
 ceases ; we cannot detect any alteration in the blood or 
 tissues to account for the change ; we cannot do anything to
 
 SIGNIFICANCE OF THE PERFORATING ULCER. 215 
 
 bring about or accelerate this mucli-to-be-desired result ; 
 the disease takes its own course and works out its own 
 cure, and if the patient can stand the terrible drain on his 
 system the disease will certainly become self-cured. 
 
 There is one point in connection with these self-cured 
 cases that deserves special notice here, and that is the pre- 
 sence in many of them of a perforating ulcer. 
 
 On page 1 7, vol. ii, ninth edition of ' Erichsen's Surgery/ 
 under the heading of " Perforating Ulcer of the Foot/^ is 
 described a case typical of the perforating ulcer found in 
 leprosy, but in this case the ulcer is due to ordinary disease 
 of the nerves supplying the part. 
 
 Perforating ulcers, therefore, are not confined to leprosy, 
 but in all cases are due to disease of the nerves. 
 
 I contend that the perforating ulcer in leprosy, though 
 one of the symptoms of the disease, is by no means neces- 
 sarily a sign that the disease exists, for I am of opinion 
 that the ulcer often remains long after the disease itself has 
 been cured. The bones become necrosed through a defect 
 in their nerve-supply, and they become virtually foreign 
 bodies, whose removal is necessary before ulceration can 
 cease. Many of the diseased bones, on account of their 
 size or situation, or for other obvious reasons, cannot be re- 
 moved at once in the ordinary way by absorption or ulce- 
 ration, and therefore remain in situ a relic of the past, but 
 not a sign of active disease. 
 
 I removed a spiculum of dead bone from the tibia of a 
 man who, twenty years previously, had suffered from 
 syphilitic periostitis, and yet no one would be justified in 
 saying, because the dead bone had not been removed earlier, 
 that the patient had been suffering from syphilis all thoseyears. 
 
 Another patient, as a complication of typhoid fever, had 
 pneumonia which developed into fibroid phthisis, of which he 
 died ten years after, yet no one would be justified in saying 
 that this patient was suffering from typhoid fever all those 
 years. 
 
 The necrosed bone causing the perforating ulcer in 
 leprosy is certainly due to changes produced by the disease, 
 but no one can be justified in saying that until the dead bone 
 is removed, the patient is suffering from the disease itself.
 
 216 IMPEY ON SPONTANEOUS RECOVERY PROM LEPROSY. 
 
 The fibroid phthisis was a result of the typhoid fever, but 
 was not the fever itself ; the necrosis causing the perforat- 
 ing ulcer is a result of leprosy, but it is not the disease 
 itself. 
 
 To prove that the ulcer is only a result of the disease, 
 and not an active symptom, remove the dead bone by opera- 
 tion, and the wound will heal as readily as in ordinary 
 necrosis, and the ulcer will disappear. The facts appear so 
 simple, and yet the presence of the perforating ulcer is the 
 stumblingblock over which so many fall ; they cannot be 
 made to understand that though this special form of ulcera- 
 tion commences while the disease is active, yet it may con- 
 tinue long after the disease has ceased to exist. 
 
 In my opinion, therefore, the presence of the perforating 
 ulcer in leprosy is no proof that the disease is present. 
 
 It may be asked, at what point does the patient cease to 
 be a leper ? I am of opinion that the patient ceases to be 
 a leper when the leper bacillus leaves the body, for to be a 
 leper without having the leper bacillus in the body is 
 obviously impossible. 
 
 Now can we in any way prove that the bacillus leaves the 
 body, and at what time the disease becomes self-cured ? 
 
 We know that the disease is due to a bacillus, and we 
 know how this bacillus acts to give rise to such terrible 
 suffering and deformity ; we know, further, that there is an 
 acute stage when the bacillus is apparently very active, and 
 we know that this stage is succeeded by one of at any rate 
 quiescence. In all diseases due to bacilli the disease follows 
 one of two courses : (1) the disease runs a rapid course 
 ending in recovery or death ; or (2) the disease, beginning 
 insidiously, becomes more and more severe until it ends in 
 death. 
 
 In the first form there is a hope of life ; in the second 
 form the bacillus, though not such an active or virulent one, 
 never leaves the body, but invades more and more of the 
 tissues. 
 
 Under the first head typhoid fever may be classed ; 
 under the second, phthisis. 
 
 Now under which of these two heads may leprosy be 
 classed ? It is a disease which runs a rapid course, and in
 
 USUAL DURATION OP THE DISEASE. 217 
 
 a large majority of cases ends in death ; but a few of the 
 cases get over the acute attack, and, so far as the disease is 
 concerned, may live for ever, i. e. the cause of the disease 
 has left the system as surely as the bacillus of typhoid 
 fever leaves the body after it has run its course. Leprosy 
 is not snch an indefinite disease as one would make out, — 
 it runs a definite course, and the patient then dies or re- 
 covers. The reason why it has hitherto been considered 
 so indefinite is the non-recognition of the self-cured cases. 
 
 Expressions like this so often occur in works on leprosy : 
 " The duration of the disease is generally about eight years, 
 but in some instances it has been known to last sixty years.'' 
 The study of the disease to a novice is a mystery to unfold, 
 whereas in reality it is a simple disease. Like all diseases, 
 the course it takes is modified by circumstances ; it may 
 end fatally or otherwise in about six years, or it may con- 
 tinue a little longer, but, so far as my experience goes, in 
 the anesthetic form of the leprosy, the maximum duration of 
 the disease is about eleven years from the time that the first 
 symptoms appear, or, including the incubating period, about 
 thirteen years. With few exceptions, all the cases which 
 exceed this period are no longer lepers. 
 
 I have prepared three tables showing the duration of the 
 disease in the Cape Colony. Since 1871, and until the 30th 
 June, 1894, excluding the patients who were discharged from 
 time to time, there were admitted into the Asylum on Robben 
 Island 965 leper patients. Of these 402 died. 
 
 There are now in the hospital 563 leper patients. 
 44 lepers have been in the hospital less than i year. 
 196 „ „ between i — 2 years. 
 
 248 „ „ ,, 2 — 3 
 
 19 >> >} » 3 — 4 
 
 6 „ ,, „ 4 — 5 
 
 21 „ „ „ 5— 6 
 
 4 " ii >> ^ — 7 
 8 „ „ „ 7 — S 
 
 5 }> !> » ^ — 9 
 I „ „ „ 9—10 
 
 3 >, „ ,y 10— II 
 
 I » ;; >y 12—13
 
 218 IMPEY ON SPONTANEOUS EECOVERY FROM LEPROSY. 
 
 leper has been in the hospital between 13 — 14 years. 
 
 15—16 
 16 — 17 
 17—18 
 19 — 20 
 21 — 22 
 
 This shows that out of this large number of patients at 
 present in the wards^ only eight have been here longer than 
 eleven years. 
 
 Of the 402 patients who have died in the asylum since 
 1871 — 
 
 151 died within i year of admission. 
 
 141 
 
 , 2 
 
 years 
 
 33 
 
 3 
 
 
 25 
 
 4 
 
 
 16 
 
 5 
 
 
 12 
 
 6 
 
 
 6 
 
 7 
 
 
 10 
 
 8 
 
 
 5 
 
 9 
 
 
 I 
 
 ) 1 1 
 
 
 I 
 
 13 
 
 
 I 
 
 16 
 
 
 402 
 
 So that out of 402 patients who died^ o^b' ^"^^^^ lived 
 longer than eleven years in the hospital. 
 
 From these tables we learn that the duration of the disease 
 is within eleven years, and that only a very small percentage 
 of the patients suffering from leprosy live longer than eleven 
 years after admission into hospital. 
 
 There are, however, a few patients in the asylum who were 
 admitted before 1871. 
 
 Of the patients in the hospital I have been able to obtain 
 fairly reliable histories of 516 cases. Of these cases — 
 
 4 contracted the disease in 1894. 
 19 ,, >, J' 1893. 
 
 30 „ „ „ 1892.
 
 STATISTICS FROM EOBBEN ISLAND. 
 
 219 
 
 44 contracted the disease in 1891. 
 
 54 ,> „ » 1890. 
 41 „ „ „ 1889. 
 26 ,, ,, ,, 1888. 
 
 55 ,, ,, .> 1887. 
 22 „ „ ,, 1886. 
 35 » » .; 1885. 
 26 „ „ „ 1884. 
 18 „ „ „ 1883. 
 32 „ „ „ 1882. 
 
 loi „ ,, „ before 1882. 
 
 Of these loi cases who have had the disease longer than 
 
 eleven years, I have made the following extracts from the 
 case books. 
 
 T. Toes. Cont. Contracted. 
 H. Hand. N. S. No sores. 
 Ft. Feet. Fts. Feet. 
 
 Explanation of Abbreviations. 
 
 F. Fingers. Ab. Abbreviated. 
 
 Hs. Hands. P. U. Perforating ulcer. 
 
 Turn. Tumified. 
 
 Females. 
 
 No. 
 
 Name. 
 
 I'orm. 
 
 Contracted 
 
 4 ■ 
 
 . A. K. . 
 
 .. A. . 
 
 .. 1879 
 
 13 • 
 
 . M.J. 
 
 „ 
 
 .. 1870 
 
 14 ■ 
 
 C. . 
 
 )j 
 
 .. 1872 
 
 16 . 
 
 . K. A. 
 
 >j 
 
 .. 1881 
 
 17 • 
 
 . K. Z. 
 
 )> 
 
 .. 1872 
 
 18 . 
 
 J. 
 
 )) 
 
 •■ 1877 
 
 79 • 
 
 L. S. . 
 
 )j 
 
 .. 1877 
 
 80 . 
 
 . L. B. . 
 
 ») 
 
 .. i860 
 
 82 . 
 
 . S. H. . 
 
 5) 
 
 .. 1870 
 
 87 . 
 
 s. s. . 
 
 „ 
 
 .. 1859 
 
 88 . 
 
 . T. A. . 
 
 ,, 
 
 .. i860 
 
 90 . 
 
 . S. A. . 
 
 ), . 
 
 - 1877 
 
 91 . 
 
 . w. s. . 
 
 ,, 
 
 .. 1878 
 
 96 . 
 
 . L. H. . 
 
 J) 
 
 .. 1876 
 
 103 . 
 
 . M. L. . 
 
 >> 
 
 . 1881 
 
 108 . 
 
 . H. R. . 
 
 J> 
 
 .. 1871 
 
 112 . 
 
 . L. F. . 
 
 ,, 
 
 .. 1871 
 
 114 . 
 
 . N. R. . 
 
 •• )> 
 
 .. 1875 
 
 121 . 
 
 . H. H. . 
 
 J> 
 
 .. 1874 
 
 136 . 
 
 . M. F. . 
 
 J> 
 
 .. 1876 
 
 Kemarks. 
 
 T. gone, F. cont., N. S. 
 
 T. and F. cont. and ab., N. S. 
 
 R. H. amp., L. H. F. gone, Ft. 
 
 gone, N. S. 
 Hs. cont. and contorted, N. S. 
 F. and T. gone, N. S. 
 F. and T. gone, N. S. 
 H. cont. and deformed, N. S. 
 F. and T. gone, N. S. 
 F. and T. gone, P. U. one foot. 
 F. and T. ab., N. S. 
 F. gone, N. S. 
 H. cont. and contorted. 
 F. cont., T. gone, N. S. 
 H. cont. and ab., N. S. 
 F. cont. and ab., P. U. on foot. 
 F. and T. ab., P. U. sole foot. 
 H. comp. but cont., T. ab., N. S. 
 H. ab. and shapeless, ankle-jt. 
 
 gone, N. S. 
 F. and T. ab., P. U. one foot. 
 F. cont., P. U. one foot.
 
 220 IMPEY ON SPONTANEOUS EECOVERY FROM LEPROSY. 
 
 No. 
 
 Name. 
 
 Form. 
 
 Contracted. 
 
 Remarks. 
 
 F. P. . 
 
 .. A 
 
 .. 1851 ... 
 
 P. and T. gone, P. U. one foot. 
 
 C. . 
 
 .. „ 
 
 .. 1874 ... 
 
 P. cont. and contorted, T. gone. 
 
 N. S. 
 
 K. . 
 
 „ 
 
 .. 1881 ... 
 
 P. and T. gone, N. S. 
 
 A. A. 
 
 )j 
 
 ... 1876 ... 
 
 P. cont. and ab., T. gone, N. S. 
 
 S. S. . 
 
 „ 
 
 .. 1837 ... 
 
 P. and T. gone, N. S. 
 
 E. P. . 
 
 • > )> 
 
 .. 1880 ... 
 
 F. gone except one thumb, T. 
 gone, N. S. 
 
 R. . 
 
 » 
 
 .. 1873 ... 
 
 Hs. and Pt. gone, N. S. 
 
 M. . 
 
 .. „ 
 
 .. 1855 - 
 
 R. H. P. gone, L. H. ab., T. ab., 
 
 N. S. 
 
 U. . 
 
 5> 
 
 .. 1880 ... 
 
 P. and T. ab., N. S. 
 
 s. s. . 
 
 )J 
 
 .. 1874 ... 
 
 Males. 
 
 P. cont., T. ab., P. U. one foot. 
 
 CM. . 
 
 .. A. 
 
 ... 1878 ... 
 
 P. and T. ab. and cont., N. S. 
 
 CM. 
 
 •> 
 
 ... 1878 ... 
 
 P. and T. cont. and ab., N. S. 
 
 CB. 
 
 ,, 
 
 ... 1878 ... 
 
 P. and T. cont. and ab., N. S. 
 
 C W. 
 
 ,, 
 
 ... i860 ... 
 
 P. ab. and cont., T. gone, N. S. 
 
 P. R. 
 
 .. » 
 
 ... 1877 ... 
 
 P. and T. cont. and ab., P. U. 
 one foot. 
 
 CM. . 
 
 ,, 
 
 .. 1854 ... 
 
 P. cont., ab. and turn., N. S. 
 
 H. 
 
 .. „ 
 
 ... 1870 ... 
 
 P. and T. cont. and ab., P. U. 
 one foot. 
 
 D. S. 
 
 „ 
 
 ... 1867 ... 
 
 P. and T. cont., P. U. one foot. 
 
 J. H. . 
 
 )» 
 
 .. 1870 ... 
 
 P. and T. cont. and ab., P. U. 
 
 H. K. 
 
 A. 
 
 A. S. 
 
 J.J. 
 
 S. 
 
 P. G. 
 
 E. 
 T. S. 
 
 C 
 
 D. 
 
 B. 
 J. M. 
 J. G. 
 
 K. 
 
 J. 
 
 1873 
 
 1877 • 
 
 . p 
 
 1873 • 
 
 . p. 
 
 1875 . 
 
 . p 
 
 1872 . 
 
 . p 
 
 1877 ■ 
 
 . p. 
 
 1867 . 
 
 . p. 
 
 1869 . 
 
 . p. 
 
 1875 . 
 
 . p 
 
 1875 ■ 
 
 . p. 
 
 1879 . 
 
 . p. 
 
 1878 . 
 
 . p. 
 
 1879 . 
 
 . p 
 
 1878 . 
 
 . p 
 
 1878 . 
 
 . p 
 
 one foot, 
 and T. cont. and ab., P. U. 
 
 one foot, 
 and T. cont., P. U. one foot, 
 and T. cont. and ab., P. U. 
 
 one foot, 
 and T. gone, N. S. 
 and T. cont. and ab., N. S. 
 and T. cont. and ab., P. U. 
 
 one foot, 
 cont., N. S. 
 
 and T. cont., P. U. one foot, 
 and T. cont. and ab., N. S. 
 and T. cont., N. S. 
 and T. cont. and ab., N. S. 
 and T. truncated, N. S. 
 and T. gone, N. S. 
 and T. cont. and turn., N. S. 
 ab. and cont., T. ab., P. U. 
 
 one foot.
 
 No. 
 
 Name. 
 
 Form. 
 
 Contracted. 
 
 113 .. 
 125 .. 
 
 D. . 
 
 C. . 
 
 .. A . 
 
 .. 1875 
 .. 1878 
 
 132 .. 
 
 133 •• 
 
 M. . 
 W. . 
 
 
 .. 1847 
 .. 1879 
 
 138 .. 
 142 .. 
 
 D. . 
 . C.J. . 
 
 J) 
 
 .. 1871 
 .. 1872 
 
 152 .. 
 
 . T. K. . 
 
 }> 
 
 .. 1874 
 
 157 •• 
 
 . H. T. . 
 
 .. „ . 
 
 .. 1873 
 
 165 .. 
 
 C. . 
 
 )) 
 
 .. 1856 
 
 167 .. 
 176 .. 
 
 F. . 
 
 M. . 
 
 . G. G. . 
 
 j> • 
 
 .. 1867 
 .. 1877 
 .. 1877 
 
 CASE STATEMENTS FROM ROBBEN ISLAND. 221 
 
 Remarks. 
 
 F. and T. cont., P. U, one foot. 
 F. and T. cont. and ab., P. U. 
 
 one foot. 
 F. and T. ab. and cont., N. S. 
 F. and T. ab. and cont., P. U. 
 
 one foot. 
 F. and T. ab. and cont., N. S. 
 One H. amp., one wrist gone, 
 
 ankles gone, N. S. 
 F. and T. cont. and ab., P. U. 
 
 one foot. 
 F. cont. and ab., T. ab., P. U. 
 
 one foot. 
 F. and T. cont. and ab., P. U. 
 
 one foot. 
 F. and T. cont. and ab., N. S. 
 F. and T. cont. and ab., N. S. 
 F. and T. cont. and ab., P. U. 
 
 one foot. 
 181 ... B. ... „ ... 1880 ... F. and T. cont. and ab., ulcera- 
 
 tion continuing. 
 193 ... P. S. ... „ ... i860 ... F. and T. truncated, N. S. 
 195 ... G. C. ... „ ... 1874 ... F. and T. cont. and contorted, 
 
 N. S. 
 202 ... M. B. ... „ ... 1854 ... F. and T. cont. and ab., P. U. 
 
 one foot. 
 F. and T. cont. and ab., N. S. 
 F. and T. cont. and ab., N. S. 
 F. L. H. ab. and cent., E. H. 
 
 semi-cont., N. S. 
 F. and T. cont., N. S., suspicion 
 
 tuber. 
 F. L. H. cont., R. H. semi-cont., 
 
 N. S. 
 F. cont. and ab., P. U. one foot. 
 F. and T. cont. and tum., P. U. 
 
 one foot. 
 F. and T. ab. and cont., N. S. 
 F. and T. cont., P. U. both feet. 
 F. and T, cont. and ab., N. S. 
 
 Of these 10 1 cases^ 72 are witliout ulcers; the hands 
 and feet have suffered to a variable extent. Each has been 
 subjected to severe ulceration, but this has ceased in some 
 instances for many years. In one instance only the true 
 leprous ulcerative process is still active, and in 28 cases 
 
 209 ., 
 226 .. 
 
 231 .. 
 
 K 
 
 . S. P. ... 
 
 . s. s. ... , 
 
 „ ... 1870 
 » ... 1877 
 „ .. 1877 
 
 238 .. 
 
 . D. P. ... ., 
 
 „ ... 1879 
 
 244 .. 
 
 B. ... , 
 
 „ ... 1873 
 
 245 .. 
 252 .. 
 
 N. ... , 
 . K.J. ... , 
 
 . ... 1875 
 , ... 1872 
 
 253 •• 
 
 2.55 •• 
 
 256 .. 
 
 . F. H. ... , 
 . K. B. ... , 
 . K. K. ... , 
 
 , ... 1876 
 , ... 1878 
 ,, ... 1878
 
 222 IMPEY ON SPONTANEOUS RECOVERY FROM LEPROSY. 
 
 perforating ulcers exist in one or both feet. Many of 
 those in which the ulcerative process has ceased are of 
 shorter duration than some of those in which the perforating 
 ulcer is found. As will be seen from the following table 
 some of the patients who now have perforating ulcers con- 
 tracted the disease upwards of thirty years ago. 
 
 I contracted the disease in 1851. 
 
 I y> !j ,) 1854- 
 
 I „ „ „ 1856. 
 
 I „ „ „ 1864. 
 
 I „ „ „ 1867. 
 
 3 » >> ^y 1870- 
 
 1 „ ,, „ 1871. 
 
 I ,; „ „ 1872. 
 
 3 >^ ^y » 1873. 
 
 3 ;. ,, ^y 1874- 
 
 2 „ „ „ 1875. 
 I „ „ „ 1876. 
 
 4 >y ^> yy 1877. 
 
 3 >> '> '} 1878. 
 
 I „ „ ,, 1879. 
 
 I ,, ,, ,, 1881. 
 
 This shows that the perforating ulcer remains, though the 
 ordinary symptoms of leprosy have ceased to exist for 
 upwards of — in some cases — thirty years. 
 
 In all these cases with perforating ulcers the ulcer is due 
 to the necrosed bone, and if the bone were removed by 
 operation the ulcer would readily heal, so that I think it 
 may fairly be conceded that the ulcer is not a sign that the 
 disease exists. 
 
 If, therefore, the perforating ulcer is not a sign of the 
 existence of the disease, then those patients who have these 
 ulcers need not necessarily be suffering from leprosy. 
 
 Anyone examining the cicatrices and stumps of a person 
 who has passed through the ulcerative stage of leprosy will 
 agree with me that the appearance presented by these is 
 not that of arrestation merely, they appear cured. The 
 tissues are not infiltrated and thickened by inflammatory 
 products, the skin is firm though supple, it is normal in
 
 STATEMENTS AS TO RECOVERED OASES. 223 
 
 colour, or pale, never red or irritable. If the parts are 
 injured in any way the wounds heal readily, as in ordinary 
 healthy tissues, and the health of the patient is good. 
 
 These are the facts which lead me to believe that the 
 duration of aneesthetic leprosy seldom exceeds eleven years, 
 and that almost all the patients who exceed this period are 
 self-cured cases. They all show the indelible marks and 
 bear signs of having suffered from the loathsome disease, 
 but in my opinion the disease has left them, and they are 
 no longer lepers. 
 
 It may at first appear that the percentage of cured cases 
 here is higher than in any other country, but in reality this 
 is not the case. In Norway, according to Thin, the 
 statistical report published in 1882 shows the total number 
 of cured lepers in the previous twenty-five years to be 107. 
 In the same period 4891 patients had died. 
 
 Leprosy has existed in this colony since 1756, but asylums 
 for the reception of patients suffering from leprosy were 
 first established in 18 17. There was no law compelling 
 lepers to enter asylums, so that their stay in the asylum was 
 purely a voluntary one, and the number of admissions into 
 the asylums is no criterion of the number of lepers existing 
 in the colony. 
 
 We know that upwards of 400 patients were admitted into 
 the first asylum, which was opened in 1817 and closed in 
 1846, when the remaining patients were transferred to 
 Bobben Island. 
 
 Since 1846 there have been admitted into the Robben 
 Island Asylum 1697 leper patients, of whom over 600 have 
 been admitted since the Leprosy Repression Act was put 
 into force in 1892. 
 
 For some years, roughly speaking, there have been 
 about 100 cured cases in the leper wards, but, as will be 
 seen by looking at the list of names, many of these are o£ 
 long standing. 
 
 I case contracted the disease in 1837. 
 
 1 „ „ „ 1851- 
 
 2 „ „ „ 1854. 
 
 I » >, „ 1856.
 
 224 IMPET ON SPONTANEOUS EECOVERT FROM LEPROSY. 
 
 I case contracted the disease in 1857. 
 
 I 
 
 4 
 3 
 I 
 I 
 
 7 
 o 
 6 
 6 
 6 
 6 
 
 4 
 12 
 1 1 
 
 7 
 3 
 4 
 7 
 
 J J 
 
 )) 
 
 1859. 
 
 55 
 
 55 
 
 i860. 
 
 >> 
 
 55 
 
 1867. 
 
 55 
 
 55 
 
 1868. 
 
 55 
 
 55 
 
 1869. 
 
 55 
 
 55 
 
 1870. 
 
 5' 
 
 55 
 
 187I. 
 
 55 
 
 55 
 
 1872. 
 
 55 
 
 55 
 
 1873- 
 
 55 
 
 55 
 
 1874. 
 
 55 
 
 55 
 
 1875. 
 
 55 
 
 55 
 
 1876. 
 
 55 
 
 55 
 
 1877. 
 
 55 
 
 5! 
 
 1878. 
 
 55 
 
 55 
 
 1879. 
 
 55 
 
 55 
 
 1880. 
 
 55 
 
 55 
 
 I881. 
 
 55 
 
 55 
 
 1882. 
 
 It will, therefore, appear that the self-cured cases in 
 the asylum at present ai'e an accumulation of years. 
 The Leprosy Kepression Act was put into force in 1892, 
 and lepers of all classes and grades were collected from 
 all parts and sent to Robben Island. Many of these were, 
 in my opinion, self-cured cases, so that it is not fair to 
 conclude that because there are less than 600 lepers in 
 the asylum, and the number of cured cases is 100, the 
 proportion of cases is unduly high here, higher than it is 
 in any other country. According to Thin, during the 
 twenty-five years ending in 1832 there had been sixty-one 
 cures in the Limgegaard Leper Asylum, against 165 deaths, 
 a pi'oportion of about i to 2f. In the Robben Island 
 Asylum since 1853 there have been 776 deaths and 100 cures, 
 or a proportion of about i to 7I. 
 
 I have quoted these figures in order to compare my per- 
 centage of cures with those of another asylum, but for 
 obvious reasons the conclusions derived from such figures are 
 not, strictly speaking, of much value, especially as there is
 
 CONCLUSIONS. 225 
 
 probably some diversity of opinion as to when the disease 
 may be considered cured. 
 
 I am of opinion that if it is conceded that the perforating 
 ulcer is not necessarily a sign that the disease is still active, 
 then about 15 per cent, of the ansesthetic cases become 
 cured ; if, however, this is not acknowledged, then only 
 about 7 per cent, of the cases become cured. 
 
 There are other facts which force me to the conclusion 
 that some lepers do become self-cured, of which the most 
 important are the following : 
 
 (i) None of the self-cured cases die of or from the effects 
 of leprosy ; the patients may be very much crippled and 
 deformed by the disease, but when it leaves them their general 
 health becomes good ; and if they are not carried off by 
 some intercurrent affection they may and generally do live 
 to a ripe old age. 
 
 (2) We know that leprosy resists all treatment, nothing 
 that we can do for the patient has any effect on the course 
 of the disease ; it goes on from bad to worse, uninterrupt- 
 edly, until a certain stage is reached when the ulceration 
 ceases. 
 
 (3) When the disease reaches this stage the ulcerative 
 process ceases, the ulcers heal spontaneously, and firm cica- 
 trices are formed which do not break down again. 
 
 (4) When the anaesthetic parts are accidentally injured or 
 burnt, the wounds are not leprous, and heal very readily. 
 
 (5) In the examination of innumerable sections of tissues 
 from these self-cured cases I have not been able to detect 
 the lepree bacillus. 
 
 (6) If the disease is due to the presence of the bacillus, 
 then the patient must be free from the disease when the 
 bacillus is absent. 
 
 (7) In a large number of the cases which reach this stage 
 the nerves regain their power to a certain extent, and 
 sensation and the power of motion are restored to the extre- 
 mities to a variable extent. 
 
 (8) Whilst the disease exists there are constant neuralgic 
 pains in the nerves ; these pains cease with the self-cure of 
 the disease, and they do not recur. 
 
 (9) Authorities all agree that in a few lepers the disease 
 
 15
 
 226 IMPEY ox SPONTANEOUS RECOVERY PROM LEPROSY. 
 
 is permanently arrested, which in my opinion is tantamount 
 to saying the disease is cured. 
 
 (lo) Some authorities do acknowledge that the disease is 
 in some cases cured. 
 
 hi) I believe that the contraction of the tissues resulting 
 from the inflammation caused by the bacillus in the nerves 
 is the cause of the death of the bacilli. 
 
 RoBBEN Island; 
 
 November Uth, 1S94.
 
 EOBBEN ISLAND STATISTICS. 
 
 227 
 
 r^ 
 
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 I 
 
 PUINTKD BY ADLARD AND SON, 
 BAUTIIOLOMEW CLOSE, E.C., AND 20, HANOVEE SQUAUE, W.
 
 REPORT 
 
 PRESENTED TO THE 
 
 THIRTY-SEVENTH ANNUAL MEETING 
 
 NEW SYDENHAM SOCIETY 
 
 HELD IN LONDON, 
 August 2nd, 1895. 
 
 BALANCE SHEET FOR 1894, LIST OF OFFICERS FOR 1895-96, 
 AND LIST OF PUBLISHED WORKS. 
 
 Agent and Depot for the Publications, 
 H. K. LEWIS, 136, GOWER STEEET, LONDON,
 
 OFFICERS FOR 1895-96. 
 
 |lresibeiTl. 
 THOMAS BRYANT, Esq. 
 
 * THOMAS BARLOW, M.D 
 
 *E. H. BENNETT, M.D. (Dublin). 
 
 SiK W. H. BROADBENT, Bart., M.D 
 ♦ALFRED H. CARTER, M.D. 
 (Birmingham). 
 
 W. S. CHURCH, M.D. 
 
 C. J. HARE, M.D. 
 
 CONSTANTINE HOLMAN, M.D. 
 
 P. W. LATHAM, M.D. (Cambridge). 
 
 I9^tct-^resib£nts. 
 
 Sib JOSEPH LISTER, Bart., F.R.f 
 THOMAS OLIVER, M.D. 
 
 (Newcastle). 
 W. MILLER ORD, M.D. 
 T. PICKERING PICK, Esq. 
 HENRY POWER, Esq. 
 SiK WM. ROBERTS, M.D., F.R.S. 
 Sir T. GRAINGER STEWART, Edi 
 HERMANN WEBER, M.D. 
 
 J 
 
 €omxdL 
 
 "W. 
 
 THEODORE D. ACLAND, M.D. 
 'G. ERNEST ALFORD, Esq. 
 
 (Weston-super-Mare). 
 MITCHELL BANKS, M.D. 
 
 (Liverpool). 
 A. A. BOWLBY, Esq. 
 R. L. BOWLES, M.D. 
 THOMAS BUZZARD, M.D. 
 W. WATSON CHEYNE, Esq., F.R.S. 
 J. S. CLOUSTON, M.D. (Morningside). 
 ♦JOHN WARD COUSINS, M.D. 
 
 (Southsea). 
 H. RADCLIFFE CROCKER, M.D. 
 W. CLEMENT DANIEL, M.D. 
 
 (Epsom). 
 J. N. C. DAVIES-COLLEY, Esq. 
 JULIUS DRESCHFELD, M.D. 
 
 (Manchester). 
 E. LONG FOX, M.D. (Bristol). 
 J. F. GOODHART, M.D. 
 G. E. HERMAN, M.D. 
 JAMIESON B. HURRY, M.D. 
 
 (Reading). 
 
 *T. VINCENT JACKSON, Esq. 
 
 (Wolverhampton) . 
 *W. H. JALLAND, Esq. (York). 
 W. ALLAN JAMIESON, M.D. 
 
 (Edinburgh). 
 THOMAS JONES, Esq. 
 
 ( Manchester). 
 PERCY KIDD, M.D. 
 W. WARD LEADAM, M.D. 
 JORDAN LLOYD, Esq. 
 
 (Birmingham). 
 STEPHEN MACKENZIE, M.D. 
 HUBERT M. MURRAY, M.D. 
 R. DOUGLAS POWELL, M.D. 
 •R. J. PYE-SMITH, Esq. 
 
 (Sheliield). 
 THOMAS SCATTERGOOD, Esq. 
 
 (Leeds). 
 •HENRY STEAR, Esq. 
 
 (Saffron Walden). 
 ALFRED WINKFIELD, Esq. 
 
 (Oxford). 
 F. P. WEAVER, M.D. 
 
 ^xtmutzx. 
 
 W. SEDGWICK SAUNDERS, M.D., F.S.A., 13, Queen Street, Cheapside, E.C. 
 
 ^ubitors. 
 
 E. CLAPTON, M.D. | *A. E. SANSOM, M.D. 
 
 *WAREN TAY, Esq, 
 
 Pon. Secretary. 
 
 JONATHAN HUTCHINSON, Esq., F.R.S., LL.D., 15, Cavendish Square, W 
 
 ! 
 
 Those marked with an asterisk were not in ojjice last year,
 
 REPORT 
 
 Presented to the Thirty-seventh Annual Meeting of the 
 New Sydenham Society, held in London, Friday, 
 August 2nd, 1895. 
 
 The works which have heen issued for the year 1894 are 
 the following : — 
 
 I. Monographs on the Parasites of Malarial Fevers, 
 comprising — 1st, that of Professor Marchiafava and 
 Dr. Bignami, of Eome ; and 2nd, that of Dr. Man- 
 naberg, of Vienna. Both of these have been libe- 
 rally illustrated. 
 II. A Fasciculus of the Atlas of Pathology, comprising the 
 first part of Diseases of the Testis (with letterpress). 
 III. Dr. Pierre Marie's Treatise on Diseases of the Spinal 
 Cord. Translated by Dr. Lubbock. With many 
 woodcuts. 
 
 The Council much regrets that owing to the illness of the 
 Editors, and other unforeseen circumstances, it has been 
 impossible to produce a Fasciculus of the Lexicon of Medical 
 Terms during the year. This work is now again in active 
 progress, and the next fasciculus may be expected shortly. 
 It will conclude the letter P. 
 
 The Society owes its best thanks to Dr. Charles, of Eome, 
 for much disinterested labour in connexion with the works 
 just mentioned on the Malarial Parasites. 
 
 The works which are proposed as the series for 1895 are 
 as follows : — 
 
 The Second and concluding Volume of Sir William Gull's 
 
 Works, with Portrait and Memoir. 
 A Fasciculus of the Atlas of Pathology, concluding 
 
 Diseases of the Testis. 
 The First Volume of Binz's Lectures on Pharmacology, 
 A Fasciculus of the Lexicon of Medical Terms.
 
 4 REPORT. 
 
 The Clinical Treatise on Cholalithiasis, recently published 
 by Dr. Naunyn, of Strasburg, has been adopted for transla- 
 tion. The translation has been entrusted to Dr. Archibald 
 Garrod. 
 
 The Committee in charge of the National Leprosy Fund, 
 having offered to allow copies of their Prize Essays on Leprosy 
 to be struck off from their type for distribution to the Society's 
 members, the proposal has been gladly accepted. The Essays 
 to be thus published are three or four in number. The cost to 
 the Society will be little more than for paper and binding. 
 
 Amongst other works which the Council has in preparation 
 may be mentioned : — 
 
 The Second and concluding Volume of Binz's Lectures on 
 
 Pharmacology. 
 Selected Papers on Actino-Mycosis. Edited by Dr. Sims 
 
 Woodhead. 
 A Volume of Selected Monographs on Gynecological 
 
 Subjects. 
 Selected Lectures from Jaccoud's Clinical Medicine. 
 Selections from the Works of Professor Fournier. 
 A Volume of Selected Monographs on Diseases of the Ear. 
 
 A Series of Volumes of Selected Clinical Lectures on Medi- 
 cine and Surgery from various (Foreign) sources. 
 Four Prize Essays on subjects connected with Leprosy. 
 
 The Council and the Society's officials have recently de- 
 voted much attention to the endeavour to obtain the services of 
 Local Secretaries in towns not hitherto thus represented. 
 Considerable success has attended these eJfforts, and thirty 
 new Local Secretaries have been appointed during the year. 
 Much yet remains to be done in making the advantages which 
 the Society offers more widely known in the profession, and 
 the Council trusts that all members will recognize a duty in 
 this direction. 
 
 The Society's accounts have been audited as usual. The 
 balance carried over from last year was i'62 2s. 8d,
 
 
 Ol 
 
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 So
 
 CLASSIFIED LIST 
 
 SOCIETY'S PUBLICATIONS. 
 
 PALUDISM. By Dr. A. Laveran. Translated by J. W. Martin, 
 M.D., F.R.C.P.E. 
 
 "We think the members of the medical profession in the United Kingdom 
 and English-speaking countries generally are under a debt of gratitude to the 
 New Sydenham Society for bringing under their notice one of the freshest and 
 ablest monographs of recent years." — Dublin Medical Journal, April, 1894. 
 
 " The New Sydenham Society has done well in issuing a translation of 
 the monograph by Dr. Laveran, in which the whole subject is treated with 
 remarkable lucidity and scientific precision." — Lancet, July 21, 1894. 
 
 COLLECTION OF THE PUBLISHED WRITINGS 
 
 OF SIK WILLIAM WITHEY GULL, Bart., M.D., F.K.S., 
 Pliysiciau to Guy's Hospital. Vol.1. Medical Papers. Edited 
 and Arranged by Theodore Dyke Acland, M.D. 
 
 MONOGRAPHS ON MALARIA:— 
 
 Ou Summer- Autumn Malarial Fevers. By Dr. E. Marchiafava 
 and Dr. A. Bignami. Translated from the lirst Italian 
 Edition by J. Harry Thompson, M.A., M.D. ; and 
 
 The Malarial Parasites. A Description based upon observations 
 made by the author and other observers. By Julius Mauna- 
 berg, M.D. Illustrated by four Lithographic Plates and 
 six Chart'-'. Translated from the German by li. W. Felkin, 
 M.D., F.K.S.E. 
 
 •• This important volume is well worthy of the aiiention of the English 
 
 reader (It) will prove a valuable addition to the admirable series with 
 
 which the New Sydenham Society is enriching medical literature." — Lancet, 
 Aug. 4, 1894. 
 
 " A knowledge of the facts these works describe is indispensable for 
 teachers of medicme and pathology everywhere, and for all practitioners in 
 malarial countries."— L'r;^. Medical Juurnal, Oct. 13, 1894.
 
 THE NEW SYDENHAM SOCIETY. 
 
 MICRO-ORGANISMS, WITH SPECIAL REFERENCE 
 
 TO THE ETIOLOGY OF THE INFECTIOUS DISEASES. 
 By Dr. C. Flugge, 0. 0. Professor and Director of the Hygienic 
 Institute at Gottingen. Translated by W. Watson Cheyne, M.B., 
 Surgeon to King's College Hospital. ^Yitb 144 Drawings. 
 " This volume forms an important addition to English medical literature, 
 Fliigge's book being justly considered one of the best standard text-books." — 
 British Medical Juiirnal. 
 
 •' This translation is a most important addition to the English literature 
 concerning Bacteria, and well deserves a place beside the most important 
 
 volumes hitherto issued by the New Sydenham Society The work is 
 
 most valuable, and we can cordially recommend it to all who take an interest 
 in Micro-organisms. To Mr. Watson Cheyne's work as a translator, too high 
 praise cannot be given. We have rarely met with a translation which could be 
 read with as much pleasure, and in which the language and style were as good." 
 — Dublin Medical jfounial, Sept. 1890. 
 
 LECTURES ON GENERAL PATHOLOGY. 3 Vols. By 
 Julius Cohxheim. Translated from the Second German Edition 
 by Alexander B. McKee, M.B., Dublin. 
 
 " The excellence of the author's work is retamed by the care and ability 
 with which the Lectures are done into English by Dr. McKee, and the 
 volumes form a useful and welcome addition to the list of valuable books 
 provided for the profession by the New Sydenham Society." — Medical Press. 
 
 LECTURES ON CHILDREN'S DISEASES. 2 Vols. By 
 Dr. C. Henoch. Translated from the Fourth Edition (1889) by 
 John Thomson, M.B., F.R.C.P. Edinb. 
 
 " The clinical types are depicted with the hand of a master, and the remarks 
 upon etiology and treatment are exhaustive and precise. It is long since we 
 have read any book with more pleasure and profit than we have experienced in 
 perusing Prof. Henoch's work in its English dress." — Glasgow Med. jfournal, 
 Aug. 1889. 
 
 " It is an exceedingly valuable work, reflecting as it does the very best 
 clinical opinion in Germany. Useful hints may be gathered on almost every 
 page ; few authorities are quoted, the author mainly relying on his own varied 
 clinical experience, which has now extended over forty-five years. Dr. Thomson 
 has done his work as a translator well, and has succeeded in producing a read- 
 able English version of a most valuable text-book." — British Medical jfournal. 
 
 RECENT ESSAYS BY VARIOUS AUTHORS ON 
 
 BACTEIilA IN KELATION TO DISEASE. Selected and 
 Edited by \V. Watson Cheyne, M.B., F.R.C.S. 
 
 " This is a valuable collection of some of the most important papers on 
 Bacteriology which have appeared in Germany, including Koch's papers on 
 the investigation of Pathogenic Organisms, the Etiology of Tuberculosis, and 
 the Etiology of Cholera ; Frielander's paper on the Micrococci of Pneumonia; 
 and others on Leprosy, Enteric Fever, Glanders, &c., by well-known bacterio- 
 logists. The work of translation has been uniformly well done, and has been 
 distributed among a large number of collaborators. The volume has had the 
 great advantage of being edited by Mr. Watson Cheyne, and will be highly 
 prized by all members of the Society as a most useful and interesting addition 
 to their book-shelves." — Birvi. Med. Review, July, 1886.
 
 CLASSIFIED LIST OF PUBLICATIONS. 
 
 DISEASES OF DIGESTIVE ORGANS. 2 vols. By Dr. C. 
 A. EwALD. Translated from the Third German Edition (1890) 
 by Egbert Saundby, M.D. 
 
 " The Profession is indebted to Dr. Saundby for a very readable trans- 
 lation of these lectures by the well-known Berlin Professor The merit 
 
 of these lectures is of a very high order. Under each disease all the various 
 headings are discussed with much perspicuity, and the text is interspersed 
 with excellent records of illustrative cases, not too many in number. The 
 treatment of the various affections is, without exception, admirably given, and 
 the morbid anatomy is unusually well described. There is a happy combina- 
 tion of scientific knowledge with much practical experience, and the balance 
 between the two is alwajs nicely maintained. The New Sydenham Society 
 has done a good ser\ ice in making these lectures available to a wider circle of 
 readers." — British Medical yoiirnal. 
 
 " The New Sydenham Society has been the means of bringing before the 
 notice of the English reader many works of high merit which have appeared in 
 foreign countries. The selection of Professor Ewald's classical treatise upon 
 digestion has been no less happy than many others that have preceded it, 
 whilst the assignment of the task of translating it to Dr. Saundby was fitting 
 and could not have been better." — Lancet. 
 
 GEOGRAPHICAL AND HISTORICAL PATHOLOGY. 
 
 Vols. 1., II., and III. I3y Dr. Aug. Hirsch. Translated from 
 the Second Edition by Chakles Creighton, M.D. 
 
 Vol. I. " The Council of the New Sydenham Society has done the Pro- 
 fession in England a right good service in having brought the great work of 
 Professor Hirsch, of Berlin, within the reach of English readers; and it has 
 been particularly fortunate in having enlisted the services of Dr. Charles 
 Creighton in the very onerous task of translating so large a volume. The third 
 chapter, dealing with Sweating Sickness, is perhaps the most interesting in the 
 whole volume, and contains a vast amount of information which the reader will 
 search for in vain elsewhere." — Medical Times and Gazette, May lo, 1884. 
 
 " The book is indeed a marvel of industry and erudition, and one which 
 ought to be consulted by every writer on Medicine ; no summary will, however, 
 suffice to indicate the wealth of material so laboriously collected and so 
 skilfully arranged, and our readers must turn to the volume itself, which will 
 well repay perusal." — Lancet, July 12, 1884. 
 
 Vol. II. " It is a deep mine of facts and information combined, and 
 judiciously arranged by the learned author ; and Dr. Creighton has admirably 
 performed his part in presenting it in an attractive English dress." — Dublin 
 Medical Journal, Sept., 1884. 
 
 ON THE TEMPERATURE IN DISEASE : A MANUAL 
 
 OE MEDICAL TliEKMOMETRY. By Dr. C. A. Wunder- 
 LicH. (Leipzig.) Translated by Dr. Bathurst Woodman. 
 With forty Woodcuts and seven Lithographs. 
 
 LECTURES ON CLINICAL MEDICINE, delivered at the 
 Hotel Dieu, Paris. By Professor Trousseau. Five Volumes. 
 Vol. 1, translated, with notes and appendices, by the late 
 Dr. Bazire. Vols. 2 to 5, translated from the third edition, 
 revised and enlarged, by Sir John Eose Cormack.
 
 10 THE >fEW SYDENHAM SOCIETY. 
 
 LATHAM'S COLLECTED WORKS. 2 vols. Edited by Dr. 
 KoBERT Martin, With Memoir of Latham by Sir Thomas Watson. 
 
 LOCAL ASPHYXIA AND SYMMETRICAL GANGRENE 
 
 OF THE EXTREMITIES. By Maurice Raynaud. Trans- 
 lated by Dr. Thomas Barlow. 
 
 ON THE NATURE OF MALARIA. By Professors Edwin 
 Klebs aud C. Tommasi-Ckudeli ; and Alterations in the Red 
 Globules in Malaria Infection ; and On the Origin of 
 Melan^mia. By Professor Ettore Marchiafava and Dr. A. 
 Celli. Translated by Dr. E. Drummond, of Rome. 
 
 CLINICAL LECTURES ON MEDICINE AND SUR- 
 GERY, Translated from the German, and selected from Pro- 
 fessor Volkmann's Series. Three Volumes, 
 
 (Third Series.) " This volume is replete with interesting clinical details. 
 
 The work is one well worthy of close and attentive study," — Dublin 
 
 Medical Jotwnal, Aug. 1894. 
 
 MEMOIRS ON DIPHTHERIA; containing Memoirs by 
 Bretonneau, Trousseau, Daviot, Guersaut, Bouchet, Empis, &c. 
 Selected and Translated by Dr, R, H, Semple. 
 
 RADICKE'S PAPERS ON THE APPLICATION OF 
 
 STATISTICS TO MEDICAL INQUIRIES. Translated by 
 Dr. Bond. 
 
 LECTURES ON PHTHISIS. By Professor Niemeyer. Trans- 
 lated b;) Professor Baumler. 
 
 THE COLLECTED WORKS OF DR. ADDISON. Edited, 
 with Introductory Prefaces to several of the Papers, by Dr. 
 WiLKS and Dr. Daldy. Portrait, and numerous Lithographs. 
 
 GUIDE TO THE QUALITATIVE AND QUANTITA- 
 TIVE ANALYSIS OE THE URINE, By Dr, C, Neubauer 
 and Dr, J. Vogel. Fourth edition, considerably enlarged. 
 Translated by William 0, Markham, r,R.C,P,L, With four 
 Lithographs, and numerous Woodcuts. 
 
 MEMOIRS ON ABDOMINAL TUMOURS AND INTU- 
 MESCENCE, By Dr, Bright. Reprinted from the " Guy's 
 Hospital Reports," with a Preface by Dr. Barlow. Numerous 
 VVoodcuts.
 
 CLASSIFIED LIST OF PUBLICATIONS. ll 
 
 A CLINICAL ACCOUNT OF DISEASES OF THE 
 
 LIVEli. By Prof. Fkerichs. 2 vols. Translated by Dr. 
 MuECHisoN. Coloured Lithographs, and numerous Woodcuts. 
 
 CZERMAK ON THE PRACTICAL USES OF THE 
 
 LAEYNGObCOPE. Translated by Dr. G. D. Gibb. Numerous 
 Woodcuts. 
 
 A HAND-BOOK OF PHYSICAL DIAGNOSIS, COM- 
 
 PEISING THE THEOAT, THOEAX, AND ABDOMEN. 
 By Dr. Paul Guttmann, of Berlin. Translated by Dr. Napier, 
 of Glasgow. 
 
 ESSAYS ON ACROMEGALY. By Drs. Pierre Marie and 
 SouzA Leite. Translated by Procter S. Hutchinson, M.R.C.S. 
 
 AN ATLAS OF ILLUSTRATIONS OF PATHOLOGY, 
 
 COMPILED (CHIEELY FEOM OEIGINAL SOUECES) 
 EOE THE SOCIETY. 
 
 The Committee in charge of this work consists of Dr. Gee, 
 Dr. Green, Mr. Holmes, and Mr. Hutchinson. 
 
 NINE FASCICULI have been published, and it is proposed 
 to issue one every year. 
 
 " Of the many valuable works published by this great Society, none are 
 more acceptable to us than the 'Atlas of Pathology.'. . . . Such a vast and 
 desirable undertaking as the publishing of this work is worthy of the Society 
 named after the greatest English physician." — Medical Press and Circular, 
 August 14, 1889. 
 
 The following subjects have been illustrated : — 
 
 FIRST FASCICULUS. 
 
 Diseases of the Kidney. 
 Scrofula ; Syphilis ; and Lymph- Adenoma. — Plate I. 
 
 5 Figures. 
 
 Nephritis after Diphtheria ; Scarlet Fever ; and Burns. — Plate II. 
 
 7 Figures. 
 
 The Granular Kidney in different stages. — Plate III. 
 
 8 Figures. 
 
 Embolism ; Infarction Processes from Pyasmia ; Jaundice and 
 Purpura ; Scrofula. — Plate IV. 
 
 6 Figures.
 
 12 THE NEW SYDENHAM SOCIETY. 
 
 SECOND FASCICULUS. 
 
 Diseases of the Kidney, Suprarenal Capsules, and Spleen, 
 
 Amyloid Disease aud Cancer of the Kidney. — Plate V. 
 
 5 Figures. 
 
 Various Diseased Conditions of the Spleen. — Plate VI. 
 5 Figures. 
 
 Diseases of the Suprarenal Capsules and Spleen. — Plate VII. 
 9 Figures. 
 
 Mici'oscopic Pathology of Kidneys. — Plate VIII. 
 
 20 Figures. — Lardaceous Disease, Contracted Granular Kidney, Catarrhal 
 Nephritis, Casts. 
 
 Microscopic Pathology of the Kidney and Spleen. — Plate IX. 
 
 23 Figures. — Scarlatinal Nephritis, Fatty and Cystic Degeneration, Inter- 
 stitial Nephritis, &c., Spleen in Hodgkin's Disease, Adenoma of Suprarenal 
 Capsule, &c. 
 
 Microscopic Pathology of Spleen and Suprarenals. — Plate X. 
 
 15 Figures. — Leucocythasmic Spleen, Muscular Hypertrophy, Tubercle of 
 Spleen, Addison's Disease of Suprarenals. 
 
 With Essay on the Pathology of the Kidney, by Dr. Greenfield. 
 Essay on the Pathology of the Spleen and Suprarenals, by 
 Dr. Goodhart. 
 
 THIRD FASCICULUS. 
 
 Diseases of the Liver. 
 
 Lymph-Adenoma of Liver. — Plate XI. 
 
 Plate XII. 
 
 Fig. I. Dilatation of the Bile Ducts in the Liver from pressure of a gall stone 
 
 in cystic duct. 
 Fig. 2. Cancer of the Liver, with dilatation of the ducts and staining of the 
 hepatic tissue. 
 
 Plate XIII. 
 Syphilitic Cirrhosis of the Liver. 
 
 Plate XIV. 
 
 Fig. 1. Red Atrophy, with acute Yellow Atrophy of the Liver. 
 
 Fig. 2. Microscopical appearances of the 3'ellow swollen parts of the Liver 
 
 (Acute Yellow Atrophy). 
 Fig. 3. Microscopical appearances of Red Atrophy of the Liver. 
 
 Plate XV. 
 
 Fig. I. Lardaceous Liver. 
 
 Fig. 2. Lardaceous Liver, showing the iodine reaction. 
 
 Plate XVI. 
 Fig. I. Cancer of the Liver. 
 
 Fig. 2. Nutmeg Liver, Chronic Congestion, and Atrophy of the Liver from 
 mitral disease.
 
 CLASSIFIED LIST OF PUBLICATIONS. 
 
 13 
 
 " We look on this Pathological Atlas, in all its three fasciculi, as one of the 
 best things that the Society has as yet done. The illustrations are nearly life 
 size ; the colouring is beautiful and true to nature ; and we have not seen in 
 this or any other country any work of this kind that satisfied us so much. 
 Taken alone, it would be well worth the annual guinea; and will, when 
 finished, constitute a treatise which every practising physician should possess." 
 — Medical Press and Circular, June 22nd, 1881. 
 
 FOURTH FASCICULUS. 
 
 Diseases of the Liver, including one Figure of Spleen. 
 Diseases of the Liver and Spleen. — Plate XVIL 
 Fig. I. Cirrhosis of the Liver resembling the Nutmeg Liver. 
 Fig. 2. Brown Atrophy of the Liver. 
 Fig. 3. Cirrhosis of the Liver. 
 Fig. 4. Lymph-Adenoma of tho Spleen (Hodgkin's Disease). 
 
 Diseases of the Liver. — Plate XVIII. 
 Fig. I. Fatty Liver from Poisoning by Phosphorus. 
 Fig. 2. Cirrhosis of the Liver. 
 Fig. 3. Tubercular Liver. 
 Fig. 4. Cirrhosis of the Liver. 
 
 Diseases of the Liver. — Plate XIX. 
 Cystic Disease of the Liver. 
 
 Microscopic Pathology of the Liver. — Plate XX. 
 
 Fig. I. Lardaceous Disease of the 
 Liver. Fig. 2. Fatty Liver. Fig. 3. 
 EarlyCirrhosis. Figs. 4^5. Cirrhosis 
 of the Liver (after Hamilton). Fig. 6. 
 Cirrhosis of the Liver. Fig. 7. A Ve- 
 getation from the surface of the Liver. 
 Fig. 8. Spindle-cell Sarcoma of the 
 Liver. Fig. 9. Disseminated Growths 
 
 of Fibrous Nature in the Liver. Fig. 
 10. Lardaceous Disease of the Liver. 
 Fig. II. Cavernous Tumour in the 
 Liver. Fig. 12. Acute Yellow Atrophy 
 of the Liver. Fig. 13. Cavernous Tu- 
 mour in the Liver. Fig. 14. Early 
 Cirrhosis. Fig. 15. Columnar Epi- 
 thelioma of the Liver. 
 
 Microscopic Pathology of the Liver. — Plate XXI. 
 
 Fig. I. Cirrhosis of the Liver. Fig. 
 2. Cirrhosis of the Liver. Fig. 3. 
 Monolobular Cirrhosis. Fig. 4. The 
 Nutmeg Liver (Romose Atrophy of 
 Moxon). Fig. 5. Tubercular Liver. 
 Fig. 6. The Nutmeg Liver. Fig. 7. 
 Miliary Gummata. Fig. 8. Idiopathic 
 
 Microscopic Pathology of 
 
 Fig. I. "Pericellular" Cirrhosis. 
 Fig. 2. Cirrhosis of the Liver. Fig. 3. 
 Nutmeg Liver. Fig. 4. Cystic Liver. 
 Fig. 5. Cystic Liver. Fig. 6. Early 
 Cancer of the Liver. Fig. 7. Extreme 
 Tubercular Disease of the Liver. Fig. 
 8. Brown Atrophy of the Liver. Fig. g. 
 Extreme Tubercular Disease. Fig. 10. 
 
 Anasmia. Figs. 9 & 10. Cancer of the 
 Bile Ducts. Fig. 11. Cancerspreading 
 from the Biliary Ducts. Fig. 12. Early 
 Gummatous Infiltration of the Liver. 
 Fig. 13. " Common" Cirrhosis. Fig. 
 14. Tubercular Liver. Fig. 15. Idio- 
 pathic Ana^mia. 
 
 the Liver.— Plate XXII. 
 
 Myxoedematous Liver. Figs. 11, 12 & 
 13. " Contracting Scirrhus of the Liver 
 simulating Cirrhosis." Figs. I4,i5& 16. 
 Varieties of Cell Vacuoiation and Pro- 
 liferation. Fig. 17. Primary Adenoma 
 of the Liver. Fig. 18. Leukjemic 
 Liver. Fig. 19. Primary Adenoma gf 
 the Liver,
 
 14 THE NEW SYDENHAM SOCIETY. 
 
 FIFTH FASCICULUS. 
 
 Diseases of the Liver (chiefly of the Gail-Bladder and Larger 
 
 Bile Ducts). 
 Syphilitic and Lardaceous Disease of the Liver. — Plate XXIII. 
 
 Diseases of the Liver. — Plate XXIV. 
 
 Fig. I. Abscesses in the Liver. 
 
 Fig. 2. Papilloma of the Gall-Bladder. 
 
 Diseases of the Liver. — Plate XXV. 
 Cancer of Gall-Bladder and Liver. 
 Gall-stones, with Obstruction and Dilatation of the Cystic Duct. 
 
 Diseases of the Liver. ^ — Plate XXVI. 
 Cancer of the Stomach extending to the Cystic Duct. 
 " We have nothing but praise to bestow on these plates, which are wonder- 
 fully good, and well worth the whole guinea subscription." — Medical Press, 
 August 2g, 1883. 
 
 SIXTH FASCICULUS. 
 
 Hydatid Cysts of the Liver.— Plate XXVII. 
 
 Urinary CalcuH.— Plates XXVIII. to XXXI. 
 
 Comprising 46 Figures. 
 
 " Of the many valuable works published by this great Society, none are 
 more acceptable to us than this Atlas of Pathology, of which we have received 
 the sixth fasciculus. Such a vast and desirable undertaking as the publishing 
 of this work is worthy of the Society named after the greatest English physician. 
 .... We think that no medical man will be consulting his best interests if he 
 hesitates to become a member of the Society. He certainly will have no more 
 useful books than those bearing the medallion of the immortal Sydenham." — 
 Medical Press and Circular. 
 
 SEVENTH FASCICULUS. 
 
 Urinary Calculi and Gall Stones. — Plate XXXII. 
 Enlargement of the Prostate Gland. — Plate XXXIII. 
 Enlargement of Prostate, Urinary Calculi. — Plate XXXIV. 
 Ostpitis Deformans (Paget's Diseased — Plate XXXV. 
 Comprising 30 Figures. 
 
 EIGHTH FASCICULUS. 
 
 Diseases of Brain and Spinal Cord. 
 
 Plate XXXVI. 
 Fig. I. Hydatid in the Posterior Corner of the Right Lateral Ventricle. 
 Fig. 2. Abscess on the Under Surface of the Right Cerebellar Hemisphere, 
 close to the Petrous Portion of the Temporal Bone. 
 
 Plate XXXVII. 
 
 Fig. I. Hasmorrhage into the Right Hemisphere and Median Lobe of the 
 Cerebellum. 
 
 Fig. 2. Tubercles of various sizes situated on the Upper Surface of the Cere- 
 bellar Hemispheres.
 
 CLASSIFIED LIST OF PUBLICATIONS. 15 
 
 Fig. 3. A Tuberculous Tumour situated between the left side of the Pons 
 Varolii, the Medulla Oblongata, and the adjacent surface of the 
 Cerebellar Hemisphere. 
 
 Plate XXXVIII. 
 
 Fig. I. A severely crushed Spinal Cord. 
 
 Fig. 2. The Cervical Spinal Cord of a Man who had died under almost precisely 
 
 similar conditions to those specified in the preceding case. 
 Fig. 3. Haemorrhage external to the Vertebral Theca. 
 
 Plate XXXIX. 
 Figs. I, 2, & 3. A Tuberculous Tumour on the Spinal Dura Mater. 
 
 Plate XL. 
 
 Fig. I. Cartilaginous Deposits on tlie Spinal Arachnoid. 
 Fig. 2. Myelitis after Concussion of the Spine. 
 
 Plate XLI. 
 
 Fig. I. Tubercle in Pia Mater of Cord. 
 
 Fig. 2. A Fibrous Tumour lodged in the Cauda Equina. 
 
 " The New Sydenham Society is doing good service in issuing a series of 
 
 pathological drawings, which are extremely well executed and faithful 
 
 The explanatory text is clear and concise ; and indeed the whole production is 
 highly creditable to the Society, and will be much appreciated by its members." 
 — Lancet, Jan. 2, 1893. 
 
 NINTH FASCICULUS. 
 
 Diseases of the Testis. (Part I.) 
 
 Plate XLII. 
 
 Fig. I. fiydrocele of the Spermatic Cord. 
 
 Fig 2. ,, ,, Epididymis. 
 
 Fig. ■<. Pedunculated Cartilaginous F^ody attached to tlie Globus Major. 
 
 Fig. 4. A Calcareous Plate in the Tunica Vaginalis, thai portion immediately 
 
 covering the Testis. 
 Fig. 5. A number of Calcareous and Cartilaginous Bodies formed in the 
 
 Visceral Layer of the Tunica Vaginalis, and on the Globus Major 
 
 of the Epididymis. 
 Fig. 6. A Multilocular Cyst developed between the Tunica Vaginalis and the 
 
 Tunica albuginea. 
 Fig. 7. A Hydrocele of the upper part of the Tunica Vaginalis, the lower part 
 
 having become obliterated by adhesion to the Testicle, which is 
 
 seen in section. 
 
 Plate XLIII. 
 Fig. I. The Common Hydrocele of the Tunica Vaginalis. 
 Fig. n. A Varicocele of moderate size unravelled. 
 Fig. HI. A large Varicocele. 
 
 Plate XLIV. 
 Fig. I. Undescended and Atrophied Testis. 
 Fig. II. Atrophy (extreme) of one Testicle and Epididymis. 
 Fig. III. Cystic Disease (? Sarcoma) of the Testis,
 
 16 THE NEW SYDENHAM SOCIETY. 
 
 Plate XLV. 
 Syphilis of the Testicle. 
 Fig. I. Breaking down Gumma in the Testis. 
 Fig. 2. Gumma of the Testis due to Inherited Syphilis. 
 Figs. 3 & 4. Gummatous Disease of Testis and Lung. 
 
 Fig. 5. Gummatous deposit in Testis and Epididymis from acquired Syphilis. 
 Fig. 6. Gummatous Disease of the Testis, with great enlargement of the 
 Organ. 
 
 Plate XLVI. 
 Tumours of the Testicle (3 figs.) ; Gumma of the Testicle (1 fig.) 
 Fig. I. Medullary Cancer. 
 Fig. 2. Cystic Chondro-Sarcoma. 
 Fig. 3. Gumma of Testicle, with Hydrocele. 
 
 Fig. 4. A Sarcoma involving the whole Testicle, and spreading up the 
 Spermatic Cord. 
 
 ON THE DISEASES OF OLD AGE. By Prof. Charcot. 
 Translated by Mr. William Tuke. 
 
 " The New Sydenham Society has been well advised in presenting to its 
 readers one of the most important neurological works which has appeared of 
 
 late years Charcot's volume is a book to read and re-read for all of us." 
 
 — British Medical Jojivnal, June 23, 1883. 
 
 THE DIAGNOSIS AND TREATMENT OF DISEASES 
 
 OF THE CHEST. By Dr. Stokks. A Reprint Edited by 
 Dr. Hudson, of Dublin. 
 
 THE COLLECTED WORKS OF DR. WARBURTON 
 
 BEGBIE. Edited by Dr. Dyce Duckworth. With a Memoir 
 and Portrait. 
 
 SELECTIONS FROM THE CLINICAL WORKS OF 
 
 DR. DUCHENNE (of Boulogne). Translated and Edited by 
 Dr. Vivian Poore. 
 
 " The work of condensation and selection appears to have been admirably 
 performed ; nearly all the material is drawn from Duchenne's great work, 
 which bears the somewhat misleading title of ' L'Electrisation Localisee.' " — 
 British Medical Journal, Jan. 12, 1884. 
 
 CLINICAL LECTURES ON THE PRACTICE OF 
 
 MEDICINE. Vols. I. and II. By the late Robert J. Graves, 
 M.D. Reprinted from the Second Edition, Edited by Dr. 
 Neligan. 
 
 "The reprint of 'Graves' Practice of Medicine' once more places within 
 the reach of every member of the profession a classical work by one of the 
 greatest clinical teachers." — British Medical Journal, February 20, 1886
 
 CLASSIFIED LIST OF PUBLICATIONS. 17 
 
 ALBUMINURIA IN HEALTH AND DISEASE. By 
 
 Dr. H. Senator. Translated by Dr. T. P. Smith. 
 
 " Dr. Senator on Albuminuria may be taken as the latest utterances of 
 science upon this obscure and difficult subject, to the elucidation of which the 
 
 author has contributed so much The translation is faithfully rendered 
 
 by Dr. T. P. Smith, and the monograph is one which requires to be carefully 
 studied, for it is full of closely-reasoned argument." — Lancet, June 20, 1885. 
 
 SOME CONSIDERATIONS ON THE NATURE AND 
 
 PATHOLOGY OF TYPHUS AND TYPHOID FEVER. 
 By the late Dr. P. Stewart, Edited by Dr. W. Cayley. 
 
 " Dr. Cayley has edited the late Dr. H. P. Stewart's paper on the Identity 
 or Non-identity of Typhus or Typhoid Fever. It is satisfactory to find that a 
 scientific production of such undoubted merit has been rescued from oblivion." 
 — Lancet, June 20, 1885. 
 
 ESMARCH ON THE USES OF COLD IN SURGICAL 
 
 PEACTICE. Translated by Dr. Montgomery. Woodcuts. 
 
 " Esmarch's treatise is of high practical interest." — British Medical J ournaL 
 
 BILLROTH'S LECTURES ON SURGICAL PATHO- 
 LOGY AND THEEAPEUTICS. A Hand-book for Students 
 and Practitioners. 2 vols. 
 
 INVESTIGATION INTO THE ETIOLOGY OF THE 
 
 TRAUMATICINFECTIVE DISEASES. By R. Koch. Trans- 
 lated, with Lithographic Plates, by Mr. Watson Cheyne. 
 
 ON THE PROCESS OF REPAIR AFTER RESECTION 
 
 AND EXTIRPATION OF BONES. By Dr. A. Wagner, of 
 Berlin. Translated by Mr. T. Holmes. 
 
 CLINICAL LECTURES. Selected from Professor Volkmann's 
 Series. 2 vols. (See "Medicine.") 
 
 THE WORKS OF ABRAHAM COLLES. Chiefly his 
 Treatise on the Venereal Disease and on the Use of Mercury. 
 Edited, with Portrait, by Dr. McDonnell, of Dubhn.
 
 18 THE NEW SYDENHAM SOCIETY. 
 
 A TREATISE ON GYNECOLOGY, CLINICAL AND 
 
 OPERATIVE. By S. Pozzi. 3 Vols. 
 
 " The appearance of the third (and last) volume of Pozzi's work in its 
 English form enables us to express an opinion on the whole treatise. It is a 
 good work on Gynecology, well translated ; and authors, translators, and the 
 New Sydenham Society are all to be congratulated on its successful completion. 
 .... A good index to the three volumes is appended." — Edin. Med. jfounial, 
 April, 1894. 
 
 " This, the third volume, completes Professor Pozzi's splendid work on 
 Gynaecology'. In our notices of the two former volumes we freely expressed 
 our admiration of the book, and on reading the present volume, we find that 
 the same care and trouble has been expended as in the preceding volumes. 
 Whilst such monographs are produced by the New Sydenham Society, there 
 are many and strong inducements to those members of the medical profession 
 who are not members to join. They will consult their own interests by doing 
 so." — Med. Press, Feb. 7, 1894. 
 
 A TEXT-BOOK OF MIDWIFERY. By Otto Spiegelberg. 
 Translated from the Second German Edition by Dr. J. B. 
 Hurry. 2 vols. 
 
 " The reputation attained by the late author of this work suffices to explain 
 its translation and publication by the New Sydenham Society. Written in a 
 lucid and easy style, it leads the reader on indefinitely without ever causing 
 
 weariness The book is well and profusely illustrated, and should find 
 
 a place in the general practitioner's library. Very few English text-books 
 describe treatment as this does. The translation is everything that can be 
 desired." — London Mcdieal Record. 
 
 " The issue of the second volume of Spiegelberg's Midwifery, translated 
 by Dr. Hurry, under the auspices of the New Sydenham Society, now places 
 this valuable work in a complete form within the reach of the English reader 
 
 who is not familiar with German It would be difficult to speak too 
 
 highly of the book as a general text-book of Midwifery; it is neither too long 
 nor too difficult for the student, while the practitioner wishing to read up the 
 authorities on some special point will find ample information of a practical 
 kind. Dr. Hurry is to be congratulated on the way he has done his work. 
 The book is commendablv free from idiomatic indications of its foreign origin." 
 — British Medical Journal. Oct. 5, 1889. 
 
 "The New Sydenham Society has done much good work and conferred 
 many benefits upon the English student and practitioner, but it has not done 
 better than by giving Spiegelberg's great book on Midwifery to the English 
 reader." — Lancet, Jan. 7, 1888. 
 
 HISTORY AND ETIOLOGY OF SPONDYLOLIS- 
 THESIS. By Dr. Franz Ludwig Neugebauer, of Warsaw. 
 Translated by Dr. Fancourt Barnes. 
 
 ON THE MORE IMPORTANT DISEASES OF WOMEN 
 
 AND CHILDKEN, with other Papers, by Dr. Gooch. Ke- 
 printed; with a Prefatory Essay by Dr. Egbert Ferguson. 
 With woodcuts.
 
 CLASSIFIED LIST OF PUBLICATIONS. 19 
 
 CLINICAL MEMOIRS ON DISEASES OF WOMEN. 
 
 ByDrs.BERNUTz and GoupiL. 2 vols. Translated aud abvidgecl 
 by Dr. Meadows. 
 
 MOVEABLE KIDNEY IN WOMEN. By Dr. Leopold 
 Landau. Translated and Edited, with notes, by Francis Henry 
 Champneys, M.A. 
 
 " The essay of Dr. Leopold Landau on Moveable Kidney in Women fills a 
 gap in medical literature. It deals with the subject in the most thorough 
 manner; but space forbids our attempting any analysis of the work, for the 
 translation of which we are indebted to Dr. Champneys." — Lancet, June 20, 1885. 
 
 TREATISE ON THE THEORY AND PRACTICE 
 
 OF MIDWIFERY. 3 vols. Edited and Annotated by Dr. 
 McClintock, of Dublin. With Portrait of Sjiellie. 
 
 IStstasts of X%t E^t antr lEar, 
 
 ON THE ANOMALIES OF ACCOMMODATION AND 
 
 EFFRACTION OF THE EYE, with a PRELIMINARY 
 ESSAY ON PHYSIOLOGICAL DIOPTRICS. By F. C. 
 Donders, M.D., Professor of Physiology and OjDhthalmology in 
 the University of Utrecht. Written expressly for the Society. 
 Translated from the Author's Manuscript by W. D. Moore, M.D. 
 
 THREE MEMOIRS ON GLAUCOMA AND ON 
 
 IRIDECTOMY AS A MEANS OF TREATMENT. By 
 Professor Von Gr.efe. Translated by Mr. T. Windsor, of 
 Manchester. 
 
 ON THE MECHANISM OF THE BONES OF THE 
 
 EAR AND THE MEMBRANA TYMPANI. (Pamphlet.) 
 By Professor Helmholtz. Translated by Mr, Hinton. 
 
 THE AURAL SURGERY OF THE PRESENT DAY. 
 
 By W. Kramer, M.D., of Berlin. Translated by Henry Power, 
 Esq., F.R.C.S., M.B. With two Tables and nine Woodcuts. 
 
 VON TROELTSCH'S TREATISE ON DISEASES OF 
 
 THE EAR. Translated, with Notes, by Mr. Hinton.
 
 '2,0 THE NEW SYDENHAM SOCIETY. 
 
 HANDBOOK OF THE PRACTICE OF FORENSIC 
 
 MEDICINE, BASED UPON PEESONAL EXPERIENCE. 
 By J. L. Casper, M.D., late Professor of Medical Jurisprudence 
 in the University of Berlin. Translated by G. W. Balfour, 
 M.D. 4 vols. 
 
 Stscasts of i^t ilcrljotts S»stcm. 
 
 SCHRCEDER VAN DER KOLK ON A CASE OF 
 
 ATEOPHY OF THE LEFT HEMISPHEEE OF THE 
 BEAIN. Translated by Dr. W. Moore, of Dublin. Four 
 
 Lithograplis. 
 
 ON THROMBOSIS OF THE CEREBRAL SINUSES. 
 
 By Professor Von Dusch. Translated by Dr. Whitley. 
 
 LECTURES ON DISEASES OF THE NERVOUS 
 
 SYSTEM. By Professor Ch.^rcot. (First, Second, and Third 
 Series.) Translated by Dr. Sigerson, of Dublin. With woodcuts. 
 
 A MANUAL OF MENTAL PATHOLOGY AND THERA- 
 PEUTICS. By Professor Geiesixger. Translated by Dr. 
 LocKHART EoBERTSON and Dr. James Rutherford. 
 
 ON EPILEPSY. By Professor Schrceder van der Kolk. 
 
 CHARCOT'S TREATISE ON THE LOCALISATION 
 
 OF CEREBRAL AND SPINAL DISEASE. Translated 
 by Dr. Hadden. 
 
 " It will give to its reader a clear understanding of what is known of the 
 subject it professes to treat of." — Edinburgh Medical Journal, Dec, 18S3. 
 
 PIERRE MARIE'S LECTURES ON DISEASES OF 
 
 THE SPINAL CORD. Translated by Dr. Montagu Lubbock. 
 
 " Dr. Pierre Marie's ' Legons ' are already well known and highly esteemed 
 as a masterly exposition of the diseases of the spinal cord, and their selection 
 for translation and publication by the Xew Sydenham Society is a well-merited 
 recognition of their importance, and will render them available to a still wider 
 circle of readers." — Glasgow Medical jfonrnal, July, 1895.
 
 CLASSIFIED LIST OF PUBLICATIONS. 21 
 
 ilnatomg, i^i&gstolog^, antr Central ^at!)ologp» 
 
 A MANUAL OF HUMAN AND COMPARATIVE HIS- 
 TOLOGY. By S. Stkickeb. 3 vols. Translated by Mr. Power. 
 
 EXPERIMENTAL RESEARCHES ON THE EFFECTS 
 
 OF LOSS OF BLOOD IN PEODUCING CONVULSIONS. 
 By Drs. Kussmaul aud Tenner. Translated by Dr. Bronner, 
 of Bradford. 
 
 A MANUAL OF PATHOLOGICAL HISTOLOGY, 
 
 intended to serve as an introduction to the study of Morbid 
 Anatomy. By Professor Kindfleisch. (Bonn.) 2 vols. Trans- 
 lated by Dr. Baxter. 
 
 AN ATLAS OF ILLUSTRATIONS OF PATHOLOGY. 
 
 (See " Medicine,'' page 10.) 
 
 ON THE MINUTE STRUCTURE AND FUNCTIONS 
 
 OF THE SPINAL COED. By Professor Schrceder van der 
 KoLK. Translated by Dr. W. D. Moore. Numerous Lithographs. 
 
 ON THE MINUTE STRUCTURE AND FUNCTIONS 
 
 OF THE MEDULLA OBLONGATA, AND ON EPILEPSY, 
 By Professor Schrceder van der Kolk. Translated by Dr. W. 
 D. Moore. Numerous Lithographs. 
 
 itftrosptcts, antr SS^orlis of (iBicneval iteftvtnct, 
 
 A YEAR-BOOK OF MEDICINE AND SURGERY, AND 
 
 THEIK ALLIED SCIENCES, for 1859. Edited by Dr. 
 Harley, Dr. Handfield Jones, Mr. Hulke, Dr. Graily Hewitt, 
 and Dr. Odling. 
 
 YEAR-BOOK for 1860. Edited by Dr. Harley, Dr. Handfield 
 
 Jones, Mr. Hulke, Dr. Graily Hewitt, and Dr. Sanderson. 
 
 YEAR-BOOK for 1861. Edited by Dr. Harley, Dr. Handfield 
 Jones, Mr. Hulke, Dr. Graily Hewitt, and Dr. Sanderson. 
 
 YEAR-BOOK for 1862. Edited by Dr. Montgomery, Dr. 
 Handfield Jones, Mr. Windsor, Dr. Graily Hewitt, and 
 Dr. Sanderson.
 
 22 THE NEW SYDENHAM SOCIETY. 
 
 YEAR-BOOK for 1863. By the same Editors. 
 
 YEAR-BOOK for 1864. Edited by Mr. Hinton, Dr. Handfield 
 Jokes, Mr. Wi.nusou, L)r. M. J3kight, aud Dr. Hilton Fagge. 
 
 A BIENNIAL RETROSPECT OF MEDICINE, SUR- 
 
 GEliY, AND THElii ALLIED SCIENCES, for the Years 
 1865 aud 1806. EcUted by Mr. Power, Dr. Anstee, Mr. 
 Holmes, Dr. Barnes, Mr, Windsor, and Dr. Hilton Fagge. 
 
 A BIENNIAL RETROSPECT OP MEDICINE, SUR- 
 GES Y, AND THEUl ALLIED SCIENCES, for the Years 
 1867 and 1868. Edited by Mr. H. Po^-er, Dr. Anstie, Mr. 
 Holmes, Mr. E. B. Carter, Dr. Barnes, and Dr. Thomas 
 Stevenson. 
 
 A BIENNIAL RETROSPECT for 1869 and 1870. 
 
 A BIENNIAL RETROSPECT for 1871 and 1872. 
 
 A BIENNIAL RETROSPECT for 1873 and 1874. 
 
 THE MEDICAL DIGEST. Bemg a means of ready reference 
 to the principal contributions to Medical Science during the last 
 Thirty years. By Dr. Kiohard Neale. 
 
 BIBLIOTHECA THERAPEUTICA; OR BIBLIO- 
 
 GKAPHY OF THEBAPEUTICS. By E. J. Waring, M.D. 
 2 vols. 
 
 A LEXICON OF MEDICAL TERMS. Edited by Mr. 
 Power aud Dr. Sedgwick. Parts I. to XXI. This Lexicon is 
 based upon the well-kuown work of Dr. Mayne, the copyright 
 of which was purchased by the Society. It is, however, 
 entirely rewritten by the present Editors, and very much 
 enlarged. 
 
 " The work is carefully and elaboratel}' done, and comprehends every 
 reference which the medical or scientific inquirer could possibly require." — 
 Medical Press and Circular, June 22nd, ibSi. 
 
 '•When complete, the work will be a most valuable addition to the library, 
 not only of medical men, but of those scientists who are interested in Medicine 
 and the allied sciences.'' — R. Ncalc, M.D., in Luudun Med. Recorder, Feb. 1888. 
 
 " When finished, the Lexicon will be a credit tu British Medicine, and worthy 
 of the great Physician whose name the Society bears.'" — Dublin Medical Journal, 
 Aug., i8go.
 
 CLASSIFIED LIST OF PUBLICATIONS. 23 
 
 SELECTED MONOGRAPHS ON DERMATOLOGY:— 
 
 Selections from the Dermatological Writings of Dr. P. G. Unna. 
 
 (Translations, chiefly in abstract. Edited by Phineas S. 
 
 Abrahams, M.A., M.D., B.Sc, F.R.C.P.I.) 
 On the appearance of Herpes Zoster during the administration of 
 
 Arsenic. By Ludwig Nielsen, M.D. 
 A collection of Dr. Duhring's Papers on Dermatitis Herpeti- 
 formis. 
 The Sensation of Itching. By Edward Bennet Bronson, M.D. 
 Report of a case of the Mycosis Fongoide of Alibert. Hy Henry 
 
 W. Blanc, M.D. 
 Pellagria. By Ludwig Berger, M.A. (Translated and abridged 
 
 by Frank H. Barendt, M.D. Loud., F.R.C.S. Eng.) 
 Drug Eruptions. A Clinical Study of the Irritant Effects of 
 
 Drugs upon the Skin. By Prince A. Morrow, A.M., M.D. 
 
 (Edited by T. Colcott Fox, M.B. Lond., F.R.C.P.) 
 Researches on Psoriasis. By Ludwig Nielsen, M.D. (Translated 
 
 by Frank H. Barendt, M.D.) 
 
 " This is one of the works published by the New Sydenham Society for 
 1892, and illustrates well the good work that the Society is doing in presenting 
 monographs on various subjects in a more accessible form than they were 
 
 originally published The whole forms a most useful and instructive 
 
 volume to all who are interested in dermatological subjects." — Lancet, July 8, 
 1893. 
 
 " The selection of the monographs on dermatological subjects which are 
 contained in this volume has been judicious, and their publication in this form 
 
 will serve a useful purpose All the papers composmg the volume are 
 
 well worth reprinting in a work of this kind, and Dr. Duhring's and Dr. 
 Morrow's papers alone, as not being otherwise readily accessible, would 
 constitute ample justification for its publication." — British Medical yonrnal, 
 July 8, 1893. 
 
 ON SYPHILIS IN INFANTS. By Paul Diday. Translated 
 by Dr. Whitley. 
 
 ON DISEASES OF THE SKIN, INCLUDING THE 
 
 EXANTHEMATA. By Professor Hjii>EA. 5 vols. Translated 
 and Edited by Dr. Hilton Fagge, Dr. Pye-Smith, and Mr. 
 Waken Tay. 
 
 LANCEREAUX'S TREATISE ON SYPHILIS. 2 vols. 
 Translated by Dr. Whitley.
 
 21 
 
 THE NEW SYDENHAM SOCIETY. 
 
 lu seventeen Fasciculi comprising the following subjects. 
 Unless otherwise indicated, the I'iates are original. 
 
 PLATE 
 
 Favus. From Hebra. . . . . . .1. 
 
 Tinea Tonsm-ans. From Hebra. . . . .11. 
 
 Lupus Exulcerans. From Hebra. .... UI. 
 
 Psoriasis JJiliusa. From Hebra. .... IV. 
 
 Ichthyosis. From Hebra. . . . . .V. 
 
 Lupus berpigmosus ; Alopecia Areata. From Hebra. VI. 
 Lupus Vulgaris et berpiginosus (Cicatrising). From 
 
 Hebra VH. 
 
 Herpes Zoster FrontaUs (affecting the Frontal and 
 
 Trochlear Branches ol the Fiith Nerve). . . VIII. 
 Molluscimi Contagiosum, a, on a Child's Face ; b, on 
 the Breast of the Child's Mother ; c, Anatomical 
 Characters of the Tumours; n, Microscopic Cha- 
 racters. ........ IX. 
 
 Morbus Addisonii. ....... X. 
 
 Leucoderma. ........ XI. 
 
 Pemphigus. ........ XII. 
 
 Pityriasis Versicolor. ...... XIII. 
 
 Psoriasis Inveterata. ....... XIV. 
 
 Eczema Impetigmodes on Face of Adult. . . . XV. 
 
 Eczema on the Face, &c., of Infant; Eczema Eubrum 
 
 on Leg of Adult XVI. 
 
 Psoriasis of Hands and Finger-nails; Syphilitic 
 Psoriasis of Finger-nails ; Congeuito- Syphihtic 
 Psoriasis of Finger- and Toe-nails; Onychia 
 Mahgna; Chronic General Onychitis.. . . XVII. 
 
 MoHuscum Fibrosum seu Simplex. .... XVIII. 
 
 Psoriasis-Lupus (Lupus non Exedens, in numerous 
 
 Symmetrical Patches). ..... XIX. 
 
 Pon-igo Contagiosa (e pediculis). .... XX. 
 
 Erythema Nodosum. ....... XXI. 
 
 Morbus PecUcularis. ....... XXII. 
 
 Herpes Zoster (with scars of a former attack). . XXIU. 
 
 Erythema Cu'cmatum. ...... XXIV. 
 
 Eczema [ixom. Sugar) XXV. 
 
 Acne Vulgaris. ........ XXVI. 
 
 Scabies (on Hand of Child). Scabies (with (Edema, 
 
 &c.) Scabies Norvegica XXVII. 
 
 Porrigo Contagiosum after Vaccination. Circinate 
 
 Eruptions in Congenital Syphilis. . . . XXVIII. 
 True Eeprusy (^Tubercular turm). True Leprosy 
 
 (Anifc&metic iormj. ...... XXIX.
 
 CLASSIFIED LIST OF PUBLICATIONS. 
 
 25 
 
 PLATE 
 
 Pityriasis Eubra. ....... XXX. 
 
 Papular Syphilitic Eruption, with Indurated Chancre 
 
 on the Skin of the Abdomen. .... XXXI. 
 
 Pruriginous Impetigo after Varicella. .... XXXII. 
 
 Lichen of Infants. ....... XXXIII. 
 
 Kerion of Scalp after Ringworm. .... XXXIV. 
 
 Eruption produced by Iodide of Potassium. . . XXXV. 
 
 Tinea Ckcinata XXXVI. 
 
 Eupia-Psoriasis (from inheril,ed Syphilis). . . . XXXVII. 
 
 Prmrigo Adolesceutium, ...... XXXVIII. 
 
 Purpura Thrombotica. ...... XXXIX. 
 
 Syphilitic Rupia, with Keloid on Scars . . . XL. 
 
 Frambcesia (Endemic Verrugas). .... XLI. 
 
 Lupus Erythematosus. ...... XLII. 
 
 Ulceratmg Eruption from Bromide of Potassium. . XLIII. 
 
 Morphsea, or Addison's Keloid XLIV. 
 
 Purpura Haemorrhagica. ...... XLV. 
 
 Molluscum Contagiosum. ...... XL VI. 
 
 Pemphigus Foliaceus. ...... XL VII. 
 
 Inherited Syphilis XL VIII. 
 
 Syphilitic Tubercular Lupus XLIX. 
 
 " This Fasciculus supplies life-size portraits of pityriasis rubra, papular 
 syphilis, with indurated chancres, and pruriginous impetigo following varicella, 
 which are extremely beautiful, and look life-like." — Edin. Medical jfournal, 
 May, 1872. 
 
 " They are better, to our mind, than any other plates in use amongst us ; 
 and there cannot be a question as to the Society's issue being as popular as it 
 is useful." — Lancet. 
 
 " We have received the thirteenth fasciculus of this splendid collection of 
 drawings, of which no further praise is needed than to say that they are 
 executed with the same artistic skill and fidelity to nature which have charac- 
 terised the whole series." — Dublin jfournal of Medical Science, May, 1874. 
 
 A CATALOGUE OF THE PORTRAITS COMPRISED 
 
 IN THE SOCIETY'S ATLAS OE SKIN DISEASES. 
 Prepared, at the request of the Council, by Mr. Hutchinson. 
 Parts 1 and 2. 
 
 " The descriptions, cases, and plates are well given There is one 
 
 good feature in some of the cases described. Take that of Addison's Keloid, 
 p. 160. In it we have notes, &c., of a rare skin disease, which has been 
 accurately described by the observers under whose care the patient had been a 
 various stages of the case. This is, therefore, a valuable contribution to med 
 cine." — Edinburgh Medical Journal, February, 1877.
 
 ( 26 ) 
 
 LIST OF PUBLISHED WORKS 
 
 Arranged according to the Year of Issue. 
 
 Vol. 1859. {First Year.) 
 
 1. DiDAY on Infantile Syphilis. 
 
 2. GoocH on Diseases of Women. 
 
 3. Memoirs on Diphtheria. 
 
 4. Van der Kolk on the Spinal Cord, &c. 
 
 5. Monographs (Kussmaul and Tenner, Graefe, Wagner, &c.) 
 
 1860. {Second Year.) 
 
 6. Dr. Bright on Abdominal Tumours. 
 
 7. Frerichs on Diseases of the Liver. Vol. I. 
 
 8. A Yearbook for 1859. 
 
 9. Atlas of Portraits of Skin Diseases. (1st Fasciculus.) 
 
 1861. {Third Year.) 
 
 10. A Yearbook for 1860. 
 
 11. Monographs (Czermak, Dusch, Eadicke, &c.) 
 12.*Casper's Forensic Medicine. Vol. I. 
 
 14.*Atlas of Portraits of Skin Diseases. (2nd Fasciculus.) 
 
 1862. {Fourth Year.) 
 
 13. Frerichs on Diseases of the Liver. Vol. XL 
 
 15. A Yearbook for 1861. 
 
 16. Casper's Forensic Medicine. Vol. IL 
 
 17. Atlas of Portraits of Skin Diseases. (3rd Fasciculus.) 
 
 1863. {Fifth Year.) 
 
 18. Kramer on Diseases of the Ear. 
 
 19. A Yearbook for 1862. 
 
 20. Neubauer and Vogel on the Urine.
 
 LIST OF PUBLISHED WORKS. 27 
 
 Vol. 18G4. {Sixth Year.) 
 
 21. Casper's Forensic Medicine. Vol. III. 
 
 22.*DoNDERS on Accommodation and Refraction of the Bye. 
 
 23. A Yearbook for 1863. 
 
 24. Atlas of Portraits of Skin Diseases. (4th Fasciculus.) 
 
 1865. {Seventh Year.) 
 
 25. A Yearbook for 1864. 
 
 26. Casper's Forensic Medicine. Vol. IV. 
 
 27.*Atlas of Portraits of Skin Diseases. (5th Fasciculus.) 
 
 1866. {Eighth Year.) 
 
 28. Bernutz and Goupil on the Diseases of Women. Vol. I. 
 
 29. Atlas of Portraits of Skin Diseases. (6th Fasciculus.) 
 
 30. Hebra on Diseases of the Skin. Vol. I. 
 
 31. Bernutz and Goupil on Diseases of Women. Vol. II. 
 
 1867. {Ninth Year.) 
 
 32. Biennial Retrospect of Medicine and Surgery. 
 
 33. Griesinger on Mental Pathology and Therapeutics. 
 34.*Atlas of Portraits of Skin Diseases. (7th Fasciculus.) 
 35. Trousseau's Clinical Medicine. Vol. I. 
 
 1868. {Tenth Year.) 
 
 36. The Collected Works of Dr. Addison. 
 
 37. Hebra on Skin Diseases. Vol. II. 
 
 .38. Lancereaux's Treatise on Syphilis. Vol. I. 
 
 39. Atlas of Portraits of Skin Diseases. (8th Fasciculus.) 
 
 40. Catalogue of Atlas of Skin Diseases. (First Part.) 
 
 1869. {Eleventh Year.) 
 
 41. Lancereaux's Treatise on Syphilis. Vol. II. 
 
 42. Trousseau's Clinical Medicine. Vol. II. 
 
 43. Biennial Retrospect of Medicine and Surgery. 
 
 44. Atlas of Portraits of Skin Diseases. (9th Fasciculus.) 
 
 1870. {Twelfth Year.) 
 
 45. Trousseau's Lectures on Clinical Medicine. Vol. III. 
 
 46. Niemeyer's Lectures on Pulmonary Consumption. 
 
 47. Stricker's Manual of Histology. Vol. I. 
 
 48. Atlas of Portraits of Skin Diseases. (10th Fasciculus.)
 
 28 THE NEW SYDENHAM SOCIETY. 
 
 Vol. 1871. {Thirteenth Year.) 
 
 49. Wunderlich's Medical Thermometry. 
 
 50. Biennial Eetrospect of Medicine and Surgery. 
 
 51. Trousseau's Clinical Medicine. Vol. IV. 
 
 52. Atlas of Portraits of Skin Diseases. (11th Fasciculus.) 
 
 1872. {Fourteenth Year.) 
 
 53. Stricker's Manual of Histology. Vol. II. 
 
 54. Eindfleisch's Pathological Histology. Vol. I. 
 
 55. Trousseau's Clinical Medicine. Vol. V. 
 
 56. Atlas of Portraits of Skin Diseases. (12th Fasciculus.) 
 
 1873. {Fifteenth Year.) 
 
 57. Stricker's Manual of Histology. Vol. III. 
 
 58. Eindfleisch's Pathological Histology. Vol. II. 
 
 59. Biennial Eetrospect of Medicine and Surgery. 
 
 60. Atlas of Portraits of Skin Diseases. (13th Fasciculus.) 
 
 1874. {Sixteenth Year.) 
 
 61. Hebra on Skin Diseases. Vol. III. 
 
 62. Von Troeltsch on Diseases of the Ear. 
 Helmholtz on Membrana Tympani, &c. (In one Vol.) 
 
 63. Atlas of Portraits of Skin Diseases. (14th Fasciculus.) 
 
 64. Hebra on Skin Diseases. Vol. IV. 
 
 1875. {Seventeenth Year.) 
 
 65. Biennial Eetrospect of Medicine and Surgery. 
 
 66. Catalogue of Atlas of Skin Diseases. (Second Part.) 
 
 67. Atlas of Portraits of Skin Diseases. (15th Fasciculus.) 
 
 68. Clinical Lectures by various German Professors. Vol. I. 
 
 69. Latham's Works. Vol, I. 
 
 1876. {Eighteenth Year.) 
 
 70. Smellie's Midwifery, by McClintock. Vol. I. 
 
 71. Clinical Lectures by various German Professors. Vol. II. 
 72.*Charcot's Clinical Lectures on Diseases of the Nervous 
 
 System. Vol. I. 
 73. Billroth's Lectures on Surgical Pathology. Vol. I. 
 
 1877. {Nineteenth Year.) 
 
 74. Smellie's Midwifery, by McClintock. Vol. II. 
 
 75. The Medical Digest, by Dr. Neale. 
 
 76. Billroth's Lectures on Surgical Pathology. Vol. II. 
 
 77. Atlas of Illustrations of Pathology. (Fasciculus I.)
 
 LIST OF PUBLISHED WORKS. 29 
 
 Vol. 1878. {Tiventieth Year.) 
 
 78. Bibliotheca Therapeutica, by Dr. Waring. Vol. I. 
 
 79. Smellie's Midwifery, by McClintock. Vol. III. 
 
 80. Latham's AVorks. Vol. II. 
 
 81. Lexicon of Medical Terms. (First Part.) Issued with 
 
 Part II. only, as Vol. 83. 
 
 1879. {Twenty-first Year.) 
 
 82. Bibliotheca Therapeutica, by Dr. Waring. Vol. II. 
 
 83. Lexicon of Medical Terms. (Second Part.) Including 
 
 re-issue of First Part. 
 
 84. Manual of Physical Diagnosis, by Dr. Guttmann. 
 
 85. Atlas of Illustrations of Pathology. (Fasciculus II.) 
 
 1880. {Twenty-second Year.) 
 
 86. Hebra on Diseases of the Skin. Vol. V. 
 
 87. Lexicon of Medical Terms. (Third Part.) 
 
 88. Koch's Piesearches on Wound Infection. 
 
 89. Lexicon of Medical Terms. (Fourth Part.) 
 
 90. Charcot's Clinical Lectures on Diseases of the Nervous 
 
 System. Vol. II. 
 
 91. Atlas of Illustrations of Pathology. (Fasciculus III.) 
 
 1881. {Twenty-third Year.) 
 
 92. Selections from the Works of Abraham Colles. 
 
 93. Lexicon of Medical Terms. (Fifth Part.) 
 
 94. Billroth's Clinical Surgery. 
 
 95. Charcot on Diseases of Old Age. 
 
 96. Lexicon of Medical Terms, (Sixth Part.) 
 
 97. Atlas of Illustrations of Pathology. (Fasciculus IV.) 
 
 1882. {Twenty-fourth Year.) 
 
 98. Stokes on Diseases of the Chest. 
 
 99. Atlas of Portraits of Skin Diseases. (16th Fasciculus.) 
 
 100. The Collected Works of Dr. Warburton Begbie. 
 
 101. Lexicon of Medical Terms. (Seventh Part.) 
 
 102. Charcot on Localisation of Cerebral and Spinal Disease. 
 
 103. Lexicon of Medical Terms. (Eighth Part.)
 
 30 THE NEW SYDENHAM SOCIETY. 
 
 Vol. 1883. {Tiventy -fifth Year.) 
 
 104. Atlas of Illustrations of Pathology. (Fasciculus V.) 
 
 105. Selections from the Works of Dr. Duchenne. 
 
 106. HiKSCH on Geograjihical and Historical Pathology. Vol. I. 
 
 107. Lexicon of Medical Terms. (Ninth Part.) 
 
 1884. {Twenty -sixth Year.) 
 
 108. Atlas of Portraits of Skin Diseases. (17th Fasciculus.) 
 
 109. Graves's Clinical Medicine. Vol. I. (Eeprinted.) 
 
 110. Selected Monographs : — Senator on Albuminuria ; 
 
 Stewart on Typhus and Typhoid Fever ; Landau 
 on Moveable Kidney in Women. 
 
 111. Lexicon of Medical Terms. (Tenth Part.) 
 
 1885. {Tiventy -seventh Year.) 
 
 112. Handbook of Geographical and Historical Pathology. 
 
 By Dr. Aug. Hirsch. Vol. IL 
 
 113. Graves's Clinical Medicine. Vol. H. 
 
 114. Lexicon of Medical Terms. (Eleventh Part.) 
 
 1886. {Twenty-eighth Year.) 
 
 115. Selected Essays on Micro-Parasites in Disease. Edited 
 
 by W. Watson Cheyne. 
 
 116. Lexicon of Medical Terms. (Twelfth Part.) 
 
 117. Handbook of Geographical and Historical Pathology. 
 
 By Dr. Aug. Hirsch. Vol. HL 
 
 118. Lexicon of Medical Terms. (Thirteenth Part.) 
 
 1887. {Twenty -ninth Year.) 
 
 119. Spiegelberg's Midwifery. Vol. I. Translated by Dr. 
 
 J. B. Hurry. 
 
 120. Lexicon of Medical Terms. (Fourteenth Part.) 
 
 121. Selected Monographs : — Eaynaud's Disturbances of 
 
 Circulation in the Extremities ; Klebs and Tommasi- 
 Crudeli on the Nature of Malaria ; Marchiafava and 
 Celli on the Blood in Malaria-Infection ; Neugebauer 
 on Spondylolisthesis. 
 
 122. Atlas of Pathology. (Fasciculus VI.)
 
 LIST OF PUBLISHED WORKS. 31 
 
 Vol. 1888. {Thirtieth Year.) 
 
 123. Spiegelberg's Midwifery. Vol. II. Translated by Dr. 
 
 J. B. Hurry. 
 
 124. Lexicon of Medical Terms. (Fifteenth Part.) 
 
 125. Henoch's Diseases of Children. Vol. I. 
 
 126. Cohnheim's General Pathology. Vol. I. 
 
 1889. {Thirty-first Year.) 
 
 127. Atlas of Pathology. (Fasciculus VII.) 
 
 128. Charcot's Clinical Lectures on Diseases of the Nervous 
 
 System. Vol. III. 
 
 129. Cohnheim's General Pathology. Vol. II. 
 
 130. Lexicon of Medical Terms. (Sixteenth Part.) 
 
 131. Henoch's Lectures on Diseases of Children. Vol. II. 
 
 1890. {Thirty-second Year.) 
 
 132. Fltjgges Micro-Organisms. 
 
 133. Cohnheim's General Pathology. Vol. III. 
 
 134. Lexicon of Medical Terms. (Seventeenth Part.) 
 
 135. Atlas of Pathology. (Fasciculus VIII.) Diseases of 
 
 Brain and Spinal Cord. 
 
 1891. {Thirty -third Year.) 
 
 136. Ewald's Diseases of Digestive Organs. Vol. I. Trans- 
 
 lated by Dr. Saundby. 
 
 137. Essays on Acromegaly. By Drs. Pierre Marie and 
 
 Souza Leite. Translated by Procter S. Hutchinson, 
 M.E.C.S. 
 
 138. Lexicon of Medical Terms. (Eighteenth Part.) 
 
 139. Ewald's Diseases of Digestive Organs. Vol. II. Trans- 
 
 lated by Dr. Saundby. 
 
 140. Pozzi's Treatise on Gynaecology. Vol. I. Translated by 
 
 Dr. Lazarus Barlow and Mr. L. P. Mark. 
 
 1892. {Thirty-fourth Year.) 
 
 141. Lexicon of Medical Terms. (Nineteenth Part.) 
 
 142. Lexicon of Medical Terms. (Twentieth Part.) 
 
 143. A Volume of Dermatological Papers. 
 
 144. Pozzi on Gynsecology. Vol. II. 
 
 145. Pozzi on Gynaecology. Vol. III.
 
 32 THE NEW SYDENHAM SOCIETY. 
 
 1893. {Thirty-fifth Year.) 
 
 146. Laveran on Paludism and its Organism. Translated by 
 
 Dr. J. W. Martin. 
 
 147. The Works of Sir William Gull. Vol. I. 
 
 148. Monographs and Lectures from German sources. 
 
 149. Lexicon of Medical Terms. (Twenty-first Part.) 
 
 1894. {Thirty-sixth Year.) 
 
 150. Two Monographs on Malaria and the Parasites of 
 
 Malarial Fevers. 
 
 151. Atlas of Pathology. (Fasciculus IX.) Diseases of the 
 
 Testis. (Part L) 
 
 152. Pierre Marie's Diseases of Spinal Cord. 
 
 Volumes marked * are now quite out of print.
 
 ( 33 ) 
 
 LIST OF SURPLUS VOLUMES, 
 With Prices. 
 
 N.B. — The prices affixed can be continued only for a limited period until 
 surplus stock is disposed of. 
 
 {Some of iliesc arc hi Paper Covers only.) 
 
 ATLAS OF PATHOLOGY. Fasciculi i to 8. los. 6d. 
 
 each. 
 
 ATLAS OF SKIN DISEASES. Fasciculi 4 and 7 to 17. 
 
 los. 6d. each. 
 
 BERNUTZ AND GOUPIL'S DISEASES OF WOMEN. 
 
 Vol. II., 2S. 
 
 BILLROTH'S CLINICAL SURGERY. 6s. 
 
 BRIGHT ON ABDOMINAL TUMOURS. 5s. 
 
 CASPER'S FORENSIC MEDICINE. Vol. II., 5s. 
 
 CHARCOT'S DISEASES OF NERVOUS SYSTEM. 
 
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 EASE. 5s. 
 
 FRERICH'S DISEASES OF THE LIVER. Vol. I., 
 
 2s. 6d. 
 
 GERMAN CLINICAL LECTURES. Series II., com. 
 
 plete in itself. 3s. 6d. 
 
 C
 
 34 THE NEW SYDENHAM SOCIETY. 
 
 GRAVES'S CLINICAL MEDICINE. 2 vols. los. 
 
 GRIESINGER'S MENTAL PATHOLOGY. 5s. 
 
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 NER, GRAEFE, WAGNER, &c.). 2s. 6d. 
 
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 LIST OF SUKPLUS VOLUMES. B5 
 
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 STOKES ON DISEASES OF THE CHEST. 3s. 6d. 
 
 STRICKER'S MANUAL OF HISTOLOGY. 3 vols. 
 
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 and v., 5s. each. 
 
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 YEAR-BOOKS AND BIENNIAL RETROSPECTS, 
 
 1839-74. II volumes, is. 6d. each, or the set of ii volumes for 12s. 6d. 
 
 Several of these works are well suited for presents to 
 Students or for Class Prizes. Amongst them may be espe- 
 cially mentioned Stricker's Histology ; Frerich's On Dis- 
 eases of the Liver; Latham's Works; Hebra's Diseases of the 
 Skin ; and Guttmann's Physical Diagnosis, &c.
 
 LAWS OF THE NEW SYDENHAM SOCIETY. 
 
 I. — The Society is instituted for the ptirpose 
 of supplying certain acknowledged deficiencies 
 in the existing means of diffusing medical 
 literature, and shall be called " The New 
 Sydenham Society." 
 
 II- — The Society shall carry out its objects 
 by a succession of publications, of which the 
 following shall be the chief: — 1. Translations 
 of Foreign Works, Papers, and Essays of merit, 
 to be reproduced as early as practicable after 
 their original issue. 2. British Works, Papers, 
 Lectures, &c., which, whilst of gi-eat value, 
 have become from any cause difficult to be 
 obtained, excluding those of living authors. 
 3. Annual Volumes consisting of Reports in 
 Abstract of the progress of the different 
 branches of Medical and Surgical Science 
 during the year. 4. Dictionaries of Medical 
 Bibliography and Biogi-aphy. Those included 
 under Nos. 1 and 2 shall be held to have the 
 first claim on the attention of the Society ; 
 and the carrying out of those underNos.3 and 
 4 shall be considered dependent upon the 
 amount of funds which may be placed at its 
 disposal. 
 
 III. — The Subscription constituting a Mem- 
 ber shall be One Guinea, to be paid in advance 
 on the 1st of January annually, and it shall 
 entitle the subscriber to a copy of every work 
 published for that year. No books shall be 
 issued to any Member until his subscription 
 for the year has been paid. 
 
 IV.— The Officers of the Society shaU be 
 elected from the Members, and shall consist 
 of a President, sixteen Vice-Presidents, a 
 Treasurer, a Secretary, and a Council of 
 thirty-two, in whom the power of framing 
 Bye-laws and of directing the affairs of the 
 Society shall be vested. Twelve of the Council 
 shall be provincial residents. 
 
 v.— Five Members of the Council shall form 
 a quorum. 
 
 VI.— The Officers of the Society shall be 
 elected by ballot at the General Anniversary 
 Meeting of the Society. Balloting lists of 
 Officers proposed by the Council, with blank 
 places for such alterations as any Member 
 may wish to make, shall be laid on the 
 Society's table for the use of Members. 
 
 VII. — The President, Vice-Presidents, and 
 Council, shall be eligible for re-election, except 
 that of the Vice-Presidents four, and of the 
 Council eight, shall retii-e every year. 
 
 VIII. — The Council shall appoint local Hono- 
 rary Secretaries wherever they shall see fit. 
 
 IX. — The business of the President shall be 
 to preside at the Annual and Extraordinary 
 Meetings of the Society; in his absence one of 
 the Vice-Presidents, or the Treasurer, or any 
 Member of the Council chosen by the Members 
 present, shall take the Chair. 
 
 X. — The Treasurer, or some person ap- 
 pointed by him, shall receive all moneys due 
 to the Society. 
 
 XI.— The money in the hands of the Trea- 
 surer, which shall not be immediately required 
 for the uses of the Society, shall be vested in 
 such speedily available securities as shall be 
 approved by the Council. 
 
 SII.— The CouncU shall select the "Works to 
 be published by the Society, and shall make 
 all arrangements, pecuniary or otherwise, in 
 regitrd to their publication. In the event of 
 any Member of the Council being appointed to 
 edit any Work for the Society, f<jr which he is 
 to receive pecuniary remuneration, he shaU 
 immediately cease to be a Member of the 
 Council, and shall not be eligible for re- 
 election till after the publication of the Work. 
 
 XIII.— The Council shall lay before the 
 Members at each Anniversary Meeting a Report 
 of their proceedings during the past year, and 
 also an account of the Receipts and Expendi- 
 ture of the Society; and shall further cause to 
 be printed and circulated among the Members 
 an abstract of such Report and Accounts im- 
 mediately after such Anniversary Meeting. 
 
 XIV. — The annual Accounts of the Receipts 
 and Expenditure of the Society shall be 
 audited by a Committee of three Members, 
 selected at the preceding Anniversary Meeting 
 from among the Members at large. 
 
 XV. — The Secretary shall have the manage- 
 ment of the general Correspondence of the 
 Society, and of such other business as may 
 arise in carrying out its objects. 
 
 X\^. — The local Secretaries shall further 
 the objects of the Society in theu- respective 
 districts, and shall be in communication with 
 the metropolitan Secretary. 
 
 XVII. — The Anniversary Meeting shall be 
 held in the same town as, and at the time of, 
 the Annual Meeting of the British Medical 
 Association, notice of it having been given 
 to all Members at least a week before the day 
 fixed on. 
 
 XVIII. — The Members generally shall be 
 invited and encouraged to propose Works, &c., 
 and to make any suggestions to the Council 
 they may think likely to be useful. 
 
 XIX. — The Works of the Society shall be 
 printed for the Members only. 
 
 XX. — No alteration in the Laws of the 
 Society shall be made, except at a General 
 Meeting. Notice of the alteration to bo pro- 
 posed must also have been laid before the 
 Council at least a month previously. 
 
 XXI. — The Council shall have powir to call 
 a General Jleetiug of the jNIembers at any time, 
 and shall also be required to do so within three 
 weeks, upon receiving a requisition in writing 
 to that effect from not less than twenty Mem- 
 bers of the Society. 
 
 XXII.— All Special General Meetings of the 
 Society shall be held at such place as the 
 Council may apijoint. 
 
 XXIII. — The Council shall meet at least 
 once in two months, unless by special resolu' 
 tion to the contrary.
 
 GENERAL INFORMATION. 
 
 The Subscription is One Guinea annually, to be paid in 
 ADVANCE. The best mode of sending money is by Cheque, 
 Post-office or Postal Order, payable to Mr. H. K. Lewis ; 
 or by Cheque to the order of the Treasurer, Dr. Sedgwick 
 Saunders. It is requested that in future all communi- 
 cations in reference to the payment of Subscriptions, or 
 the issue of Books, may be made to Mr. Lewis, the Society's 
 Agent, and not to the Secretaries. 
 
 Important Notice to New Subschibk-rs and Local 
 Secretaries. — New Members who subscribe for the current 
 year and not fewer than three past years at the same time, will 
 be allowed to select volumes from the surplus stock to the 
 value of one guinea without additional payment. The like 
 privilege will be secured each year by any Local Secretary 
 who has the subscriptions of all the members on his list 
 (the number being not less than ten) paid before the end of 
 March for the current year. Arrangements have been made 
 by which new Members can obtain single Volumes, or sets 
 of Volumes, from the Society's stock in hand. Some of the 
 Volumes, of which a larger surplus exists than of others, can be 
 purchased at fixed prices (for which see list). The Society's 
 Agent is empowered to make special arrangements with new 
 Members who may wish to obtain any of the past Volumes. 
 
 Carriage, &c. — The Society's Works are supplied free 
 of cost to any address in London, Edinburgh, or Dublin; 
 but the expenses of Carriage to all other places must be borne 
 by the members to whom they are sent. Members are 
 requested to give detailed instructions respecting the mode
 
 38 THE NEW SYDENHAM SOCIETY. 
 
 by which they wish their Volumes to be forwarded, and 
 also to remember that the Society's responsibility ceases 
 when the Book has been delivered according to the in- 
 structions given. Members residing in the British Isles 
 wishing to receive their Works by post can do so by 
 prepaying the sum of 2s. for the year for postage. 
 
 Binding Cases and Portfolios.— The Society's Agent 
 is prepared to supply, at fixed prices, Cases for binding the 
 Lexicon, and Portfolios for the reception of the Plates of 
 Skin Diseases, and for the Pathological Atlas. 
 
 To prevent misapprehensions as regards the punctual issue 
 of each year's series it seems desirable to reprint the following 
 extract from the Beport for the year 1882 : — 
 
 "If the members would kindly understand that the Society's 
 financial year is from January to December, its year of issue 
 from Juue to June, and that its subscriptions are due in 
 advance, the working of the Society would be much facilitated. 
 From this point of view, the issue of volumes for each succeeding 
 year has always in the past been punctually completed, and 
 probably will be so in the future. The works promised are issued 
 J'or the year specified, but are not all of them issued in it." 
 
 The Council will always be glad to receive suggestions 
 from Members, particularly with regard to any recent foreign 
 works which are thought suitable for publication by the 
 Society {vide Law XVIII.) . It is requested that such com- 
 munications be forwarded to the Secretary in the first instance.
 
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