I get the impression, though I may well be wrong, that leprosy was much more prevalent, at least in England, during the centuries before about 1400, than in the centuries thereafter. But an effective cure for the illness was only developed in the 1940s - prior to this it was incurable and the only method of limiting its transmission was by the age-old method of isolating the sufferers from the population as a whole. Leprosy isn’t actually particularly contagious and whilst all the factors affecting transmission remain uncertain even today, the spread of leprosy does seem to be linked to generally insanitary conditions. Yet in terms of general health and sanitation the Middle Ages were not particularly any less salubrious than, say, during the famines of the 16th and 17th centuries or in the squalid industrial cities of the 19th century. To the medieval mind leprosy was almost certainly a catch-all term that often included numerous other, often ill-defined and unrelated illnesses such as topical fungal or bacterial infections, and even non-infectious conditions such as the results of dietary deficiencies, and this may well skew the numbers. However the general state of medical knowledge/ignorance was not so very different between, say, the 11th and 17th centuries, and yet the incidence of leprosy amongst the population as a whole does seem to decrease in later years.
 
So, firstly am I correct in thinking leprosy was actually more prevalent in the Middle Ages, and if that is the case why did its incidence decline thereafter?

It may be one of those chicken and egg conundrums. There was undeniably a pan-European sharp growth in hospitals dedicated to treating leprosy between the 11th and 13th centuries, and this is often used to infer that there had been an equivalent growth in the numbers of people affected. However the establishment of these hospitals could also have been simply down to a policy instituted by the orders who ran them (with the Benedictines seemingly taking the lead), and the perception that the disease had become more prevalent based on their establishment. In the same way, the very existence of these leprosariums did indeed eventually help restrict its spread so that by the 15th century it had seemingly disappeared enough to warrant these hospitals'conversion to mad houses and the like, or being simply closed down en masse as happened in England. A perceived "return" of the disease in the 18th century that was noticed in Europe may therefore in fact have simply been a natural consequence of poor hospital treatments compared to a few centuries earlier.

One way of testing all this is to analyse the skeletal remains buried within old leper hospitals and colonies, and then check if the numbers related to specific periods are greater than for others. Though even then this might simply just reflect admission policy variations on the part of the orders. All the lepers buried in Regensburg's old monastic hospital over seven centuries were being thus disinterred when I was there many years ago to make way for a new hospital extension, and that had been one of the things they had hoped to ascertain. They didn't.

There are "leper fields" near where I live, MM - here is some information about them:

http://jasonhargreavesblog.blogspot.co.uk/2010/09/jason-hargreaves-blog-in-fields-where.html




In the shadow of Great Torrington in North Devon, on the River Torridge, lies the hamlet of Taddiport. The name is derived from toad pit or toad gate, toad referring to leper. There was a leper colony in Taddiport from the 13th to the mid-17th century. Two strip fields, known locally as leper fields, remain just outside of the settlement. They are the remnants of an extensive medieval strip field system, in which the lepers grew food.

The church of St Mary Magdalen bears witness to the past, in 1418 it was mentioned in the Registers of the Bishops of Exeter as a leper hospital. It is one of several St Mary Magdalen chapels in the Diocese, all of which were leper hospitals. The hospital building is near the village hall and was designed to look after three patients at any time. The church is small, basic in design and barely stands out from the surrounding buildings. It is difficult to spot looking down the valley, from Great Torrington. There is a Norman window set in one wall, below which there used to be a five feet tall door.

The church, land and hospital were made part of a charity, initially to fund them for the use of lepers. By the mid-17th century there were no longer any lepers in Taddiport, Tristram Arscott was the owner of the land and buildings and he consented to their use by the poor. The charity stipulated that the buildings must be maintained and that any profit could be split annually, between the parishes of Great and Little Torrington. Land rent formed much of the income and what remains today is distributed to invalids and the old at Christmas.

Interesting that the blog mentions that "by the mid-17th century there were no longer any lepers in Taddiport" - your question as to why leprosy died out is indeed interesting.

nordmann wrote:

One way of testing all this is to analyse the skeletal remains buried within old leper hospitals and colonies, and then check if the numbers related to specific periods are greater than for others. Though even then this might simply just reflect admission policy variations on the part of the orders. All the lepers buried in Regensburg's old monastic hospital over seven centuries were being thus disinterred when I was there many years ago to make way for a new hospital extension, and that had been one of the things they had hoped to ascertain. They didn't.

Not easy to investigate,indeed, even today with the benefit of advanced technology it's not always possible to definitively ascertain whether a skeleton had leprosy or not.

Whether or not Robert the Bruce had leprosy has been debated for a long time and over the past six months there have been two facial reconstructions taken from his skull cast. The first, by Glasgow University and John Moore's, said he had - and it showed. Either that or he had had a very dodgy nose job.




http://www.telegraph.co.uk/science/2016/12/08/face-robert-bruce-reconstructed-showing-scottish-king-had-leprosy/


But then the University of Western Ontario did the same and said he didn't. Or he had a better plastic surgeon.




http://mediarelations.uwo.ca/2017/02/16/western-researcher-forensic-sculptor-reject-scottish-king-roberts-leprosy-label/

And leprosy is still about. In a remote feudal area area, along with 2 others in search of craftsmen whose wares  might be promoted to preserve their craft and help them make a living, in one home, so it turned out, there was a leper. He and two other men were in an open shed, wood turning to make walking canes and furniture legs by using extended feet  to twirl the cutting tool. His feet and hands showed deformity but not his face yet - though it was said by his brother once we were back in their little house having tea that his eye sight was weakening. He had refused further medical treatment once it had been diagnosed - a very cheap treatment is available. I deduced shame was the reason and eventually that was admitted. I explained that leprosy was the old name for what is now called Hanson's disease...........I hope I got that right..... and wrote it out for him to take with his brother again on the long trek to a medical centre. He was so pleased at this ray of hope so I hope it happened. In another closer to home leper colony, families produce - mainly leather work - is sold in the city where there is no stigma or fear in buying it. Expert medical support is gradually eradicating it there but rural communities still hide their lepers or banish them to excluded places.

Somewhat ironically one of the modern drugs used to treat leprosy (or Hansen's disease as you rightly say P) is thalidomide, and so unless women take  great care not to conceive during treatment there remains the risk of their children being born with blindness, deafness and limb defects. Sadly in some cases in regions where these things are poorly understood, the children so affected suffer the double stigma of being thought to carry a sort of congenital leprosy, or that, while the mother's disease is cured, it has been transferred out of her onto the child.

As well as Robert the Bruce, Henry IV of England is also thought to have been afflicted with leprosy, which if true (meaning 2 cases in the royal families of Britain, both in the same time period, none after) also tends to suggest, albeit weakly, that leprosy was more prevalent in medieval times.

Its prevalence may well have been greater in Europe during the period you mention. The policy of restricting opportunity for transmission as later instigated by the religious orders across almost the whole of the continent was probably the major factor in bringing the incidence of the disease so much down in subsequent centuries.

Norwegian pathologists who pioneered identification and treatment of Hansen's Disease also identified something in the pathological history that they called the Brazil Effect - which may in fact have accounted for much of the perceived resurgence in cases noticed in several European countries in the 18th century. Basically, early Spanish and Portuguese travellers had brought leprosy to South America, whose indigenous populations were assumed by the pathologists never to have been exposed to this illness before. The result was inevitably pandemic, and the entire continent became something of a global leprosy incubation area for generations afterwards. As a result those travelling in the opposite direction in the centuries after conquest seem to have reintroduced the disease to a Europe which had almost completely rid itself of it in the meantime, but had also rather effectively dismantled the hospital and isolation networks which had played such a big role in that eradication before.

Yes this study on sequencing the genome of leprosy bacteria taken from medieval skeletons reports that modern strains of the disease are essentially unchanged from those in the middle ages and the authors suggest that the population as a whole developed resistance and the incidence of leprosy declined because of the policy of isolating sufferers (and the genes which made them more susceptible) from the rest of the population.

Baldwin IV of Jerusalem definitely had leprosy and was diognosed as a child by his tutor the historian William of Tyre (later Archbishop of Tyre). Didn't stop Balwin riding into battle, even though he was unable to hold the reins of his horse nor hold a weapon and shield.

ID, many years ago I had the privilege of visiting Spinalonga, the island leper colony off Elounda in Crete, before it was cleaned up and made available as a tourist day-trip destination.

The colony was shut down in 1962, in the end rather suddenly as the house interiors demonstrated, all of which showed signs of a rather hurried evacuation of tenants when it occurred - provisions still in kitchen cabinets, TVs and radio sets still set to the last channel their owners listened to, beds still made and unmade, children's toys on the floor, books on shelves, etc. It was like Pompeii in terms of the vibe, and very unsettling indeed.

The official history relates that the colony was established in 1903 and took over a village vacated by Muslim families. This much is true, but what the official history does not relate is the version the elderly locals proudly told visitors such as myself - that the island Muslim community proved obstinate at the time, growing in size in fact instead of moving to Turkey under the relocation agreement Crete had independently brokered with the Ottoman administration. Fearful that Spinalonga would become an embarrassing symbol of effective Muslim resistance to the "Hellenisation" of Crete, the Venizelos-led local government in Elounda - nervous about starting any military action which might give their royalist opposition any excuse to have them deposed but equally intent on evicting the Muslim enclave of about 1500 families in their midst - came up with probably what must rank as one of the most striking bits of political lateral thinking ever. They declared the uninhabited part of Spinalonga to be a leper colony, rounded up all the lepers in Crete (then a few hundred miserable souls confined to atrocious cave-dwelling existences and shunned by the general community), who enthusiastically availed of the newly built huts and facilities in the designated location. The Muslims were gone within a month.

Nordmann, I'm intrigued why was Spinalonga abandoned with such haste?

Hansen's disease was being treated properly by then, so those living there could choose to die there or travel to the mainland for better treatment.

It was actually phased out over about two or three years, but when a free hospital place became available the authorities tended to move the people very quickly. And since no one was being moved to the island any longer the houses were just left as they were, by the looks of things very respectfully too, by the remaining population. It was a very small, self-contained, and a very private unhassled community. Hence the respect and the lack of pilfering etc I suppose.

There was a priest in charge when it closed and he was the last to go. I met him in Aghios Nikolaos about 20 years later through a mutual friend - it was thanks to him that I got permission to travel over, probably the last year before PASOK approved the redesignation of the island as a tourist spot (amongst about 500 other communally owned sites in Crete). He wouldn't go himself, he said it would be too painful for him.

This is Spinalonga today, an island just off the Cretan coast. One can see why it was used for quarantine.

There was a rumour 25 years ago that Xenia, the hotel group, had acquired it, with a view to converting the whole island into a five star millionaires' exclusive "retreat", and given the commercial history and character of the good burghers of Aghios Nikolaos in recent decades this probably had more basis in actual fact than an admittedly rumour-ridden Cretan society tends to afford credit to.

The lepers' burial ground is in the small enclosure over the promontory fort. Their village is to its left in the picture and extends along the seafront at the top. The constrained areas under the fort - old battery positions and storage areas - was where the lepers were initially camped. The story goes (and in Crete I found it was always wise to class "history" as "story") that the first who arrived were assailed with stones thrown by the villagers from the fort's heights above them. Though under armed guard the militia were under strict instructions not to shoot the assailants. The lepers, quite understandably, then took to throwing the missiles back at the villagers. It was a morbid fear of contagion from being struck by these that prompted the village to "sue for peace" and accept the offer of subsidised deportation they had resisted for months beforehand. The priest corrected this story, playing down the incidental violence and favouring the far more plausible theory that the small island's only spring, situated at the sheer part of the island, needed its water to be pumped through the lepers' area to reach the village. I reckon even today this would give rise to real concerns, however scientifically unfounded, among people in the same circumstances.

Leprosy, in terms of stigma and superstition, has in fact not changed much since medieval times at all in many parts of the world, as Priscilla's post also indicates.

In his 1908 article on the leper colony on the Hawaiian island of Molokai, Jack London states that even then it was known that 'leprosy is not so contagious as is imagined'. He later describes it as being 'so feebly contagious' that neither he nor his wife 'had any apprehension of contracting the disease' during their visit there.

He also mentions the fascinating phenomenon in which some residents of the colony who were subsequently declared leprosy-free were nevertheless reluctant to leave and did everything they could to stay. Needless to say that London's view never really seemed to reach the main stream. Nearly 30 years earlier Lew Wallace's novel Ben Hur (1880) had done much to reinforce the stigma attached to leprosy as did the Hollywood movie of the same name made 50 years after London's trip.

Vizzer,

and yes "our" Father Damien overthere. About the controversy of Father Damien.
https://en.wikipedia.org/wiki/Father_Damien
And the elimination:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307180/
And the transmission:
http://www.medicinenet.com/leprosy/page5.htm


Kind regards, Paul.

nordmann wrote:

I had the privilege of visiting Spinalonga, the island leper colony off Elounda in Crete, before it was cleaned up and made available as a tourist day-trip destination.

Thanks to its Venetian fortress and 20th century leper colony, Spinalonga is now one of the most popular day-trips in Crete. Another leper colony in Greece, which also closed down around the same time, is the less well known Lovokomeio on the island of Chios. Rather than an adapted Venetian fortress, however, on this occasion it were the Genoese who founded a purpose-built leper colony there in the 14th century and which continued to be used as such for 600 years.

I found this interesting.

Following the surprise 2016 finding of leprosy (of the same strain that affects humans) amongst wild red squirrels on Brownsea Island in Dorset, recent genetic analysis of a pre-Norman skull unearthed in a garden in Hoxne, Suffolk has shown that leprosy was already present in East Anglia around 885-1015AD. This early date, coupled with the prevalence of leper hospitals in East Anglia from the 11th century onwards, adds weight to the idea that the disease was endemic in this region earlier than in other parts of the country. Moreover at that time East Anglia had strong trade connections with Denmark and Sweden, with Kings Lynn and Yarmouth being significant centres for the importation of squirrel pelts, which were then a highly-prized commodity throughout Europe. This trade in Scandinavian squirrel fur may account for the region becoming an epicentre for the leprosy epidemic that subsequently spread throughout medieval England.  

Could squirrel fur trade have contributed to England's medieval leprosy outbreak? - originally reported in 'The Journal of Medical Microbiology' (2017) Volume 66, Issue 11.

Pertinent to that, in Essex there was still a leper hospital I recall hearing about as a child.  Also. at the small east coast port of Maldon there are still the remains of the leper colony church - St Giles - and its address is Spital Road..... and not very far from the centre of town either.
My own experience in the subcontinent of lepers is meeting one in a family of craftsmen very deep in the outback, making stuff from turned wood - sitting in a side opened shed their feet operating the turning strings....I'm not sure how he coped. His brother said he refused to go for treatment because of the stigma. I persuaded him to call it   correctly - Hansen's disease - and that the drugs to at least hold it to a constant were very cheap. I wrote it down and it seemed to bring great relief all round. I believe it was followed through too.... a friend later took their stuff to sell for them in posh city craft outlets.... that was after the feudal lord about there had taken his free pickings... scream! Sorry to have intruded this tale into your most interesting info. We supported another leper colony by providing materials for their families to make stuff to sell in bazaars - a Dutch nun lived with them and did great work with small leather things made from donated offcuts.

St Giles is the patron saint of - amongst others - hermits, beggars, outcasts, cancer patients and lepers. When I was  a lad the parish church were I went to sunday School was dedicated to St Giles - it had originally been the chapel of the town's Victorian poorhouse and then of the local hospital when that took over the workhouse buildings. I think that's probably why it had a particular link to the charity Lepra, for which I remember it raised funds every year, although I suspect their fund-raising emphasis has probably changed now that leprosy, or Hanson's disease as you rightly say, has thankfully become increasingly rare.

However that said I was reading a recent article in The Guardian that said the incidence of the disease is again rising rapidly in Bangladesh, in part because it had officially been declared eradicated from the country in 1998 (at least statistically, with less than one case per 10,000 of the population) but that in itself seems to have led to a reduction in funding, perhaps coupled with some complacency. Leprosy is slow to manifest itself, with its detection being further compounded by ignorance, shame and discrimination, meaning its sufferers often keep their symptoms hidden until the physical damage is already severe, by which time although drugs can stop the disease progressing further, they cannot reverse any disability. And even now while it seems to be generally linked to poor nutrition, unsanitary conditions and a lack of health facilities, the exact reasons for its incidence are still poorly understood.

Of course the story of Father Damian high lights the slow infection rate. In the east I saw many any empty ruined hut dwelling in densely populated settlements where leprosy had broken out. That the infection was somehow imbedded in the fabric and possibly grimy surrounds was the general belief. No one would live in those huts nor on the land where they were built.

When I worked in London I spent some time in Ilford which is part of London Borough of Redbridge now though it used to be part of Essex.  There's an old building which used to be a leper hospital in Ilford.  It's a listed building.  There used to be some almshouses in the building though I'm not sure if they are still there. Editing this - the building is still there but I am unsure as to whether or not part of it is still used as almshouses.