SKIN DISEASES

Favus; Leprosy—Leper Houses—Causes of the Disease.

This disagreeable affection must have been very common at one time, for Edmondston says, “it is less frequent at present (1809) than formerly.” Fortunately it is now almost unknown, but I understand it may occasionally be seen in the Fair Isle, where it was so universally prevalent in the days of Sir Robert Sibbald, that he informs us it was a common expression in speaking of the islanders to say, “ that there was not a hair between them and heaven.” Dr Edmondston ascribes its less frequency at his time than formerly to “a change in the mode of life of the lower class of the people,” which is probably a correct explanation.

LEPROSY

Shetland was the last part of Scotland in which this dreadful disease was met with. “The disease appears to have continued in the northern islands of Scotland long after it had disappeared from the mainland of Scotland, and, indeed, all other parts of Great Britain.” This dire disease must have appeared in Shetland at a very early period. Amongst the sick who repaired to the grave of St Magnus in Orkney, early in the twelfth century, were two lepers from Shetland. Brand takes notice of this malady.

He tells us “there is no sickness or disease this country is more subject to than scurvy. . . . And sometimes this scurvy degenerates into a kind of leprosy, which they call a bastard scurvy, and is discerned by hairs falling from the eyebrows and the nose falling in, <fec.; which, when the people come to know, they separate and set them apart for fear of infection, building huts or little houses for them in the fields. I saw the ruins of one of these houses about half a mile from Lerwick, where a woman was for some years kept for this reason.”

Dr Edmondston also takes notice of this loathsome malady. He says, “Elephantiasis, known by the name of leprosy, was very frequent in Zetland about sixty years ago, but its occurrence since that time has only been occasional, and at present scarcely an instance of it is to be met with. Formerly, when this affection was very prevalent, the unfortunate individuals who were seized with it were removed to small huts erected for the purpose, and there 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 Papa Stour, on the west side of the country, appear to have been the places in which it raged with the greatest malignity.” Sir J. Y. Simpson, in his learned series of papers on Leprosy in the Edinburgh Medical and Surgical Journal for 1841, says—“I had in my possession a MS. extract from the session books of Walls, shewing the expenses incurred in keeping the lepers at Papa from 1736 to 1740. In 1742, there is a long entry in the session records of Walls, earnestly enjoining a day of general thanksgiving for the supposed total deliverance of the country from the effects of the leprosy.” But although it may have been eradicated from Walls, the disease continued for many years afterwards to exist in Shetland, for, in the Statistical Account of Scotland, published in 1798, the Rev. Dr Jack of Northmavine, refers to it as then existing in his parish.

And long before that date it had reappeared in Walls, for, in the session books of the parish, reference is twice made to the case of a woman who was suffering from the malady, viz., in 1772 and in 1776. This is the last mention of leprosy in the session books of Walls; but Mr Rannie, session clerk of the parish, in sending the extracts to Sir James Simpson, states regarding this woman—“I have been informed by old persons that she lived but a short time after she was put into the house built for her on the common at a distance from the other houses.” Mr Rannie adds— “It has been reported to me, that, in Papa, about the year 1778, a leprous woman was put out, and died in the fields before a house could be built; and that, about the same time, there were leprous persons in the district of Watsness, and that the son and daughter of a man, Henry Sinclair, were infected, and sent to the hospital at Edinburgh.” So recently as 1798, a Shetland leper was a patient in the Edinburgh Infirmary, and was seen or treated by various physicians, amongst whom were Drs Hamilton and Thomson. The latter gentleman pronounced the case to be one of Elephantiasis Graecorum. The patient was John Bems, age twenty-eight. This was one of the last, if not the very last case that has occurred in Shetland.

We have thus documentary evidence for the existence of houses for the reception of lepers at Papa Stour and near Lerwick; but tradition points to traces of buildings in other districts in the country, as the ruins of leprous houses (or spilt men's houses, as they are popularly termed). But the disease seems to have been most common in Walls and the island of Papa, to which latter place patients were sent from all the western districts. I lately explored what appeared to be the ruins of the Papa leper-houses; but the schoolmaster of the island, who accompanied me, could not tell whether tradition pointed to that place. These ruins are those of several single-storied, stone-built cottages, situated on the common in the interior of the island, at distances from each other varying from a few yards to a quarter of a mile. The nearest is about half a mile from the dwellings of man, which have occupied the same site for generations.

Sir James Simpson inserts in his paper the copy of a manuscript entitled, “ Care of the Lepers in Papa: as drawn up by Andrew Fisken, about the year 1736 or 1737.” This very lucid description proves the disease to have been t^ie Greek elephantiasis, and this conclusion is strengthened by the circumstance that such high authorities as Drs Willan and Thomson declared the last case of Shetland leprosy, seen at Edinburgh Royal Infirmary, to be of that form. The description of Mr Fisken is too long for insertion here, but I shall take the liberty of transcribing the notes of Berns’s case, as extracted by Sir James Simpson from Dr Thomson’s manuscript:—“His face was studded over with small subcutaneous tubercles. The skin over these tubercles was of a reddish colour, intermixed with blotches, like those which occur in the pityriaris vesicolor. The hair of the eye-brows and eye-lids had fallen off, and the skin of the face, as well as of the rest of the body, seemed as, if smeared with oil His voice was weak and hoarse, so that he seemed to speak as in a whisper. On inspecting the fauces, they appeared in some places raw and excoriated, and in others rough and puckered. A slight ulceration was perceptible on the septum narium, and the nose seemed a little depressed. In various parts of the body, especially on the arms, thighs, and legs, besides the small subcutaneous tubercles, other large ones were to be perceived by feeling for them. These larger bumps or tubercles, which were not perceptible to the eye, and which did not occasion any discoloration of the skin, were without pain, and had a striking resemblance to the tubercles occurring in the flesh of those affected with scurvy.”

One remarkable point in connection with leprosy in Shetland is that while elsewhere the patients were chiefly males, of the sixteen cases of which we have distinct mention in that country, thirteen were females. The following is a classification of the cases according to sex, and with the name of the person who reports them:—

The exciting causes of leprosy are involved in even greater obscurity than the date of its origin in these islands. Various opinions have been expressed on this subject. Thus Brand ascribes leprosy “to the many gray fishes, such as sillocks, piltocks, &c., which they eat,” which, however, is manifestly incorrect, as sillocks, or the young of the Gadus Car-bonarius, are much used at the present day, and form a most nourishing and wholesome article of diet. The Rev. Dr Jack attributes it to “low living, unwholesome or ill-prepared food, and living nastily.” Dr Edmondston speaks of “ salt and rancid meat, and a scarcity of vegetable matter,” as possibly having something to do with its origin; and Dr Copland1 considers “smoked, windied, and semi-putrid or rancid flesh, meats, or fish,” as among the exciting causes of the disorder. All these influences spoken of by the three last-mentioned authors probably contribute in a considerable degree to keep up the malady and increase its violence, but they cannot be held as causing it, since, in many districts where such conditions exist, the disease is unknown; and it was formerly very prevalent in Eastern countries where rancid and salt meat and fish were unknown. In the olden time Shetlanders were much more filthy in their habits than they are now, and their diet included more nitrogenous substances. “Vivda” or sun-dried and unsalted mutton, was a favourite article of food, and the flesh of whales, seals, and sea-fowl was freely partaken of, while cabbage was used as a substitute for potatoes, which were only introduced about the middle of last century.

That leprosy was almost universally believed in Shetland to be contagious is evident from the writings of Edmondston and Fisken. Dr Jack is almost the only writer who dissents from this opinion, and it is now held by Sir James Simpson, and all our best authors on the subject, that elephantiasis was and is not contagious, but hereditary. On this latter point all authors agree, including those who had an opportunity of observing the disease in Shetland.