have the case of Australia, where it has yond question also that there are many been carried by the Chinese, and of Amer other cases in this country at the present ica where several distinct centres of infec- moment which are carefully concealed from tion have appeared within living memory. the knowlerige of every one but the mediThus there is California, where it was in- cal adviser. Nearly every skin specialist ported by the “ Heathen Chinee ;'' some must be able to attest this fact. of the North-Western States, where it was But the most striking extension of the brought from Norway by Scandinavian disease has been witnessed in the Sandwich emigrants ; and Salt Lake City, to which Islands. llere Dr. W. Hillebrand saw the it was conveyed by Mormon converts from first case—the first spark of the conflagrathe Sandwich Islands. * In Louisiana, tion-in 1853, "in & thinly-populated where last century leprosy prevailed so ex- district of Oahu, about twenty miles from tensively that a hospital for it was founded Honolulu, in a small village near the sea. in 1785, it again showed itself in 1866, in The disease, however, was not officially a woman whose father was a native of the recognized till 1859. At that time only South of France. From this fresh centre a few cases became known, but with every the disease has spread to such an extent subsequent year the leprous patients prothat Dr. Blanc recently saw forty-two senting themselves at the public dispensar y cases in New Orleans alone. The disease increased in number, until during 1864 also appeared in Oregon among the Chi- and 1865 it was considered of quite ordinese, but was promptly checked, and in nary occurrence that lepers should apply South Carolina a linnited outbreak occurred for relief." | A census taken by the between 1847 and 1882. Sixteen cases Hawaiian Government about that time were reported, the first victims being Jews gave the number of known lepers, suffering belonging to families which had emigrated from the tubercular form of the disease, to the United States early in the century ; as 230 out of a population of 67,000. In several of the rest were Jews, but there 1866 the segregation settlement at Molokai were also some native Americans, and at was opened, and since that time more than least one Irishman among them.

3,000 cases have been received there. In France the disease is also extending, The last report of the Hawaiian Board of as we learn from a communication made to Health


the total number of lepers in the Académie de Médecine of Paris on the the settlement on the 1st of April, 1888, 14th of October, 1887, by Dr. Besnier, as 749, but Dr. Prince A. Morrow, of the distinguished physician of the Hôpital New York, who visited Molokai in the St.-Louis. This authority stated that, early part of this year, puts the present since France had extended her colonial number at nearly 1,100. possessions, French soldiers, sailors, tra- In the West Indies the disease has been ders, and missionaries have fallen victims to steadily extending its ravages for many leprosy in large numbers.

Thus at Trinidad, where in In the United Kingdom we have at 1805 the three first victims could still be prese no leprosy of home growth, but pointed out, an investigation ordered by we are probably never without a few cases Governor Woodford in 1813 revealed among those who have lived for some time seventy-three lepers in a total population in countries where the disease is common. of about 32,000. Two years later there From an unofficial return, recently pub- were seventy-seven.f The evil was unforlished in one of the medical journals, it tunately not considered of sufficient magappears that in the early part of the pres- pitude to need State interference. Ten ent year there were several patients in years later, however, a half-hearted attempt London suffering from leprosy. There is, at segregation was made, but in 1840 it or was quite lately, a boy in a large public · was found that the number of sufferers bad school in whom there are the strongest so much increased that a proposal to estabgrounds for suspecting the existence of

* Letter quoted by C. N. Macnamara, Leprosy leprosy in the early stage : the disease is

a Communicable Disease. 2nd ed. London : supposed to have been communicated by 1889, p. 61. vaccination in the West Indies. It is be

| For the information above given relative This fact was communicated to the New

to Trinidad, I am indebted to the work already York Academy of Medicine by Dr. P. A. Mor. cited, La Lèpre est Contagieuse. Trinidad, row on the 6th of June, 1889.

1879 : p. 264, et seq. NEW SERIES. – VOL. LI., No. 1, 5


years back.


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lish a settlement on a little island a few the disease prevented them indulging their miles off had to be abandoned, because it cannibal propensities in relation to the was too small to hold them. In 1878 the poor lepers. It has been noticed in recent number of lepers was officially stated to be years that there has been considerable in860 in a population of 120,000. These crease in the amount of leprosy, though it figures have an eloquence of their own is still principally confined to the neighwhich requires no comment from me to borhood of Lake Taupo. emphasize the startling truth which they In India, the last official report gives convey—namely, that at Trinidad in the 135,000 as the number of lepers, but Mr. years between 1813 and 1878 leprosy in E. Clifford says * that there can be little creased nearly four times as rapidly as the doubt that they already exceed 250,000, population ! We shall see presently to and that their numbers are still growing. what cause it was undoubtedly attributable. In Canada it has recently been discovered

In British Guiana the increase of leprosy that the cases in the lazaretto at Tracadie in recent years has been not less remark- do not comprise all the lepers in New able. In 1858 an asylum for lepers was Brunswick, and a considerable number of established at the mouth of the Mahaica other cases are believed to exist, especially Creek. On the 31st of December, 1859, among the French residents in the northern there were only 105 inmates at the asylum. part of the province. At the Cape, In 1869 they had increased to 300, and though it was recently denied officially that the place could hold no more. Increased leprosy is increasing, a strong impression space was provided, and in 1889 we find prevails that the disease is extending. The from the official reports that over 500 same may be said of our Australian colwere dealt with.

Around this leper asy- onies, and the statement to that effect lum, outside its boundaries, there are large made by the Prince of Wales at the first numbers of lepers not included in these meeting of the committee of the “ Father returns. Dr. Hillis, the best living Damien Memorial Fund " at Marlborough authority on the subject, informs me that House has not, so far as I know, been the increase of leprosy in British Guiana called in question. Such a state of things during the past ten years has been very may well cause anxiety, not only to those great, although during that period the responsible for the welfare of our colonies, general sanitary condition of the colony but to all lovers of humanity. has improved. He estimates that at the The facts above set forth represent an present time there must be more than a unspeakable amount of suffering to many thousand lepers in British Guiana, a num- races whose destinies we have taken into ber equal to 1 in 250 of the whole popula- our keeping, but besides this they indicate tion. Considering the very high death- a possible danger to ourselves. Leprosy rate of the disease- -16 per cent. annually has before now overrun Europe and in

-it is clear that it is spreading with great vaded England, without respecting the apidity.

“silver streak” which keeps off other When New Zealand was first taken pos- enemies; and it is perfectly conceivable session of by the English, a peculiar form that, under certain circumstances, it might of leprosy akin to the anæsthetic form was do so again. It is well known that, in found to exist. Dc. John Myles, of Tar- recent years, our countrymen whose lot auaki, who recently paid a visit to this is cast in places where the disease is incountry, informed me that the disease is digenous have ceased to show the immumost common in a zone of about twenty- nity from its attacks which fire miles round Lake Taupo. The whites, thought to be their privilege. Can all it appears, do not become leprous, except this misery be prevented! I do not hesihe " Pakeha Maoris,' as the

It may be doubtful called who live much with the Maoris or whether the disease can be staniped out, intermarry with them. No system of re- but it is certain that its advance can be straint exists now, but when the Maoris checked, and that its ravages can be conpossessed the country_they killed those fined within comparatively narrow limits. who became leprous. Fear of contracting How is this to be done ? Only in one of



tate to answer, Yes,

* John D. Hillis, F.R.C.S.I., late Medical * Father Damien. London: Macmillan & Co. Superintendent of the Leper Asylum, British 1889 : p. 153. Guiana. Timehri, June 1889 : pp. 77, 78. † British Medical Journal, August 3, 1889.

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two ways-by eliminating the cause of the in the lake of Taupo. White of Selborne disease, or by preventing its tranmission. attributed the disappearance of leprosy

The former of these methods is unfor. from this country to“ improved agricul. tunately impossible, for we are at present ture and an abundant supply of fresh food entirely in the dark as to the cause of lep- and vegetables." Beyond all question rosy. The subject has for centuries been good food is an essential factor in the a favorite playground for the scientific preservation of health, but it does not folimagination, and, as Cicero said of the low that bad food is the cause of leprosy. philosophers, there is no absurdity which The same may be said as to hygienic conhas not found defenders among the va- ditions. Malaria may conceivably predisrious scientific pundits who have wrestled pose to leprosy, as to other diseases, by with the problem. Climate, soil and race weakening the constitution-or, as modern bave each beeu tried and found wanting, pathological illuminati phrase it, “ lessenfor the disease exists in every kind of ing the resistance of the tissues to the atclimate and on every variety of soil, and tacks of microbes”—but there is nothing no race is exempt from it, although cer- to show that it has any more direct effect. tainly some divisions of the great human The gratuitons "primary dyscrasia" of family appear to be more open to its at- Danielssen and Boeck ; the less mystetacks than others. Almost since the dawn rious but not less gratuitous

" defect in of medical speculation food has been re- developinent of certain elements in the garded by many as the fons et origo mali, skin" of Vandyke Carter ; the "absence and there has been a remarkable“ stream of potash in the blood of Hjaltelin (of of tendency' toward fixing on fish as the Iceland), and the “ absence of salt in the particular esculent at fault. As far back food of Munro, are all very pretty theas the days of Aretæus, the eating of fish ories as they stand, but they are rather to and milk at the same meal was reputed to be admired than adopted. At present the be an infallible cause of leprosy ; the old bacillus holds the field ; but that “fearful proverb of Provence, “Le poisson fait wild fowl” must be known in all its ten devenir ladre," représented a popular be- "categories" before our acquaintance lief which has for centuries been almost with it is likely to prove of practical seruniversally prevalent in European haunts vice. Especially one would wish to know of leprosy ; and even at the present day, whence it comes. At the present time when the theory has completely “ deli- there is a tendency to trace disease germs quesced under the solvent action of to our poor relations,” but animals can what Magendie called le fait brut, a dis- hardly be held accountable for the manutinguished surgeon still tenderly hugs his facture of leprosy, as it is very doubtful old mumpsimus, and sees putrid fish * at whether they are themselves susceptible of the bottom of every case of leprosy, though it. It would be curious, however, if after the patient may have never had a chance all the bacillus of leprosy should be traced of eating fish of any kind. The "exquis- to

The " exquis- to fish ; I am not aware that it has ever ite reason" appears to be that, if the leper been looked for in them, or that any athimself did not, some of his ancestors may tempts have been made to inoculate them have dono 80. It is, in fact, a case of with the disease. original dietetic sin, fish being the patho- If, however, the origin of leprosy is still logical apple

one of the great unanswered riddles of the whoso mortal taste universe, there is not the same mystery as Bronght death into the world and all our woe. to the mode of its transmission. The evi

It is interesting, however, to observe dence in favor of contagion is to my mind that the Maoris in New Zealand attribute quite overwhelming. The contagiousness the peculiar form of leprosy from which of the disease was never doubted till it had they suffer to eating a small carp which nearly died out ; men ceased to believe in exist in large numbers in a discased state contagion when they no longer saw daily

instances of it. The whole system of * Raymond (Histoire de l'Éléphantiasis. Lau- medical police by which leprosy was finally saone, 1767, p. 23) tells us that in the South of France it was not putridity, but the opposite tion that it was contagious, and no meas

driven out of Europe was based on the nocondition, that was dreaded. “ Les gens du pays attribuent la cause occasionnelle du mal ures not based on that principle have ever

à l'usage du poisson mangé trop frais." had the slightest effect in checking its


ravages. The alarming spread of this The mental condition of the other mem. loathsome pest in recent years is in my bers of the committee must have been opinion due to the fact that for some time tabulæ rasæ of ideal blankness on every. the opposite doctrine gained the ascend- thing connected with leprosy. One can ency, and held captive the minds of men. only marvel at the sublime self-confidence For this pernicious error, and for all the with which such a body-seeing as it did disastrous consequences that have flowed with only one eye, and that, as will pres• and continue to flow from it, the Royal ently be shown, a dim or distorted oneCollege of Physicians of London is chiefly undertook to guide the footsteps of Gov. responsible.

ernment over ground so difficult even for Though the miserable story is too well the clear-sighted The result of their laknown to those who are interested in the bors was the Report on Leprosy published subject of leprosy, it may be well briefly in 1867, an ill-starred document which has to recall the facts. In 1862, some alarm probably done more to propagate the disbeing felt as to the spread of leprosy in ease than any other single agency since the Barbadoes, the Colonial Office requested Crusades. In that report the Patres Conthe College of Physicians to draw up a scripti of English medicine expressed the series of questions relative to the nature, following opinion, each individual sentence causes, and prevalence of the disease. A and clanse of which is absolutely and form containing these questions was circu- demonstrably erroneous : lated throughout the colonies, and upward of 250 replies were received from medical most experienced observers in different parts

The all but unanimous conviction of the men in different parts of the world, exclu- of the world is quite opposed to the belief sive of those from Her Majesty's Consuls that leprosy is contagious or communicable by and of communications from the Governors proximity or contact with the diseased. The of British colonies. The mass of infor- evidence derived from the experience of the mation thus obtained was tben submitted clusive on this point.

attendants in leper asyloms is especially con. to the College, which undertook, appar- The few instances that have been reported ently, with a lightness of heart worthy of in a contrary sense either rest on imperfect M. Émile Ollivier, to “collate, digest, and observation, or they are recorded with so little

attention to the necessary details as not to report upon" it.

affect the above conclusion. A committee was chosen by the College That leprosy is rarely, if ever, transmissible to discharge this important public duty, [in married life), when one of the parties has but there is every reason to believe that no tendency whatever to the disease, is the only two of the physicians on the com

opinion of the great majority of the responmittee had the smallest practical acquaint- dents who have had the largest opportunities ance with leprosy. One of them, the late Dr. Owen Rees, bad met with one remark

If this deliverance had been merely a able case, and another, Dr. Gavin Milroy, theoretical opinion promulgated by the

a hurried visit to Demerara, where College of Physicians for the edification he was egregiously hoaxed even by dull- of the few medical men in this country witted lepers.*

who concern themselves with its utter

ances, no one would have had any right to * A striking instance related by Dr. Hillis complain. But in this case the decision (Timehri, June 1889 : p. 79) will suffice : "One that leprosy was not contagious led at once man stated to Dr. Gavin Milroy when he was to practical consequences of the most farin Demerara, at the penal settlement, that be reaching importance. The measures debelieved his leprosy arose from the salt diet

vised by humane and enlightened statesthe prisoners are accustomed to, whereas in fact his wife had suffered from leprosy pre

men for the mitigation of the scourge were vious to his being sentenced to penal servi. abandoned ; the leper-houses throughout tude, and a child of this same man and woman Her Majesty's dominions were thrown died at the leper hospital at Mahaica." But what must always discredit Dr. Milroy's judg. lution into the stream of healthy life near

open, each discharging its measure of polDuent is the incredulity with which he roceived Dr. Hillebrand's account of the out- it ; and a general relaxation of sanitary disbreak of leprosy in the Sandwich Islands : the subsequent course of events is a terrible com- Report on Leprosy by the Royal College of mentary on the inability to appreciate facts Physicians, prepared for ter Majesty's Secretary

gross as a mountain, open, palpable,” which of State for the Colonies. London : 1867, p. inspired the unlucky manifesto of 1867,



cipline with regard to leprosy supervened. * course I do not blame those responsible It may without much exaggeration be said for the Report for not having known that if leprosy slew its thousands before, better ; they acted according to their it has slain its tens of thousands within lights, and it can hardly be imputed to the confines of the British Empire since them as a crime that these "lights” proved 1867. Even outside the limits of Her ignes fatui to those who looked to their Majesty's sway the evil effect of this de- for guidance. What they cannot, howcision has been felt, for the authority of ever, be readily absolved from is the havan institution which was supposed to be ing undertaken to decide a question with the concrete embodiment of medical sci- which they were quite incompetent to ence in this country necessarily had great deal. weight on the minds of some foreign prac- But if the judges were incompetent, it titioners. That this unfortunate Report on is no less certain that many of the witLeprosy did not do still more harm is only nesses were untrustworthy. The answers due to the fact that the dangerous doctrine received to the questions in the circular which it was intended to enforce was not afford ample proof that many of the reuniversally acted upon ; the practical com- spondents knew little and cared less about mon sense of mankind in many places the disease. The truth is that the myswhere leprosy has its home refusing to be tery still surrounding leprosy is in great led astray by theoretical opinion. Of measure due to the want of careful study

by a sufficiently large number of observers. * As evidence of this I need only cite two

The subject is so repulsive that it has been, instances, not more flagrant than hundreds of and still is to some extent, segregated" others, bnt which happen to be the first that by medical men from their mental purview come to hand. Dr. Munro says (Edin. Med.

as a pariah among

diseases. But while Journ., vol. xxv. p. 424) : " It is sad to think that in any colony of England a leper shonld positive evidence of contagion of the most be allowed to keep a school, as I have seen to striking kind is contained in the very

Remy horror in St. Kitt's. In misgoverned Crete port * which denies its existence, the Colsuch things might be, but done in an English lege, forgetting the cardinal principle that colony, with the tacit sanction of the Govern.

even one well-attested fact outweighs any ment, instructed by the Royal College of Physicians of London as to the non-contagious amount of negative statements, seems to nature of the disease, the latter acting on ut- have settled the matter by the simple exterly worthless negative eridence—so done, pedient of counting rather than weighing such an affair is a disgrace to humanity !''

the opinions submitted to them. One is Again, take the following plain unvarnished tale from Dr. Hillis (Timehri, June 1889 : P.

reminded of the story of the Frenchinan 80) : “A respectable young lad became leprous accused of stealing à horse, who, when through, as I believe, playing with a boy who the judge said, Tbree witnesses saw you had leprosy and who lived further down the do it," promptly replied, “ Ah, sir ! three street. When seen he was in an advanced

thousand could easily be found who did stage of tubercular leprosy, covered with sores, and he was sent bome and treated by not see me.” the late Sir Erasmus Wilson, and the family. Let us now consider the conclusions of left the house. I subsequently learned that the Report somewhat more closely. The another family shortly took over the same

first statement, that “the all but unani. house without its having undergone any porification or disinfecting, and it must be re

mous conviction of the most experienced membered the boy had been confined for observers in different parts of the world is months to one room and was covered with quite opposed to the belief that leprosy is these sores. Had he died of some endemio contagious or communicable by proximity disease considered contagious, but question.

or contact with the diseased,' is to-day ably so, how much money would have been spent on painting, papering, &o. by the au. exactly the reverse of the truth. For this thorities ! But in the case mentioned no such steps were considered necessary. I am not * I need only cite the evidence of Drs. God. finding fault with disinfection as carried out ing and Stevenson of Barbadoes (Report, p. in Georgetown-far from it ; it is merely con- 32), Dr. Aquart of Grenada (Ibid. p. 36), Drs. tended that, owing to the opinions that the Manget, Reed, Pollard, Duffey, Carney, aud Executive have to guide them" (i.e. the Report Van Holst of British Guiana (ibid. pp. 45-46), of the Royal College of Physicians), “ they the Proto-medico of Corfu (ibid. p. 67), Drs. would not be justified under the present rul- Regnaud and Bolton of Mauritins (Ibid. p. 86), ings on the subject in going to any expense

the Civil Commissioner of Seychelles (Ibid. p. under the Public Health Ordinance, as leprosy 90), and Mr. Macnamara, then of Mozofferpore is not considered a contagious disease." (Ibid. p. 141).



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