Conditions capable of sufficiently re ducing the vital resistance of the or ganism — insufficient or unwholesome food, excessive use of salt, a fish diet, exposure to cold and damp, alcoholism, malaria, overwork, syphilis, tuberculosis, etc.—are recognized predisposing factors. They seem, in my opinion, to render the organism susceptible to the influence of the leprosy bacillus precisely as does heredity.
In neither of its true forms is true leprosy really infectious, and if it be con tagious, I‘hich is personally disbelieved, its contagion is extremely sluggish and operative only under telluric, atmos pheric, and other external conditions pre disposing to its independent development. George Birdwood (Asiatic Quarterly, Apr., 'DO).
According to Jeanselme and Laurens, and Sticker, lepers eliminate the bacillus of leprosy in enormous numbers through the upper respiratory tract and particu larly the nasal cavities. During the active stages of the disease the nasal secretions and the sputa of tbe subjects thus disseminate the bacillus of leprosy, by emptying their nostrils and expecto rating over the restricted grounds in which they are segregated.
Leprosy is essentially a Chinese dis ease, extending from its focus in the southeastern provinces to every region visited by the lower class of Chinamen, and to no others. James Cantlie (Lan cet, Jan. 1, '98).
The telluric origin of leprosy would thus find an explanation. Though but slightly communicable by the leper him self when free, his compulsory segrega tion within a certain area of ground would thus cause him to transform this area into a focus of infection. His spu tum, nasal secretion, and other contam inated ejecta would play the role in leprosy that the sputum plays in the propagation of tuberculosis.
[In formulating this hypothesis I wish to emphasize the fact that it is only sup ported by collateral evidence. Still it seems to clear many mooted points. It was therefore deemed sufficiently sug gestive to merit incorporation in these colunms. C. E. DE M. SAJOUS.] Personal view that leprosy is of telluric origin. Long-continued intimate contact with lepers is often suffered with im punity, while leprosy is often contracted when there has been no conscious contact with any leper. Evidently the discovery of the bacillus leprm does not necessarily imply that leprosy is spread by personal conununication. Tetanus is an infective
disease, but it is seldom if ever main tained by communication between those suffering from it and the healthy-. Ash burton Thompson (Brit. Med. J our., May 7, '98).
A subject predisposed by heredity or debilitating factors could thus become infected in various ways by dust or water contaminated with secretions containing Hansen's bacilli. The upper respiratory tract is particularly exposed to infection through dust inhaled. The breath of the patient, especially during the act of sneezing, has been found charged with bacilli, and the air so charged may come into contact with the nasal mucous mem brane of persons in the immediate vicin ity.
The front part of the nasal mucous membrane and the greater portion of that covering the nasal sputum, is the region N‘ h•prosy first, and perhaps always, attacks. 0110 hundred and forty-threc lepers examined to ascertain this fact. ln 33 out of 57 cases of tubercular lep rosy the leprous bacillus 11 as found in thc nasal secretion, and yet in only 2 eases NI ere there any leprous nodules in the nose. 1:: 45 out of 68 cases of tunes thetic leprosy, and in 27 out of 28 of the mixed form, the bacillus was also found.
In 23 out of 153 cases there was evi dence of disease in thc bronchi, but in only 14 of these were leprous bacilli found in the sputum. In 10 out of 27 cases in hich the exudation from the ulcers was examined, the leprous bacilli was found. In 21 eases the bacillus was demonstrated in thc secretion of the fauces in 9 in stances. Sticker (Minch. med. Woch., Nos. 39 and 40, '97).
Experiments showing that very great numbers of bacilli were given out in sneezing,—in one instance more than 110,000. Conclusion that in lepers in whom there is an affection of the mucous membranes of the air-passages, not neces sarily of an extreme grade, thousands of bacilli are thrown out to a considerable distance in speaking, coughing, and sneezing, and that this dissemination cannot be prevented by therapeutic measures. Dissemination of the bacilli from the upper air-passages is relatively the most important of the various ways of infection. Sehliffer (Archiv f. Derm. u. Syph., '98; Boston Med. and Surg. Jour., Mar. 16, '99).