Considering (1) the slow progress of the bacillus leprosm through the tissues, (2) the fact that diseased regions alone contain the organism, and (3) that the general blood-stream contains no bacilli, the belief seems warranted that the un infected areas of a leper are liable to con tamination, through solutions of con tinuity of the mucous surfaces or of the skin, epithelial denudation, absorption into the gastro-intestinal canal, etc., when brought into contact with leprosy bacilli of external origin.
The natural history of the organism is not sufficiently known to warrant for this view more than the position of a work ing-hypothesis. C. E. DE AI. SAJous.] Segregation within a restricted district under such circumstances would greatly compromise the chances of recovery of the sufferers so segregated. Constantly exposed to contaminated soil and sur roundings, reinfection would seal the doom of many who, under the influence of hygienic surroundings, would be re stored to health by appropriate treat ment. Lazarettos, pest-houses, etc., would thus become foci of infection.
it is probable that the mouth and nasal cavities are the avenues of entrance of the bacillus leprosze. Leprosy is con tagious, but not hereditary. Hansen (Monats. f. prak. Herm., B. 25, .No. 9).
This is strongly sustained by the fact that in such institutions practically all the patients die of the disease or its com plications, while, among lepers only ex posed to the average contaminating in fluences of cities, many are saved.
Of 1034 eases of leprosy observed dur ing a period of 14 years and 9 months, 422 have been cured of their loathsome ness, while medicines failed to make any lasting impression on the remaining 612.
R. S. Chew (Med. Age, Dec. 27, '98).
According to Morrow's computation, the number of lepers in the Molokai set tlement (Hawaii) averages about 1200, but he contends that, notwithstanding the optimistic view of the health author ities that leprosy is on the decrease, the annual consignment of lepers to the set tlement shows but little, if any, diminu tion. "All the indications point to the existence of a vast deal of latent leprosy, which, as the disease develops into a recognizable form, must continue for many years to come to furnish a con stantiv-reeurring series for the leper colony." What probably does exist in llawaii is a large number of vulnerable individ uals, vulnerable through the operation of the various factors enumerated, and espe cially active, in our new possession, on account of the deteriorated state of the natives. These etiological factors, as
well as susceptible subjects, are to be found in all countries and especially in districts where poverty, filth, bad food, and alcoholism prevail. Were compul sory isolation abandoned, therefore, lep rosy—like syphilis, tuberculosis, cancer, etc.—would assume the position of a general disease, its development being commensurate with its low degree of contagiousness and the hygienic level and customs of the communities exposed. In the United States the debilitating influence of excessive and unduly pro longed physical and mental activity would tend to increase vulnerability, and the dissemination of leprosy might thus be greatly enhanced.
In all countries where leprosy has be come epidemic its advance is insidious; it spreads slowly, and, before the health authorities awaken to a realization of the danger, it has made such headway that its further progress cannot be arrested. Morrow (N. Y. Med. Jour., Nov. 7, '96).
Segregation of lepers is, therefore, imperative, but only on the condition that they be compensated for their isola tion on behalf of others by adequate pro tection against continued infection and by the most conscientious efforts to re store them to health and to their fami lies.
According to Brocq, the first leper, a Chinese coolie, NA as discovered in the vicinity of Honolulu in 1853. Eight years later several apers were found among his associates. and twenty years after this (1880) with a population of 44,000 people, there were 2000 lepers upon the Haw aiian Islands (statistics of Wood, White, and Tyson).
A leprous fisherman, who came from San Mauritius to the Island of Rodri guez, infected this place. The island of Pinez was, according to Fourne, infected by prisoners brought from New Cale donia. Eight years later the disease broke out among the natives.
Zuranga reports that a leprous sailor, while visiting in Parcent, infected the friend and the brother of the friend with whom Ile was stopping. The former in fected a friend, who, in his turn, infected a number of his acquaintances.