“My cleir voice and my courtlie carrolling.
Is rawk (rank) as roke, full hideous, hoir, and hace.”.
But I have still further and stronger proof to adduce that the leprosy of the Scotch was the tubercular lepra or Greek elephantiasis. It has been already stated that the disease continued to prevail in the Shetlands, apparently long after it had left all the more southern parts of the British Islands. We have found Brand stating in 1700,[201] the disease to be “discovered (I quote his own words) by hairs falling from the eyebrows, the nose falling in,” etc. I have shown also that in some districts of Shetland the disease continued to a later date, and that, down to 1742, the infected were kept in the island of Papa, or, as it is sometimes written, Papastour. Through Mr. Charles Duncan, who has kindly exerted himself in Shetland to procure me information on the present subject, I have been favoured with the sight of an old but important document relative to the lepers of Papa, and the symptoms under which they laboured. The document in question was, as Mr. Duncan informs me, drawn up for Sir John Pringle, by the Rev. Andrew Fisken, minister of Delting, Walls, and Sandness. The old copy I refer to belongs to the Rev. James Barclay (son of the late Dr. Barclay of Lerwick), and I publish its contents with his permission. The minute description which it gives of the symptoms in the lepers of Shetland can leave no doubt as to the disease under which they suffered being the true tubercular leprosy, or Elephantiasis Græcorum, and the value of the evidence which it affords on this point is only increased by the fact, that the writer did not himself belong to the medical profession. The importance of the document must plead as an excuse for its length. The copy which is quoted below, is marked on the back, in an old handwriting, “Case of the Lepers in Papa, as drawn up by Mr. Andrew Fisken, about the year 1736 or 1737.” It proceeds as follows:—
“There are in the Island of Papastour in Zetland five women who labour under a disease that, generally in this place, gets the name of Leprosie, though others alledge it deserves rather to be called a scurvy. The disease has the following appearances, viz.—
“The persons affected at first find an unusual itching in their skin, with small, knotty, hard lumps to be felt under the cuticle; their whole body appears plumper than ordinary, and their eyes are observed to be clearer coloured, with a look more piercing than formerly. Their face and legs are full of small lumps or hard tumours, which in a little suppurate and throw out a black, thin, ichorous matter, and gradually encrease, especially in the face, till they turn confluent. It is also observed that where these lumps do not appear, the skin feels hard and callous, like a piece of unwrought leather, and the cuticle smoother than ordinary, and unctuous or greasy, which appears from pouring water into the palms of their hands, where it will separate into small globules, such as appear when water is poured out of a greasy vessel. The extraordinary plumpness, or rather swelling of the body, observed in the beginning of this disease, does, in a few months, disappear, and they turn very lean and weak, only their face always, and sometimes also their legs, continue swelled. A great many little lumps like small hard seeds are then to be felt everywhere under their skin, which gradually increase till they break out externally, throwing out a fœtid thin ichor, which ceases to run in a little time, and a hard scab covers the part, which sometimes dries, and falling off, leaves the skin entire; at other times breaks out again, and runs as before. The hair falls off from their eyebrows, and they have their throats much inflamed, especially the uvula, which is gradually (and after some years continuing under the disease) entirely destroyed. Their voice is so weakened that they cannot speak louder than one whispering. They have frequent flushes of heat in their skin, which is succeeded by an universal chilliness, and they are not at that instant able to suffer the cold air without a very acute soreness in their skin. As the disease encreases, it appears still the more frightful and loathsome; their face full of large and deep ulcers, resembles somewhat a lump of rotten cork; their gums and teeth are quite rotten, and in the night-time they are much troubled with deep-seated pains in their bodies, and have in the day-time frequent stitches and pains in all parts of their body, with a general weight and inactivity of their limbs. The women also cease to have their menstrua upon their being seized with this distemper. Their appetite and digestion is as good as ordinary; their stools regular; nothing extraordinary to be observed in their urine. They sleep pretty well, but seldom or never sweat any.
“This disease is found by experiment to be very infectious, and seems also to run in blood, most people that have taken it without infection from another having been related to three families in the isle. It affects any age or sex, and it is observed that young persons bear it longer than those of a more advanced age, some having lived ten years under it, others only two, some four, some six, etc., but none ever recover after the symptoms above-written do appear. The persons that fall into this direful case are, as soon as it is observed, obliged to retire to a solitary little hut, built on purpose for them, at a distance from all houses, and are not allowed any converse with their husbands, wives, or nearest relations, but have their necessaries of life furnished them by a contribution from all the inhabitants of the isle, and brought to their hut, which they take in when the person who brought it has retired to the windward of their house at some distance.
“There has never been any cure of this disease attempted here, save that a few years ago a young woman in a neighbouring parish had some bolusses of mercury given her in order to a salivation; but some dangerous symptoms appearing, the administrator thought fit to proceed no further, and the patient continues still alive in the same case she was before taking the mercury.”
In the voluminous MS. Medical Notes, bequeathed by Sir John Pringle to the College of Physicians of Edinburgh,[202] I find a copy of the above account of the Papa lepers. Sir Andrew Mitchell of Westshore seems to have transmitted the account to him without giving any notice of the writer of it. It is entered in Sir John’s notes under the date of 1759; but it was without doubt drawn up many years previously. I have already alluded to an entry in the Session Records of Walls, regarding the disappearance of leprosy from that parish and district in 1742. The entry seems to have been made at a sitting of the session “at North-house in Papastour;” and its expressions[203] show that at the date of it (17th March 1742) there were no lepers in Papa. From the MS. extracts furnished to me by Mr. Rannie, session-clerk, it appears that there is only mention of one other instance afterwards in the Session-books of the parish, viz. in December 1772 and 1776. The female who was the subject of it, and whose case is represented in the records as “singularly clamant,” was ordered to be provided, at the expense of the session, “with back and bed clothes, a house fit for her to lodge in, and maintenance to be brought to her daily at the house.” Mr. Rannie further states, “I have been informed by old persons that she lived but a short time after she was put into the house built for her in the common, at a distance from other houses.” He 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 Watness, and that the son and daughter of a man Henry Sinclair were infected and sent to the hospital at Edinburgh.”
At a still later date a case of Shetland leprosy was detected in the Edinburgh Infirmary. In 1798, a male patient from Shetland was for some time in the hospital wards, under the care of various physicians. As the form of disease under which he laboured was considered as very anomalous, Dr. Thomson was requested by Dr. Hamilton to visit the patient, and detected the case to be one of Greek elephantiasis. I am kindly permitted to extract the following notes of the case from Dr. Thomson’s manuscripts:—
“His face was studded all over with small subcutaneous tubercles. The skin over these tubercles was of a reddish colour, intermixed with blotches, like those which occur in the pityriasis versicolor. The hair of the eyebrows and eyelids had fallen off, and the skin of the face, as well as of most 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, particularly on the arms, thighs, and legs, besides the small subcutaneous tubercles, other larger 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.”