‘Opening Up the Body’ is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Natasha Shillingford, Project Archivist.
Amy Bradshaw, a seven-year-old girl, was admitted to St George’s Hospital on 24th July 1883 and she later died on 10th January 1884. She was suffering from Leprosy.
The medical case notes record that ‘Her mother was a native of Oxfordshire, her father of Barbados, where his family had lived for three generations since leaving Scotland.’ Amy was one of six children, one of whom died in infancy of dysentery, and two had Leprosy. The sister next above her in age was four and a half years older, and she developed symptoms of Leprosy in 1875. Amy was said to have first developed symptoms herself in 1879, when her mother noticed raised spots ‘like blind boils’ on her back and thighs, which after a time turned brown and were succeeded by a fresh crop.
On admission she was described as ‘a dark intelligent child of characteristically leprous aspect. Over the face and hand the flattened tubercles, in parts red, in parts brown, are abundantly scattered: the nose enlarged, flattened at the tip, red and pigmented; the lower lip the same.’ On her arms, legs and feet were depressed cicatrices and scattered dark brown pigment.
On examination the larynx and epiglottis were found to be thickened and unnaturally white and a lumpy deposit was found. ‘The timbre of the voice is somewhat nasal and the vowel sounds slightly continental.’
Amy was treated with Chaulmoogra Oil in the form of an emulsion which was seen as a success and the child was happy as a rule, although she occasionally complained of soreness and aching in the leprous tubercles. On 17th December her temperature rose rapidly ‘when an acute invasion of the new growth set in with much pain and suppuration.’ The medical case notes report that Amy’s elder sister who was suffering from the same symptoms, was allowed to leave the hospital on 23rd December to spend Christmas at home. However, she developed pneumonia shortly after and died on 6th January. Amy also gradually developed pneumonia in the hospital and ‘sank with great pain, and high fever, dying in Jan 10 1884.’ The post mortem report states ‘Face disfigured by leprosy cicatrices.’
Leprosy affects the nerves, respiratory tract, skin and eyes. It can cause loss of fingers and toes, gangrene, ulcerations, skin lesions and weakening of the skeleton. If left untreated, it can lead to a loss of sensation in the hands and feet. This lack of ability to feel pain can lead to the loss of extremities from repeated injuries or infection due to unnoticed wounds. Leprosy can also damage the nerves in the face which causes problems with blinking and eventual blindness. Other symptoms, which can be seen in the case of Amy Bradshaw, include flattening of the nose due to destruction of nasal cartilage, and phonation and resonation of sound during speech.
The disease takes its name from the Greek word λέπρᾱ (léprā), from λεπῐ́ς (lepís; “scale”). Leprosy has a long and complicated history and for centuries has been associated with social stigma, which even in the modern day continues to be a barrier to self-reporting and early treatment.
The earliest possible account of a disease which is believed to be Leprosy appears in an Egyptian papyrus document written around 1500 BC. Indian texts from 600 BC also describe a disease that resembles Leprosy. The first account of the disease in Europe occurs in the records of Ancient Greece after the army of Alexander the Great came back from India, and then in Rome in 62BC which coincided with the return of troops from Asia Minor.
Leprosy had entered England by the 4th century AD and was a common feature of life by 1050, although throughout its history it has been feared and misunderstood. It was often believed to be a hereditary disease, or some believed that it was a punishment or curse from God. Pope Gregory the Great (540-604) considered people with Leprosy to be heretics.
Others thought that the suffering of lepers echoed the suffering of Christ and they were enduring purgatory on earth and would go straight to heaven when they died. Therefore, they were considered closer to God than other people.
Leprosy patients were often stigmatised and shunned by the rest of society. During the middle ages people suffering from Leprosy were made to wear special clothing, ring bells to warn others of their presence, and walk on a different side of the road.
A passage from Leviticus 13: 44-46 shows the biblical perception that people with leprosy were unclean and should be ostracised from society:
the man is diseased and is unclean. The priest shall pronounce him unclean because of the sore on his head.
Anyone with such a defiling disease must wear torn clothes, let their hair be unkempt, cover the lower part of their face and cry out, ‘Unclean! Unclean!’ As long as they have the disease they remain unclean. They must live alone; they must live outside the camp.
Even in more modern times, patients with Leprosy were often confined to colonies called Leprosariums because of the stigma of the disease. Some of these colonies were situated in remote lands or islands, such as the island of Spinalonga off the coast of Crete which was used as a leper colony from 1903 to 1957. The novel ‘The Island’ by Victoria Hislop tells the story of the leper colony on Spinalonga and its inhabitants.
In 1873 Dr Gerhard Henrik Armauer from Norway identified the germ that causes Leprosy. The discovery of Mycobacterium Leprae proved that leprosy was not a hereditary disease, or a punishment by God, but an infection caused by bacteria.
Patients with Leprosy were often treated, as can be seen in the case of Amy Bradshaw, with oil from the chaulmoogra nut. The treatment was said to be painful and its success was questionable, although some patients appeared to benefit. Leprosy is now curable with multidrug therapy (MDT) which was developed in the early 1980s
The last case of indigenous leprosy in the UK was diagnosed in 1798. Leprosy can no longer be contracted in this country, but there are around 12 new cases diagnosed each year. The World Health Organisation (WHO) (https://www.who.int/news-room/fact-sheets/detail/leprosy) figures state that in 2018 there were 208,619 new cases of leprosy diagnosed. This is approximately one every two minutes.
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